mRNA Polyadenylation Machineries in Intestinal Protozoan Parasites.

In humans, mRNA polyadenylation involves the participation of about 20 factors in four main complexes that recognize specific RNA sequences. Notably, CFIm25, CPSF73, and PAP have essential roles for poly(A) site selection, mRNA cleavage, and adenosine residues polymerization. Besides the relevance of polyadenylation for gene expression, information is scarce in intestinal protozoan parasites that threaten human health. To better understand polyadenylation in Entamoeba histolytica, Giardia lamblia, and Cryptosporidium parvum, which represent leading causes of diarrhea worldwide, genomes were screened for orthologs of human factors. Results showed that Entamoeba histolytica and C. parvum have 16 and 12 proteins out of the 19 human proteins used as queries, respectively, while G. lamblia seems to have the smallest polyadenylation machinery with only six factors. Remarkably, CPSF30, CPSF73, CstF77, PABP2, and PAP, which were found in all parasites, could represent the core polyadenylation machinery. Multiple genes were detected for several proteins in Entamoeba, while gene redundancy is lower in Giardia and Cryptosporidium. Congruently with their relevance in the polyadenylation process, CPSF73 and PAP are present in all parasites, and CFIm25 is only missing in Giardia. They conserve the functional domains and predicted folding of human proteins, suggesting they may have the same roles in polyadenylation.

Responses of an endangered brown bear population to climate change based on predictable food resource and shelter alterations.

The survival of an increasing number of species is threatened by climate change: 20%-30% of plants and animals seem to be at risk of range shift or extinction if global warming reaches levels projected to occur by the end of this century. Plant range shifts may determine whether animal species that rely on plant availability for food and shelter will be affected by new patterns of plant occupancy and availability. Brown bears in temperate forested habitats mostly forage on plants and it may be expected that climate change will affect the viability of the endangered populations of southern Europe. Here, we assess the potential impact of climate change on seven plants that represent the main food resources and shelter for the endangered population of brown bears in the Cantabrian Mountains (Spain). Our simulations suggest that the geographic range of these plants might be altered under future climate warming, with most bear resources reducing their range. As a consequence, this brown bear population is expected to decline drastically in the next 50 years. Range shifts of brown bear are also expected to displace individuals from mountainous areas towards more humanized ones, where we can expect an increase in conflicts and bear mortality rates. Additional negative effects might include: (a) a tendency to a more carnivorous diet, which would increase conflicts with cattle farmers; (b) limited fat storage before hibernation due to the reduction of oak forests; (c) increased intraspecific competition with other acorn consumers, that is, wild ungulates and free-ranging livestock; and (d) larger displacements between seasons to find main trophic resources. The magnitude of the changes projected by our models emphasizes that conservation practices focused only on bears may not be appropriate and thus we need more dynamic conservation planning aimed at reducing the impact of climate change in forested landscapes.

[Quercetin attenuates Staphylococcus aureus virulence by reducing alpha-toxin secretion]. / Quercetina atenúa la virulencia de Staphylococcus aureus al disminuir la secreción de alfa toxina.

Alpha toxin, a pore-forming protein with cytotoxic activity, is one of the major virulence factors secreted by most strains of Staphylococcus aureus. The relevance of this protein in the pathogenesis of pneumonia associated with S.aureus infections has already been established. Therefore, inhibiting alpha toxin secretion can be an alternative for controlling these infections. This study shows that quercetin, a naturally occurring flavonoid, inhibits hemolytic activity in a dose-dependent manner and reduces alpha toxin secretion in culture supernatants of methicillin-sensitive and methicillin-resistant S.aureus. Furthermore, quercetin significantly prevents damage to human alveolar cells when co-cultured with S.aureus. Our results suggest that quercetin can reduce S.aureus virulence by affecting alpha-toxin secretion.

Segmental Clavicle Fracture in a Polytraumatized Patient: Case Report.

