What Abductor Repair Technique Provides the Best Functional Outcomes after Proximal Femur Endoprosthetic Reconstruction for Oncologic Indications? A Systematic Review.

BACKGROUND: There is conflicting data regarding the optimal abductor mechanism (AM) repair technique after resection of proximal femur tumors. We sought to compare functional outcomes following tumor resection and reconstruction with proximal femoral replacement (PFR) based on the AM repair technique utilized. METHODS: We conducted a systematic review following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines. We established two study groups based on AM repair technique: soft-tissue reattachment (STr) and greater trochanter preservation (GTp). In the STr group, the gluteus medius and minimus were reattached to the endoprosthesis, whereas in the GTp group, the greater trochanter and gluteal tendons were preserved. The STr group was further subdivided into direct and indirect reattachment, with the latter involving the use of a Trevira tube, Prolene mesh, or synthetic ligament. Weighted means adjusting for sample size were calculated. RESULTS: A total of 658 patients from 12 articles were included. Patients who had STr displayed higher MSTS scores (75 versus 67.3%, P < 0.001), and lower rates of Trendelenburg gait (33.9 versus 52.4%, P < 0.01) and ambulation with assistive devices (AD) (30.4 versus 54.9%, P < 0.001) compared to the GTp group. Within the STr group, indirect reattachment was associated with higher Musculoskeletal Tumor Society scores (87.2 versus 70.1%, P < 0.001) and lower rates of Trendelenburg gait (3.8 versus 36.3%, P < 0.001) and ambulation with AD (0 versus 42.4%, P < 0.001) compared to direct reattachment. Reattachment hardware failure rate in GTp was 15%. CONCLUSION: A STr provided superior functional outcomes compared to GTp in tumor-related PFR. From a functional outcome perspective, use of indirect STr was better compared to direct STr.

Universal and Expanded Screening Strategy for Congenital Cytomegalovirus Infection: Is Pool Testing by a Rapid Molecular Test in Saliva a New Choice in Developing Countries?

BACKGROUND: Several screening strategies for identifying congenital CMV (cCMV) have been proposed; however, the optimal solution has yet to be determined. We aimed to determine the prevalence of cCMV by universal screening with saliva pool testing and to identify the clinical variables associated with a higher risk of cCMV to optimize an expanded screening strategy. METHODS: We carried out a prospective universal cCMV screening (September/2022 to August/2023) of 2186 newborns, analyzing saliva samples in pools of five (Alethia-LAMP-CMV®) and then performed confirmatory urine CMV RT-PCR. Infants with risk factors (small for gestational age, failed hearing screening, HIV-exposed, born to immunosuppressed mothers, or <1000 g birth weight) underwent expanded screening. Multivariate analyses were used to assess the association with maternal/neonatal variables. RESULTS: We identified 10 infants with cCMV (prevalence: 0.46%, 95% CI 0.22-0.84), with significantly higher rates (2.1%, 95% CI 0.58-5.3) in the high-risk group (p = 0.04). False positives occurred in 0.09% of cases. No significant differences in maternal/neonatal characteristics were observed, except for a higher prevalence among infants born to non-Chilean mothers (p = 0.034), notably those born to Haitian mothers (1.5%, 95% CI 0.31-4.34), who had higher odds of cCMV (OR 6.82, 95% CI 1.23-37.9, p = 0.04). Incorporating maternal nationality improved predictive accuracy (AUC: 0.65 to 0.83). CONCLUSIONS: For low-prevalence diseases such as cCMV, universal screening with pool testing in saliva represents an optimal and cost-effective approach to enhance diagnosis in asymptomatic patients. An expanded screening strategy considering maternal nationality could be beneficial in resource-limited settings.

Ethnicity and refractive errors in Peruvian children aged 7-11 years: A five-year analysis of the Demographic and Health Survey.

