Long-read whole genome sequencing reveals HOXD13 alterations in synpolydactyly.

Synpolydactyly 1, also called syndactyly type II (SDTY2), is a genetic limb malformation characterized by polydactyly with syndactyly involving the webbing of the third and fourth fingers, and the fourth and fifth toes. It is caused by heterozygous alterations in HOXD13 with incomplete penetrance and phenotypic variability. In our study, a five-generation family with an SPD phenotype was enrolled in our Rare Disease Genomics Protocol. A comprehensive examination of three generations using Illumina short-read whole-genome sequencing (WGS) did not identify any causative variants. Subsequent WGS using Pacific Biosciences (PacBio) long-read HiFi Circular Consensus Sequencing (CCS) revealed a heterozygous 27-bp duplication in the polyalanine tract of HOXD13. Sanger sequencing of all available family members confirmed that the variant segregates with affected individuals. Reanalysis of an unrelated family with a similar SPD phenotype uncovered a 21-bp (7-alanine) duplication in the same region of HOXD13. Although ExpansionHunter identified these events in most individuals in a retrospective analysis, low sequence coverage due to high GC content in the HOXD13 polyalanine tract makes detection of these events challenging. Our findings highlight the value of long-read WGS in elucidating the molecular etiology of congenital limb malformation disorders.

Effectiveness and Tolerability of 3-Day Mebendazole Treatment of Giardia duodenalis Infection in Adults and Children: Two Prospective, Open-Label Phase IV Trials.

BACKGROUND: Giardia duodenalis is the most common intestinal pathogenic protozoan infection reported in humans. Both in vitro studies and 4 separate, sequential, comparative clinical trials conducted by our group in Cuba demonstrated mebendazole activity against G. duodenalis infection in both children and adults. OBJECTIVE: The 2 additional, prospective, open-label, Phase IV follow-up studies reported here were performed to further assess the effectiveness and safety profile of mebendazole in the outpatient treatment of G. duodenalis infection. METHODS: Assenting children (n = 522) whose guardians gave permission and consenting adults (n = 423) diagnosed with G. duodenalis infection were given mebendazole (200 mg 3 times daily for 3 days). Medical histories and stool samples were obtained and physical/laboratory examinations were performed pretreatment then repeated on days 3, 5, and 7 after treatment completion. The evaluation of efficacy (ie, cure) was based on parasitologic response to therapy. Participants were considered cured, if no Giardia trophozoites or cysts were found in any of the 3 posttreatment fecal specimens evaluated by direct wet mounts and/or after Ritchie concentration techniques. RESULTS: No participant refused to be enrolled and all returned for follow-up examinations. At the end of the treatment, stool samples were negative in 450 out of 522 children (86.2%) and 392 of 423 adults (92.7%). Treatment was well tolerated. In adults, the only adverse effect reported was abdominal pain (6.2%). Side effects reported in children included abdominal pain (5.6%), nausea (2.9%), and vomiting (2.3%). Reported side effects were all mild, transient, and self-limited and did not require discontinuation of treatment or additional medication. CONCLUSIONS: Mebendazole may be an effective alternative treatment of G. duodenalis infections in both children and adults.

Uterine flushings from women treated with levonorgestrel affect sperm functionality in vitro.

Levonorgestrel (LNG), a synthetic 19 nor-testosterone derivative, is widely used for emergency contraception. It is well known that LNG prevents ovulation only when given prior to the surge of serum luteinizing hormone (LH) during the periovulatory phase of the menstrual cycle. This observation suggests that LNG, given its contraceptive efficacy, has additional effects other than those affecting ovulation. In this study, we have evaluated the effects on human sperm functionality of uterine flushings (UF) obtained from women at day LH + 1 of a control cycle (CTR-LH + 1) and after receiving LNG (LNG-LH + 1) two days before the surge of LH. Human sperm from normozoospermic donors were incubated with UF and protein tyrosine phosphorylation, sperm motility, acrosome reaction as well as zona pellucida (ZP) binding capacity were assessed. A significant decrease in total motility and tyrosine phosphorylation accompanied by an increase on spontaneous acrosome reaction was observed when sperm were incubated in the presence of LNG-LH + 1. None of these effects were mimicked by purified glycodelin A (GdA). Moreover, the addition of UF obtained during the periovulatory phase from LNG-treated women or the presence of purified GdA significantly decreased sperm-ZP binding. The data were compatible with changes affecting sperm capacitation, motility and interaction with the ZP. These results may offer evidence on additional mechanisms of action of LNG as an emergency contraceptive.

