Adaptations to nitrogen availability drive ecological divergence of chemosynthetic symbionts.

Bacterial symbionts, with their shorter generation times and capacity for horizontal gene transfer (HGT), play a critical role in allowing marine organisms to cope with environmental change. The closure of the Isthmus of Panama created distinct environmental conditions in the Tropical Eastern Pacific (TEP) and Caribbean, offering a "natural experiment" for studying how closely related animals evolve and adapt under environmental change. However, the role of bacterial symbionts in this process is often overlooked. We sequenced the genomes of endosymbiotic bacteria in two sets of sister species of chemosymbiotic bivalves from the genera Codakia and Ctena (family Lucinidae) collected on either side of the Isthmus, to investigate how differing environmental conditions have influenced the selection of symbionts and their metabolic capabilities. The lucinid sister species hosted different Candidatus Thiodiazotropha symbionts and only those from the Caribbean had the genetic potential for nitrogen fixation, while those from the TEP did not. Interestingly, this nitrogen-fixing ability did not correspond to symbiont phylogeny, suggesting convergent evolution of nitrogen fixation potential under nutrient-poor conditions. Reconstructing the evolutionary history of the nifHDKT operon by including other lucinid symbiont genomes from around the world further revealed that the last common ancestor (LCA) of Ca. Thiodiazotropha lacked nif genes, and populations in oligotrophic habitats later re-acquired the nif operon through HGT from the Sedimenticola symbiont lineage. Our study suggests that HGT of the nif operon has facilitated niche diversification of the globally distributed Ca. Thiodiazotropha endolucinida species clade. It highlights the importance of nitrogen availability in driving the ecological diversification of chemosynthetic symbiont species and the role that bacterial symbionts may play in the adaptation of marine organisms to changing environmental conditions.

Six-minute walking distance and desaturation-distance ratio in allogeneic stem cell transplantation.

BACKGROUND: Most patients with haematological malignancies who undergo allogeneic haematopoietic stem cell transplant (HSCT) receive chemotherapy before the transplant to control the disease. Certain chemotherapy drugs can cause lung toxicity. Conversely, in patients with chronic respiratory conditions, the 6-min walking test (6MWT) and the desaturation-distance ratio (DDR) have demonstrated prognostic significance. Our objective was to determine whether the 6MWD and DDR, assessed prior to HSCT, have a prognostic impact on survival at 24 months post-HSCT. METHODS: A prospective experimental study was conducted in consecutive patients referred for allogeneic HSCT at Hospital Clinic, Barcelona, Spain. A complete functional respiratory study, including the 6MWT and DDR, was conducted prior to admission. The area under the curve (AUC) and cut-off points were calculated. Data on patients' characteristics, HSCT details, main events, with a focus on lung complications, and survival at 24 months were analysed. RESULTS: One hundred and seventy-five patients (39% women) with mean age of 48 ± 13 years old were included. Before HSCT, forced vital capacity and forced expiratory volume in the first second were 96% ± 13% predicted and 92% ± 14% predicted, respectively; corrected diffusing capacity for carbon monoxide 79% ± 15% predicted; 6MWD was 568 ± 83 m and DDR of .27 (.20-.41). The cut-off points for 6MWD and DDR were 566 m, [.58 95% CI (.51-.64)], p = .024 and .306, [.63 95% CI (.55-.70)], p = .0005, respectively. The survival rate at 24 months was 55%. CONCLUSION: Our results showed that individuals who exhibit a 6MWD shorter than 566 ms or a decline in DDR beyond .306 experienced reduced survival rates at 24 months after HSCT.

The association of histopathologic features after neoadjuvant chemo-immunotherapy with clinical outcome: Sub-analyses from the randomized double-blinded, placebo-controlled, Phase III IMagyn050/GOG3015/ENGOT-ov39 study.

OBJECTIVE: Histopathologic characteristics after neoadjuvant chemotherapy (NACT) may correlate with outcome. This study evaluates histopathologic features after immunotherapy and NACT/bevacizumab, and associated clinical outcomes. METHODS: Evaluable tissue from IMagyn050/GOG3015/ENGOT-ov39 patients from prespecified anatomic sites from interval cytoreductive surgery (ICS) after NACT/bevacizumab plus atezolizumab/placebo underwent central histopathologic scoring and analyzed with clinical outcomes. RESULTS: The predefined population had 243 evaluable NACT patients, with 48.1% tumors being PD-L1-positive. No statistically significant differences in PFS (16.9 months vs. 19.2 months, p = 0.21) or OS (41.5 months vs. 45.1 months, p = 0.67) between treatment arms were seen. Substantial residual tumor (RT) (3+) was identified in 26% atezolizumab vs. 24% placebo arms (p = 0.94). Most showed no (1+) necrosis (82% vs. 96%, respectively, p = 0.69), moderate (2+) to severe (3+) fibrosis (71% vs. 75%, respectively, p = 0.82), and extensive (2+) inflammation (53% vs. 47% respectively, p = 0.48). No significant histopathologic differences were identified by tissue site or by arm. Multivariate analyses showed increased risk for progression with moderate and substantial RT (13.6 mon vs. 21.1 mon, hazard ratio 2.0, p < 0.01; 13.6 mon vs. 21.1 mon, HR 1.9, p < 0.01, respectively); but decreased risk for death with extensive inflammation (46.9 mon vs. 36.3 mon, HR 0.65, p = 0.02). Inflammation also correlated with greater likelihood of response to NACT/bevacizumab plus immunotherapy (odds ratio 2.9, p < 0.01). Modeling showed inflammation as a consistent but modest predictor for OS. CONCLUSIONS: Detailed histologic assessment of ICS specimens appear to identify characteristics, such as inflammation and residual tumor, that may provide insight to certain clinical outcomes. Future work potentially leveraging emerging tools may provide further insight into outcomes.