OBJECTIVE: To assess the association between ethnicity and self-reported refractive errors (REs) among Peruvian children aged 7-11 years. MATERIALS AND METHODS: We conducted a cross-sectional study incorporating a secondary data analysis of 2017-2021 data from the Peruvian Demographic and Health Survey (DHS). REs and ethnicity were obtained from focal child's mother's report. Four outcomes were assessed: hyperopia, myopia, astigmatism and any RE. We included potential confounders, such as age, sex, wealth index, area of residence, region of origin, frequency of watching TV and watching screens at less than 30 cm distance. Generalised linear models with the Poisson family and log link function were used to calculate crude prevalence ratio and adjusted prevalence ratio (aPR) with 95% confidence intervals (95% CI). RESULTS: Data from a total of 52,753 children were included. The prevalence of RE in children aged 7-11 years was 10.90% (95% CI 10.49-11.33), of which 5.19% were hyperopia, 3.35% myopia and 2.36% astigmatism. Those of the Aymara ethnicity were less likely to suffer from any RE and astigmatism (aPR = 0.68, 95% CI 0.46-0.99, p = 0.046; aPR = 0.70, 95% CI 0.53-0.92, p = 0.012, respectively), Members of Amazon groups were more likely to have hyperopia (aPR = 1.95, 95% CI 1.14-3.36, p = 0.015) and Quechuas were more likely to have myopia (aPR =1.29, 95% CI 1.02-1.62, p = 0.028), where all were compared to Mestizos. CONCLUSION: About 1 in 10 Peruvian children suffer from a RE. The most frequent RE in this study was hyperopia. Ethnic differences were seen in the frequency of RE.

Access to HIV/STI testing among male and female Venezuelan migrants in Peru: evidence from a nationwide survey.

BACKGROUND: Human immunodeficiency virus (HIV) infection and sexually transmitted infections (STIs) are major global public health issues. Migrants represent a vulnerable group that faces multiple barriers to access to healthcare services, including HIV/STI testing. This study aimed to assess the factors associated with access to HIV/STI testing in male and female Venezuelan migrants in Peru. METHODS: This was a cross-sectional study involving secondary data analysis of the 2022 Venezuelan Population Residing in Peru Survey. The study was conducted in the eight most populated cities inhabited by Venezuelan migrants and refugees. For each city, the sampling design was probabilistic, stratified, and independent. The outcome variable was whether participants had access to HIV or other STI testing during their stay in Peru. Statistical analysis was stratified by sex owing to potential effect modification. Crude and adjusted prevalence ratios were calculated using generalized linear models Poisson family with log link function. Confidence intervals were calculated to 95%. RESULTS: A total of 3,723 male and 3,984 female migrants were included. Access to HIV/STI testing among male and female migrants was 19.85% and 25.16%, respectively. Among male migrants, being LGBTI, health insured, and married or cohabiting were associated with increased access to HIV/STI testing. Among females, those aged 18-44 years, those who were married or cohabiting and were health insured, and those residing for more than 1 year in Peru were significantly more likely to have access to HIV/STI testing. Moreover, physical/mental disability and unemployed status were associated with a lower probability of HIV/STI testing in females. CONCLUSIONS: Only two in ten Venezuelan migrants and refugees in Peru were screened for HIV/STI, with fewer males than females. Sex-specific sociodemographic, health-related, and migration-related variables were independently associated with access to HIV/STI testing.

Pre-extensively drug-resistant and extensively drug-resistant tuberculosis in Latin America and the Caribbean: A systematic review and meta-analysis.

BACKGROUND: The growing threat from pre-extensively drug-resistant tuberculosis (pre-XDR-TB) and extensively drug-resistant tuberculosis (XDR-TB) poses a major public health concern in Latin America and the Caribbean (LAC). Therefore, this study aimed to summarize the available evidence on the prevalence of pre-XDR-TB and XDR-TB among patients with multidrug-resistant tuberculosis in LAC. METHODS: A systematic review was conducted in the following databases on June 3, 2023: PubMed, Scopus, Ovid Medline, Web of Science, Scielo and LILACS. We estimated pooled proportions using a random effects model (Dersimonian and Laird). The 95% confidence intervals (95% CI) were calculated using the binomial exact method (Clopper-Pearson Method). Subgroup (by time period and country) and sensitivity analyses were performed. RESULTS: Twenty-nine studies were eligible for qualitative synthesis and 27 for meta-analysis (n = 15,565). The pooled prevalence of XDR-TB in the study participants was 5% (95% CI: 3%-6%), while that of pre-XDR-TB was 10% (95% CI 7%-14%). Cuba (6%, 95% CI 0%-17%) and Peru (6%, 95% CI 5%-7%) had the highest pooled prevalence of XDR-TB. Regarding pre-XDR-TB, Brazil (16%, 95% CI 11%-22%) and Peru (13%, 95% CI: 9%-16%) showed the highest prevalence. CONCLUSIONS: The pooled prevalence of pre-XDR-TB and XDR-TB in LAC was 10% and 5%, respectively. Governments should strengthen drug-resistance surveillance and TB programs.

