Personalized Versus Non-personalized Nutritional Recommendations/Interventions for Type 2 Diabetes Mellitus Remission: A Narrative Review.

It is a well-evidenced fact that diet significantly impacts type 2 diabetes mellitus (T2DM) prevention and management. However, dietary responses vary among different populations, necessitating personalized recommendations. Substantial evidence supports the role of diet in T2DM remission, particularly low-energy or low-carbohydrate diets that facilitate weight loss, enhance glycemic control, and achieve remission. This review aims to comprehensively analyze and compare personalized nutritional interventions with non-personalized approaches in T2DM remission. We conducted a literature search using the Academy of Nutrition and Dietetics guidelines, focusing on clinical and observational trials published within the past decade. We present the strengths and drawbacks of incorporating personalized nutrition into practice, along with the areas for research in implementing personalized interventions, such as cost-effectiveness and accessibility. The findings reveal consistently higher diabetes remission rates in personalized nutrition studies compared to non-personalized interventions.

Explainable artificial intelligence for the automated assessment of the retinal vascular tortuosity.

Retinal vascular tortuosity is an excessive bending and twisting of the blood vessels in the retina that is associated with numerous health conditions. We propose a novel methodology for the automated assessment of the retinal vascular tortuosity from color fundus images. Our methodology takes into consideration several anatomical factors to weigh the importance of each individual blood vessel. First, we use deep neural networks to produce a robust extraction of the different anatomical structures. Then, the weighting coefficients that are required for the integration of the different anatomical factors are adjusted using evolutionary computation. Finally, the proposed methodology also provides visual representations that explain the contribution of each individual blood vessel to the predicted tortuosity, hence allowing us to understand the decisions of the model. We validate our proposal in a dataset of color fundus images providing a consensus ground truth as well as the annotations of five clinical experts. Our proposal outperforms previous automated methods and offers a performance that is comparable to that of the clinical experts. Therefore, our methodology demonstrates to be a viable alternative for the assessment of the retinal vascular tortuosity. This could facilitate the use of this biomarker in clinical practice and medical research.

Neddylation of phosphoenolpyruvate carboxykinase 1 controls glucose metabolism.

Neddylation is a post-translational mechanism that adds a ubiquitin-like protein, namely neural precursor cell expressed developmentally downregulated protein 8 (NEDD8). Here, we show that neddylation in mouse liver is modulated by nutrient availability. Inhibition of neddylation in mouse liver reduces gluconeogenic capacity and the hyperglycemic actions of counter-regulatory hormones. Furthermore, people with type 2 diabetes display elevated hepatic neddylation levels. Mechanistically, fasting or caloric restriction of mice leads to neddylation of phosphoenolpyruvate carboxykinase 1 (PCK1) at three lysine residues-K278, K342, and K387. We find that mutating the three PCK1 lysines that are neddylated reduces their gluconeogenic activity rate. Molecular dynamics simulations show that neddylation of PCK1 could re-position two loops surrounding the catalytic center into an open configuration, rendering the catalytic center more accessible. Our study reveals that neddylation of PCK1 provides a finely tuned mechanism of controlling glucose metabolism by linking whole nutrient availability to metabolic homeostasis.

Computer-assisted evaluation of retinal vessel tortuosity in moderate-to-late preterm children.

PURPOSE: Since very preterm children often have increased retinal tortuosity that may indicate decisive architectural changes in the systemic microvascular network, we used a new semi-automatic software to measure retinal vessel tortuosity on fundus digital images of moderate-to-late preterm (MLP) children. METHODS: In this observational case-control study, the global and local tortuosity parameters of retinal vessels were evaluated on fundus photographs of 36 MLP children and 36 age- and sex-matched controls. The associations between birth parameters and parameters reflecting retinal vessel tortuosity were evaluated using correlation analysis. RESULTS: Even after incorporation of anatomical factors, the global and local tortuosity parameters were not significantly different between groups. The MLP group showed a smaller arteriolar caliber (0.53 ± 0.2) than the controls (0.56 ± 0.2; p = 0.013). Other local tortuosity parameters, such as vessel length, distance to fovea, and distance to optic disc, were not significantly different between arteries and veins. Tortuosity in both groups was higher among vessels closer to the fovea (r = -0.077, p < 0.001) and the optic disc (r = -0.0544, p = 0.009). Global tortuosity showed a weakly positive correlation with gestational age and a weakly negative correlation with birth weight in both groups. CONCLUSION: MLP patients did not display increased vessel tortuosity in comparison with the controls; however, the arteriolar caliber in the MLP group was smaller than that in children born full-term. Larger studies should confirm this finding and explore associations between cardiovascular and metabolic status and retinal vessel geometry in MLP children.