Distribution of free-living amoebae in a treatment system of textile industrial wastewater.

Free-living amoebae have been found in soil, air and a variety of aquatic environments, but few studies have been conducted on industrial wastewater and none on wastewater from the textile industry. The aim of this study was to determine the presence and distribution of free-living amoebae in a biological treatment system that treats textile industrial wastewater. Samples were taken from input, aeration tank, sedimentation tank and output. Samples were centrifuged at 1200g for 15min, the sediment was seeded on non-nutritive agar with Enterobacter aerogenes (NNE) and the plates were incubated at 30 and 37°C. Free-living amoebae were present in all stages of the treatment system. The highest number of amoebic isolates was found in the aeration tank and no seasonal distribution was observed during the year. A total of 14 amoeba genera were isolated: Acanthamoeba, Echinamoeba, Korotnevella, Mayorella, Naegleria, Platyamoeba, Saccamoeba, Stachyamoeba, Thecamoeba, Vahlkampfia, Vannella, Vermamoeba, Vexillifera and Willaertia. The most frequently found amoebae were Acanthamoeba and Vermamoeba which were found in all treatment system stages. The constant presence and diversity of free-living amoebae in the treatment system were important findings due to the characteristics of the wastewater from the textile plant in terms of the residue content from colorants, fixers, carriers, surfactants, etc., used in fabric dyeing and finishing processes. The factors that determined the presence and distribution of amoebae in the activated sludge system were their capacity to form cysts, which allowed them to resist adverse conditions; food availability; an average temperature of 27-33°C; dissolved oxygen in average concentrations above 2mg/L, and pH in a range of 5.9-7.1.

Effect of a low versus intermediate tidal volume strategy on pulmonary complications in patients at risk of acute respiratory distress syndrome-a randomized clinical trial.

Introduction: There is no consensus on whether invasive ventilation should use low tidal volumes (VT) to prevent lung complications in patients at risk of acute respiratory distress syndrome (ARDS). The purpose of this study is to determine if a low VT strategy is more effective than an intermediate VT strategy in preventing pulmonary complications. Methods: A randomized clinical trial was conducted in invasively ventilated patients with a lung injury prediction score (LIPS) of >4 performed in the intensive care units of 10 hospitals in Spain and one in the United States of America (USA) from 3 November 2014 to 30 August 2016. Patients were randomized to invasive ventilation using low VT (≤ 6 mL/kg predicted body weight, PBW) (N = 50) or intermediate VT (> 8 mL/kg PBW) (N = 48). The primary endpoint was the development of ARDS during the first 7 days after the initiation of invasive ventilation. Secondary endpoints included the development of pneumonia and severe atelectases; the length of intensive care unit (ICU) and hospital stay; and ICU, hospital, 28- and 90-day mortality. Results: In total, 98 patients [67.3% male], with a median age of 65.5 years [interquartile range 55-73], were enrolled until the study was prematurely stopped because of slow recruitment and loss of equipoise caused by recent study reports. On day 7, five (11.9%) patients in the low VT group and four (9.1%) patients in the intermediate VT group had developed ARDS (risk ratio, 1.16 [95% CI, 0.62-2.17]; p = 0.735). The incidence of pneumonia and severe atelectasis was also not different between the two groups. The use of a low VT strategy did neither affect the length of ICU and hospital stay nor mortality rates. Conclusions: In patients at risk for ARDS, a low VT strategy did not result in a lower incidence of ARDS than an intermediate VT strategy.Clinical Trial Registration: ClinicalTrials.gov, identifier NCT02070666.

Expanding the clinical phenotype of FGFR1 internal tandem duplication.

Closed spinal dysraphism (SD) is a type of neural tube defect originating during early embryonic development whereby the neural tissue of the spinal defect remains covered by skin, often coinciding with markers of cutaneous stigmata. It is hypothesized that these events are caused by multifactorial processes, including genetic and environmental causes. We present an infant with a unique congenital midline lesion associated with a closed SD. Through comprehensive molecular profiling of the intraspinal lesion and contiguous skin lesion, an internal tandem duplication (ITD) of the kinase domain of the fibroblast growth factor receptor 1 (FGFR1) gene was found. This ITD variant is somatic mosaic in nature as supported by a diminished variant allele frequency in the lesional tissue and by its absence in peripheral blood. FGFR1 ITD results in constitutive activation of the receptor tyrosine kinase to promote cell growth, differentiation, and survival through RAS/MAPK signaling. Identification of FGFR1 ITD outside of central nervous system tumors is exceedingly rare, and this report broadens the phenotypic spectrum of somatic mosaic FGFR1-related disease.