The Telephone Language Screener (TLS): standardization of a novel telephone-based screening test for language impairment.

BACKGROUND: This study aimed at developing and standardizing the Telephone Language Screener (TLS), a novel, disease-nonspecific, telephone-based screening test for language disorders. METHODS: The TLS was developed in strict pursuance to the current psycholinguistic standards. It comprises nine tasks assessing phonological, lexical-semantic and morpho-syntactic components, as well as an extra Backward Digit Span task. The TLS was administered to 480 healthy participants (HPs), along with the Telephone-based Semantic Verbal Fluency (t-SVF) test and a Telephone-based Composite Language Index (TBCLI), as well as to 37 cerebrovascular/neurodegenerative patients-who also underwent the language subscale of the Telephone Interview for Cognitive Status (TICS-L). An HP subsample was also administered an in-person language battery. Construct validity, factorial structure, internal consistency, test-retest and inter-rater reliability were tested. Norms were derived via Equivalent Scores. The capability of the TLS to discriminate patients from HPs and to identify, among the patient cohort, those with a defective TICS-L, was also examined. RESULTS: The TLS was underpinned by a mono-component structure and converged with the t-SVF (p < .001), the TBCLI (p < .001) and the in-person language battery (p = .002). It was internally consistent (McDonald's ω = 0.67) and reliable between raters (ICC = 0.99) and at retest (ICC = 0.83). Age and education, but not sex, were predictors of TLS scores. The TLS optimally discriminated patients from HPs (AUC = 0.80) and successfully identified patients with an impaired TICS-L (AUC = 0.92). In patients, the TLS converged with TICS-L scores (p = 0.016). DISCUSSION: The TLS is a valid, reliable, normed and clinically feasible telephone-based screener for language impairment.

How long have you exercised in your life? The effect of motor reserve and current physical activity on cognitive performance.

OBJECTIVES: Aging of the population encourages research on how to preserve cognition and quality of life. Many studies have shown that Physical Activity (PA) positively affects cognition in older adults. However, PA carried out throughout the individual's lifespan may also have an impact on cognition in old age. We hypothesize the existence of Motor Reserve (MR), a flexible and dynamic construct that increases over time and compensates for age-related motor and cognitive loss. METHODS: Two questionnaires were developed and validated to estimate MR (Physical Activity carried out throughout the individual's lifespan) and Current Physical Activity (CPA, PA carried out in the previous 12 months). They were administered to 75 healthy individuals over 50 to verify the relation with cognition. MR and CPA include physical exercise (i.e., structured activities to improve or maintain physical fitness) and incidental PA, which we consider as any movement that leads to a metabolic cost above baseline (e.g., housekeeping, walking). In addition, the Cognitive Reserve Index questionnaire (CRI), a reliable predictor of cognitive performance, was used to measure each participant's Cognitive Reserve. RESULTS: The factors that most influenced performance are Age and Cognitive Reserve, but also MR and CPA together and MR when it is the only factor. CONCLUSIONS: Cognitive variability in adult and elderly populations is explained by both MR and CPA. PA training could profitably be included in new preventive and existing interventions.

Prevalence of Critical Congenital Heart Disease Detected in the Pulse Oximetry Test in Asymptomatic Newborns, ≥35 Gestational Weeks, in a Maternity in Southern Brazil