UHPLC-MS Phenolic Fingerprinting, Aorta Endothelium Relaxation Effect, Antioxidant, and Enzyme Inhibition Activities of Azara dentata Ruiz & Pav Berries.

Azara dentata Ruiz & Pav. is a small Chilean native plant from Patagonia, a producer of small white reddish berries. For the first time, the proximal analysis of the fruits, phenolic fingerprinting, the antioxidant activity, and the enzymatic inhibition and relaxation effects in rat aorta induced by the ethanolic extract of these fruits were investigated. The proximal composition and the mineral (Ca: 2434 ± 40 mg/kg; Mg: 702 ± 13 mg/kg; Fe: 117.1 ± 1.6 mg/kg; Zn: 16.1 ± 0.4 mg/kg) and heavy metal (As: 121 ± 11 µg/kg; Cd: 152 ± 5 µg/kg; Hg: 7.7 ± 1.3 µg/kg; Pb 294 ± 4 µg/kg) contents were analyzed. Anthocyanins, flavonoids, phenolic acids, and coumarins were identified using UHPLC-PDA-QTOF-MS. The ethanolic extracts showed a total phenolic content of 23.50 ± 0.93 mg GAE/g extract. In addition, the antioxidant activity was assessed using both DPPH and TEAC (28.64 ± 1.87 and 34.72 ± 2.33 mg Trolox/g of dry fruit, respectively), FRAP (25.32 ± 0.23 mg Trolox equivalent/g dry fruit), and ORAC (64.95 ± 1.23 mg Trolox equivalents/g dry fruit). The inhibition of enzymatic activities (acetylcholinesterase IC50: 2.87 + 0.23 µg extract/mL, butyrylcholinesterase IC50: 6.73 + 0.07 µg extract/mL, amylase IC50: 5.6 ± 0.0 µg extract/mL, lipase IC50: 30.8 ± 0.0 µg extract/mL, and tyrosinase IC50: 9.25 ± 0.15 µg extract/mL) was also assessed. The extract showed 50-60% relaxation in rat aorta (intact), mediated thorough the release of endothelial nitric oxide. Our results suggest that A. dentata is a good source of compounds with the capacity to inhibit important enzymes, can be hypotensive, and can thus have good potentiality as supplements in the amelioration of neurodegenerative diseases and could also have potential to be used to develop new functional foods. The study highlights the benefits of these neglected small fruits and could boost their consumption.

Green gentrification in European and North American cities.

Although urban greening is universally recognized as an essential part of sustainable and climate-responsive cities, a growing literature on green gentrification argues that new green infrastructure, and greenspace in particular, can contribute to gentrification, thus creating social and racial inequalities in access to the benefits of greenspace and further environmental and climate injustice. In response to limited quantitative evidence documenting the temporal relationship between new greenspaces and gentrification across entire cities, let alone across various international contexts, we employ a spatially weighted Bayesian model to test the green gentrification hypothesis across 28 cities in 9 countries in North America and Europe. Here we show a strong positive and relevant relationship for at least one decade between greening in the 1990s-2000s and gentrification that occurred between 2000-2016 in 17 of the 28 cities. Our results also determine whether greening plays a "lead", "integrated", or "subsidiary" role in explaining gentrification.

Validation of a New Software Application for Tear Breakup Measurement.

SIGNIFICANCE: Tear film instability has been recognized as one key mechanism on dry eye disease. There is a need for new instruments, methods, or protocols to improve the repeatability and reproducibility of the tear film stability to facilitate its clinical evaluation use as a rapid and reliable primary diagnostic test. PURPOSE: The present pilot study aimed to validate a method to automatically measure the tear film breakup time (BUT). METHODS: A total of 264 videos of BUT were randomly selected among the clinical history of subjects attending the optometry clinic. Videos were stored in a backup server through a secure file transfer protocol and analyzed by three different examiners: two masked observers (subjective evaluation) and a third investigator using the automatic software application (objective evaluation). Subjective evaluation was conducted only once on an online software designed for this protocol where videos were presented in random masked order. Automatic evaluation based on color and texture analysis was performed by (1) automatic localization of sequences of interest in the video, (2) extraction of the region of interest within each frame, and (3) automatic BUT measurement from evolution curves in the region of interest as time elapsed from the beginning of the sequence of interest until the curve exceeds a threshold. RESULTS: Substantial correlation was observed among the examiners (intraclass correlation coefficient, 0.752). There was a statistical difference between observer 1 and 2 evaluations (t test, P < .001), whereas data provided by the software showed no significant differences from those of the observers (t test, P ≥ .26). Similar results to the whole data set analysis were obtained when the sample was reassessed only considering mean BUT values ≤15 seconds. CONCLUSIONS: The present pilot study showed acceptable clinical results for the software application designed to objectively measure the BUT.

Traffic Noise Annoyance in the Population of North Mexico: Case Study on the Daytime Period in the City of Matamoros.