Changes to women's childbirth plans during the COVID-19 pandemic and posttraumatic stress symptoms: a cross-national study.

A considerable number of women giving birth during COVID-19 pandemic reported being concerned about changes to their childbirth plans and experiences due to imposed restrictions. Research prior to the pandemic suggests that women may be more at risk of post-traumatic stress symptoms (PTSS) due to unmet expectations of their childbirth plans. Therefore, this study aimed to examine if the mismatch between women's planned birth and actual birth experiences during COVID-19 was associated with women's postpartum PTSS. Women in the postpartum period (up to 6 months after birth) across 11 countries reported on childbirth experiences, mental health, COVID-19-related factors, and PTSS (PTSD checklist DSM-5 version) using self-report questionnaires (ClinicalTrials.gov: NCT04595123). More than half (64%) of the 3532 postpartum women included in the analysis reported changes to their childbirth plans. All changes were significantly associated with PTSS scores. Participants with one and two changes to their childbirth plans had a 12% and 38% increase, respectively, in PTSS scores compared to those with no changes (Exp(ß) = 1.12; 95% CI [1.06-1.19]; p < 0.001 and Exp(ß) = 1.38; 95% CI [1.29-1.48]; p < 0.001). In addition, the effect of having one change in the childbirth plan on PTSS scores was stronger in primigravida than in multigravida (Exp(ß) = 0.86; 95% CI [0.77-0.97]; p = 0.014). Changes to women's childbirth plans during the COVID-19 pandemic were common and associated with women's postpartum PTSS score. Developing health policies that protect women from the negative consequences of unexpected or unintended birth experiences is important for perinatal mental health.

Impact of Argemone mexicana L. on tomato plants infected with Phytophthora infestans.

Background: Fungal diseases can cause significant losses in the tomato crop. Phytophthora infestans causes the late blight disease, which considerably affects tomato production worldwide. Weed-based plant extracts are a promising ecological alternative for disease control. Methods: In this study, we analyzed the plant extract of Argemone mexicana L. using chromatography-mass spectrometry analysis (GC-MS). We evaluated its impact on the severity of P. infestans, as well as its effect on the components of the antioxidant defense system in tomato plants. Results: The extract from A. mexicana contains twelve compounds most have antifungal and biostimulant properties. The findings of the study indicate that applying the A. mexicana extract can reduce the severity of P. infestans, increase tomato fruit yield, enhance the levels of photosynthetic pigments, ascorbic acid, phenols, and flavonoids, as well as decrease the biosynthesis of H2O2, malondialdehyde (MDA), and superoxide anion in the leaves of plants infected with this pathogen. These results suggest that using the extract from A. mexicana could be a viable solution to control the disease caused by P. infestans in tomato crop.

Olaparib Addition to Maintenance Bevacizumab Therapy in Ovarian Carcinoma With BRCA-Like Genomic Aberrations.

Importance: Testing for homologous recombination deficiency is required for the optimal treatment of high-grade epithelial ovarian cancer. The search for accurate biomarkers is ongoing. Objective: To investigate whether progression-free survival (PFS) and overall survival (OS) of patients with high-grade epithelial ovarian cancer treated with maintenance olaparib or placebo differed between patients with a tumor BRCA-like genomic profile and patients without a tumor BRCA-like profile. Design, Setting, and Participants: This cohort study was a secondary analysis of the PAOLA-1 randomized clinical trial that compared olaparib plus bevacizumab with placebo plus bevacizumab as maintenance treatment in patients with advanced high-grade ovarian cancer after a good response to first-line platinum with taxane chemotherapy plus bevacizumab, irrespective of germline or tumor BRCA1/2 mutation status. All patients with available tumor DNA were included in the analysis. The current analysis tested for an interaction between BRCA-like status and olaparib treatment on survival outcomes. The original trial was conducted between July 2015 and September 2017; at the time of data extraction for analysis in March 2022, a median follow-up of 54.1 months (IQR, 28.5-62.2 months) and a total follow-up time of 21 711 months was available, with 336 PFS and 245 OS events. Exposures: Tumor homologous recombination deficiency was assessed using the BRCA-like copy number aberration profile classifier. Myriad MyChoice CDx was previously measured. The trial was randomized between the olaparib and bevacizumab and placebo plus bevacizumab groups. Main Outcomes and Measures: This secondary analysis assessed hazard ratios (HRs) of olaparib vs placebo among biomarker strata and tested for interaction between BRCA-like status and olaparib treatment on PFS and OS, using Cox proportional hazards regression. Results: A total of 469 patients (median age, 60 [range 26-80] years) were included in this study. The patient cohort consisted of women with International Federation of Gynaecology and Obstetrics stage III (76%) high-grade serous (95%) ovarian cancer who had no evaluable disease or complete remission at initial or interval debulking surgery (76%). Thirty-one percent of the tumor samples (n = 138) harbored a pathogenic BRCA mutation, and BRCA-like classification was performed for 442 patients. Patients with a BRCA-like tumor had a longer PFS after olaparib treatment than after placebo (36.4 vs 18.6 months; HR, 0.49; 95% CI, 0.37-0.65; P < .001). No association of olaparib with PFS was found in patients with a non-BRCA-like tumor (17.6 vs 16.6 months; HR, 1.02; 95% CI, 0.68-1.51; P = .93). The interaction was significant (P = .004), and HRs and P values (for interaction) were similar in the relevant subgroups, OS, and multivariable analyses. Conclusions and Relevance: In this secondary analysis of the PAOLA-1 randomized clinical trial, patients with a BRCA-like tumor, but not those with a non-BRCA-like tumor, had a significantly longer survival after olaparib plus bevacizumab treatment than placebo plus bevacizumab treatment. Thus, the BRCA1-like classifier could be used as a biomarker for olaparib plus bevacizumab as a maintenance treatment.