Clavicle fracture represents 5% of the fractures in adults. However, segmental clavicle fractures are infrequent and have been understudied in the current literature. Cases have been reported showing adequate results with both surgical and conservative management, and yet, it has not been possible to reach a consensus regarding diagnosis or management of such condition. A patient with a middle and lateral segmental clavicle fracture is reported, after presenting multiple trauma in a road traffic accident, also suffering trauma to the right hemi body, multiple rib segmental fractures and hemothorax. After stabilization, he was taken to surgery for open reduction and internal fixation of the clavicle using a double plate technique, as it has been rarely described in the literature. The functional result was shown to be adequate and satisfactory in the postoperative follow-up. Despite the limited evidence available on the management of this type of pathology, surgical management is a valid option given the risk of non-union. The foregoing is concluded by the potential harm in patient functionality.

Experience with the Kosmos ultrasonographic tool in the approach and treatment of ambulatory patients of a heart failure clinic: a single-center cross-sectional study.

BACKGROUND: In Mexico, the epidemiology of heart failure is still not well understood. However, it is known that the primary cause of hospital admissions in patients with heart failure is pulmonary and systemic congestion. OBJECTIVE: To estimate congestion status and assess cardiac function using portable ultrasound in patients with heart failure. METHOD: A cross-sectional observational study was conducted. Patients who attended the Heart Failure Clinic at the Ignacio Chávez National Cardiology Institute in Mexico City between May and August 2022 were selected. They underwent ultrasonographic evaluation using a portable device to assess pulmonary and systemic congestion, as well as cardiac function and structure. RESULTS: One-hundred patients diagnosed with heart failure were prospectively included during the study period; 76% were male, with an average age of 59 years (range: 50-68 years). The recorded LVEF median was 34% (IQR: 27-43.5%). When evaluating pulmonary congestion, 78% of the patients showed a pattern A and 22% a pattern B. Following the VExUS protocol, 92% of the patients were at grade 0, 2% at grade 1, and 6% at grade 2. CONCLUSIONS: The use of the portable ultrasound facilitated the quantitative characterization of the echocardiographic features of the studied population. This device could provide better clinical characterization which, in turn, might allow for optimized drug prescription for heart failure and dose adjustments of diuretics based on echocardiographic congestion findings.

ANTECEDENTES: En México aún es muy poco conocida la epidemiología de la insuficiencia cardiaca, sin embargo se sabe que la principal causa de ingresos hospitalarios en los pacientes con insuficiencia cardiaca es la congestión pulmonar y sistémica. OBJETIVO: Estimar el estado de congestión y evaluar la función cardiaca mediante el ultrasonido portátil en pacientes con insuficiencia cardiaca tratados en un centro de tercer nivel en México. MÉTODO: Se llevó a cabo un estudio observacional transversal. Se seleccionaron pacientes que acudieron a la Clínica de Insuficiencia Cardiaca del Instituto Nacional de Cardiología Ignacio Chávez en la Ciudad de México entre mayo y agosto de 2022. Se les sometió a una evaluación ultrasonográfica mediante un dispositivo portátil para valorar la congestión pulmonar y sistémica, así como la función y estructura cardiaca. RESULTADOS: Se incluyeron de forma prospectiva 100 pacientes diagnosticados con insuficiencia cardiaca en el periodo de estudio. El 76% fueron hombres, con una edad mediana de 59 años (RIQ: 50-68 años). La mediana del FEVI registrada fue del 34% (RIQ: 27.0-43.5%). Al evaluar la congestión pulmonar, el 78% de los pacientes presentaron un patrón A y el 22% un patrón B. Siguiendo el protocolo VExUS, el 92% de los pacientes mostraron un grado 0, el 2% un grado 1 y el 6% un grado 2. CONCLUSIONES: El uso del ultrasonido portátil facilitó la caracterización cuantitativa de las características ecocardiográficas de la población estudiada. Este dispositivo podría ofrecer una mejor caracterización clínica que, a su vez, permita una optimización en la prescripción de medicamentos para la insuficiencia cardiaca y el ajuste de dosis de diuréticos según los hallazgos ecocardiográficos de congestión.