Analysis of expressed sequence tags generated from full-length enriched cDNA libraries of melon.

BACKGROUND: Melon (Cucumis melo), an economically important vegetable crop, belongs to the Cucurbitaceae family which includes several other important crops such as watermelon, cucumber, and pumpkin. It has served as a model system for sex determination and vascular biology studies. However, genomic resources currently available for melon are limited. RESULT: We constructed eleven full-length enriched and four standard cDNA libraries from fruits, flowers, leaves, roots, cotyledons, and calluses of four different melon genotypes, and generated 71,577 and 22,179 ESTs from full-length enriched and standard cDNA libraries, respectively. These ESTs, together with ~35,000 ESTs available in public domains, were assembled into 24,444 unigenes, which were extensively annotated by comparing their sequences to different protein and functional domain databases, assigning them Gene Ontology (GO) terms, and mapping them onto metabolic pathways. Comparative analysis of melon unigenes and other plant genomes revealed that 75% to 85% of melon unigenes had homologs in other dicot plants, while approximately 70% had homologs in monocot plants. The analysis also identified 6,972 gene families that were conserved across dicot and monocot plants, and 181, 1,192, and 220 gene families specific to fleshy fruit-bearing plants, the Cucurbitaceae family, and melon, respectively. Digital expression analysis identified a total of 175 tissue-specific genes, which provides a valuable gene sequence resource for future genomics and functional studies. Furthermore, we identified 4,068 simple sequence repeats (SSRs) and 3,073 single nucleotide polymorphisms (SNPs) in the melon EST collection. Finally, we obtained a total of 1,382 melon full-length transcripts through the analysis of full-length enriched cDNA clones that were sequenced from both ends. Analysis of these full-length transcripts indicated that sizes of melon 5' and 3' UTRs were similar to those of tomato, but longer than many other dicot plants. Codon usages of melon full-length transcripts were largely similar to those of Arabidopsis coding sequences. CONCLUSION: The collection of melon ESTs generated from full-length enriched and standard cDNA libraries is expected to play significant roles in annotating the melon genome. The ESTs and associated analysis results will be useful resources for gene discovery, functional analysis, marker-assisted breeding of melon and closely related species, comparative genomic studies and for gaining insights into gene expression patterns.

Professional liability in oral surgery: legal and medical study of 63 court sentences.

OBJECTIVES: Dentistry, like all other health care professions, has in recent years been subjected to an increase in legal pressure by patients. Nevertheless, there are areas of activity in dentistry in which, whether because of their frequency or due to the importance of the damage and sequelae claimed, this legal pressure is greater. Amongst these areas of activity is that of oral surgery. STUDY DESIGN: To be meticulously analyzed in this report are 63 sentences issued by courts of second instance or higher levels regarding lawsuits involving oral surgery. The data collection file includes 13 variables. The descriptive and comparative statistical study by cross-referencing certain variables provides us with a clear and accurate picture of the lawsuit profile. RESULTS AND CONCLUSIONS: Implantological surgery was the practice subject to the most claims due to surgery (55.6 percent: 35 sentences), and it drew our attention that in 71.4% of all cases (45 sentences) there was a ruling against the professional. The most frequent range of damage payments was between €18,001 and €60,000 (40.9%: 18 sentences), the highest amount having been €24,000, an important factor to take into account when contracting professional civil liability insurance.

Eye Salvage with Intra-Arterial and Intra-Vitreal Chemotherapy in Patients with Retinoblastoma: 8-Year Single-Institution Experience in Colombia.

INTRODUCTION: Intra-arterial chemotherapy (IAC) is useful for eye preservation in advanced retinoblastoma (Rb). Intra-vitreal chemotherapy (IvitC) is the latest treatment for vitreous seeds. METHODS: The present study is a retrospective assessment of 100 eyes, treated with primary or secondary IAC alone or with IvitC. We evaluated demographic and clinical variables, eye salvage, associated adverse events, and patient survival. Data were analyzed using descriptive statistics. Kaplan-Meier survival curves and Cox hazard ratios were utilized to assess the effect of demographic and clinical variables over eye salvage. RESULTS: Bilateral Rb was observed in 61% of patients, and 57% of eyes received secondary treatment. Forty eyes needed intra-arterial plus IvitC and 62 presented advanced disease (group D and E). Three- and 5-year ocular survival probabilities were 75 and 68%. We found a higher risk in group D and E eyes and those requiring 2 or more routes for ophthalmic artery catheterization. Patients coming from other countries also showed increased risk. Using primary or secondary treatment, or IvitC, did not affect this risk. Overall rates of survival and eye salvages were 98.8 and 73%, and we had a 100% catheterization success and none ophthalmic arterial occlusions. CONCLUSIONS: In an upper middle-income country such as Colombia, a specialized institution counting with therapeutic alternatives and a multidisciplinary team can reach rates of patient survival and eye salvage similar to those of high-income countries.