Patient Safety Incidents in Primary Care: Comparing APEAS-2007 (Spanish Patient Safety Adverse Events Study in Primary Care) with Data from a Health Area in Catalonia (Spain) in 2019.

The initial APEAS study, conducted in June 2007, examined adverse events (AEs) in Spanish Primary Healthcare (PHC). Since then, significant changes have occurred in healthcare systems. To evaluate these changes, a study was conducted in the Camp de Tarragona PHC region (CTPHC) in June 2019. This cross-sectional study aimed to identify AEs in 20 PHC centres in Camp de Tarragona. Data collection used an online questionnaire adapted from APEAS-2007, and a comparative statistical analysis between APEAS-2007 and CTPHC-2019 was performed. The results revealed an increase in nursing notifications and a decrease in notifications from family doctors. Furthermore, fewer AEs were reported overall, particularly in medication-related incidents and healthcare-associated infections, with an increase noted in no-harm incidents. However, AEs related to worsened clinical outcomes, communication issues, care management, and administrative errors increased. Concerning severity, there was a decrease in severe AEs, coupled with an increase in moderate AEs. Despite family doctors perceiving a reduction in medication-related incidents, the overall preventability of AEs remained unchanged. In conclusion, the reporting patterns, nature, and causal factors of AEs in Spanish PHC have evolved over time. While there has been a decrease in medication-related incidents and severe AEs, challenges persist in communication, care management, and clinical outcomes. Although professionals reported reduced severity, the perception of preventability remains an area that requires attention.

The Viable but Non-Culturable (VBNC) State, a Poorly Explored Aspect of Beneficial Bacteria.

Many bacteria have the ability to survive in challenging environments; however, they cannot all grow on standard culture media, a phenomenon known as the viable but non-culturable (VBNC) state. Bacteria commonly enter the VBNC state under nutrient-poor environments or under stressful conditions. This review explores the concept of the VBNC state, providing insights into the beneficial bacteria known to employ this strategy. The investigation covers different chemical and physical factors that can induce the latency state, cell features, and gene expression observed in cells in the VBNC state. The review also covers the significance and applications of beneficial bacteria, methods of evaluating bacterial viability, the ability of bacteria to persist in environments associated with higher organisms, and the factors that facilitate the return to the culturable state. Knowledge about beneficial bacteria capable of entering the VBNC state remains limited; however, beneficial bacteria in this state could face adverse environmental conditions and return to a culturable state when the conditions become suitable and continue to exert their beneficial effects. Likewise, this unique feature positions them as potential candidates for healthcare applications, such as the use of probiotic bacteria to enhance human health, applications in industrial microbiology for the production of prebiotics and functional foods, and in the beer and wine industry. Moreover, their use in formulations to increase crop yields and for bacterial bioremediation offers an alternative pathway to harness their beneficial attributes.

[Spanish Society of Pulmonology and Thoracic Surgery (SEPAR) Consensus for post-COVID-19 Clinical Follow-up]. / Documento de consenso de la Sociedad Española de Neumología y Cirugía Torácica (SEPAR) para el seguimiento clínico post-COVID-19.

SARS-CoV-2 infection can cause a range of respiratory sequelae, especially in patients who have had severe Covid-19 pneumonia. Given the high number of patients who have developed this infection over a short period of time, numerous post-Covid-19 follow-up visits are being carried out, but no clinical follow-up protocol has been established to advise on the complementary tests to be performed and the frequency of these procedures. This consensus document was drawn up by professionals from different areas of the Spanish Society of Pulmonology and Thoracic Surgery (SEPAR) in order to assist the clinician in identifying possible respiratory complications that may occur during the months following the acute disease, and to protocolize their follow-up and additional tests to be performed. It recommends examinations and interventions to be carried out at various stages in the post-Covid-19 period, and details the specific objectives of these procedures. Primarily, we aim to ensure that patients receive timely clinical follow-up, following a pre-established schedule that takes into account the severity of the disease and the likelihood of long-term sequelae. Another objective is to avoid overloading the health system by eschewing examinations and/or consultations that are, in many cases, unnecessary. Finally, we define criteria for referring patients with specific established sequelae (interstitial lung disease, pulmonary vascular disease, bronchiectasis) to the corresponding specialized units.

Tipos de partos y niveles de oxitocina, cortisol y hormonas tiroideas en plasma del cordón umbilical / Types of deliveries and levels of oxytocin, cortisol and thyroid hormones in umbilical cord plasma

Introducción: La placenta sintetiza y secreta varias hormonas que permiten la regulación del embarazo, el trabajo de parto y la adaptación metabólica materno-fetal. Su comportamiento asociado al tipo de parto puede dar información relevante sobre efectos epigenéticos. Objetivo: Describir el tipo de parto con los niveles de oxitocina, cortisol y hormonas tiroideas en plasma de cordón umbilical al nacer. Método: A 50 mujeres con embarazos principalmente normales se les cuantificaron los niveles neurohormonales en plasma de cordón umbilical, obtenido inmediatamente tras el periodo expulsivo. Los resultados se incorporaron a la base de datos clínicos de cada participante y se analizaron con Stata v.14.0. El protocolo fue aprobado por el comité de ética. Resultados: Hubo 33 partos vaginales (12 espontáneos, 13 acelerados y 8 inducidos) y 17 cesáreas (7 electivas y 10 de urgencia). Se observaron mayores niveles de cortisol en los partos vaginales acelerados; las cesáreas tuvieron menores niveles de cortisol y hormona estimulante de la tiroides. Las intervenciones clínicas, con altos o bajos niveles hormonales, están en directa relación con el tipo de parto. Conclusiones: El cortisol y la hormona estimulante de la tiroides medidos en plasma de cordón umbilical variaron según el tipo de parto. Esto es una primera cuantificación de hormonas en plasma de cordón umbilical y su posible regulación placentaria a propósito del tipo de parto.