Aim: The presence of noise in urban environments is rarely considered a factor that causes damage to the environment. The primary generating source is transportation means, with vehicles being the ones that affect cities the most. Traffic noise has a particular influence on the quality of life of those who are exposed to it and can cause health alterations ranging from annoyance to cardiovascular diseases. This study aims to describe the relationship between the traffic noise level and the perceived annoyance in the inhabitants of a city on the Northern Border of Mexico. The work carried out in a city represents the vulnerability characteristics: economic, social, and migratory of its sizable portion of the inhabitants. Due to that, it is impossible to identify precisely the number of residents as the number of vehicles in circulation. Methods: The streets and avenues with an annual average daily traffic of more than 1,000 vehicles were considered for the measurement of traffic noise. The equipment used was a vehicle gauge with non-invasive speed radar; type I integrating sound level meters, with their respective gauges and tripods. A questionnaire was applied to people living within 250 m of the streets and avenues in which the noise was measured. Results: The noise measurement found a parameter of LAeq estimated for 12 h during the day, exceeding 70 dBA. The data received from the questionnaire were statistically tested by using Pearson's correlation tests. A total number of 2,350 people were participated, of whom 1,378 were women (58.6%) and 972 were men (41.4%). The age of participants is ranged from 18 to 75 years. The overall perception of traffic noise annoyance identified that 1,131 participants (48.1%) responded "Yes" as they considered the noise annoying. Participants who responded "No" as well as those who responded "Do not know" resulted in a total of 1,219 people (51.9%). Conclusion: The results show that the population is desensitized to traffic noise and does not perceive it as an annoyance. The flow of vehicles and the type of vehicles are the significant factors for the propagation and increase in the traffic noise levels. Women present a considerable appreciation of traffic noise perception instead of younger people who demonstrate a higher tolerance to high-level exposure. This reflects the lack of information of the population around the noise problem and its effects.

Influencia del error diagnóstico en el pronóstico de la hemorragia subaracnoidea aneurismática en uruguay: analisis de una serie de 149 pacientes en un período de tiempo prepandemia y durante la pandemia SARS-Cov2 / Influence of diagnostic error on the prognosis of aneurysmal subarachnoid hemorrhage in Uruguay: analysis of a series of 149 patients in a pre-pandemic period and during the SARS-Cov2 pandemic

Introducción:La hemorragia subaracnoidea espontánea (HSA) presenta aproximadamente el 5% de todos los ACV, siendo una patología de alto impacto en la sociedad por su elevada morbi-mortalidad. La clínica de presentación es variada, lo cual lleva múltiples veces a dificultades en el diagnóstico. El objetivo de este trabajo es analizar el error diagnóstico que existe en esta patología y evaluar si el mismo se vio modificado por la interposición de la Emergencia Sanitaria declarada en el país por la pandemia del SARS-Cov2. Materiales y Métodos: es un estudio prospectivo y multicéntrico, incluyendo a todos los pacientes que presentaron HSA en el Uruguay entre el 1 de noviembre del 2019 y el 31 de julio de 2020. Se analizaron acuerdo con 3 períodos: 1) pre-pandemia, 2) cuarentena general, y 3) nueva normalidad. Se incluyeron todos los pacientes mayores de 18 años que consultaron y se les diagnosticó una HSA espontánea aneurismática. Se definió́ error diagnóstico a la imposibilidad de reconocer esta patología en la consulta médica inicial otorgándole el alta. El análisis se procesó utilizando el software SPSS versión 22. La investigación fue aprobada por todos los Comité de Ética de los diferentes centros que participaron del estudio. Resultados: de un total de 149 pacientes, la edad media fue de 57,23 años, con mayor frecuencia en el sexo femenino. Se constató error diagnóstico en 38 pacientes (25,5%), con mayor porcentaje durante la cuarentena general. El retraso en el diagnóstico por problemas asistenciales fue de un 2,6%. Se evidenció un 22,8% de complicaciones por el tratamiento indicado, y un 71,1% por la HSA, con una mortalidad global del 51,7%. Conclusiones: en el presente trabajo se observó un error diagnóstico elevado, evidenciando una relación directa y significativa con la cefalea y la HSA leve (HyH 1 y 2) como formas de presentación. Hubo un porcentaje mayor de HSA graves en comparación a la literatura, con una relación directa y significativa entre la presencia de vasoespasmo y la mortalidad con el error diagnóstico. También es claro que la crisis sanitaria determinó que ese error diagnóstico aumentara durante los primeros meses de la pandemia en Uruguay.

