eNAMPT is a novel therapeutic target for mitigation of coronary microvascular disease in type 2 diabetes.

AIMS/HYPOTHESIS: Individuals with diabetes are at high risk of cardiovascular complications, which significantly increase morbidity/mortality. Coronary microvascular disease (CMD) is recognised as a critical contributor to the increased cardiac mortality observed in people with diabetes. Therefore, there is an urgent need for treatments that are specific to CMD. eNAMPT (extracellular nicotinamide phosphoribosyltransferase) is a damage-associated molecular pattern and TLR4 ligand, whose plasma levels are elevated in people with diabetes. This study was thus designed to investigate the pathogenic role of intracellular nicotinamide phosphoribosyltransferase (iNAMPT) and eNAMPT in promoting the development of CMD in a preclinical murine model of type 2 diabetes. METHODS: An inducible type 2 diabetic mouse model was generated by a single injection of low-dose streptozocin (75 mg/kg, i.p.) combined with a high-fat diet for 16 weeks. The in vivo effects of i/eNAMPT inhibition on cardiac endothelial cell (CEC) function were evaluated by using Nampt+/- heterozygous mice, chronic administration of eNAMPT-neutralising monoclonal antibody (mAb) or use of an NAMPT enzymatic inhibitor (FK866). RESULTS: As expected, diabetic wild-type mice exhibited significantly lower coronary flow velocity reserve (CFVR), a determinant of coronary microvascular function, compared with control wild-type mice. eNAMPT plasma levels or expression in CECs were significantly greater in diabetic mice than in control mice. Furthermore, in comparison with diabetic wild-type mice, diabetic Nampt+/- heterozygous mice showed markedly improved CFVR, accompanied by increased left ventricular capillary density and augmented endothelium-dependent relaxation (EDR) in the coronary artery. NAMPT inhibition by FK866 or an eNAMPT-neutralising mAb significantly increased CFVR in diabetic mice. Furthermore, administration of the eNAMPT mAb upregulated expression of angiogenesis- and EDR-related genes in CECs from diabetic mice. Treatment with either eNAMPT or NAD+ significantly decreased CEC migration and reduced EDR in coronary arteries, partly linked to increased production of mitochondrial reactive oxygen species. CONCLUSIONS/INTERPRETATION: These data indicate that increased i/eNAMPT expression contributes to the development of diabetic coronary microvascular dysfunction, and provide compelling support for eNAMPT inhibition as a novel and effective therapeutic strategy for CMD in diabetes.

Algorithm Training and Testing for a Nonendoscopic Barrett's Esophagus Detection Test in Prospective Multicenter Cohorts.

BACKGROUND & AIMS: Endoscopic Barrett's esophagus (BE) and esophageal adenocarcinoma (EAC) detection is invasive and expensive. Nonendoscopic BE/EAC detection tools are guideline-endorsed alternatives. We previously described a 5-methylated DNA marker (MDM) panel assayed on encapsulated sponge cell collection device (CCD) specimens. We aimed to train a new algorithm using a 3-MDM panel and test its performance in an independent cohort. METHODS: Algorithm training and test samples were from 2 prospective multicenter cohorts. All BE cases had esophageal intestinal metaplasia (with or without dysplasia/EAC); control subjects had no endoscopic evidence of BE. The CCD procedure was followed by endoscopy. From CCD cell lysates, DNA was extracted, bisulfite treated, and MDMs were blindly assayed. The algorithm was set and locked using cross-validated logistic regression (training set) and its performance was assessed in an independent test set. RESULTS: Training (N = 352) and test (N = 125) set clinical characteristics were comparable. The final panel included 3 MDMs (NDRG4, VAV3, ZNF682). Overall sensitivity was 82% (95% CI, 68%-94%) at 90% (79%-98%) specificity and 88% (78%-94%) sensitivity at 84% (70%-93%) specificity in training and test sets, respectively. Sensitivity was 90% and 68% for all long- and short-segment BE, respectively. Sensitivity for BE with high-grade dysplasia and EAC was 100% in training and test sets. Overall sensitivity for nondysplastic BE was 82%. Areas under the receiver operating characteristic curves for BE detection were 0.92 and 0.94 in the training and test sets, respectively. CONCLUSIONS: A locked 3-MDM panel algorithm for BE/EAC detection using a nonendoscopic CCD demonstrated excellent sensitivity for high-risk BE cases in independent validation samples. (Clinical trials.gov: NCT02560623, NCT03060642.).

Climate and human stressors on global penguin hotspots: Current assessments for future conservation.