Introduction: The placenta synthesizes and secretes several hormones allowing the regulation of pregnancy, labor and maternal-fetal metabolic adaptation. Their behavior associated with the type of delivery, may provide relevant information on epigenetic effects. Objective: To describe the type of delivery with the levels of oxytocin, cortisol and thyroid hormones in umbilical cord plasma at birth. Method: Neurohormonal levels from umbilical cord plasma obtained immediately post expulsion, were quantified in 50 women with mainly normal pregnancies. Results incorporated into the clinical database of each participant, statistically analyzed in Stata v.14.0. Protocol approved by ethics committee. Results: 33 were vaginal deliveries (12 spontaneous, 13 accelerated, 8 induced) and 17 cesarean sections (7 elective and 10 emergency). Higher cortisol levels were observed in accelerated vaginal deliveries, cesarean sections had lower cortisol and thyroid stimulating hormone levels. While clinical interventions, with high or low hormone levels, were related to the type of delivery. Conclusions: Cortisol and thyroid stimulating hormone measured in umbilical cord plasma varied according to the type of delivery. This is a first quantification of hormones in umbilical cord plasma and their possible placental regulation in relation to the type of delivery.

Conductas sexuales por sexo en población universitaria chilena que demanda test rápido de VIH / Sex-disaggregated sexual behaviors among Chilean university students taking a rapid HIV test

OBJETIVO: Caracterizar por sexo una población universitaria que accedió voluntariamente a una prueba de detección rápida del virus de la inmunodeficiencia humana (VIH). MÉTODO: Estudio analítico de 3864 universitarios/as. Variables: sociodemográficas y académicas, comportamiento sexual, prevalencia de infecciones de transmisión sexual (autorreporte) y motivos para realizarse el test rápido. RESULTADOS: El 61,4% son mujeres, edad media 21,64 años, edad de inicio de la actividad sexual 17,01 años. Actividad sexual casual: 36,8%, destacando los hombres (p < 0,001). Sexo anal: 44,5%. Prevalencia de infecciones de transmisión sexual: 7,5%, destacando los hombres en gonorrea (p < 0,001) y sífilis (p = 0,032). Test rápido VIH (+): 0,2%. Consumo de sustancias durante la actividad sexual: 50%. El 41,1% nunca pregunta a su contacto sexual el estado serológico de VIH, destacando los hombres (p < 0,001), y el 64,4% no sabe si ha tenido una pareja sexual VIH (+), destacando los hombres (p < 0,001). El 16,5% siempre ha usado preservativo, destacando las mujeres (p = < 0,001). El 26,21% usa redes sociales para encuentros sexuales, con diferencias por sexo. CONCLUSIONES: Las mujeres demandan más el test rápido de VIH que los hombres. Existen conductas de riesgo y diferencias por sexo: poco uso del preservativo, relaciones sexuales casuales y bajo la influencia de sustancias, prácticas sexuales anales y orales sin protección, desconocer el estado serológico de su contacto sexual y uso de redes sociales para encuentros sexuales.

OBJECTIVE: To characterize a university population that willingly took a rapid HIV test by sex. METHOD: An analytical study with 3,864 university students. Variables: socio-demographic and academic variables, sexual behavior, (self-reported) STI prevalence, and reasons to take the rapid test. RESULTS: 61.4% are women; average age: 21.64 years; age of first sexual intercourse: 17.01 years; casual sexual activity: 36.8%, mostly men (p < 0,001), anal sex: 44.5%; STI prevalence: 7.5%, with gonorrhea and syphilis being more common among men (p < 0.001 and p < 0.032, respectively; positive rapid HIV test: 0.2%; substance use during sex: 50%. 41.1% of the participants, most of them men (p < 0.001), have never asked their partner about their serologic HIV status, and 64.4% does not know if they have had a HIV+ partner, an attitude that is more prevalent among men (p < 0.001). 16.5% has always used prophylactics, mostly women (p < 0.001). 26.21% uses social networks to arrange sexual encounters. CONCLUSIONS: Women ask more for the rapid HIV test than men. There are several risky behaviors and gender differences: low use of prophylactics, casual sexual relationships under the influence of substances, unprotected anal and oral sex practices, ignorance of their sexual partners serologic status, and the use of social networks for sexual encounters.