Clinical practice guidelines for diagnostic and treatment of the chronic heart failure.

Chronic heart failure continues to be one of the main causes of impairment in the functioning and quality of life of people who suffer from it, as well as one of the main causes of mortality in our country and around the world. Mexico has a high prevalence of risk factors for developing heart failure, such as high blood pressure, diabetes, and obesity, which makes it essential to have an evidence-based document that provides recommendations to health professionals involved in the diagnosis and treatment of these patients. This document establishes the clinical practice guide (CPG) prepared at the initiative of the Mexican Society of Cardiology (SMC) in collaboration with the Iberic American Agency for the Development and Evaluation of Health Technologies, with the purpose of establishing recommendations based on the best available evidence and agreed upon by an interdisciplinary group of experts. This document complies with international quality standards, such as those described by the US Institute of Medicine (IOM), the National Institute of Clinical Excellence (NICE), the Intercollegiate Network for Scottish Guideline Development (SIGN) and the Guidelines International Network (G-I-N). The Guideline Development Group was integrated in a multi-collaborative and interdisciplinary manner with the support of methodologists with experience in systematic literature reviews and the development of CPG. A modified Delphi panel methodology was developed and conducted to achieve an adequate level of consensus in each of the recommendations contained in this CPG. We hope that this document contributes to better clinical decision making and becomes a reference point for clinicians who manage patients with chronic heart failure in all their clinical stages and in this way, we improve the quality of clinical care, improve their quality of life and reducing its complications.

La insuficiencia cardiaca crónica sigue siendo unas de las principales causas de afectación en el funcionamiento y en la calidad de vida de las personas que la presentan, así como una de las primeras causas de mortalidad en nuestro país y en todo el mundo. México tiene una alta prevalencia de factores de riesgo para desarrollar insuficiencia cardiaca, tales como hipertensión arterial, diabetes y obesidad, lo que hace imprescindible contar con un documento basado en la evidencia que brinde recomendaciones a los profesionales de la salud involucrados en el diagnóstico y el tratamiento de estos pacientes. Este documento establece la guía de práctica clínica (GPC) elaborada por iniciativa de la Sociedad Mexicana de Cardiología (SMC) en colaboración con la Agencia Iberoamericana de Desarrollo y Evaluación de Tecnologías en Salud, con la finalidad de establecer recomendaciones basadas en la mejor evidencia disponible y consensuadas por un grupo interdisciplinario y multicolaborativo de expertos. Cumple con estándares internacionales de calidad, como los descritos por el Institute of Medicine de los Estados Unidos de América (IOM), el National Institute of Clinical Excellence (NICE) del Reino Unido, la Intercollegiate Network for Scottish Guideline Development (SIGN) de Escocia y la Guidelines International Network (G-I-N). El grupo de desarrollo de la guía se integró de manera interdisciplinaria con el apoyo de metodólogos con experiencia en revisiones sistemáticas de la literatura y en el desarrollo de GPC. Se llevó a cabo y se condujo metodología de panel Delphi modificado para lograr un nivel de consenso adecuado en cada una de las recomendaciones contenidas en esta GPC. Esperamos que este documento contribuya para la mejor toma de decisiones clínicas y se convierta en un punto de referencia para los clínicos que manejan pacientes con insuficiencia cardiaca crónica en todas sus etapas clínicas, y de esta manera logremos mejorar la calidad en la atención clínica, aumentar la calidad de vida de los pacientes y disminuir las complicaciones de la enfermedad.

A Case Series and Literature Review of Subacute Infective Endocarditis: A Clinical Challenge.