Abstract Background Congenital heart diseases (CHD) are one of the most prevalent malformations, and the screening tests to identify critical congenital heart disease (CCHD) is the pulse oximetry test, with subsequent investigation and treatment. Objective To quantify positive pulse oximetry tests and verify the prevalence of CCHD detected by it in asymptomatic newborns, ≥35 gestational weeks, in a Brazilian maternity hospital. Methodology This is an observational, retrospective, quantitative, analytical and cross-sectional study, conducted from October 2020 to May 2022, in a maternity hospital in southern Brazil, through the collection of records of positive oximetry pulse tests, following the norms of screening CCHD test of the Brazilian Society of Pediatrics (SBP), after they were evaluated with echocardiography for confirmation or exclusion of CHD. Results A total of 5,667 newborns were evaluated in this study, according to the inclusion criteria; 0.17% (n = 10) had a positive pulse oximetry test. Regarding the results of the echocardiography of the neonates with a positive test, two were normal, seven were cases of patent foramen ovale (PFO), and one was a case (0,017%) with interatrial communication (IAC) diagnosis. In the same period, five neonates with CCHD were born, symptomatic, diagnosed by physical examination, and referred to neonatal intensive care units (NICU) before taking the neonatal cardiac screening (< 24 hours of life). Conclusion The prevalence of positive pulse oximetry tests was 0.17% and none CCHD was detected. Five cases of CCHD were born in this period, but they were diagnosed before the recommend time to perform the screening test.

Optimizing congenital cytomegalovirus detection by pool testing in saliva by a rapid molecular test.

Universal congenital cytomegalovirus (cCMV) screening in saliva is increasingly recommended. The aim of our study was to correlate the performance of a point-of-care rapid molecular test with CMV real time PCR (CMV RT-PCR) detection, using saliva pool-testing in newborns under a universal screening strategy. Saliva swabs were prospectively collected from newborns < 21 days old and tested by Alethia-LAMP-CMV assay in pools of 5 samples. In positive pools, subjects were tested individually and by saliva and urine CMV RT-PCR. A subset of negative pools were studied with both techniques and viral loads in whole blood were determined in positive patients. From 1,642 newborns included in 328 pools, 8 were confirmed by urine CMV RT-PCR, (cCMV prevalence 0,49%). The PPA and NNA of the pooled saliva Alethia-LAMP-CMV testing were 87,5% and 99,8% with a negative and positive predictive value of 99,9% and 77,7%, respectively. Two false positives were detected (0,12%). A subset of 17 negative pools (85 samples), studied by saliva CMV RT-PCR, showed 100% concordance.  Conclusion: CMV pool-testing using a rapid molecular test in saliva proved feasible when compared to PCR gold standards. This strategy could improve cost-effectiveness for cCMV universal neonatal screening, based on the low prevalence of the infection and could be a more affordable approach in less developed regions with reduced detection capacity. What is Known: • cCMV is the most frequent congenital infection and a leading nongenetic cause of sensorineural hearing loss and brain disease. • Universal screening could allow early detection of congenitally infected infants, improving clinical outcome. • Saliva PCR is the preferred and non-invasive test for newborn cCMV screening. What is New: • The feasibility of a universal cCMV screening by pool-testing in saliva using a rapid test in pools of 5 samples. • PPA and NPA were 87,5 and 99,8% compared to CMV PCR in urine. • This strategy could be relevant specially in LMIC where detection capacity is reduced and could improve cost-effectiveness. • cCMV prevalence in our center was 0,49%.

Ni-Al Bronze in Molten Carbonate Manufactured by LPBF: Effect of Porosity Design on Mechanical Properties and Oxidation.

Fuel cell technology has developed due to diminishing dependence on fossil fuels and carbon footprint production. This work focuses on a nickel-aluminum bronze alloy as an anode produced by additive manufacturing as bulk and porous samples, studying the effect of designed porosity and thermal treatment on mechanical and chemical stability in molten carbonate (Li2CO3-K2CO3). Micrographs showed a typical morphology of the martensite phase for all samples in as-built conditions and a spheroid structure on the surface after the heat treatment, possibly revealing the formation of molten salt deposits and corrosion products. FE-SEM analysis of the bulk samples showed some pores with a diameter near 2-5 µm in the as-built condition, which varied between 100 and -1000 µm for the porous samples. After exposure, the cross-section images of porous samples revealed a film composed principally of Cu and Fe, Al, followed by a Ni-rich zone, whose thickness was approximately 1.5 µm, which depended on the porous design but was not influenced significantly by the heat treatment. Additionally, by incorporating porosity, the corrosion rate of NAB samples increased slightly.

Inequalities in anemia among Peruvian children aged 6-59 months: A decomposition analysis.