Protocolo de desensibilización rápida en pacientes con reacción moderada a severa de hipersensibilidad a citostáticos / Rapid desensitization protocol in patients with moderate to severe hypersensitivity reaction to cytostatics

Introducción: La desensibilización rápida a medicamentos induce una tolerancia temporal a los quimioterapéuticos que provocan reacciones de hipersensibilidad. Objetivo: Evaluar el protocolo de desensibilización rápida en escenario ambulatorio en pacientes que presentaron reacciones de hipersensibilidad a fármacos citotóxicos. Métodos: Se realizó un estudio observacional, y retrospectivo, de 30 pacientes con cáncer que desarrollaron reacciones de hipersensibilidad entre los años 2016 y 2018, tratados en el Hospital de Día del Servicio de Oncología del Clínico Quirúrgico Hermanos Ameijeiras. Se clasificaron según su intensidad, y se analizaron variables demográficas, características clínicas, y síntomas presentados. Se utilizó un protocolo en doce etapas basado en tres diluciones del fármaco. Se administró premedicación en todos los casos. Se realizó estadística descriptiva, y para la asociación entre variables, se utilizó la prueba estadística Chi-cuadrado. Resultados: La mediana de edad fue 54 años (23;77). Predominaron las mujeres; los menores de 60 años; tumor primario de colon; antecedentes de alergia; el oxaliplatino como fármaco más implicado; las RHS durante la infusión; e intensidad moderada. Fueron más frecuentes los síntomas cutáneos y gastrointestinales. Con la aplicación del protocolo se completó la quimioterapia planificada a los 30 pacientes (145 ciclos adicionales). Solo se presentaron ocho desensibilizaciones con reacciones leves de tipo cutáneas. El 94,5 por ciento de las desensibilizaciones no presentaron reacción alguna. Conclusiones: Constituye el primer reporte nacional de la utilización exitosa de un protocolo de desensibilización rápida a citostáticos que demostró ser eficaz y seguro en el escenario ambulatorio, con un manejo multidisciplinario(AU)

Introduction: Rapid desensitization to drugs induces a temporary tolerance to chemotherapeutics causing hypersensitivity reactions. Objective: To evaluate the rapid desensitization protocol in an outpatient setting in patients who had hypersensitivity reactions to cytotoxic drugs. Methods: An observational and retrospective study was carried out in 30 cancer patients, who developed hypersensitivity reactions, from 2016 to 2018. They were treated in the outpatient Oncology service at Hermanos Ameijeiras Surgical Clinical Hospital. These subjects were classified according to intensity; demographic variables, clinical characteristics, and symptoms were analyzed. A twelve-step protocol based on three dilutions of the drug was used. Premedication was administered in all cases. Descriptive statistics and for the association between variables were performed. Chi-square statistical test was used. Results: The median age was 54 years (23; 77). Predominance was observed in women, those under 60 years of age, primary colon tumor, history of allergy, oxaliplatin as the drug most implicated, HRH during infusion, and moderate intensity. Skin and gastrointestinal symptoms were more frequent. The planned chemotherapy was completed with the application of the protocol, in all 30 patients (145 additional cycles). There were only eight desensitization with mild skin-type reactions. 94.5 percent of desensitizations did not show any reaction. Conclusions: It constitutes the first national report of successful use of a rapid desensitization protocol to cytostatics that proved to be effective and safe in the outpatient setting with multidisciplinary management(AU)

Propuesta para manejo de la coagulopatía asociada a la COVID-19 en adultos / A proposal for the management of COVID-19-induced coagulopathy in adults

Resumen La infección por coronavirus 2 del síndrome respiratorio agudo grave (SARS-CoV-2) es la causante de la pandemia de enfermedad por coronavirus 2019 (COVID-19), con un índice de letalidad alto. La mayoría de los pacientes graves desarrollan un tipo especial de coagulopatía no descrito hasta ahora y la cual se considera ahora la principal causa de muerte. Por esta razón, el tratamiento anticoagulante se ha convertido en una de las piedras angulares del tratamiento de esta infección. Sin embargo, la velocidad con la que se genera la evidencia respecto al uso de anticoagulantes es muy rápida y, en ocasiones difícil de interpretar y contradictoria. Luego de hacer una revisión extensa de la literatura publicada, se hace esta propuesta para el uso del tratamiento anticoagulante tomando en cuenta los recursos disponibles en México.

Abstract Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection is the cause of the coronavirus disease 2019 (COVID-19) pandemic, which has a high case fatality rate. Most severely ill patients develop a special type of coagulopathy that had not been described before and that is now considered the main cause of death. For this reason, anticoagulant treatment has become one of the cornerstones of the treatment of this infection. However, the rate at which the evidence regarding the use of anticoagulants is generated is quite fast, and sometimes it is difficult to interpret and conflicting. After having performed an extensive review of the published literature, this proposal for the use of anticoagulant treatment is made, taking into account available resources in Mexico.

Memory training combined with 3D visuospatial stimulus improves cognitive performance in the elderly: pilot study / Treinamento de memória combinado com estímulo visuoespacial em 3D melhora o desempenho cognitivo em idosos: estudo piloto

ABSTRACT. Studies suggest that the engagement of aged participants in cognitive stimulation programs can reduce expected cognitive decline associated with age. Objective: To evaluate the effects of memory training (MT) associated with three-dimensional multiple object tracking (3D-MOT) NeuroTracker (NT) in the elderly. Methods: Forty-four participants (>60 years of age) were recruited and randomly distributed into two groups: experimental (EG; n=22) and comparative (CG; n=22). Both groups performed 12 one-hour MT sessions, twice a week, consisting of specific computerized stimuli associated with teaching of mnemonic strategies; 10 minutes of NT was part only of the EG's sessions. In pre- and post-training periods, both groups were evaluated using a sociodemographic questionnaire, neuropsychological assessment, as well as a specific measure offered by NT. Results: Both groups benefited from the MT and reported more positive feelings regarding their memory and quality of life. However, the EG obtained better results in tests consistent with the strategies trained and which involved attentional resources, reaction time, visual processing speed, episodic, semantic, subjective and working memory as well as aspects of social cognition. Conclusions: This study showed that the combination of MT and 3D-MOT contributed for a better cognitive performance in the EG. Thus, the results of the present study encourage further research and the development of combined cognitive interventions for the elderly population with and without cognitive deficits.