Endocarditis is a life-threatening, relatively rare disease caused by an infection of the endocardial epithelium of the heart. Its clinical presentation is highly variable, depending on whether it presents acutely, subacutely, or chronically. Also, the wide array of causal etiologies and pathogens makes its diagnosis and treatment complex and challenging. The main etiological agents are Staphylococci and Streptococci, while fastidious microorganisms are infrequent agents of this pathology. Advancements in the identification of microorganisms with novel molecular techniques have revealed new previously unidentified pathogens. Despite their low frequency, these fastidious pathogens are highly relevant, as they have been associated with a higher rate of complications and mortality. Therefore, it is necessary to be aware of the wide array of clinical presentations and important considerations for the management of patients with subacute endocarditis with atypical microorganisms. In this article, we present a case series involving three different clinical presentations of subacute endocarditis with fastidious microorganisms, which required extensive medical management and surgical valve repair with favorable and unfavorable outcomes. We also engage in a review of the literature on their microbiology, diagnosis, and treatment.

Pneumonia Mortality Trends in Children under 5 Years of Age in the Context of Pneumococcal Conjugate Vaccination in Peru, 2003-2017.

Worldwide, conjugated pneumococcal vaccines (PCVs) have proven effective against invasive pneumococcal disease, but non-invasive pneumonia is a major cause of mortality in young children and serotypes vary geographically, affecting effectiveness. We analyze nationwide death certificate data between 2003-2017 to assess the impact of PCVs on pneumonia mortality among young children from Peru. We report descriptive statistics and perform timeseries analysis on annual mortality rates (AMRs) and monthly frequencies of pneumonia deaths. Children under 5 years of age accounted for 6.2% (n = 10,408) of all pneumonia deaths (N = 166,844), and 32.3% (n = 3363) were children between 1-4 years of age, of which 95.1% did not report pneumonia etiology. Comparing periods before and after PCV introduction in 2009, mean AMRs dropped 13.5% and 26.0% for children between 1-4 years of age (toddlers/preschoolers), and children under 1 year of age (infants), respectively. A moderate correlation (Spearman's r = 0.546, p < 0.01) in the monthly frequency of pneumonia deaths was estimated between both age groups. Quadratic regression suggests a change in direction around 2005 (highest pneumonia mortality) for both age groups, but percentage change analysis identified an inflection point in 2013 for infants only, not for toddlers/preschoolers, suggesting that the impact of PCVs might be different for each age group.

Infant mortality rates and pneumococcal vaccines: a time-series trend analysis in 194 countries, 1950-2020.

Pneumonia due to Streptococcus pneumoniae (pneumococcus) is a major cause of mortality in infants (children under 1 year of age), and pneumococcal conjugate vaccines (PCVs), delivered during the first year of life, are available since the year 2000. Given those two premises, the conclusion follows logically that favourable impact reported for PCVs in preventing pneumococcal disease should be reflected in the infant mortality rates (IMRs) from all causes. Using publicly available datasets, country-level IMR estimates from UNICEF and PCV introduction status from WHO, country-specific time series analysed the temporal relationship between annual IMRs and the introduction of PCVs, providing a unique context into the long-term secular trends of IMRs in countries that included and countries that did not include PCVs in their national immunisation programmes. PCV status was available for 194 countries during the period 1950-2020: 150 (77.3%) of these countries achieved nationwide PCV coverage at some point after the year 2000, 13 (6.7%) achieved only partial or temporary PCV coverage, and 31 (15.9%) never introduced PCVs to their population. One hundred and thirty-nine (92.7%) of countries that reported a decreasing (negative) trend in IMR, also reported a strong correlation with decreasing maternal mortality rates (MMRs), suggesting an improvement in overall child/mother healthcare. Conversely, all but one of the countries that never introduced PCVs in their national immunisation programme also reported a decreasing trend in IMR that strongly correlates with MMRs. IMRs have been decreasing for decades all over the world, but this latest decrease may not be related to PCVs.

Herd immunity in older adults from a middle-income country: A time-series trend analysis of community-acquired pneumonia mortality 2003-2017.