Introduction: Spontaneous subarachnoid hemorrhage (SAH) represents approximately 5% of all strokes, being a pathology of high impact in society, due to its high morbidity and mortality. The clinical presentation is varied, which leads many times to difficulties in diagnosis. The objective of this work is to analyze the diagnostic error that exists in this pathology, and to assess whether it was modified by the introduction of the Health Emergency declared in the country by the SARS-Cov2 pandemic. Materials and Methods: it is a prospective and multicenter study, including all patients who presented SAH in Uruguay between November 1, 2019 and July 31, 2020. They were analyzed according to 3 periods: 1) pre-pandemic, 2) general quarantine, and 3) new normality. All patients over 18 years of age who consulted and were diagnosed with spontaneous aneurysmal SAH were included. Diagnostic error was defined as the inability to recognize this pathology in the initial medical consultation and discharge. The analysis was processed using SPSS version 22 software. The research was approved by all the Ethics Committees of the different centers that participated in the study. Results: of a total of 149 patients, the mean age was 57.23 years, more frequently in the female sex. Diagnostic error was found in 38 patients (25.5%), with a higher percentage during general quarantine. The delay in diagnosis due to healthcare problems was 2.6%. There were 22.8% complications due to the indicated treatment, and 71.1% due to SAH, with an overall mortality of 51.7%. Conclusions: in the present work, a high diagnostic error was observed, showing a significant direct relationship with headache and mild SAH (HyH 1 and 2) as forms of presentation. There was a higher percentage of severe SAH compared to the literature, with a direct and significant relationship between the presence of vasospasm and mortality with diagnostic error. It is also clear that the health crisis determined that this diagnostic error increased during the first months of the pandemic in Uruguay

Diffusion Tensor Imaging of the Sciatic Nerve as a Surrogate Marker for Nerve Functionality of the Upper and Lower Limb in Patients With Diabetes and Prediabetes.

BACKGROUND: Nerve damage in diabetic neuropathy (DN) is assumed to begin in the distal legs with a subsequent progression to hands and arms at later stages. In contrast, recent studies have found that lower limb nerve lesions in DN predominate at the proximal sciatic nerve and that, in the upper limb, nerve functions can be impaired at early stages of DN. MATERIALS AND METHODS: In this prospective, single-center cross-sectional study, participants underwent diffusion-weighted 3 Tesla magnetic resonance neurography in order to calculate the sciatic nerve's fractional anisotropy (FA), a surrogate parameter for structural nerve integrity. Results were correlated with clinical and electrophysiological assessments of the lower limb and an examination of hand function derived from the Purdue Pegboard Test. RESULTS: Overall, 71 patients with diabetes, 11 patients with prediabetes and 25 age-matched control subjects took part in this study. In patients with diabetes, the sciatic nerve's FA showed positive correlations with tibial and peroneal nerve conduction velocities (r = 0.62; p < 0.001 and r = 0.56; p < 0.001, respectively), and tibial and peroneal nerve compound motor action potentials (r = 0.62; p < 0.001 and r = 0.63; p < 0.001, respectively). Moreover, the sciatic nerve's FA was correlated with the Pegboard Test results in patients with diabetes (r = 0.52; p < 0.001), prediabetes (r = 0.76; p < 0.001) and in controls (r = 0.79; p = 0.007). CONCLUSION: This study is the first to show that the sciatic nerve's FA is a surrogate marker for functional and electrophysiological parameters of both upper and lower limbs in patients with diabetes and prediabetes, suggesting that nerve damage in these patients is not restricted to the level of the symptomatic limbs but rather affects the entire peripheral nervous system.

Diámetro transversal del maxilar en pacientes con maloclusión del Policlínico Mario Escalona. 2019 / Maxillary transverse diameter in patients with malocclusion treated at Mario Escalona Polyclinic. 2019

Introducción: Las anomalías de crecimiento y desarrollo transversal del maxilar constituyen un diagnóstico frecuente en pacientes con maloclusiones. Objetivo: Describir el diámetro transversal del maxilar en pacientes con maloclusiones del Policlínico Mario Escalona, 2019. Material y método: Estudio descriptivo transversal. El universo estuvo formado por todos los pacientes (69), de 12 a 25 años con maloclusiones ingresados en el Servicio de Ortodoncia del policlínico Mario Escalona desde abril de 2018 a febrero de 2019. Se determinó el índice de Bogue y de Mayoral. Los resultados se presentaron en tablas. Resultados: Se encontró el diámetro de Bogue disminuido en el 65,0 por ciento de los pacientes donde se determinó. Todas las medidas de Mayoral analizadas presentaron como promedio valores por debajo de la norma en cada etapa de crecimiento y desarrollo; exceptuando las medidas de 4 a 4 en el Prepúber. En ambos sexos el índice de Mayoral en sus tres niveles o referencias se encontró como promedio por debajo de la norma. En el sexo femenino se detectaron las medias menores (33,7mm, 38,3mm, 44,4mm) respecto al masculino. Se diagnosticó Micrognatismo transversal en el 75,36 por ciento de los pacientes; 80,49 por ciento en las hembras y 67,86 por ciento en varones. Conclusiones: Se encontró una alta frecuencia de micrognatismo transversal. Se detectó discrepancias ligeras del índice de Mayoral según la clasificación sindrómica y la etapa de crecimiento y desarrollo, mientras que en cuanto al sexo se identificaron diferencias de consideración(AU)