RESUMO. Estudos sugerem que o envolvimento de idosos em programas de estimulação cognitiva pode reduzir o declínio cognitivo esperado associado à idade. Objetivo: Avaliar os efeitos de um treinamento de memória (TM) associado a um estímulo visuoespacial tridimensional (3D-MOT) NeuroTracker (NT) em idosos. Método: Quarenta e quatro participantes (>60 anos) foram recrutados e distribuídos aleatoriamente em dois grupos: experimental (GE; n=22) e comparativo (GC; n=22). Ambos os grupos realizaram 12 sessões do TM de uma hora, duas vezes por semana, consistindo em estímulos computadorizados específicos associados ao ensino de estratégias mnemônicas; apenas nas sessões do GE foram utilizados 10 minutos com o NT. Nos períodos pré- e pós-treinamento, ambos os grupos foram avaliados por meio de questionário sociodemográfico, avaliação neuropsicológica e medidas cognitivas específicas do NT. Resultados: Ambos os grupos se beneficiaram do TM e relataram sentimentos mais positivos em relação à memória e à qualidade de vida. No entanto, o GE obteve melhores resultados em testes consistentes com as estratégias treinadas e que envolviam recursos atencionais, tempo de reação, velocidade de processamento visual, memória episódica, semântica, subjetiva e de trabalho, além de aspectos da cognição social. Conclusões: Este estudo mostrou que a combinação do TM e 3D-MOT contribuiu para um melhor desempenho cognitivo no GE. Dessa forma, os resultados do presente estudo incentivam novas pesquisas e o desenvolvimento de intervenções cognitivas combinadas para a população idosa com e sem déficits cognitivos.

Exposición a oxitocina sintética intraparto y riesgo de depresión post parto / Intrapartum synthetic oxytocin exposure and risk of postpartum depression

RESUMEN Una complicación frecuente del postparto es la depresión, con una prevalencia del 10 al 20% a nivel mundial. La oxitocina ha sido reconocida como un potente neuromodulador presente en la respuesta materna y la vinculación con su recién nacido. El uso de oxitocina sintética intraparto es una práctica frecuente. Objetivo: Relacionar la exposición a oxitocina sintética intraparto con el riesgo de depresión postparto en mujeres atendidas en un hospital público del sur de Chile, durante los años 2014-2015. Material y método: Estudio cuantitativo de cohorte, analítico, prospectivo. Muestreo no probabilístico, consecutivo a 58 mujeres desde el último trimestre de la gestación hasta las doce semanas postparto, midiendo el riesgo de depresión mediante la escala de Edimburgo. Se relacionaron variables bio-psicosociales y perinatales, con un nivel de significación <0,05. Aprobado por comité de ética. Resultados: La edad promedio fue 26,07 años, la mayoría había cursado enseñanza media, desempeñándose en quehaceres domésticos, con atención sanitaria gratuita y poseían una percepción de buen apoyo social. En los aspectos perinatales el 63,7 % se expusieron a oxitocina sintética. El riesgo de depresión se observó en un 12,07%. Las dosis y tiempo de exposición, al igual que el tipo de parto no resultaron estadísticamente significativos para el riesgo de depresión. Factores protectores y de riesgo psicosociales como perinatales, tampoco demostraron diferencias. Conclusiones: En este grupo, no se encontró asociación estadística entre la exposición a oxitocina intraparto con la sintomatología de depresión en el periodo de posparto, medida a través de la escala de Edimburgo.

ABSTRACT Depression is a frequently-seen postpartum complication, with 10-20% prevalence worldwide. Oxytocin has been recognized as a powerful neuromodulator and is present in the mothers' response and bonding with their newborn. Use of intrapartum synthetic oxytocin is a common practice. Objective. To study potential connections between administration of intrapartum synthetic oxytocin and risk of postpartum depression in women from a public hospital in southern Chile, from 2014 to 2015. Material and method. Analytical, prospective cohort study with a consecutive sampling of 58 women, since their third trimester of pregnancy to twelve weeks after birth, using the Edinburgh Postnatal Depression Scale (EPDS). Biopsychosocial and perinatal variables were analyzed (significance level < 0.05). This study was approved by the hospital ethics committee. Results. Average age was 26.07 years. Most of them had attended high school and were homemakers, had free health care and reported a good social support network. 63.7% received synthetic oxytocin. Risk of postpartum depression was 12.07%. Protective factors, and psychosocial and perinatal risk factors, as well as dosage and exposure time, were not statistically significant. Conclusion. According to EPDS, this group showed no statistical relationship between administration of intrapartum oxytocin and postpartum depression symptoms.