Projection of E-Learning in Higher Education: A Study of Its Scientific Production in Web of Science.

E-learning is conceived as a purely virtual training approach. Different learning styles have been proliferated in recent years, especially now, due to the impact of COVID-19 in the educational field. The aim of this study is to discover the evolution of e-learning in higher education (ELHI) in scientific literature indexed on the Web of Science. Co-word analysis and bibliometric analysis was performed. A total matrix of 1261 documents was analyzed through SciMAT software. The results revealed that studies on ELHI are written in English and presented by conference papers. The main source of publication for the conferences is EDULEARN proceedings, while the journal source is Procedia-Social and Behavioral Sciences. Spain is the country with the highest volume of production. It is concluded that research on ELHI use does not have an established line of research, due to its recent creation and the lack of related research. The bibliometric analysis specifies that the research is oriented towards knowing the level of acceptance and application of the pedagogical method in the teaching and learning processes.

Adaptation and Validation of the Motivated Strategies for Learning Questionnaire for Spanish Adolescents.

This work adapts and validates the scale of the motivated strategies for learning questionnaire (MSLQ), which is used to measure motivation. For this, an instrumental design was carried out with the purpose of analyzing the psychometric properties of the instrument. The sample consisted of 307 participants enrolled in compulsory secondary education. Reliability with fit indices were good in model B (proposed) with composite reliability, global reliability index, and Cronbach's alpha. The original model (A) presented small problems that had to be adjusted when carrying out the translation. We concluded that adaptation and subsequent validation of the MSLQ instrument into a Spanish context was positive. In this sense, adequate adjustment rates have been achieved. However, in its contextual adequacy, the need arises to modify the presentation of the items alluding to intrinsic motivation due to the difficulty of measuring such a construct. Among the implications reached in this study is the possibility of having a validated instrument for the Spanish adolescent context to measure motivation on educational aspects. Furthermore, this tool can serve as the basis for the design of other instruments that measure this construct in other age ranges.

Spanish Adaptation and Validation of the Teaching and Learning Experiences Questionnaire.

Training processes are mainly based on the pedagogical methods applied by teachers. In many cases, these pedagogical methods are adapted to the social, economic, and cultural environment of the students themselves. In this study, we used a psychometric analysis based on the analysis of structural equations to detect the psychometric properties through classical goodness-of-fit indices. The objective of this study was to translate, adapt, and validate the instrument called the Teaching and Learning Experiences Questionnaire (ETLQ) for the population of Spanish adolescents in secondary education. The rrecommendations in the literature were followed for its translation and adaptation into Spanish. The results indicate that, after translation and adaptation, the model remained in 11 factors with acceptable goodness-of-fit indices. We conclude that the process of translation, adaptation, and validation of the ETLQ has produced a valid and reliable tool due to the psychometric findings revealed in the present work.

Molecular classification of a complex structural rearrangement of the RB1 locus in an infant with sporadic, isolated, intracranial, sellar region retinoblastoma.

Retinoblastoma is a childhood cancer of the retina involving germline or somatic alterations of the RB Transcriptional Corepressor 1 gene, RB1. Rare cases of sellar-suprasellar region retinoblastoma without evidence of ocular or pineal tumors have been described. A nine-month-old male presented with a sellar-suprasellar region mass. Histopathology showed an embryonal tumor with focal Flexner-Wintersteiner-like rosettes and loss of retinoblastoma protein (RB1) expression by immunohistochemistry. DNA array-based methylation profiling confidently classified the tumor as pineoblastoma group A/intracranial retinoblastoma. The patient was subsequently enrolled on an institutional translational cancer research protocol and underwent comprehensive molecular profiling, including paired tumor/normal exome and genome sequencing and RNA-sequencing of the tumor. Additionally, Pacific Biosciences (PacBio) Single Molecule Real Time (SMRT) sequencing was performed from comparator normal and disease-involved tissue to resolve complex structural variations. RNA-sequencing revealed multiple fusions clustered within 13q14.1-q21.3, including a novel in-frame fusion of RB1-SIAH3 predicted to prematurely truncate the RB1 protein. SMRT sequencing revealed a complex structural rearrangement spanning 13q14.11-q31.3, including two somatic structural variants within intron 17 of RB1. These events corresponded to the RB1-SIAH3 fusion and a novel RB1 rearrangement expected to correlate with the complete absence of RB1 protein expression. Comprehensive molecular analysis, including DNA array-based methylation profiling and sequencing-based methodologies, were critical for classification and understanding the complex mechanism of RB1 inactivation in this diagnostically challenging tumor.