Objective: To quantify the inequalities of anemia in Peruvian children aged 6-59 months and uncover its contributing factors. Materials and methods: We conducted a cross-sectional study based on the secondary data analysis of the 2021 Peruvian Demographic and Health Survey (DHS). Our sample included Peruvian children aged 6-59 months with complete data for the variables of interest. Anemia was defined as having a hemoglobin level of less than 11 g/dL, adjusted by altitude. Erreygers Concentration Index (ECI) and concentration curves were computed to estimate the socio-economic inequality in anemia among Peruvian children. Moreover, ECI was decomposed to figure out the contributing factors to the inequality of anemia and the residual variation. Results: Nationwide, the prevalence of anemia in Peruvian children was 29.47%. We found a pro-poor inequality regarding anemia at the national level (ECI = -0.1848). The determinants included in the model explained 81.85% of the overall socio-economic inequality in anemia. The largest contribution to inequality was from household- and community-related factors. Having a higher mother's education level (26.26%) and being from the highlands (24.91%) were the major significant contributors to the overall health inequality. Conclusion: Almost one-third of Peruvian children have anemia. A pro-poor inequality of anemia in Peruvian children was found. Public policies ought to address the major contributing factors of anemia inequality.

Inequalities in COVID-19 vaccination coverage in Peru: An ecological study.

Objective: To assess the correlation between COVID-19 vaccination coverage and the Human Development Index (HDI) at the provincial level in Peru. Study design: Ecological study. Methods: We conducted a cross-sectional ecological study based on secondary data analysis. Coverages of the first, second, and third doses of the vaccine against COVID-19 and the HDI were evaluated. The magnitude of the correlations was assessed using Spearman's rank correlation coefficients with their corresponding bootstrapped 95% confidence intervals (95% CI). Scatter plots were also constructed. Results: A total of 196 provinces were included. There was a moderate correlation between the first dose of the COVID-19 vaccine and the HDI (r = 0.3807 [95% CI 0.2585-0.5030], p < 0.0001). The same direction was found for the second (r = 0.4064 [95% CI 0.2853-0.5276], p < 0.0001) and third dose (r = 0.4435 [95% CI 0.3201-0.5669], p < 0.0001). Conclusions: A positive correlation was found between COVID-19 vaccination coverage and the HDI, suggesting the presence of inequalities in access to vaccines. Individualised strategies are needed in lower HDI regions to tackle inequalities.

Factors associated with not receiving the primary series and booster dose of the COVID-19 vaccine among Venezuelan migrants in Peru: A population-based cross-sectional study.

BACKGROUND: Ensuring broad COVID-19 vaccination coverage among migrants is a global public health concern. Thus, our study aimed to assess the factors associated with not receiving the primary series and booster dose of the COVID-19 vaccine among Venezuelan migrants in Peru. METHODS: This was a cross-sectional study based on secondary data analysis of the 2022 Venezuelan Population Residing in Peru Survey. Our population included Venezuelan migrants and refugees over 18 years old living in Peru with complete information for the variables of interest. Two outcome variables were assessed: not receiving the primary series and not receiving the booster dose of the COVID-19 vaccine. Crude and adjusted prevalences were calculated with 95% confidence intervals. RESULTS: A total of 7,727 Venezuelan adults were included in our study, of whom 6,511 completed the primary series. The overall COVID-19 vaccination coverage of the primary series was 84.17%, whilst the coverage of the booster dose was 28.06%. Being younger, uninsured, illegally-staying, and having a low educational level were associated with both outcomes. CONCLUSION: Several sociodemographic and migration-related variables were associated with both outcomes. Governmental policies prioritizing vaccination among Venezuelan migrants are needed to ensure broad coverage in this vulnerable group.

Inequalities in infant vaccination coverage during the COVID-19 pandemic: A population-based study in Peru.