Background and Aims: Community-acquired pneumonia is responsible for substantial mortality, and pneumococcus is commonly accepted as a major cause of pneumonia, regardless of laboratory confirmation. Child immunization programs have reported success in decreasing pneumonia mortality: directly in young children and indirectly (herd immunity) in unvaccinated adult populations in some countries. We assess changes in mortality trends for all-cause pneumonia in older adults associated with the introduction of pneumococcal vaccination for children in Peru. Methods: This is a secondary analysis on administrative data collected periodically by the Peruvian Ministry of Health. An observational retrospective time series analysis was conducted using longitudinal population-based data from death certificates in Peru between 2003 and 2017. The time series includes 6 years before and 9 years after the introduction of the pneumococcal-conjugated vaccines in the national child immunization program in 2009. Monthly frequencies and annual rates for all-cause pneumonia deaths in children under 5 years of age and adults over 65 years of age are presented. Linear and quadratic trends are analyzed. Results: Deaths among older adults accounted for 75.6% of all-cause pneumonia mortality in Peru, with 94.4% of these reporting "pneumonia due to unspecified organism" as the underlying cause of death. Comparing pre- and post-child immunization program periods, annual average mortality rates from unspecified pneumonia decreased by 22.7% in young children but increased by 19.6% in older adults. A linear trend model supports this overall tendency, but a quadratic curve explains the data better. Conclusion: Pneumococcal-conjugated vaccines are developed using serotypes prevalent in selected countries from less common (invasive) pneumococcal disease and expected to prevent mortality worldwide from widespread (noninvasive) pneumonia. Our results do not support the presence of herd immunity from pneumococcal vaccination of children for community-acquired pneumonia in the increasingly ageing population of Peru. This should direct future research and could influence public health policy.

Effectiveness of antibiotic-coated intramedullary nails for open tibia fracture infection prevention. A systematic review and meta-analysis.

INTRODUCTION: Open Tibia fractures are associated with high rates of Fracture Related Infection (FRI). Given the negative outcomes and increased costs related to the latter, several prophylactic local antibiotic delivery methods have been proposed, aiming to decrease the FRI rate. Our objective with this study was to determine the effectiveness of antibiotic-coated intramedullary nails for open tibia FRI prevention. PATIENTS AND METHODS: We conducted a PRISMA compliant systematic review and meta-analysis. Queries were performed on Embase, PubMed, Lilacs and Cochrane data libraries. Seventeen studies were included for qualitative analysis and 2 studies were amenable for meta-analysis. RESULTS: Global infection, deep infection and non-union rates were 8.4%, 5.4% and 3.7% in the antibiotic-coated nail group and 22%, 14% and 14% in the non-antibiotic-coated nail group respectively. The meta-analysis showed a protective trend that favored the antibiotic-coated nail group although it didn't achieve statistical significance: deep infection Relative Risk (RR) (RR = 0.17 CI95% [0.02 - 1.31]); global infection RR = 0.36 CI95% [0.10 - 1.35]) and non-union (RR = 0.14 CI95% [0.02 - 1.22]), CONCLUSIONS: Our findings suggest a favorable trend towards antibiotic-coated nail, with decreased risk of global infection, deep infection and non-union as compared to non-antibiotic-coated nail in patients with open tibia fractures. Nonetheless, higher level evidence studies are required to confirm our findings.

Erratum to 'Superficial Femoral Artery Pseudoaneurysm, Compartment Syndrome, and Deep Vein Thrombosis After Total Knee Arthroplasty' [Arthroplasty Today 6 (2020) 227-230].

[This corrects the article DOI: 10.1016/j.artd.2020.02.003.].

Outcomes of a Modified Arthroscopic-assisted Reconstruction Technique for Lateral Ankle Instability.

