Mindfulness and the challenges of working from home in times of crisis.

Many employees unexpectedly were required to work from home during the COVID-19 pandemic of 2020. With this abrupt change came the challenge of blurred lines between career and personal life. Lacking designated home office spaces, countless individuals had to create improvised work setups in living rooms, kitchens, bedrooms-wherever there was space. Moreover, the closure of schools forced many working parents to attempt productivity while concurrently supervising their children. As a result of these changes, numerous employees have experienced lower work productivity, lessened motivation, increased stress, and poorer mental health. One approach that may help employees going through the challenges associated with working from home is mindfulness. Mindfulness may be particularly beneficial as it can (1) help employees mentally disconnect from work when they need to; (2) improve individuals' attention to work tasks and thereby improve their performance; and (3) allow workers to better manage screen fatigue. In this installment of Work/Life Balance, we elaborate on how mindfulness may help employees deal with these work issues, explain how mindfulness can be cultivated, and provide a list of mindfulness techniques. We also provide a set of recommendations for managers and team leaders responsible for their employees' well-being and productivity.

Challenges in Managing Pregnancy in Underserved Women with Chronic Kidney Disease.

BACKGROUND: Chronic kidney disease (CKD) is a global public health problem and is linked to adverse outcomes during pregnancy; the high prevalence of CKD (3-6%) in women of childbearing age is of particular relevance in emerging countries where CKD prevalence is higher and resources are limited. Although CKD is a public health problem in Mexico, there is scant information on outcomes in pregnant CKD women in this country. We report maternal-fetal outcomes in a prospective cohort of poor, CKD pregnant women, and compare results with those of pregnant women without CKD. METHODS: A prospective study of pregnant CKD women referred to a public obstetrics/nephrology clinic from July 2013 to December 2017; sociodemographic and clinical data, including complications and perinatal outcomes, were recorded. CKD was defined at referral as per KDIGO guidelines; preeclampsia and superimposed preeclampsia were defined as appearance or worsening of hypertension and proteinuria. Findings were compared to official data for -Mexico and to a historic control of pregnant women without CKD who delivered at our hospital. RESULTS: Sixty-two pregnancies in CKD patients, age 23.4 ± 5.8 years were observed; 46.8% of patients were primiparous. At referral, serum creatinine was 1.8 (1.1-3.0) mg/dL with an estimate glomerular filtration rate (eGFR) of 38.1 (21.9-68.0) mL/min/1.73 m2. In half of the cases, CKD was diagnosed during pregnancy. Forty-eight pregnant women without CKD, age 27 (22-34) years, who delivered during the study period were selected as controls: 33% were primiparous, serum creatinine was 0.50 (0.4-0.6) mg/dL, and estimate glomerular filtration rate was 135 (112-174) mL/min/1.73 m2. Twenty patients needed dialysis (HD-CKD): 2 were already on dialysis, and 18 began treatment during pregnancy; 42 CKD patients did not require dialysis (non-HD CKD). After delivery, 15 patients remained dialysis dependent while 5 did not. Preeclampsia was more frequent in CKD patients in comparison to controls. In total, 93% of CKD patients and 98% of controls delivered a live baby. Prematurity was more frequent in CKD patients than controls and was higher in HD-CKD than in non-HD CKD. Birth weight was lower in CKD when compared to controls. Logistic regression showed a higher risk of preeclampsia in CKD pregnancies than in controls, but it was not affected by age, parity, CKD stage, or need for dialysis during pregnancy. CONCLUSIONS: Underserved CKD Mexican women have a high rate of adverse maternal-fetal outcomes during pregnancy. The risk may be higher in patients needing dialysis during pregnancy, many of whom remained dialysis dependent after delivery.

Role of the inflammatory response in the hemorrhagic syndrome induced by the hemolymph of the caterpillar Lonomia achelous.