OBJECTIVE: To identify the associated factors and assess the inequalities of full vaccination coverage (FVC) among Peruvian infants aged 12-23 months during the COVID-19 pandemic in a nationally representative sample. METHODS: We carried out a population-based cross-sectional study based on a secondary data analysis using the 2021 Peruvian Demographic Health Survey (DHS) in infants aged 12 to 23 months. The sampling design was probabilistic, multistage, stratified, and independent at both departmental and area of residence levels. FVC was defined according to the WHO definition. We performed generalized linear models (GLM) Poisson family log link function to estimate crude (aPR) and adjusted prevalence ratios (aPR). Also, for inequality assessment, we calculated the concentration curve (CC), concentration index (CI), and Erreygers normalized concentration index (ECI). RESULTS: We included 4,189 infants in our analysis. Nationwide, the prevalence of FVC was 66.19% (95% CI: 64.33-68). Being younger, having a mother with no education or primary education, belonging to a large family, having no access to mass media, having had six or fewer ANC visits, and having a mother whose age was under 20 at first delivery were inversely associated with FVC. Meanwhile, living in the Highlands or on the rest of the coast, and living in rural areas were directly associated with FVC. We found a pro-rich inequality in FVC based on wealth-ranked households (CI: 0.0066; ECI: 0.0175). CONCLUSION: FVC has dropped among Peruvian infants aged between 12 and 23 months. There were several factors associated with FVC. It was more concentrated among the better-off infants, although in low magnitude.

Rural and urban disparities in anemia among Peruvian children aged 6-59 months: a multivariate decomposition and spatial analysis.

INTRODUCTION: Anemia is a global public health issue that affects mainly children aged less than 5 years. In Peru, despite the reduction in the prevalence of anemia between 2010 and 2018, anemia remains a major concern, especially in high-risk zones such as rural areas. Several sociodemographic factors have been associated with anemia in children; however, components contributing to the urban-rural gap have not been previously assessed. The purpose of this study was to evaluate the determinants of the difference in anemia prevalence between urban and rural areas, and its spatial distribution in Peruvian children aged 6-59 months. METHODS: A secondary data analysis was conducted using the 2019 Peruvian Demographic Health Survey. The study population included 18 846 children aged 6-59 months. A multivariate decomposition analysis for non-linear response model was performed to identify the factors contributing to the gap in the prevalence of anemia across urban and rural areas. Global Moran´s I autocorrelation, Ordinary Kriging interpolation and Bernoulli-based purely spatial scan statistics were employed to assess the spatial pattern of anemia. RESULTS: Nationwide, the prevalence of anemia in Peru was 29.47% (95%CI 28.63-30.33). In rural areas, it was 38.25%, and in urban areas 26.39%. The decomposition analysis revealed that 88.61% of the difference in the prevalence of anemia between urban and rural areas was attributed to the difference in the respondents' characteristics. Wealth index, mother´s education, mother´s employment status, number of living children and mother´s age were key determinants contributing to the rural-urban gap. Spatial heterogeneity of anemia prevalence in childhood was observed at both inter- and intradepartmental level. The SaTScan spatial analysis identified six significant cluster areas with high prevalence of anemia in childhood. CONCLUSION: A considerable gap of anemia prevalence between urban and rural areas was found. Targeted interventions are necessary to reduce geographic disparities.

Recomendaciones de la Asociación Colombiana de Neurología para el uso de anticuerpos monoclonales antiCGRP en la profilaxis de migraña / Recommendations on the use of the antiCGRP monoclonal antibodies for migraine prophylaxis on behalf of the Colombian Association of Neurology

RESUMEN INTRODUCCIÓN: El desarrollo de anticuerpos monoclonales (mAbs) contra el péptido relacionado con el gen de la calcitonina (CGRP) ha determinado una nueva era terapéutica en la profilaxis de migraña, demostrando su efectividad en pacientes con migraña episódica (ME) y migraña crónica (MC), con respuesta desde pacientes naïve hasta refractarios a múltiples medicamentos. La disminución del 50% de los ataques de migraña al mes (DMM) durante los primeros 3 meses de uso es el desenlace aproximado en el 50% de los pacientes que reciben esta terapia. OBJETIVO: Este consenso de la Asociación Colombiana de Neurología (ACN) tiene el objetivo de guiar la selección y uso racional de los mAbs antiCGRP en pacientes con ME y MC. MATERIALES Y MÉTODOS: El comité de cefalea de la ACN mediante la aplicación de la metodología Delphi y discusiones en reuniones posteriores desarrolló un documento en formato de consenso soportado en literatura y recomendaciones de expertos. RESULTADOS: Se obtuvieron respuestas de 14 expertos en cefalea sobre moléculas utilizadas en profilaxis de migraña, analizando su aplicabilidad en situaciones clínicas frecuentes. DISCUSIÓN: Los mAbs antiCGRP han demostrado efectividad con adecuado soporte fisiopatológico, considerando que son moléculas de alto precio en una enfermedad de alta prevalencia, existe la necesidad de guíar la selección del paciente que mejor puede beneficiarse de su administración CONCLUSIONES: Los mAbs antiCGRP están recomendados en pacientes con ME y MC que presentan falla terapéutica a otras moléculas profilácticas.