Objective The present study assesses the results of a minimally invasive surgical technique for acute and chronic ankle instability management. Methods The present case series study retrospectively evaluated 40 patients undergoing arthroscopic-assisted percutaneous ankle ligament reconstruction from 2013 to 2019. Results The present study included 17 males and 23 females with an average age of 38.3 years old. Postintervention follow-up using American Orthopaedic Foot and Ankle Society (AOFAS) Ankle-Hindfoot scores identified improvement of > 30 points in function and pain control. The most frequently occurring associated injuries were osteochondral (35%). No patient required reintervention or had infection during follow-up. Conclusion The technique in the present study is easy and achieves satisfactory results for function and pain control. Level of Evidence IV.

Microbiota of diabetic foot infections in a University Hospital in Bogotá, Colombia.

The presence of infection in diabetic foot ulcers (DFU) is one of the main causes of lower limb amputation in the world. The presence of polymicrobial infections is usually the standard for isolation in such lesions, with Gram Positive (GP) germs being the main organisms involved, as is described in the global literature. However, some studies indicate a greater number of isolates with Gram Negative (GN) germs, reported mainly in the literature of Middle Eastern countries and in the tropics.

Assisted migration and the rare endemic plant species: the case of two endangered Mexican spruces.

Background: In the projected climate change scenarios, assisted migration might play an important role in the ex situ conservation of the threatened plant species, by translocate them to similar suitable habitats outside their native distributions. However, it is unclear if such habitats will be available for the Rare Endemic Plant Species (REPS), because of their very restricted habitats. The aims of this study were to perform a population size assessment for the REPS Picea martinezii Patterson and Picea mexicana Martínez, and to evaluate the potential species distributions and their possibilities for assisted migration inside México and worldwide. Methods: We performed demographic censuses, field surveys in search for new stands, and developed distribution models for Last Glacial Maximum (22,000 years ago), Middle Holocene (6,000 years ago), current (1961-1990) and future (2050 and 2070) periods, for the whole Mexican territory (considering climatic, soil, geologic and topographic variables) and for all global land areas (based only on climate). Results: Our censuses showed populations of 89,266 and 39,059 individuals for P. martinezii and P. mexicana, respectively, including known populations and new stands. Projections for México indicated somewhat larger suitable areas in the past, now restricted to the known populations and new stands, where they will disappear by 2050 in a pessimistic climatic scenario, and scarce marginal areas (p = 0.5-0.79) remaining only for P. martinezii by 2070. Worldwide projections (based only on climate variables) revealed few marginal areas in 2050 only in México for P. martinezii, and several large areas (p ≥ 0.5) for P. mexicana around the world (all outside México), especially on the Himalayas in India and the Chungyang mountains in Taiwan with highly suitable (p ≥ 0.8) climate habitats in current and future (2050) conditions. However, those suitable areas are currently inhabited by other endemic spruces: Picea smithiana (Wall.) Boiss and Picea morrisonicola Hayata, respectively. Conclusions: Assisted migration would only be an option for P. martinezii on scarce marginal sites in México, and the possibilities for P. mexicana would be continental and transcontinental translocations. This rises two possible issues for future ex situ conservation programs: the first is related to whether or not consider assisted migration to marginal sites which do not cover the main habitat requirements for the species; the second is related to which species (the local or the foreign) should be prioritized for conservation when suitable habitat is found elsewhere but is inhabited by other endemic species. This highlights the necessity to discuss new policies, guidelines and mechanisms of international cooperation to deal with the expected high species extinction rates, linked to projected climate change.

Perpendicular duodenum jejunum anastomosis for conventional postoperative endoscopic access in biliodigestive diversions in Roux in Y.