Recombinant human ZP3-induced sperm acrosome reaction: evidence for the involvement of T- and L-type voltage-gated calcium channels.

For successful fertilization mammalian spermatozoa must undergo the acrosome reaction (AR), an exocytotic event that allows this cell to penetrate the outer layer of the oocyte, the zona pellucida (ZP). Four glycoproteins (ZP1-ZP4) compose the human ZP, being ZP3 the physiological inductor of the AR. This process requires changes in intracellular Ca(2+) concentration ([Ca(2+)](i)) involving not fully understood mechanisms. Even in mouse sperm, the pharmacologically documented participation of voltage-gated Ca(2+) (Ca(V)) channels and store-operated channels (SOCs) in the ZP-induced AR is being debated. The situation in human sperm is even less clear due to the limited availability of human ZP. Here, we used recombinant human ZP3 (rhZP3) produced in baculovirus-infected Sf9 cells to investigate the involvement of Ca(V) channels in the human sperm AR. Our findings showed that Ni(2+) and mibefradil at concentrations that block T-type or Ca(V)3 channels, and nimodipine and diltiazem that block L-type or Ca(V)1 channels, significantly inhibited the rhZP3-initiated AR. On the other hand, the AR was insensitive to concentrations of omega-Agatoxin IVA, omega-Conotoxin GVIA and SNX-482 that block P/Q, N and R-type channels, respectively (Ca(V)2 channels). Our overall findings suggest that Ca(V)1 and Ca(V)3 channels participate in human sperm AR. Consistent with this, we detected in human sperm transcripts for the Ca(V)1 auxiliary subunits, alpha(2)delta, beta(1), beta(2) and beta(4), but not the neuronal specific isoforms beta(3) and gamma(2).

Chemistry courses as the turning point for premedical students.

Previous research has documented that negative experiences in chemistry courses are a major factor that discourages many students from continuing in premedical studies. This adverse impact affects women and students from under-represented minority (URM) groups disproportionately. To determine if chemistry courses have a similar effect at a large public university, we surveyed 1,036 students from three entering cohorts at the University of California, Berkeley. We surveyed students at the beginning of their first year at the university and again at the end of their second year. All subjects had indicated an interest in premedical studies at the time they entered the university. We conducted follow-up interviews with a stratified sub-set of 63 survey respondents to explore the factors that affected their level of interest in premedical studies. Using a 10-point scale, we found that the strength of interest in premedical studies declined for all racial/ethnic groups. In the follow-up interviews, students identified chemistry courses as the principal factor contributing to their reported loss of interest. URM students especially often stated that chemistry courses caused them to abandon their hopes of becoming a physician. Consistent with reports over more than 50 years, it appears that undergraduate courses in chemistry have the effect of discouraging otherwise qualified students, as reflected in their admission to one of the most highly selective public universities in the US, from continuing in premedical studies, especially in the case of URM students. Reassessment of this role for chemistry courses may be overdue.

Effects on Personal Factors Through Flipped Learning and Gamification as Combined Methodologies in Secondary Education.

PURPOSE: This study aims to analyze the effects of a flipped and gamified program on the autonomy, competence, relation with others, satisfaction/enjoyment, intrinsic and extrinsic motivation, and boredom of students of Physical Education. METHOD: The study used a control group and an experimental group to compare pretest and posttest data in both of them. Instruments used were the Basic Psychological Needs in Exercise Scale, Sport Motivation Scale, and Sport Satisfaction Instrument, all of them validated in academic literature. RESULTS: On one hand, data indicated that autonomy has been increased with the application of these teaching methodologies. On the other hand, students' satisfaction, enjoyment, and intrinsic motivation have improved based on the interaction with gamification and flipped learning. Finally, with all dimensions, it seems that academic performance has been improved, although not in a significative way. DISCUSSION/CONCLUSION: Results of the study provide to educational researchers valuable information for a better understanding of how flipped learning and gamification influence personal performance of Physical Education students.

