Incidence, Outcomes, and Predictors of Ventricular Thrombus after Reperfused ST-Segment-Elevation Myocardial Infarction by Using Sequential Cardiac MR Imaging.

Purpose To characterize the incidence, outcomes, and predictors of left ventricular (LV) thrombus by using sequential cardiac magnetic resonance (MR) imaging after ST-segment-elevation myocardial infarction (STEMI). Materials and Methods Written informed consent was obtained from all patients, and the study protocol was approved by the committee on human research. In a cohort of 772 patients with STEMI, 392 (mean age, 58 years; range, 24-89 years) were retrospectively selected who were studied with cardiac MR imaging at 1 week and 6 months. Cardiac MR imaging guided the initiation and withdrawal of anticoagulants. Patients with LV thrombus at 6 months were restudied at 1 year. For predicting the occurrence of LV thrombus, a multiple regression model was applied. Results LV thrombus was detected in 27 of 392 patients (7%): 18 (5%) at 1 week and nine (2%) at 6 months. LV thrombus resolved in 22 of 25 patients (88%) restudied within the first year. During a mean follow-up of 181 weeks ± 168, patients with LV thrombus displayed a very low rate of stroke (0%), peripheral embolism (0%), and severe hemorrhage (n = 1, 3.7%). LV ejection fraction (LVEF) less than 50% (P < .001) and anterior infarction (P = .008) independently helped predict LV thrombus. The incidence of LV thrombus was as follows: (a) nonanterior infarction, LVEF 50% or greater (one of 135, 1%); (b) nonanterior infarction, LVEF less than 50% (one of 50, 2%); (c) anterior infarction, LVEF 50% or greater (two of 92, 2%); and (d) anterior infarction, LVEF less than 50% (23 of 115, 20%) (P < .001 for the trend). Conclusion Cardiac MR imaging contributes information for the diagnosis and therapy of LV thrombus after STEMI. Patients with simultaneous anterior infarction and LVEF less than 50% are at highest risk. © RSNA, 2017 Online supplemental material is available for this article.

[Association between physical fitness parameters and health related quality of life in Chilean community-dwelling older adults]. / Asociación predictiva entre parámetros de condición física y dimensiones de calidad de vida relacionada con la salud en adultos mayores chilenos insertos en la comunidad.

BACKGROUND: There is no conclusive evidence about the association between physical fitness (PF) and health related quality of life (HRQOL) in older adults. AIM: To seek for an association between PF and HRQOL in non-disabled community-dwelling Chilean older adults. MATERIAL AND METHODS: One hundred and sixteen subjects participated in the study. PF was assessed using the Senior Fitness Test (SFT) and hand grip strength (HGS). HRQOL was assessed using eight dimensions provided by the SF-12v2 questionnaire. Binary multivariate logistic regression models were carried out considering the potential influence of confounder variables. RESULTS: Non-adjusted models, indicated that subjects with better performance in arm curl test (ACT) were more likely to score higher on vitality dimension (OR > 1) and those with higher HGS were more likely to score higher on physical functioning, bodily pain, vitality and mental health (OR > 1). The adjusted models consistently showed that ACT and HGS predicted a favorable perception of vitality and mental health dimensions respectively (OR > 1). CONCLUSIONS: HGS and ACT have a predictive value for certain dimensions of HRQOL.

[Association of grip strength with gender age and handedness in 116 older people]. / Fuerza prensil de mano y su asociación con la edad, género y dominancia de extremidad superior en adultos mayores autovalentes insertos en la comunidad: Un estudio exploratorio.

BACKGROUND: Hand grip strength could be influenced by gender, age and handedness. AIM: To describe differences in grip strength for age, gender and upper extremity handedness in non-disabled community-dwelling older adults. MATERIAL AND METHODS: We studied 47 males aged 72.3 ± 5.6 years and 69 females 72.4 ± 6.0 years who were divided in two age groups (65-70 and ≥ 71 years old). Grip strength was determined by a standardized protocol using a hand dynamometer. RESULTS: There was an inverse correlation between grip strength and age in both hands only among men (p ≤ 0.05). When analyzing both genders, there was a significant inverse correlation between grip strength and age only in the dominant hand (p ≤ 0.05). Strength was higher in the dominant hand in both genders (p ≤ 0.05). It was also higher in men, compared to women in the two age groups studied (p ≤ 0.05). CONCLUSIONS: Grip strength is higher in men than women, it decreases with age and is higher in the dominant hand.