As charismatic and iconic species, penguins can act as "ambassadors" or flagship species to promote the conservation of marine habitats in the Southern Hemisphere. Unfortunately, there is a lack of reliable, comprehensive, and systematic analysis aimed at compiling spatially explicit assessments of the multiple impacts that the world's 18 species of penguin are facing. We provide such an assessment by combining the available penguin occurrence information from Global Biodiversity Information Facility (>800,000 occurrences) with three main stressors: climate-driven environmental changes at sea, industrial fisheries, and human disturbances on land. Our analyses provide a quantitative assessment of how these impacts are unevenly distributed spatially within species' distribution ranges. Consequently, contrasting pressures are expected among species, and populations within species. The areas coinciding with the greatest impacts for penguins are the coast of Perú, the Patagonian Shelf, the Benguela upwelling region, and the Australian and New Zealand coasts. When weighting these potential stressors with species-specific vulnerabilities, Humboldt (Spheniscus humboldti), African (Spheniscus demersus), and Chinstrap penguin (Pygoscelis antarcticus) emerge as the species under the most pressure. Our approach explicitly differentiates between climate and human stressors, since the more achievable management of local anthropogenic stressors (e.g., fisheries and land-based threats) may provide a suitable means for facilitating cumulative impacts on penguins, especially where they may remain resilient to global processes such as climate change. Moreover, our study highlights some poorly represented species such as the Northern Rockhopper (Eudyptes moseleyi), Snares (Eudyptes robustus), and Erect-crested penguin (Eudyptes sclateri) that need internationally coordinated efforts for data acquisition and data sharing to understand their spatial distribution properly.

Mercury Concentrations in Feathers of Albatrosses and Large Petrels at South Georgia: Contemporary Patterns and Comparisons with Past Decades.

Mercury (Hg) is an environmental contaminant that can negatively impact the health of humans and wildlife. Albatrosses and large petrels show some of the highest levels of Hg contamination among birds, with potential repercussions for reproduction and survival. Here, body feather total Hg (THg) concentrations were determined in breeding adults of five species of albatrosses and large petrels in the foraging guild at South Georgia during the mid-2010s. We tested the effects of species, sex and trophic ecology (inferred from stable isotopes) on THg concentrations and compared our results with published values from past decades. Feather THg concentrations differed significantly among species (range: 1.9-49.6 µg g-1 dw), and were highest in wandering albatrosses Diomedea exulans, intermediate in black-browed albatrosses Thalassarche melanophris and northern giant petrels Macronectes halli, and lowest in southern giant petrels M. giganteus and white-chinned petrels Procellaria aequinoctialis. Females were more contaminated than males in all species, potentially due to differences in distributions and diet composition. Across species, THg concentrations were not correlated with feather δ13C or δ15N values, implying that species effects (e.g., breeding and moulting frequencies) may be more important than trophic effects in explaining feather THg concentrations in this foraging guild. Within species, the only significant correlation was between THg and δ13C in wandering albatrosses, which could reflect higher Hg exposure in subtropical waters. Comparisons with THg concentrations from past studies, which reflect contamination from 10 to > 60 years ago, revealed considerable annual variation and some evidence for increases over time for wandering and black-browed albatrosses since before 1950 and from the late 1980s, respectively.

Large-Scale Indoor Camera Positioning Using Fiducial Markers.

Estimating the pose of a large set of fixed indoor cameras is a requirement for certain applications in augmented reality, autonomous navigation, video surveillance, and logistics. However, accurately mapping the positions of these cameras remains an unsolved problem. While providing partial solutions, existing alternatives are limited by their dependence on distinct environmental features, the requirement for large overlapping camera views, and specific conditions. This paper introduces a novel approach to estimating the pose of a large set of cameras using a small subset of fiducial markers printed on regular pieces of paper. By placing the markers in areas visible to multiple cameras, we can obtain an initial estimation of the pair-wise spatial relationship between them. The markers can be moved throughout the environment to obtain the relationship between all cameras, thus creating a graph connecting all cameras. In the final step, our method performs a full optimization, minimizing the reprojection errors of the observed markers and enforcing physical constraints, such as camera and marker coplanarity and control points. We validated our approach using novel artificial and real datasets with varying levels of complexity. Our experiments demonstrated superior performance over existing state-of-the-art techniques and increased effectiveness in real-world applications. Accompanying this paper, we provide the research community with access to our code, tutorials, and an application framework to support the deployment of our methodology.

Fiducial Objects: Custom Design and Evaluation.