ABSTRACT INTRODUCTION: The development of monoclonal antibodies (mAbs) against Calcitonin Gene Related Peptide (CGRP) has determined a new therapeutic era in migraine prophylaxis, demonstrating its effectiveness in patients with episodic migraine (EM) and chronic migraine (CM), obtaining a response in naive patients and in those who are refractory to multiple medications. A 50% decrease in migraine attacks per month during the first 3 months of use is the approximate outcome in 50% of patients receiving this therapy. OBJECTIVE: This consensus from the Colombian Association of Neurology (ACN) has the objective of serving as a guide for the rational use of antiCGRP mAbs in patients with EM and CM. METHODS AND MATERIALS: The headache committee through the application of the Delphi methodology and discussions in subsequent meetings, develops this consensus, supported in the published literature and expert recommendations. RESULTS: Fourteen answers from headache experts were received regarding the use of drugs for migraine prophylaxis, analyzing their applicability in frequent clinical situations. DISCUSSION: AntiCGRP mAbs have proved their effectiveness with adequate pathophysiological support, but with a high price in a highly prevalent disease, there is then a need to select the patient who best benefits from this therapy. CONCLUSIONS: AntiCGRP mAbs are recommended in patients with EM and CM that have previously failed to other prophylactic drugs.

Influence of Bacillus safensis and Bacillus pumilus on the electrochemical behavior of 2024-T3 aluminum alloy.

In this work, electrochemical techniques were employed to evaluate the contribution to the corrosion and corrosion inhibition of 2024-T3 aluminum alloy by two Gram-positive bacteria. In addition, polarized impedance was used to determine the microbial effect on the cathodic and anodic reactions. These microorganisms were collected from a tropical environment due to the favorable bacterial growth of this kind of climate. The alloy was exposed to the sterile medium and inoculated for up to 12 days evaluating the microbiological and electrochemical behavior. The results by linear scanning voltammetry showed that the B. safensis and B. pumilus caused a dual effect of increase and decrease currents, and through electrochemical impedance spectroscopy, showed in some cases, inductive loop, which could be associated with local corrosion and another case, an increasing impedance could be related to protection. In addition, a morphological characterization was performed by scanning electron microscopy before and after exposure, showing an increase in copper precipitation in the vicinity of the intermetallic phases by bacteria, attributed to local corrosion, but, in general, a significant effect of damages was not observed.

A Tribological and Ion Released Research of Ti-Materials for Medical Devices.

The increase in longevity worldwide has intensified the use of different types of prostheses for the human body, such as those used in dental work as well as in hip and knee replacements. Currently, Ti-6Al-4V is widely used as a joint implant due to its good mechanical properties and durability. However, studies have revealed that this alloy can release metal ions or particles harmful to human health. The mechanisms are not well understood yet and may involve wear and/or corrosion. Therefore, in this work, commercial pure titanium and a Ti-6Al-4V alloy were investigated before and after being exposed to a simulated biological fluid through tribological tests, surface analysis, and ionic dissolution characterization by ICP-AES. Before exposure, X-ray diffraction and optical microscopy revealed equiaxed α-Ti in both materials and ß-Ti in Ti-6Al-4V. Scratch tests exhibited a lower coefficient of friction for Ti-6Al-4V alloy than commercially pure titanium. After exposure, X-ray photoelectron spectroscopy and surface-enhanced Raman spectroscopy results showed an oxide film formed by TiO2, both in commercially pure titanium and in Ti-6Al-4V, and by TiO and Al2O3 associated with the presence of the alloys. Furthermore, inductively coupled plasma atomic emission spectroscopy revealed that aluminum was the main ion released for Ti-6Al-4V, giving negligible values for the other metal ions.