Introduction: Growth anomalies and maxillary transverse diameter are frequent diagnoses in patients with malocclusions. Objective: To describe the maxillary transverse diameter in patients with malocclusions treated at Mario Escalona Polyclinic in 2019. Material and method: A cross-sectional descriptive study was conducted. The universe consisted of 69 patients aged 12-25 years who presented malocclusions and were admitted to the Orthodontics Service of Mario Escalona polyclinic from April 2018 to February 2019. Bogue´s index and the index of Mayoral were determined. The results were presented in tables. Results: The transverse diameter of Bogue decreased in 65.0 percent of the patients in whom it was determined. All measures established by Mayoral presented ​​lower average values than the norm at each stage of growth and development; except for measures 4/4 in pre-pubertal patients. In both sexes, the index of Mayoral in its three levels or references was found as an average value below the norm. Lower averages (33.7mm, 38.3mm, 44.4mm) were identified in the female sex with respect to the male sex. Transversal micrognathism was diagnosed in 75.36 percent of patients (80.49 percent females and 67.86 percent males). Conclusions: A high frequency of transversal micrognathism was found. Slight discrepancies of the index of Mayoral were identified according to the syndromic classification and the stages of growth and development while in terms of sex, significant differences were identified(AU)

Evaluación de factores psicológicos asociados al transporte sustentable / Evaluation of Psychological Factors Associated with Sustainable Transportation

Resumen Esta investigación surge de la necesidad de encontrar nuevos hábitos de consumo sustentable y está enfocada en la identificación de los factores psicológicos asociados al uso habitual de la bicicleta como un transporte sostenible. Se evaluaron varios grupos de variables en estudiantes universitarios (N = 492). Se consultaron los tres predictores de la Teoría de Acción Planeada, algunas características sociodemográficas y los hábitos de transporte. Mediante una taxonomía de modelos lineales se integraron y analizaron estas variables. Los resultados señalan que las personas de mayor edad, mayor actitud y mayor control comportamental percibido son la mejor caracterización significativa que se puede tener de los estudiantes biciusuarios. También se encuentra que el control comportamental percibido es el correlato más fuerte con el uso de la bicicleta. Se discuten las implicaciones para campañas dirigidas a la promoción del uso de la bicicleta en los estudiantes universitarios.

Abstract This research arises from the need to find new habits of sustainable consumption, and it is focused on the identification of psychological factors associated with the regular use of the bicycle as a sustainable transportation. Several groups of variables were evaluated in 492 undergraduate students. The three predictors of the Theory of Planned Behavior, some sociodemographic characteristics, and transportation habits were consulted. Through a taxonomy of linear models, these variables were integrated and analyzed. Results indicate that older people, greater attitude, and greater perceived behavioral control are the best significant characterization that can be achieved of bike-user students. We found perceived behavioral control is the strongest correlation with the use of bicycles. Implications for campaigns aimed at promoting the use of bicycles in students are discussed.

Diabetic Polyneuropathy Is Associated With Pathomorphological Changes in Human Dorsal Root Ganglia: A Study Using 3T MR Neurography.

Diabetic neuropathy (DPN) is one of the most severe and yet most poorly understood complications of diabetes mellitus. In vivo imaging of dorsal root ganglia (DRG), a key structure for the understanding of DPN, has been restricted to animal studies. These have shown a correlation of decreased DRG volume with neuropathic symptom severity. Our objective was to investigate correlations of DRG morphology and signal characteristics at 3 Tesla (3T) magnetic resonance neurography (MRN) with clinical and serological data in diabetic patients with and without DPN. In this cross-sectional study, participants underwent 3T MRN of both L5 DRG using an isotropic 3D T2-weighted, fat-suppressed sequence with subsequent segmentation of DRG volume and analysis of normalized signal properties. Overall, 55 diabetes patients (66 ± 9 years; 32 men; 30 with DPN) took part in this study. DRG volume was smaller in patients with severe DPN when compared to patients with mild or moderate DPN (134.7 ± 21.86 vs 170.1 ± 49.22; p = 0.040). In DPN patients, DRG volume was negatively correlated with the neuropathy disability score (r = -0.43; 95%CI = -0.66 to -0.14; p = 0.02), a measure of neuropathy severity. DRG volume showed negative correlations with triglycerides (r = -0.40; 95%CI = -0.57 to -0.19; p = 0.006), and LDL cholesterol (r = -0.33; 95%CI = -0.51 to -0.11; p = 0.04). There was a strong positive correlation of normalized MR signal intensity (SI) with the neuropathy symptom score in the subgroup of patients with painful DPN (r = 0.80; 95%CI = 0.46 to 0.93; p = 0.005). DRG SI was positively correlated with HbA1c levels (r = 0.30; 95%CI = 0.09 to 0.50; p = 0.03) and the triglyceride/HDL ratio (r = 0.40; 95%CI = 0.19 to 0.57; p = 0.007). In this first in vivo study, we found DRG morphological degeneration and signal increase in correlation with neuropathy severity. This elucidates the potential importance of MR-based DRG assessments in studying structural and functional changes in DPN.