TiNi-Based Bi-Metallic Shape-Memory Alloy by Laser-Directed Energy Deposition.

In this study, laser-directed energy deposition was applied to build a Ti-rich ternary Ti-Ni-Cu shape-memory alloy onto a TiNi shape-memory alloy substrate to realize the joining of the multifunctional bi-metallic shape-memory alloy structure. The cost-effective Ti, Ni, and Cu elemental powder blend was used for raw materials. Various material characterization approaches were applied to reveal different material properties in two sections. The as-fabricated Ti-Ni-Cu alloy microstructure has the TiNi phase as the matrix with Ti2Ni secondary precipitates. The hardness shows no high values indicating that the major phase is not hard intermetallics. A bonding strength of 569.1 MPa was obtained by tensile testing, and digital image correlation reveals the different tensile responses of the two sections. Differential scanning calorimetry was used to measure the phase-transformation temperatures. The austenite finishing temperature of higher than 80 °C was measured for the Ti-Ni-Cu alloy section. For the TiNi substrate, the austenite finishing temperature was tested to be near 47 °C at the bottom and around 22 °C at the upper substrate region, which is due to the repeated laser scanning that acts as annealing on the substrate. Finally, the multiple shape-memory effect of two shape-memory alloy sides was tested and identified.

Health and economic burden due to malaria in Peru over 30 years (1990-2019): Findings from the global burden of diseases study 2019.

Background: Malaria is one of the biggest impediments to global progress. In Peru, it is still a major public health problem. Measures of health and economic burden due to malaria are relevant considerations for the assessment of current policies. Methods: We used estimates from the Global Burden of Diseases Study 2019 for malaria in Peru, grouped by gender and age, from 1990 to 2019. Results are presented as absolute numbers and age-standardized rates with 95% uncertainty intervals (UI). We collected economic data from the World Bank and The National Institute of Statistics and Informatics of Peru and Loreto to calculate the economic burden of productivity loss (EBPL) using the human capital approach. Economic values were presented in constant dollars, soles, and percentages. Findings: Rates of deaths, years of life lost (YLLs), years lived with disability (YLDs), and disability-adjusted life years (DALYs), as well as the EBPL, were drastically reduced from 1990 to 2019. DALYs had a greater percentage of YLDs in 2019 than in 1990. DALYs rates showed no preference between sexes, but the "< 1 year" age group had the highest DALYs values over the study period. We found that the EBPL due to malaria for Loreto was considerably higher than Peru's in terms of GDP percentage. Interpretation: Our study shows that the fight against malaria in Peru reduced remarkably the impact of the disease since 1990; however, during the last decade the estimates were stable or even increased. Our results help to measure the malaria impact on the health status of the Peruvian population as well as the economic pressure that it exerts, constituting remarkable tools for policymaking aimed at reducing the burden of this disease. Strengthening the malaria elimination program is important to achieve the elimination of the disease in the coming years. Funding: This study was supported by the Universidad Nacional Toribio Rodríguez de Mendoza and FONDECYT: Contrato Nº 09-2019-FONDECYT-BMINC.INV and FONDECYT-BM, Perú (Program INCORPORACIÓN DE INVESTIGADORES E038-2019-01, Registry Number: 64007).

Microbiological profile of urinary tract infections in a tertiary medical facility in Western Mexico: An update.

Urinary tract infections (UTIs) are one of the most important issues in modern medicine. In developing countries, the use of antibiotics is a common practice, and due to this, antibiotic resistance has increased. The objective of this research was to update and report on the microbiological profile of urinary tract infections based on the number of positive urine cultures (UCs), resistance, sensitivity, and the prevalence of bacterial strains. The results were obtained from the database of a tertiary medical facility in Western Mexico. The number of positive UCs was 1769 from inpatients and outpatients who were users of medical services in the hospital from January to December of 2017. The most commonly isolated microorganism was E. coli, with 1225 cases, of which 603 (49.2%) were ESBL (Extended-Spectrum Beta-Lactamase-producing bacteria) strains. The resistance rate of nitrofurantoin was 36.6%, and meropenem showed the most promising results with a resistance rate of only 7.1%. Resistances to quinolones and cephalosporins among the isolates investigated were 51%-67%. Based on our results, it is necessary to increase controls and to improve management protocols in order to achieve better medical practices by reducing antibiotic resistance.