BACKGROUND: Cholecystectomy is one of the most performed abdominal surgical procedures, with approximately 1.5 million procedures performed annually in the United States of america. Most of the biliary duct injuries during laparoscopic cholecystectomy are due to a wrong perception of the anatomy. Two thirds of postsurgical stenosis develop within two and three years after repairing and the other third in the following ten years. OBJECTIVE: To show the adequacy for postoperative endoscopic access in Roux-in-Y biliodigestive diversions. METHOD: The best technique to repair biliary duct injuries is the Roux-in-Y hepaticojejunostomy or choledochojejunostomy, from this procedure we propose a surgical technique that consists to perform a perpendicular anastomosis between the defunctionalized jejunum loop and the duodenum for later endoscopic access of the Roux-en-Y biliodigestive diversion. RESULTS: The duodenal-jejunal perpendicular anastomosis procedure was performed in four patients with Roux-Y biliodigestive diversion. CONCLUSIONS: With the technique that is proposed, we have that advantage of keeping the anastomosis permanently open due to its rhomboidal design and because of the pylorus is kept intact alkaline reflux would not be a problem.

ANTECEDENTES: La colecistectomía es una de las cirugías más frecuentes, con aproximadamente 1.2 millones de procedimientos realizados anualmente solo en los Estados Unidos de América. La mayoría de las disrupciones biliares durante la colecistectomía laparoscópica se deben a una percepción errónea de la anatomía. Dos tercios de las estenosis posquirúrgicas se desarrollan 2-3 años después de la reparación y el otro tercio en los 10 años siguientes. OBJETIVO: Mostrar la adecuación para un acceso endoscópico posoperatorio en las derivaciones biliodigestivas en Y de Roux. MÉTODO: La mejor técnica quirúrgica reportada para la reparación de las disrupciones biliares es la anastomosis hepático-yeyuno o anastomosis colédoco-yeyuno en Y de Roux. Partiendo de este procedimiento, la variante quirúrgica que proponemos consiste en realizar una anastomosis perpendicular entre el asa desfuncionalizada de yeyuno y el duodeno para el posterior acceso endoscópico de la derivación biliodigestiva en Y de Roux. RESULTADOS: Se realizó el procedimiento en cuatro pacientes con derivación biliodigestiva en Y de Roux. CONCLUSIONES: El procedimiento que proponemos tiene la ventaja de mantener abierta la anastomosis debido a su diseño romboidal, y como el píloro se encuentra indemne, el reflujo gástrico alcalino no sería ningún problema.

Assessment and Models of Insect Damage to Cones and Seeds of Pinus strobiformis in the Sierra Madre Occidental, Mexico.

Insect damage to cones and seeds has a strong impact on the regeneration of conifer forest ecosystems, with broader implications for ecological and economic services. Lack of control of insect populations can lead to important economic and environmental losses. Pinus strobiformis is the most widespread of the white pines in Mexico and is widely distributed throughout the mountains of northern Mexico. Relatively few studies have examined insect damage to the cones and seeds of these pines, especially in Mexico. In this study, we therefore analyzed insect damage to cones and seeds of P. strobiformis in Mexico by using X-ray and stereomicroscopic analysis. The specific objectives of the study were (a) to characterize insect damage by measuring external and internal cone traits, (b) to assess the health of seeds and cones of P. strobiformis in the Sierra Madre Occidental, Mexico, and (c) to estimate the relative importance of the effects of different environmental variables on cone and seed damage caused by insects. We found that 80% of P. strobiformis seeds and 100% of the tree populations studied had damage caused by insects. Most seeds were affected by Leptoglossus occidentalis, Tetyra bipunctata, Megastigmus albifrons, and the Lepidoptera complex (which includes Apolychrosis synchysis, Cydia latisigna, Eucosma bobana, and Dioryctria abietivorella). The cones of all tree populations were affected by some type of insect damage, with Lepidoptera causing most of the damage (72%), followed by Conophthorus ponderosae (15%), the hemipteran L. occidentalis (7%), and the wasp M. albifrons (6%). The proportion of incomplete seeds in P. strobiformis at the tree level, cone damage by M. albifrons and seed damage in L. occidentalis were associated with various climate and soil variables and with crown dieback. Thus, cone and seed insect damage can be severe and potentially impact seed production in P. strobiformis and the reforestation potential of the species. The study findings will enable managers to better identify insects that cause damage to cone and seeds. In addition, identification of factors associated with damage may be useful for predicting the levels of insect predation on seeds and cones.