Road risk behaviors: Pedestrian experiences.

Objective: The objective of this study was to identify pedestrian risk behaviors that result in traffic accidents and characterization of the accidents experienced by participants in this study to provide information for the generation of integral preventive strategies. Methods: The study was correlational, descriptive, and transversal and followed a quantitative approach divided into 2 stages. In the first stage, an observational study was performed to identify the manifested risk behaviors of pedestrians, which served as a basis for the construction and design of a questionnaire. In the second stage, the questionnaire was applied to a group of 1,536 participants. Pearson's correlation coefficient was applied to establish associations between gender and age with respect to risk behaviors. Results: The 3 behaviors that participants reported performing always or very often include using electronic gadgets (except mobile phones), not using a pedestrian crosswalk, and using a mobile phone. In addition, 18.5% were involved in at least one road accident as a pedestrian in the last 5 years. Of the total number of registered accidents, 21% resulted in pedestrian injuries, 48.3% of which were serious. These were due to external causes not related to human factors or unidentified (58.5%) and behavior factors as a whole (41.4%, 31.5% of which were caused by pedestrians). Pearson's correlation coefficient showed evidence of a correlation between age and risk behaviors. Conclusions: All subjects in this study performed several risky actions as pedestrians, at least occasionally, and at least one fifth had been involved in a road accident as a pedestrian. It is known that the surroundings can positively or negatively influence individuals' behaviors; therefore, once prevention measures are identified, it is possible to influence risk behaviors. Therefore, road safety education and the physical environment must be considered together, and efforts focused on optimum infrastructure also need to consider road safety education.

Relación entre oclusión dentaria y postura cráneo-cervical en niños con maloclusiones clase II y III / Relationship between dental occlusion and craniocervical posture in children with class II and III malocclusions

RESUMEN Introducción: la relación entre las maloclusiones y la postura del sistema cráneo cervical ha generado un interés creciente entre los ortodontistas. Objetivo: describir la relación entre la oclusión dentaria y la postura del sistema cráneo-cervical en niños con maloclusiones clase II y clase III. Materiales y métodos: estudio descriptivo transversal. El universo estuvo formado por 19 niños, de 7 a 12 años, con maloclusiones clase II y III de Angle. Ingresados en el Servicio de Ortodoncia de la Facultad de Estomatología de La Habana, en octubre del 2016. Se realizó examen bucal y telerradiografía. Los resultados se presentaron en tablas. Resultados: predominó la clase II de Angle, donde la distoclusión molar fue más marcada en el lado derecho (-2,95 mm) y en la clase III la mesioclusión mayor correspondió al izquierdo (2,25 mm como promedio). En ambas predominó la ½ unidad (36,8 % en clase II). El ángulo cráneo-vertebral y el espacio suboccipital estuvieron dentro del rango normal; 104,65º y 7,99 mm, en clase II y en clase III, 103,78º y 6,90 mm como promedio. La profundidad de la columna cervical fue 6,26 mm y 6,20 mm respectivamente; lo que significó una rectificación de columna cervical. Conclusiones: se encontró más frecuente la clase II de Angle. La posición de la cabeza fue normal en ambas clases y la columna cervical rectificada. Se identificaron relaciones inversas entre la magnitud de la maloclusión con la posición de la cabeza y la columna cervical.

ABSTRACT Introduction: the relationship between malocclusions and the crania-cervical system posture has generated a a growing interest among orthodontists. Objective: to describe the relationship between dental occlusion and the position of the crania-cervical system in children with class II and class III malocclusions. Materials and methods: cross-sectional, descriptive study. The universe was 19 children, aged from 7 to 12 years, class II and III Angle's malocclusions, admitted in the Orthodontics service of the Faculty of Stomatology of Havana in October 2016. Oral examination and teleradiography were performed. The results were presented in tables. Results: Class II of Angle predominated, where the molar distoclusion was more marked on the right side (-2.95 mm) and in class III the greater mesioclusion corresponded to the left (2.25 mm as average). In both, the ½ unit predominated (36.8% in Class II). The cranio-vertebral angle and the suboccipital space were within the normal range; 104.65º and 7.99 mm in class II and in class III 103.78º and 6.90 mm as average. The depth of the cervical spine was 6.26 mm and 6.20 mm respectively; which meant a rectification of the cervical spine. Conclusions: Angle's Class II was found more frequent. The position of the head was normal in both classes and also the rectified cervical spine. Inverse relationships were identified between the magnitude of the malocclusion and the position of the head and cervical spine. The objective of this work is to present a clinical case and the importance of a nurse intervention.