Camera pose estimation is vital in fields like robotics, medical imaging, and augmented reality. Fiducial markers, specifically ArUco and Apriltag, are preferred for their efficiency. However, their accuracy and viewing angle are limited when used as single markers. Custom fiducial objects have been developed to address these limitations by attaching markers to 3D objects, enhancing visibility from multiple viewpoints and improving precision. Existing methods mainly use square markers on non-square object faces, leading to inefficient space use. This paper introduces a novel approach for creating fiducial objects with custom-shaped markers that optimize face coverage, enhancing space utilization and marker detectability at greater distances. Furthermore, we present a technique for the precise configuration estimation of these objects using multiviewpoint images. We provide the research community with our code, tutorials, and an application to facilitate the building and calibration of these objects. Our empirical analysis assesses the effectiveness of various fiducial objects for pose estimation across different conditions, such as noise levels, blur, and scale variations. The results suggest that our customized markers significantly outperform traditional square markers, marking a positive advancement in fiducial marker-based pose estimation methods.

Assessing mercury contamination in Southern Hemisphere marine ecosystems: The role of penguins as effective bioindicators.

Mercury (Hg) is a global pollutant known for its significant bioaccumulation and biomagnification capabilities, posing a particular threat to marine environments. Seabirds have been recognized as effective bioindicators of marine pollution, and, among them, penguins present a unique opportunity to serve as a single taxonomic group (Sphenisciformes) for monitoring Hg across distinct marine ecosystems in the Southern Hemisphere. In this study, we conducted a comprehensive systematic review of Hg concentrations, and performed a meta-analysis that took into account the various sources of uncertainty associated with Hg contamination in penguins. Beyond intrinsic species-specific factors shaping Hg levels, our results showed that the penguin community effectively reflects spatial patterns of Hg bioavailability. We identified geographic Hg hotspots in Australia, the Indian Ocean, and Tierra del Fuego, as well as coldspots in Perú and the South Atlantic. Furthermore, specific penguin species, namely the Southern Rockhopper (Eudyptes chrysocome) and Macaroni penguin (Eudyptes chrysolophus), are highlighted as particularly vulnerable to the toxic effects of Hg. Additionally, we identified knowledge gaps in geographic areas such as the Galápagos Islands, South Africa, and the coast of Chile, as well as in species including Fiordland (Eudyptes pachyrhynchus), Snares (Eudyptes robustus), Erect-crested (Eudyptes sclateri), Royal (Eudyptes schlegeli), Yellow-eyed (Megadyptes antipodes), and Galápagos (Spheniscus mendiculus) penguins. Overall, our study contributes to the growing body of literature emphasizing the role of penguins as bioindicators of Hg pollution, but it also highlights areas where further research and data collection are needed for a more comprehensive understanding of Hg contamination in marine ecosystems in the Southern Hemisphere.

A bridge between trust and control: computational workflows meet automated battery cycling.

Compliance with good research data management practices means trust in the integrity of the data, and it is achievable by full control of the data gathering process. In this work, we demonstrate tooling which bridges these two aspects, and illustrate its use in a case study of automated battery cycling. We successfully interface off-the-shelf battery cycling hardware with the computational workflow management software AiiDA, allowing us to control experiments, while ensuring trust in the data by tracking its provenance. We design user interfaces compatible with this tooling, which span the inventory, experiment design, and result analysis stages. Other features, including monitoring of workflows and import of externally generated and legacy data are also implemented. Finally, the full software stack required for this work is made available in a set of open-source packages.

Fish and tips: Historical and projected changes in commercial fish species' habitat suitability in the Southern Hemisphere.

Global warming has significantly altered fish distribution patterns in the ocean, shifting towards higher latitudes and deeper waters. This is particularly relevant in high-latitude marine ecosystems, where climate-driven environmental changes are occurring at higher rates than the global average. Species Distribution Models (SDMs) are increasingly being used for predicting distributional shifts in habitat suitability for marine species as a response to climate change. Here, we used SDMs to project habitat suitability changes for a range of high-latitude, pelagic and benthopelagic commercial fish species and crustaceans (10 species); from 1850 to two future climate change scenarios (SSP1-2.6: low climate forcing; and SSP5-8.5: high climate forcing). The study includes 11 Large Marine Ecosystems (LME) spanning South America, Southern Africa, Australia, and New Zealand. We identified declining and southward-shifting patterns in suitable habitat areas for most species, particularly under the SSP5-8.5 scenario and for some species such as Argentine hake (Merluccius hubbsi) in South America, or snoek (Thyrsites atun) off Southern Africa. Geographical constraints will likely result in species from Southern Africa, Australia, and New Zealand facing the most pronounced habitat losses due to rising sea surface temperatures (SST). In contrast, South American species might encounter greater opportunities for migrating southward. Additionally, the SSP5-8.5 scenario predicts that South America will be more environmentally stable compared to other regions. Overall, our findings suggest that the Patagonian shelf could serve as a climate refuge, due to higher environmental stability highlighting the importance of proactive management strategies in this area for species conservation. This study significantly contributes to fisheries and conservation management, providing valuable insights for future protection efforts in the Southern Hemisphere.