Vivencias de mujeres con asistencia de parto personalizado / Women's experiences with personalized delivery assistance

RESUMEN El parto personalizado, centrado en la mujer y sus necesidades, es una tendencia de atención sanitaria que propone un complemento de calidad al modelo biomédico. Existe escasa evidencia en Chile sobre estas experiencias. Objetivo: Explorar las vivencias de mujeres que optaron por un parto personalizado, en casa o en clínicas privadas, en la provincia de Concepción, Chile. Metodología: Estudio cualitativo. Los relatos se obtuvieron mediante entrevista semi-estructurada, a 12 mujeres que constituyeron la muestra. El análisis identificó categorías y subcategorías mediante codificación abierta, aplicando la comparación constante, basado en la Teoría Fundamentada. Se utilizó el software Atlas Ti versión 7.5 y el software estadístico R Project versión 3.5.1.El estudio fue aprobado por el comité de ética de la Facultad de Medicina de la Universidad de Concepción. Resultados: Edad promedio de las mujeres fue 30 años, 7 eran primíparas y 5 multíparas. La experiencia reveló seis categorías, tres fueron propuestas (expectativas y experiencias, influencias asociadas a la decisión del parto personalizado y preparación prenatal previa), tres emergieron de manera espontánea (el parto como plenitud femenina, apoyo social, facilitadores y obstaculizadores del parto personalizado). Las primíparas enfatizan el dolor, la anestesia y los profesionales, mientras que las multíparas destacan a su recién nacido y el lugar de nacimiento. Conclusión: La experiencia de parto personalizado transforma a la mujer en su percepción de la femineidad y la maternidad. Valora su protagonismo, la presencia de personas significativas, las relaciones que se construyen con profesionales y la mínima aplicación de intervenciones.

ABSTRACT The Personalized birth, focused on the woman and her needs, is a health care tendency. There is little evidence in Chile about these experiences. Objective: To explore the experiences of women who chose a personalized birth at home or private clinics, in the Concepción province, Chile. Methodology: Qualitative study. The stories were obtained by semi-structured interview to 12 women who made up the sample. The analysis identified categories and subcategories through open coding, applying constant comparison, based on Grounded Theory. Software Atlas Ti version 7.5 and R Project version 3.5.1 were used. The study was approved by the Concepcion University Medicine faculty ethics committee. Results: The average age of the women was 30 years old, seven were primiparous and five were multiparous. Six categories were identified: three proposed (the expectations and experiences, influences associated to the personalized birth decision and prenatal preparation) and three emerging (childbirth as feminine fullness, social support, facilitators and hinders of natural birth). Primiparous stand out pain, anesthesia and professionals while the multiparous highlight their newborn and the place of birth. Conclusion: Personalized birth experience transforms women about her perception of femininity and motherhood, value their empowerment, the presence of significant people, the relationships built with the professionals and the minimum application of interventions.

Caracterización del apoyo social percibido durante el posparto y la presencia de depresión materna / Characterization of Perceived Social Support During Postpartum and the Presence of Maternal Depression

Introducción: el período de posparto es una etapa de vulnerabilidad biopsicosocial en la mujer. Se reconoce una prevalencia de depresión posparto en Chile de un 27,2 por ciento a un 41,3 por ciento. Por otra parte, el apoyo social puede ser un factor protector para este periodo. Objetivo: relacionar las características del apoyo social percibido y la presencia de depresión materna en el periodo de posparto. Métodos: estudio transversal correlacional, de 76 mujeres en periodo de posparto (30 días a 1 año), sanas y sin antecedentes de depresión. Se les evaluó sintomatología depresiva, percepción del apoyo social y funcionamiento familiar. Se agregó un cuestionario de variables biosociales, obstétricas y relacionales, previo consentimiento informado y autorización del comité de ética del centro de salud. El análisis se realizó con el programa estadístico SPSS versión 19.0. Se aplicó un análisis descriptivo univariado, bivariado y multivariado con un nivel de significación estadística menor de 0,05. Resultados: la depresión fue detectada en 27,6 por ciento de las puérperas. La asociación entre la presencia de depresión posparto con la percepción del apoyo social, resultaron estadísticamente significativas al igual que la funcionalidad familiar y la percepción de la relación con la pareja y la madre. Las variables biosociales y obstétricas no resultaron significativas para la presencia de depresión. Conclusiones: los factores protectores de la depresión materna identificados fueron: el apoyo social percibido, el funcionamiento familiar y aspectos relacionales con la pareja y la madre(AU)

Introduction: The postpartum period is a time of bio-psychosocial vulnerability in women, recognizing the prevalence of postpartum depression in Chile from 27.2 percent to 41.3 percent. Moreover, social support may be a protective factor for this period. Objective: to relate the characteristics of perceived social support and the presence of maternal depression in the postpartum period. Methods: A correlational cross-sectional study was led on 76 healthy women in postpartum period (30 days to 1 year), and without a history of depression. Depressive symptomatology, social support perception, and family functioning were evaluated. A questionnaire of biosocial, obstetrical and relational variables was added, with prior informed consent and authorization from the ethics committee of the health center. The statistical analysis was performed with SPSS version 19.0, using descriptive univariate, bivariate and multivariate a statistical significance level less than 0.05. Results: Postpartum depression was detected in a 27, 6 percent. The association between depressions with social support perception was statistically significant, as family functioning and the relationship with their partners and mothers. Biosocial and obstetric variables were not significant for the presence of depression. Conclusions: Perceived social support, family functioning and relational aspects with their partners and mothers are protective factors for maternal depression, compared with other variables(AU)

Propiedades psicométricas de una escala de Percepción Materna del Vínculo Prenatal Paterno / Psychometric properties of the scale Maternal Perception of the Prenatal Paternal Bonding