Factores sociodemográficos y nutricionales asociados a anemia en niños de 1 a 5 años en Perú

RESUMEN Objetivo: Determinar los factores sociodemográficos y nutricionales asociados a la anemia en niños de 1 a 5 años de Perú según la Encuesta Nacional Demográfica y de Salud Familiar (DHS, por sus siglas en inglés Demographic and Health Survey). Metodología: Para determinar los posibles factores sociodemográficos y nutricionales asociados a la anemia, se hizo un subanálisis de la DHS 2017, tomando en cuenta un intervalo de confianza del 95% y considerando los parámetros de complejidad de la encuesta. Se describieron las frecuencias relativas en el análisis univariado. Para el análisis bivariado se empleó el test de chi cuadrado para las variables categóricas y t-Student para las variables continuas. Para el modelo de regresión múltiple, se realizó una regresión de Poisson cruda y ajustada con el método de selección de variables tipo backward. Principales resultados: La prevalencia de anemia fue de 38.5%. Los factores independientemente asociados fueron quintil de riqueza bajo (RP(a): 1,23; IC95%: 1,0-1,4), ningún grado de instrucción o grado de instrucción primaria de la madre (RP(a): 1,25; IC95%: 1,0-1,5), edad de la madre menor de 19 años (RP(a): 1,34; IC95%: 1,1-1,7), lugar del parto no institucionalizado (RP(a): 1,24; IC95%: 1,1-1,5), no consumo de antiparasitarios (RP(a): 1,13; IC95%:1,0-1,3) y altitud mayor o igual a 4000 msnm (RP(a): 1,45; IC95%: 1,2-1,8). Conclusiones: La prevalencia de anemia en niños de 1 a 5 años en el 2017 fue moderada. Existen factores sociodemográficos y nutricionales asociados a dicha condición.

ABSTRACT Purpose: Determine the sociodemographic and nutritional factors associated with anemia in children aged 1 to 5 years in Peru according to the Demographic and Health Survey (DHS). Methods: To determine the possible sociodemographic and nutritional factors associated with anemia, a sub-analysis of the DHS 2017 was carried out, taking into account a 95% confidence interval and considering the complexity of survey parameters. Relative frequencies were described in univariate analysis. For bivariate analysis, the chi-square test was used for categorical variables and Student t-test for continuous variables. For the multivariable analysis, a crude and an adjusted Poisson regression was done with backward method for variable selection. Main results: Independently associated factors were low wealth (aPR: 1.23; 95% CI: 1.0-1.4), no degree or primary education level of the mother (aPR: 1.25; 95%CI: 1.0-1.5), mother's age under 19 years (aPR: 1.34; 95%CI: 1.1-1.7), not delivering in a health facility (aPR: 1.24; 95%CI: 1.1-1.5), no consumption of antiparasitic drugs (aPR: 1.13; 95%CI: 1.0-1.3) and living at greater than or equal to 4000 meters above sea level (aPR: 1.45; 95%CI: 1.2-1.8). Conclusions: The prevalence of anemia in children aged 1 to 5 years in 2017 was moderate. There are sociodemographic and nutritional factors associated with this condition.

El paciente con estado migrañoso en urgencias que no responde al manejo inicial / The patient with a migraine status in emergency department that does not respond to the initial management

RESUMEN El manejo del paciente con estado migrañoso en urgencias incluye un arsenal terapéutico multimodal en búsqueda de la mejoría del dolor y la reducción de la recurrencia. La mayoría de los pacientes responde al manejo inicial, pero en casos no despreciables este resultado no se obtiene con las medicaciones de primera línea y es necesario el uso de otros medicamentos y opciones terapéuticas que incluyen: bloqueos pericraneales, lidocaína, levetiracetam, propofol y, en casos seleccionados, el uso de opiodes. En este escrito se presenta un caso clínico de migraña que no mejora con el manejo inicial en urgencias y requiere el uso de otras opciones.

SUMMARY Management of the patient with status migrainosus in the emergency department includes a multimodal therapeutic arsenal seeking to improve pain and to reduce recurrence; the majority of patients respond to enhanced initial management, but in non-negligible cases this result is not obtained with first-line medications and the use of other medications and therapeutic options is necessary, including: pericranial blocks, lidocaine, levetiracetam, propofol and in selected cases the use of opioids. In this review we present a clinical case of migraine that does not improve in the initial management in the emergency department and requires the use of other options for management.