LY2444296, a κ-opioid receptor antagonist, selectively reduces alcohol drinking in male and female Wistar rats with a history of alcohol dependence.

Alcohol use disorder (AUD) remains a major public health concern. The dynorphin (DYN)/κ-opioid receptor (KOP) system is involved in actions of alcohol, particularly its withdrawal-associated negative affective states. This study tested the ability of LY2444296, a selective, short-acting, KOP antagonist, to decrease alcohol self-administration in dependent male and female Wistar rats at 8 h abstinence. Animals were trained to orally self-administer 10% alcohol (30 min/day for 21 sessions) and were made dependent via chronic intermittent alcohol vapor exposure for 6 weeks or exposed to air (nondependent). After 6 weeks, the effect of LY2444296 (0, 3, and 10 mg/kg, p.o.) was tested on alcohol self-administration at 8 h of abstinence. A separate cohort of rats was prepared in parallel, and their somatic withdrawal signs and alcohol self-administration were measured after LY2444296 administration at 8 h, 2 weeks, and 4 weeks abstinence. LY2444296 at 3 and 10 mg/kg significantly reduced physical signs of withdrawal in dependent rats at 8 h abstinence, only. Furthermore, 3 and 10 mg/kg selectively decreased alcohol self-administration in dependent rats at only 8 h abstinence. These results highlight the DYN/KOP system in actions of alcohol during acute abstinence, suggesting KOP antagonism could be beneficial for mitigating acute withdrawal signs and, in turn, significantly reduce excessive alcohol consumption associated with AUD.

Pivotal role of orexin signaling in the posterior paraventricular nucleus of the thalamus during the stress-induced reinstatement of oxycodone-seeking behavior.

BACKGROUND: The orexin (OX) system has received increasing interest as a potential target for treating substance use disorder. OX transmission in the posterior paraventricular nucleus of the thalamus (pPVT), an area activated by highly salient stimuli that are both reinforcing and aversive, mediates cue- and stress-induced reinstatement of reward-seeking behavior. Oral administration of suvorexant (SUV), a dual OX receptor (OXR) antagonist (DORA), selectively reduced conditioned reinstatement of oxycodone-seeking behavior and stress-induced reinstatement of alcohol-seeking behavior in dependent rats. AIMS: This study tested whether OXR blockade in the pPVT with SUV reduces oxycodone or sweetened condensed milk (SCM) seeking elicited by conditioned cues or stress. METHODS: Male Wistar rats were trained to self-administer oxycodone (0.15 mg/kg, i.v., 8 h/day) or SCM (0.1 ml, 2:1 dilution [v/v], 30 min/day). After extinction, we tested the ability of intra-pPVT SUV (15 µg/0.5 µl) to prevent reinstatement of oxycodone or SCM seeking elicited by conditioned cues or footshock stress. RESULTS: The rats acquired oxycodone and SCM self-administration, and oxycodone intake correlated with signs of physical opioid withdrawal, confirming dependence. Following extinction, the presentation of conditioned cues or footshock elicited reinstatement of oxycodone- and SCM-seeking behavior. Intra-pPVT SUV blocked stress-induced reinstatement of oxycodone seeking but not conditioned reinstatement of oxycodone or SCM seeking or stress-induced reinstatement of SCM seeking. CONCLUSIONS: The results indicate that OXR signaling in the pPVT is critical for stress-induced reinstatement of oxycodone seeking, further corroborating OXRs as treatment targets for opioid use disorder.

Sex-Specific Alterations in Spatial Memory and Hippocampal AKT-mTOR Signaling in Adult Mice Pre-exposed to Ketamine and/or Psychological Stress During Adolescence.