INTRODUCTION: Contact with the caterpillar of Lonomia achelous causes a hemorrhagic syndrome in humans prompted by two processes, an initial mild DIC that is later masked by overwhelming fibrinolytic activity. Although the venom affects both the hemostatic and inflammatory systems separately, it is not clear whether the hematological and hemostatic disturbances may in part be due to an indirect effect via inflammatory mediators. Here we report results on the crosstalk between these systems, particularly the effect of the pro-inflammatory cytokine TNF-α on hemostatic parameters. MATERIALS AND METHODS: the nitric oxide and TNF-α responses, as well as activation of the coagulation and fibrinolytic systems, were measured in macrophages and endothelial cells treated with Lonomia achelous hemolymph (LAH). The same responses were then determined, in a mouse model of LAH envenomation, after treatment with an anti-TNF-α antibody. RESULTS: Both macrophages and endothelial cells responded strongly to LAH in terms of pro-inflammatory mediator release and fibrinolytic activities as well as pro-coagulant activity (TF activity) in endothelial cells. Treatment with antibody against TNF-α decreased both TNF-α and NO3-/NO2- serum levels in the mice, after LAH injection. Blocking TNF-α also modified significantly the serum levels of plasminogen, fibrinogen and FXIII in mice, as well as decreased TF activity in endothelial cells. CONCLUSIONS: LAH may induce a hemostatic effect through endothelial and macrophage activation. These activated cell release hemostatic enzymes as well as pro-inflammatory mediators, principally TNF-α, that potentiate this release in an autocrine fashion, amplifying the fibrinolytic effect, which may in turn exacerbate the hemorrhagic manifestations. As far as we are aware, this is the first report of the relationship between the hemostatic system and the inflammatory responses in a hemorrhagic syndrome induce by animal secretions.

Comparative hemostatic parameters in BALB/c, C57BL/6 and C3H/He mice.

This study describes micro-methods to determine biological parameters in plasma of three strains of mice. Platelet count was significantly different among strains. C57BL/6 mice showed the highest values (988 x 10(3)/microL) and BALB/c the lowest (782 x 10(3)/microL). Fibrinogen levels were 2.55 (C57BL/6), 2.37 (BALB/c) and 2.28 g/L (C3H/He). Some inter-strain differences were observed in factor XIII (94, 118 and 114%) and plasminogen levels (142, 80 and 135%) in C57BL/6, BALB/c and C3H/He, respectively. Additionally, we observed individual mice factor XIII and plasminogen levels between 80 to 200% and 65 to 180%, respectively, in relation to pooled human plasma; and between 70 to 185% and 70 to 155%, respectively, against pooled mice plasma. To our knowledge, this is first report in the literature in diverse mice strains regarding hemostasis, mainly on factor XIII, plasminogen levels, and a very simple test that allows measurement of endogenous fibrinolytic activity present in the plasma. The different results are discussed in relationship with existing literature regarding if the animals in some studies were maintained under strict pathogen-free conditions, the collection of blood was from the heart or eye and if the analysis method was tested by counting manually or automatically. This work could contribute useful knowledge to the field of investigations regarding hemostatic disorders using mouse models, especially for laboratories that are not well equipped.

Fibrinógeno plasmático, coeficiente de permeabilidad y parámetros de polimerización del Coágulo de fibrina en hombres con trastornos lipídicos / Plasma fibrinogen, permeability coefficient and fibrin clot polymerization in male dyslipedemic patients

Diversos estudios epidemiológicos afirman que el fibrinógeno es un factor de riesgo coronario, con un mayor valor predictivo de enfermedad cardiovascular que el que tienen los lípidos sanguíneos en el desarrollo de esta patología. Es por esto que el objetivo de este trabajo fue determinar la relación que existe entre la concentración de fibrinógeno, la permeabilidad y los parámetros de polimeración de coágulo de fibrina con los lípidos séricos en hombres entre 20 y 50 años de edad; para lo cual se estudiaron 20 individuos con trastornos lipídicos, sin otra patología agregada, comparándolos con 19 sujetos sanos. Los resultados obtenidos revelan una concentración de fibrinógeno mayor en los pacientes con trastornos lipídicos que en los sujetos sanos (p<0.001), una correlación positiva entre fibrinógeno y colesterol total, cuando las concentraciones del mismo son ≥200 mg/dL (r= 0.640, p<0.046), una correlación positiva entre fibrinógeno y triglicéridos (r= 0,406, p<0,01), y una velocidad de polimeración más elevada en los pacientes con alteraciones lipídicas (p<0,009). En el estudio de permeabilidad del coágulo no se encontró ninguna diferencia relevante entre los coeficientes de permeabilidad de los grupos estudiados, ni correlación con los lípidos séricos. En conclusión los trastornos lipídicos en hombres están asociados en forma estrecha con las concentraciones plasmáticas de fibrinógeno