Impact of De-escalation on Prognosis of Patients With Bacteremia due to Enterobacteriaceae: A Post Hoc Analysis From a Multicenter Prospective Cohort.

BACKGROUND: More data are needed about the safety of antibiotic de-escalation in specific clinical situations as a strategy to reduce exposure to broad-spectrum antibiotics. The aims of this study were to investigate predictors of de-escalation and its impact on the outcome of patients with bloodstream infection due to Enterobacteriaceae (BSI-E). METHODS: A post hoc analysis was performed on a prospective, multicenter cohort of patients with BSI-E initially treated with ertapenem or antipseudomonal ß-lactams. Logistic regression was used to analyze factors associated with early de-escalation (EDE) and Cox regression for the impact of EDE and late de-escalation (LDE) on 30-day all-cause mortality. A propensity score (PS) for EDE vs no de-escalation (NDE) was calculated. Failure at end of treatment and length of hospital stay were also analyzed. RESULTS: Overall, 516 patients were included. EDE was performed in 241 patients (46%), LDE in 95 (18%), and NDE in 180 (35%). Variables independently associated with a lower probability of EDE were multidrug-resistant isolates (odds ratio [OR], 0.50 [95% confidence interval {CI}, .30-.83]) and nosocomial infection empirically treated with imipenem or meropenem (OR, 0.35 [95% CI, .14-.87]). After controlling for confounders, EDE was not associated with increased risk of mortality; hazard ratios (HR) (95% CIs) were as follows: general model, 0.58 (.25-1.31); model with PS, 0.69 (.29-1.65); and PS-based matched pairs, 0.98 (.76-1.26). LDE was not associated with mortality. De-escalation was not associated with clinical failure or length of hospital stay. CONCLUSIONS: De-escalation in patients with monomicrobial bacteremia due to Enterobacteriaceae was not associated with a detrimental impact on clinical outcome.

Riesgo de hipertensión arterial en población adulta en Matamoros, Tamaulipas, México / Risk of arterial hypertension in the adult population in Matamoros, Tamaulipas, México / Risco de hipertensão arterial na população adulta em Matamoros, Tamaulipas, México

Objetivo: conocer el riesgo de hipertensión en la población adulta de la ciudad de Matamoros, Tamaulipas. Método: el diseño fue de tipo descriptivo y transversal, una muestra de 1004 adultos. Se utilizó una cedula de datos sociodemográficos, donde se realizaron 3 mediciones de la presión arterial, de acuerdo a la Norma Oficial Mexicana NOM-030-SSA2-2009. Resultados: El género estuvo conformado del 38.7% de hombres y 61.3% de mujeres. Se observó una prevalencia de hipertensión arterial en 8.6% de la población. Fue mayor en el género masculino con 12.3% que el femenino de 6.3%. El grupo de 60 y más años (14.1%) presenta mayor prevalencia de hipertensión, seguido de 50 a 59 (13.8%) y finalmente el de 40 a 49 con 11.7%. El riesgo de hipertensión es de 87 (8,7%) de la muestra total; la alta presión arterial sistólica con 52 (5,1%), y alta presión arterial diastólica con 56 (5,5%) también deben ser consideradas hipertensión. Cuando se analizan en conjunto, los tres criterios de inclusión para hipertensión arterial suman el 19,4% de riesgo. Conclusión: el riesgo de hipertensión arterial en población adulta está latente, la prevalencia se ubica dentro de la más alta a nivel mundial.(AU)

Objective: To know the risk of hypertension in the adult population of the city of Matamoros, Tamaulipas. Method: The design was descriptive and transversal in a sample of 1004 adults. A sociodemographic data questionnaire was used and three blood pressure measurements were performed according to the Official Mexican Standard NOM-030-SSA2-2009. Results: The gender was made up of 38.7% of men and 61,3% of women. A prevalence of hypertension was observed in 8.6% of the population. It was greater in the masculine gender with 12.3% than the feminine one of 6.3%. The group of 60 and over (14.1%) had a higher prevalence of hypertension, followed by 50 to 59 (13.8%) and finally the group of 40 to 49 with 11.7%. The risk of hypertension is 87 (8.7%) of the total sample; high systolic blood pressure with 52 (5.1%), and high diastolic blood pressure with 56 (5.5%) should also be considered hypertension. When analyzed together, the three inclusion criteria for hypertension add up to a 19.4% risk. Conclusion: the risk of hypertension in the adult population is latent, the prevalence is among the highest in the world.(AU)