Background: Ketamine (KET) is administered to manage major depression in adolescent patients. However, the long-term effects of juvenile KET exposure on memory-related tasks have not been thoroughly assessed. We examined whether exposure to KET, psychological stress, or both results in long-lasting alterations in spatial memory in C57BL/6 mice. Furthermore, we evaluated how KET and/or psychological stress history influenced hippocampal protein kinase B-mechanistic target of rapamycin (AKT-mTOR)-related signaling. Methods: On postnatal day 35, male and female mice underwent vicarious defeat stress (VDS), a form of psychological stress that reduces sociability in both sexes, with or without KET exposure (20 mg/kg/day, postnatal days 35-44). In adulthood (postnatal day 70), mice were assessed for spatial memory performance on a water maze task or euthanized for hippocampal tissue collection. Results: Juvenile pre-exposure to KET or VDS individually increased the latency (seconds) to locate the escape platform in adult male, but not female, mice. However, juvenile history of concomitant KET and VDS prevented memory impairment. Furthermore, individual KET or VDS pre-exposure, unlike their combined history, decreased hippocampal AKT-mTOR signaling in adult male mice. Conversely, KET pre-exposure alone increased AKT-mTOR in the hippocampus of adult female mice. Lastly, rapamycin-induced decreases of mTOR in naïve adult female mice induced spatial memory retrieval deficits, mimicking adult male mice with a history of exposure to VDS or KET. Conclusions: Our preclinical model shows how KET treatment for the management of adolescent psychological stress-induced sequelae does not impair spatial memory later in life. However, juvenile recreational KET misuse, like psychological stress history, results in long-term spatial memory deficits and hippocampal AKT-mTOR signaling changes in a sex-specific manner.

Identifying Barriers to the Acquisition of Knowledge about Skin Integrity Impairment in Nursing Students: An Educational Intervention.

BACKGROUND: Wound healing competence is implied in the nursing profession, but there is no standardized content regulation for wound care in university curricula. The primary objective of this study was to identify the barriers to the acquisition of knowledge about skin integrity impairment. METHODS: A quasi-experimental pre-test and post-test study with an ad hoc questionnaire involved 304 students (control: 165; intervention: 139) from June to July 2023. A 10-h educational intervention focused on skin integrity assessment and treatment was conducted. RESULTS: The control group, scoring 17 ± 0.22 out of a maximum of 61, achieved a significantly lower final test score (p < 0.001) compared to the wound care educational intervention group, with the pre-test group scoring 30 ± 0.76 and the post-test group scoring 43 ± 0.61. The educational intervention in wound care program improved nursing students' knowledge of prevention, assessment/diagnosis, treatment, lower limb wounds, and wound bed preparation by replacing the number of "Don't know" answers in the post-test group with correct answers. CONCLUSIONS: The barriers identified to the acquisition of knowledge about skin integrity impairment in nursing studies are the following: the transversality of teaching, the teaching and evaluation system, and the variability in the training of professionals and teachers in charge of their education. The educational intervention can be used to consolidate knowledge and to enhance students' self-confidence in caring for patients with wounds.

Pharmaceutical products, drugs and personal care products in European waters: A protocol for systematic review and meta-analysis.

This study aims to describe a protocol for a systematic review and meta-analysis that assesses the detection and concentration of pharmaceutical products, drugs, and personal care products in European waters. This study protocol was developed following the recommendations of the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA-P) statement and the Cochrane Handbook of Systematic Reviews of Interventions. We will include studies conducted on European waters of various origins (watersheds, aquifers, rivers, seas, springs, wastewaters, and drinking water). A comprehensive search strategy will be implemented in the following databases: PubMed (Medline), EMBASE, Scopus, and Web of Science. Two independent reviewers will conduct all study selection procedures, data extraction, and methodological evaluation. Any disagreements will be referred to a third reviewer. If the studies are sufficiently homogeneous, we will conduct a meta-analysis to summarize the data. We will use the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) to assess the certainty of the evidence. The systematic review and meta-analysis will provide valuable information about the presence and concentration of these types of contaminants in water, aiding in the development of public policies regarding prevention and decontamination measures to enhancing water quality in Europe.

Prevalence and concentration of pesticides in European waters: A protocol for systematic review and meta-analysis.