Evaluating Activation and Absence of Negative Effect: Gamification and Escape Rooms for Learning.

Innovation has allowed for and developed new ways of teaching and learning. Gamification is among the new training methodologies, which is a didactic approach based on the game structure with an attractive component for students. Within gamification, flipped learning and problem-based learning, escape rooms can be found as a technical aspect, which is focused on providing enigmas and tracks for the various educational content that students have assimilated through learning based on problem solving. The aim of this study is to identify how the use of gamification with the use of educational escape rooms affects activation and absence of a negative effect on students. 61 Master students of the Autonomous City of Ceuta participated in this case study. They were divided into three study groups (1 control group; 2 experimental groups) that followed different formative actions (control group-traditional; experimental groups-escape rooms). To achieve the objectives, a mixed research design based on quantitative and qualitative techniques was followed. The instrument used for data collection was the GAMEX (Gameful Experience Scale). The results reveal that the students who had taken a gamified formative action through escape rooms obtained better assessment results in the indicators concerning motivation, teamwork, commitment, activation, and absence of a negative effect on the learning process than those with the traditional methodology.

Suicidal Ideation, Psychological Distress and Child-To-Parent Violence: A Gender Analysis.

Child-to-parent violence (CPV) is a growing public health problem with consequences for perpetrators and families. Most research has focused on individual and family risk factors. However, little is known about its links with individual outcomes. The aim of this study was to analyze the relationships between CPV and psychological distress, suicidal ideation, and self-concept in school-aged adolescents, taking into account the gender perspective. A study was conducted with a sample of 8,115 adolescents, aged between 11 and 16 years (M = 13.34; SD = 1.04) from the State of Nuevo León, Mexico. A MANOVA 3 × 2 was performed to analyze the data. The results revealed that adolescents involved in CPV showed higher levels of psychological distress and suicidal ideation and lower levels of family and social self-concept. It was also observed that girls with higher levels of CPV scored the lowest levels of psychological distress and suicidal ideation, as well as the lowest levels of family self-concept. The findings highlight that adolescents and especially girls involved in CPV also report internal maladjustment outcomes. Finally, the results and their implications for research and intervention with adolescents involved in CPV are discussed.

Tutorial Action and Emotional Development of Students as Elements of Improved Development and Preventing Problems Related with Coexistence and Social Aspects.

Integral development of students is promoted through tutorial action. Tutorial action is understood as the personal development of students, their learning, and their capabilities for social and labour integration. A descriptive, nonexperimental and ex post facto design was used. The sample consisted of 569 primary school students. The importance of emotional education and student tutoring was highlighted by the results produced. A relationship was established between working on emotions and emotional regulation, cognitive re-evaluation, and capacity to respond in an emotionally appropriate way when faced with different situations.

Response to SARS-CoV-2 Pandemic in a Non-COVID-19 Designated Latin-American Neurosurgery Department.

Background: Mexico declared the first case of novel coronavirus disease (COVID-19) in February 2020. At the time we write this article, our country is facing a community spread phase, expecting a rapid increase in the number of cases and fatalities. The Fray Antonio Alcalde Civil Hospital of Guadalajara has been declared a non-COVID-19 hospital with the mission of providing care to patients already registered and also those transferred from neurosurgical departments of neighboring centers, which have been converted into COVID-19 only hospitals. Methods: An organized response regarding personnel, surgical case selection, operating room behavior, and facility reorganization were designed to prevent an internal coronavirus outbreak in the neurosurgery department at the Fray Antonio Alcalde Civil Hospital of Guadalajara. Results: Distancing actions by the staff and residents, including ward case discussions, neurosurgery rounds, and classes, will be carried out virtually. We classified neurosurgical patients into 4 groups depending on whether their condition demands care in 0-6 hours, 6-48 hours, 48 hours to 14 days, and >14 days. Subsequently, a questionnaire with epidemiologic, radiologic, clinical, and serologic criteria will be applied to determine the risk of COVID-19 infection to define to which area they are going to be transferred according to the different risk zones in our facility. Conclusions: Despite not being a COVID-19 center, we consider all patients at the neurosurgical ward and staff members as asymptomatic carriers or infected in the preclinical period. Specific measures must be taken to ensure the safety and care of neurosurgical patients and medical staff during the community spread phase.