Objetivo: conhecer o risco de hipertensão na população adulta da cidade de Matamoros, Tamaulipas. Método: O desenho foi descritivo e transversal, em uma amostra de 1004 adultos. Utilizou-se um questionário de dados sociodemográficos e foram realizadas três medidas de pressão arterial conforme a Norma Oficial Mexicana NOM-030-SSA2-2009. Resultados: O gênero foi composto por 38.7% de homens e 61,3% de mulheres. Prevalência de hipertensão arterial foi observada em 8,6% da população. Foi maior no gênero masculino com 12,3% do que no feminino com 6,3%. O grupo de 60 anos ou mais (14,1%) apresentou maior prevalência de hipertensão, seguido pelo de 50 a 59 (13,8%) e, finalmente, o grupo de 40 a 49, com 11,7%. O risco de hipertensão é de 87 (8,7%) da amostra total; alta pressão arterial sistólica com 52 (5,1%) e alta pressão arterial diastólica com 56 (5,5%) também devem ser consideradas hipertensão. Quando analisados em conjunto, os três critérios de inclusão para hipertensão somam um risco de 19,4%. Conclusão: o risco de hipertensão na população adulta é latente, a prevalência está entre as mais altas do mundo.(AU)

Violencia en el noviazgo en jóvenes y adolescentes en la frontera norte de México / Dating violence in young people and adolescents in the northern border of Mexico / Violência no namoro de jovens e adolescentes na fronteira norte do México

Objetivo: el objetivo principal del estudio es conocer la prevalencia de los diferentes tipos de violencia en el noviazgo en jóvenes, y como objetivos específicos: analizar la asociación entre la violencia el nivel educativo, la edad y sexo de los participantes. Método: se realizó un estudio de tipo cuantitativo, transversal y correlacional, en el periodo de mayo a diciembre de 2016. Se evaluó a un total de 432 estudiantes de ambos sexos, provenientes de cinco instituciones educativas de la ciudad de Matamoros, Tamaulipas, México, mediante el CUVINO. Se consideraron tanto escuelas públicas como privadas de los niveles secundaria y preparatoria. El 53% de la muestra participante fue de estudiantes de nivel secundaria, el restante 47% de preparatorias. Resultados: se encontró una correlación positiva aunque baja entre la variable edad, y los diferentes subtipos de violencia. Se encontraron diferencias significativas en cuanto a sexo para casi todos los subtipos de violencia. No se encontraron diferencias significativas en cuanto a nivel educativo entre los diferentes tipos de violencia. Conclusión: se discute la complejidad del fenómeno de la violencia en parejas jóvenes, con relación a factores sociodemográficos e implicaciones para líneas de investigación futuras.(AU)

Objective: The main objective of the study is to know the prevalence of different types of dating violence in young people, and as specific objectives: to analyze the association between violence, educational level, age and sex of the participants. Method: a quantitative, cross-sectional and correlational study were carried out in the May-December 2016 period. 432 students of both sexes from five educational institutions from Matamoros, Tamaulipas, Mexico, were evaluated through the CUVINO. Public and private institutions from middle and high school levels were considered. 53% of the participating sample was middle-school students, the remaining 47% high school students. Results: among the findings of the study, a positive low correlation between the age variable, and the different subtypes of violence was found. Significant differences regarding sex for almost all subtypes of violence were found. No significant differences in educational level between the different types of violence were found. Conclusion: the complexity of the phenomenon of violence in young couples, in relation with sociodemographic factors and its implications for future lines of research are discussed.(AU)

Objetivo: O principal objetivo do estudo é conhecer a prevalência de diferentes tipos de violência no namoro em jovens; e como objetivos específicos: analisar a associação entre violência, escolaridade, idade e sexo dos participantes. Método: estudo quantitativo, transversal e correlacional, realizado no período de maio a dezembro de 2016. Foram avaliados 432 estudantes de ambos os sexos, de cinco instituições de ensino da cidade de Matamoros, Tamaulipas, através do CUVINO. Foram consideradas escolas públicas e privadas dos níveis secundário e preparatório. 53% da amostra participante eram de estudantes do ensino secundário, os restantes 47% do ensino médio. Resultados: entre os achados do estudo, encontrou-se uma correlação positivo, embora baixe entre a variável idade e os diferentes subtipos de violência. Diferenças significativas foram encontradas em relação ao sexo para quase todos os subtipos de violência. Não foram encontradas diferenças significativas no nível educacional entre os diferentes tipos de violência. Conclusão: discute-se a complexidade do fenômeno da violência em jovens casais, em relação aos fatores sociodemográficos e suas implicações para futuras linhas de pesquisa.(AU)