There is currently a growing interest in the so-called emerging pollutants, such as pesticides, pharmaceuticals, personal hygiene care products, drugs, etc., whose presence in natural ecosystems is not necessarily recent, but the development in latest years of new and more sensitive methods of analysis has allowed their detection. They can be present in the natural environment, food, and many products of everyday origin, which suggests that human exposure to them is massive and universal. Therefore, the study of this type of substances is becoming one of the priority lines of research of the main agencies dedicated to the protection of public and environmental health, such as the World Health Organization (WHO), United States Environmental Protection Agency (USEPA) or European Union (EU). In this sense, it is of vital importance to know the nature and quantity of this type of contaminants, to establish preventive mechanisms that minimize its presence in aquatic systems, with special requirements for human consumption. This study aimed to describe a protocol for a systematic review and meta-analysis to assess the status of pesticides in European waters. We will search for original studies in the PubMed/Medline, Scopus, Web of Science, EMBASE, ScienceDirect databases. Prevalence studies of emerging contaminants (pesticides) in water resources (watersheds, aquifers, rivers, marine and springs), wastewaters (influent and effluent), and drinking water should be included. Two reviewers will independently screen and assess the included studies, with any disagreements being resolved by a third reviewer. We will summarize the findings using a narrative approach and, if possible, conduct a quantitative synthesis (meta-analysis). We will conduct the protocol following the Preferred Reporting Items for Systematic Review and Meta-Analyses Protocols (PRISMA-P) guidelines. The review will summarize the current evidence on the presence of pesticides in European waters such as glyphosate, chlorpyrifos, pyrethroid pesticides, neonicotinoid pesticides, and/or fungicides, in samples of different water resources like wastewaters and drinking water. We expect that this systematic review will establish preventive mechanisms that minimize the presence of pesticides in water in the environment.

Cross-basin and cross-taxa patterns of marine community tropicalization and deborealization in warming European seas.

Ocean warming and acidification, decreases in dissolved oxygen concentrations, and changes in primary production are causing an unprecedented global redistribution of marine life. The identification of underlying ecological processes underpinning marine species turnover, particularly the prevalence of increases of warm-water species or declines of cold-water species, has been recently debated in the context of ocean warming. Here, we track changes in the mean thermal affinity of marine communities across European seas by calculating the Community Temperature Index for 65 biodiversity time series collected over four decades and containing 1,817 species from different communities (zooplankton, coastal benthos, pelagic and demersal invertebrates and fish). We show that most communities and sites have clearly responded to ongoing ocean warming via abundance increases of warm-water species (tropicalization, 54%) and decreases of cold-water species (deborealization, 18%). Tropicalization dominated Atlantic sites compared to semi-enclosed basins such as the Mediterranean and Baltic Seas, probably due to physical barrier constraints to connectivity and species colonization. Semi-enclosed basins appeared to be particularly vulnerable to ocean warming, experiencing the fastest rates of warming and biodiversity loss through deborealization.

Ruptura uterina asociada con útero didelfo y placenta acreta. Reporte de caso / Uterine rupture associated with uterus didelphus and placenta accreta. A case report

Resumen ANTECEDENTES: Las malformaciones müllerianas son consecuencia de una alteración en la formación de los conductos de Müller durante el desarrollo del feto. El momento en que sucede la alteración determina el tipo de malformación. La clasificación actual es la de la American Society for Reproductive Medicine ASMR que se asocia con múltiples complicaciones obstétricas, entre las más graves está la ruptura uterina. CASO CLÍNICO: Paciente primigesta de 23 años, con 39.1 semanas de embarazo, sin antecedentes personales patológicos para el padecimiento actual, sin control prenatal, con dolor abdominal intenso generalizado y disminución de los movimientos fetales desde 12 horas previas a su valoración. Al ingreso de la paciente al hospital su feto se encontró muerto; hemoglobina de 7.9 g/dL, tensión arterial de 96-53 mmHg, taquicárdica, con datos clínicos de irritación peritoneal. En la laparotomía exploradora el feto se encontró muerto, en la cavidad abdominal. Hemoperitoneo de 1300 mL, útero didelfo, con ruptura uterina hacia el fondo. Datos de acretismo placentario. Por lo anterior, se procedió a la histerectomía obstétrica, con sangrado de 2000 cc. Fue necesaria la reanimación y la permanencia de 24 horas en la unidad de cuidados intensivos. La TAC abdomino-pélvica se reportó sin alteraciones renales, con una tumoración adherida cerca del peritoneo parietal sugerente de riñón ectópico. El puerperio trascurrió sin contratiempos por lo que fue dada de alta del hospital. CONCLUSIÓN: En el embarazo, las malformaciones müllerianas son causa de complicaciones obstétricas graves, entre ellas la ruptura uterina. El diagnóstico oportuno es decisivo para la prevención de complicaciones y el control prenatal.