Clinical phenotypes, aetiologies, management, and mortality in acute heart failure: a single-institution study in Latin-America.

AIMS: Little is known regarding acute heart failure (AHF) clinical characteristics and its hospital outcome in Latin America. This study sought to assess the prevalence of, and identify differences among, in-hospital outcomes in patients hospitalized for AHF who were stratified by clinical phenotype at a hospital in Latin America. METHODS AND RESULTS: This is a retrospective cohort study of patients with AHF who were hospitalized in the coronary care unit of a Latin American teaching hospital from January 2006 to December 2018. Cox regression analysis was used to identify predictors of mortality. Of 21 042 patients admitted, 7759 (36.6%) had AHF. Their median age was 62 years, and 35% were women. De novo heart failure was seen in 39.4% of patients. Most common was AHF-associated acute coronary syndromes (ACS-HF) in 43.0%, decompensated heart failure (DHF) in 33.7%, hypertensive heart failure (HT-HF) in 11.8%, and cardiogenic shock (CS) in 5.2%. Pulmonary oedema (PO) (3.3%) and right heart failure (RHF) (3.0%) were least frequent. Coronary artery disease was the most frequent aetiology in 56.5% of patients, valvular heart disease in 22.4%, and cardiomyopathies in 12.3%. Other less frequent aetiology included adult congenital heart disease (2.5%), lung diseases (2.1%), acute aortic syndromes (1.4%), pericardial diseases (0.8%), and intracardiac tumours (0.3%). Aetiology could not be established in 1.6% of patients. Before admission, patients with worsening chronic heart failure and reduced ejection fraction were treated with renin-angiotensin system blockers (60.4%), beta-blockers (42.5%), or spironolactone (34.4%). The percentages of patients given in-hospital management with intravenous diuretics, vasodilators, inotropes, and vasopressors were 81.2%, 33.4%, 18.9%, and 20.4%, respectively. The overall in-hospital mortality was 17.9% (71.3%, 43.9%, 23.8%, 14.9%, 13.6%, and 10.1% for CS, PO, RHF, DHF, ACS-HF, and HT-HF, respectively; P < 0.0001). Multivariate analysis revealed that PO (hazard ratio [HR] 2.68, 95% confidence interval [CI] 1.73-4.14, P < 0.0001) and CS (HR 3.37, 95% CI 2.12-5.35, P < 0.0001) were independent predictors of in-hospital mortality. Use of intravenous diuretics was linked to reduction of in-hospital mortality (HR 0.70, 95% CI 0.59-0.59, P < 0.0001). By contrast, increased in-hospital mortality was associated with the use of intravenous inotrope or vasopressor (HR 1.49, 95% CI 1.27-1.76 and HR 2.91, 95% CI 2.41-3.51, P < 0.0001, respectively). CONCLUSIONS: Real-world evidence from a university hospital in Latin America shows that the high mortality among patients with AHF may depend, among other factors, on patients' AHF clinical phenotypes. The clinical characteristics and aetiologies of AHF appear to differ between these data from Mexico and those from European and US registries.

Nonfatal natural and environmental injuries treated in emergency departments, United States, 2001-2004.

Exposure to adverse natural and environmental events (eg, extreme temperatures and disasters) poses a public health burden when resulting in injuries requiring emergency care. We examined the incidence and characteristics of persons with environmental exposure-related injuries treated in US-based hospital emergency departments during 2001 to 2004 by using the National Electronic Injury Surveillance System-All Injury Program. An estimated 26 527 (95% CI = 18 664-34 390) injuries were treated annually-78% were heat-related. People with heat-related conditions were men (P < 0.001) and had a median age of 34 years (range = <1 month-94 years). Targeting vulnerable populations in community-wide response measures may reduce injuries from adverse environmental exposures, especially heat.