Antecedentes: La incorporación del hombre al proceso reproductivo, haciéndose parte de éste, es una posibilidad para mejorar los resultados a largo plazo en las tareas de crianza y en el desarrollo general del niño(a). Crear un instrumento que permita medir la vinculación de manera temprana puede ser una estrategia que optimice recursos y equilibre roles parentales en ambos progenitores. Objetivo: Evaluar las propiedades psicométricas de la escala Percepción materna del Vínculo afectivo prenatal paterno (PeMViPP). Material y método: Estudio cuantitativo, observacional, de validación de cuestionario. Se diseña la escala PeMViPP, en base a la evidencia científica, con 13 preguntas y tres factores: "Interacción directa con el hijo", "Apoyo y contención"; y "Auto-análisis y corrección del patrón de conducta" con respuestas tipo likert. Se resguardaron aspectos éticos con la aprobación de comité. La muestra fue de tipo aleatorio simple, correspondió a 240 mujeres puérperas atendidas en una maternidad del sistema público chileno. Se aplicaron pruebas de validación de contenido, de constructo y de criterio, junto a la medición de la confiabilidad. Resultados y conclusiones: mediante Análisis Factorial Exploratorio se identificaron 10 ítems y un solo factor denominado Percepción de vínculo prenatal paterno. Con una adecuada confiabilidad interna a=0.90. Se identificó que una variable materna influye en la percepción de este vínculo, correspondiendo al embarazo planificado con un p valor < 0,0001. La escala PeMViPP, posee adecuadas propiedades psicométricas para evaluar esta relación prenatal vincular con el progenitor. Este estudio genera una escala chilena validada para futuras investigaciones en vinculación paterna temprana.

Background: The incorporation of the male parent into the reproductive process, becoming part of it, is a possibility to improve the long-term results in the tasks of parenting and overall development of the child. Creating an instrument to measure early bonding can be a strategy that optimizes resources and balances parental roles in both parents. Objective: To evaluate the psychometric properties of the scale Maternal Perception of the Prenatal Paternal Bonding (MPePPB). Material and method: Quantitative, observational, questionnaire validation study. The scale MPePPB, based on scientific evidence, is designed with 13 questions and three factors: "Direct interaction with the child", "Support and containment"; and "Self-analysis and correction of behavior pattern" with likert responses. Ethical committee approval. The sample was that of simple random type, corresponding to 240 puerperal women attended in a maternity of the chilean public system. Validation tests of content, construct and criteria, together with the measurement of reliability were applied. Results and conclusions: 10 Factors and a single factor called Perception of paternal prenatal bonding were identified through Exploratory Factor Analysis. With an adequate internal reliability a = 0.90. It was identified that a maternal variable influences the perception of this bonding, corresponding to the planned pregnancy p value <0.0001. The MPePPB scale has adequate psychometric properties to evaluate this prenatal relationship with the parent. This study generates a validated chilean scale for future research in early paternal bonding.

Descripción de niveles de ansiedad, desesperanza y autoestima en un grupo de mujeres chilenas con diagnóstico de infertilidad primaria: un estudio piloto / Description of anxiety, hopelessness and self-esteem levels in a group of Chilean women diagnosed with primary infertility: A pilot study

describir los niveles de ansiedad, desesperanza y autoestima de mujeres con diagnóstico de infertilidad primaria que acuden a iniciar tratamiento de fertilización in vitro en un centro privado de alta complejidad.Materiales y métodos: serie de casos en la que se incluyeron mujeres chilenas con diagnóstico de infertilidad primaria entre los 20 y 45 años, sin hijos, heterosexuales, con óvulos propios, que aceptaron participar del estudio previo consentimiento informado, quienes acudieron entre junio y diciembre del año 2012 a iniciar tratamiento de fertilización in vitro a una institución privada de referencia especializada en el manejo de este problema en Concepción (Chile). Muestra no probabilística, consecutiva. Se analizaron variables biosociales, antecedentes de patología previa, niveles de ansiedad, desesperanza, autoestima y apoyo social percibido. El análisis estadístico se realizó con el programa SPSS versión 19.0, aplicando análisis univariado.Resultados: se analizó una muestra de 40 mujeres, con un promedio de edad de 35,75 años, las cuales poseen educación técnica o universitaria completa, todas trabajaban y tenían un nivel de ingreso medio-alto. El antecedente de patologías previas más frecuente correspondió a ovario poliquístico (50 %). En las mujeres estudiadas se observó ansiedad en el 47,5 %, desesperanza en el 62,5 % y baja autoestima en el 55 %. El 50 % de ellas percibió un bajo apoyo social.Conclusiones: en mujeres con infertilidad se encontraron importantes niveles de ansiedad, desesperanza y baja autoestima. Es importante hacer una evaluación de estas condiciones en mujeres sometidas a tratamiento de infertilidad ya que la condición de salud mental constituye un importante aspecto de la salud sexual y reproductiva de las mismas...

To describe levels of anxiety, hopelessness and self-esteem in women with a diagnosis of primary infertility seeking to initiate in vitro fertilization treatment at a high-complexity private centre.Materials and methods: Case series including Chilean women aged 20 to 45, who came between June and December 2012 to initiate in vitro fertilization treatment at a private referral institution in Concepcion, Chile, specialized in the management of this problem. The women were childless, heterosexual and had a diagnosis of primary infertility. They had their own eggs and agreed to participate in the study after going through the informed consent process. A consecutive non-probabilistic sample was used. The variables analysed included biosocial factors, prior disease history, levels of anxiety, hopelessness and self-esteem, and perceived social support. A univariate statistical analysis was performed using the SPSS software package, version 19.0.Results: A sample of 40 women was analysed. Mean age was 35.7 years. All the women had completed technical or university education, they all worked, and their level of income was medium to high. The most frequent history of prior disease was was polycystic ovary (50%). In the women included in the study, anxiety was found in 47.5%, hopelessness in 62.5% and low self-esteem in 55%. There was a perception of low social support in 50% of them.Conclusions: Significant levels of anxiety, hopelessness and low self-esteem were found in women with infertility. It is important to evaluate these conditions in women undergoing infertility treatment, considering that mental health is an important component of sexual and reproductive health...