Abstract BACKGROUND: Müllerian malformations are the consequence of an alteration in the formation of the Müllerian ducts during fetal development. The time at which the alteration occurs determines the type of malformation. The current classification is that of the American Society for Reproductive Medicine ASMR, which is associated with multiple obstetric complications, among the most serious of which is uterine rupture. CLINICAL CASE: A 23-year-old primigravid patient, 39.1 weeks pregnant, with no personal pathological history for the current condition, without prenatal control, with severe generalized abdominal pain and decreased fetal movements for 12 hours prior to her evaluation. On the patient admission to the hospital her fetus was found dead; hemoglobin 7.9 g/dL, blood pressure 96-53 mmHg, tachycardic, with clinical data of peritoneal irritation. At exploratory laparotomy the fetus was found dead, in abdominal cavity. Hemoperitoneum of 1300 mL, didelphic uterus, with uterine rupture towards the fundus. Data of placental accretism. Therefore, obstetric hysterectomy was performed, with bleeding of 2000 cc. Resuscitation and a 24-hour stay in the intensive care unit was necessary. The abdomino-pelvic CT scan showed no renal alterations, with an adherent tumor near the parietal peritoneum suggestive of ectopic kidney. The puerperium was uneventful, and she was discharged from the hospital. CONCLUSION: In pregnancy, Müllerian malformations are a cause of serious obstetric complications, including uterine rupture. Timely diagnosis is decisive for the prevention of complications and prenatal management.

Morbilidad materna extrema (near miss) por dengue grave. Reporte de un caso / Extreme maternal morbidity (near miss) for severe dengue. A case report

Resumen INTRODUCCION: El dengue es causado por un virus perteneciente a la familia Flaviviridae; existen cuatro serotipos relacionados: DENV-1, DENV-2, DENV-3, DENV-4 trasmitidos por picadura del mosquito hembra de las especies Aedes aegypti y Aedes albopictus. CASO CLÍNICO: Paciente de 19 años, con 36 semanas de embarazo por fecha de la última menstruación y diagnóstico de dengue por serología positiva (Ag-NS1) y trombocitopenia (68,000/mm3). El padecimiento se inició con fiebre de 38.0°C, de tres días de evolución acompañado de artralgias, mialgias, dolor retro ocular y contracciones uterinas. La paciente se ingresó al área de terapia intensiva debido a insuficiencia respiratoria (que ameritó ventilación mecánica invasiva), insuficiencia renal aguda y hematológica, posterior a cesárea. Ameritó reintervención quirúrgica por sangrado intrabdominal por trastornos de la coagulación. Durante su estancia hospitalaria requirió 50 concentrados plaquetarios, 8 concentrados eritrocitarios, 14 plasmas frescos y 4 aféresis plaquetarias. Después de 14 días de estancia hospitalaria se dio de alta por mejoría clínica. CONCLUSIÓN: Si no se actúa inmediatamente, el dengue grave es una causa de desenlace fatal madre-hijo. La identificación oportuna de las complicaciones agregadas a esta enfermedad en la embarazada denota la importancia de la prevención, el diagnóstico temprano y su tratamiento. De igual manera, es importante que en pacientes embarazadas con esta comorbilidad el servicio de Obstetricia intervenga oportunamente en la vigilancia pre y posquirúrgica.

Abstract BACKGROUND: Dengue is caused by a virus belonging to the Flaviviridae family, there are four related serotypes: DENV-1, DENV-2, DENV-3, DENV-4 transmitted by the bite of the female mosquito of the species Aedes aegypti and Aedes albopictus. CLINICAL CASE: 19-year-old female patient, 36 weeks pregnant by date of last menstrual period and diagnosed with dengue due to positive serology (Ag-NS1) and thrombocytopenia (68,000/mm3). The illness started with fever of 38.0°C, of three days of evolution accompanied by arthralgias, myalgias, retro ocular pain and uterine contractions. The patient was admitted to the intensive care unit due to respiratory failure (which required invasive mechanical ventilation), acute renal and hematologic failure, following cesarean section. She required surgical reintervention for intra-abdominal bleeding due to coagulation disorders. During her hospital stay she required 50 platelet concentrates, 8 erythrocyte concentrates, 14 fresh plasmas and 4 platelet apheresis. After 14 days of hospital stay he was discharged due to clinical improvement. CONCLUSION: If no immediate action is taken, severe dengue is a cause of fatal mother-child outcome. The timely identification of the complications associated with this disease in pregnant women highlights the importance of prevention, early diagnosis and treatment. Similarly, it is important that in pregnant patients with this comorbidity, the obstetrics service should intervene in a timely manner in pre- and post-surgical surveillance.

Prevalencia por áreas sanitarias de enfermedad renal crónica en la población diabética de Extremadura durante los años 2012, 2013 y 2014. Un estudio observacional / Prevalence by health areas of chronic kidney disease in diabetic population of Extremadura during the years 2012, 2013 and 2014. An observational study

Antecedentes y objetivo: La diabetes mellitus es la principal causa de enfermedad renal crónica (ERC) en nuestro país. El objetivo fue estimar la prevalencia global y por áreas sanitarias de ERC en la población diabética de Extremadura. Pacientes y métodos: Estudio observacional, longitudinal, retrospectivo en la población diabética atendida en el Sistema Extremeño de Salud durante el periodo 2012-2014. Se incluyeron 90.709 pacientes ≥ 18 años. El cálculo del filtrado glomerular estimado (FGe) se realizó mediante la ecuación CKD-EPI (derivada de la ecuación desarrollada por la Chronic Kidney Disease Epidemiology Collaboration) y se calculó el cociente albúmina/creatinina en orina (CAC). Se consideró paciente con ERC a todo aquel que en su última analítica tenía un FGe<60 mL/min/1,73 m2 y/o un CAC ≥ 30 mg/g, confirmados en una determinación previa separada al menos por tres meses. Resultados: La prevalencia global de ERC fue del 15,6% (17,5% en mujeres y 13,7% en varones) y fue mayor en la provincia de Cáceres (17%) que en la de Badajoz (14,8%, p<0,001), encontrándose la menor prevalencia en el área sanitaria de Navalmoral de la Mata (13%) y la mayor en la de Plasencia (17,8%, p < 0,001). La prevalencia de ERC definida sin necesidad de confirmación de la sostenibilidad del daño renal o del FGe disminuido fue del 26,1% (29,3% en mujeres y 22,9% en varones), lo que supone una sobreestimación de la prevalencia del 67%. Conclusiones: La prevalencia de ERC en población diabética extremeña es menor a la referida habitualmente y difiere significativamente entre sus áreas sanitarias. (AU)

Background and objective: Diabetes mellitus is the leading cause of chronic kidney disease (CKD) in our country. The objective was to estimate the global prevalence and by health areas of CKD in the diabetic population of Extremadura. Patients and methods: Observational, longitudinal retrospective study in the diabetic population attended in the Extremadura Health System in 2012–2014. A total of 90,709 patients ≥ 18 years old were studied. The estimated glomerular filtration rate (eGFR) was calculated using the Chronic Kidney Disease Epidemiology Collaboration equation (CKD-EPI). The presence of CKD was defined as follows: an eGFR<60 mL/min/1.73 m2 in a time period of greater than three months or the presence of renal damage, as evaluated by an urine albumin-creatinine ratio (UACR) ≥ 30 mg/g, with or without reduced eGFR, also in a time period of greater than three months. Results: The overall prevalence of CKD was 15.6% (17.5% in women and 13.7% in men) and it was higher in the province of Cáceres (17%) than in Badajoz (14.8%, p<0.001), with the lowest prevalence in the Navalmoral de la Mata health area (13%) and the highest in Plasencia (17.8%, p<0.001). The prevalence of CKD defined without the need for confirmation of the sustainability of kidney damage or decreased eGFR was 26.1% (29.3% in women and 22.9% in men), which represents an overestimation of the prevalence of 67%. Conclusions: The prevalence of CKD in Extremadura's diabetic population is lower than usually referred to and differs significantly between its health areas. (AU)

Pandemia de la COVID-19 y salud mental: reflexiones iniciales desde la atención primaria de salud española / COVID-19 pandemic and mental health: Initial considerations from spanish primary health care

En el trabajo se hace una aproximación a las características psicológicas y psicosociales que está adquiriendo la pandemia de la COVID-19 en los países de nuestro medio socio-cultural. Se discute la escasez de investigaciones al respecto y la necesaria aceptación de la incertidumbre para enfrentar la situación, tanto a nivel social, como sanitario y personal. En consecuencia, se proponen una serie de reflexiones y recomendaciones para los cuidados psicológicos de la población, los trabajadores sanitarios y la organización social basándose en: 1) La existencia de investigaciones psicológicas y psicosociales sobre temas conectados con estos y 2) En las nuevas perspectivas neurocientíficas sobre las emociones y su elaboración en situaciones de crisis

An approach is made to the psychological and psychosocial characteristics that the COVID-19 pandemic is acquiring in the countries of our socio-cultural environment. The scarcity of research in this regard and the necessary acceptance of uncertainty to face the situation, both socially, as well as health and psychological, are discussed. Consequently, a series of reflections and recommendations are proposed for the psychological care of the population, health workers and social organization based on: 1) The existence of psychological and psychosocial research into connected fields and 2) In the new neuroscientific perspectives on emotions and their elaboration in crisis situations