Immediate effects of a direct myofascial release technique on hip and cervical flexibility in inactive females with hamstring shortening: A randomized controlled trial.

BACKGROUND: Currently, greater background is required about the effectiveness of myofascial release (MFR) on muscle flexibility. OBJECTIVE: Our goal was to determine the immediate effect of a direct MFR technique on hip and cervical flexibility in inactive females with hamstring shortening. METHOD: The sample group included 68 female university students, randomly divided into a control group (n = 34) and an experimental group (n = 34). A placebo technique was used with the control group, and direct MFR on the posterior thigh region was used with the experimental group. RESULTS: The mixed factorial ANOVA did not show significant intergroup differences (p > 0.05). In the experimental group, Bonferroni post hoc test showed significant intragroup differences between pre-test and post-test 1, as well as between pre-test and post-test 2 for the three ischiotibial muscle flexibility tests (p < 0.001). Cervical flexion range of motion showed significant differences between pre-test and post-test 1 (p < 0.001). CONCLUSIONS: We conclude that the protocol based on a single direct MFR intervention was no more effective than the placebo in improving flexibility both locally at the hamstring level and remotely at the level of the cervical extensor muscles. Future research should consider different MFR techniques on the immediate increase in muscle flexibility and the long-term effect of MFR, as well as consider different intervention groups.

Antibiotic resistance: Microbiological profile of urinary tract infections in Mexico.

OBJECTIVE: The objective of this study was to describe the prevalence, microbiological profile, bacterial resistance, and the sensitivity to antibiotics of microorganisms causing urinary tract infection (UTI) at a single-site tertiary referral hospital in the western region of Mexico. METHODS: A total of 5895 culture samples processed at the microbiology laboratory from August 1, 2014, to July 31, 2015, were analyzed. RESULTS: A total of 5895 samples for urine cultures (UC) were collected, of which 3363 were taken in women (57.05%) and 2532 in men (42.95%). A prevalence of 24% was calculated. From 1444 positive UC, 1512 microorganisms were isolated; the major etiological agent was Escherichia coli, representing 67.28% followed by Pseudomonas with 7.12%. With respect to fungi, Candida glabrata was found as the most common agent. Susceptibility to daptomycin and linezolid was 100%, and meropenem, 91.4%. Highest antimicrobial resistance was found for ampicillin (77.47%) and moxifloxacin (72.89%). Nearly 49% of E. coli strains and 27% of Klebsiella pneumoniae strains showed extended-spectrum beta-lactamase (ESBL) production. CONCLUSIONS: Bacterial UTI persists as one of the most common infections affecting all age groups and both genders. As in other countries, E. coli ranks first in Mexico, with 67.28%, and nearly 50% of the strains produce ESBL.

OBJETIVO: Describir la prevalencia, el perfil microbiológico, la resistencia y la sensibilidad a los antibióticos de microorganismos causantes de infecciones de vías urinarias en un centro de referencia de tercer nivel en el occidente de México. MÉTODO: Se realizó un estudio transversal que incluyó 5895 urocultivos procesados en el laboratorio de microbiología del 1 de agosto de 2014 al 31 de julio de 2015. RESULTADOS: De los 5895 urocultivos, 3363 correspondieron a mujeres (57.05%) y 2532 a varones (42.95%). De los 1444 resultados positivos, se aislaron 1512 microorganismos (prevalencia del 24%); el más común fue ­Escherichia coli, con un 67.28%, seguido por Pseudomonas con un 7.12%. Candida glabrata se reportó como el patógeno fúngico más frecuente. De manera general, la sensibilidad a la daptomicina y al linezolid fue del 100%, y al meropenem fue del 91.4%. La resistencia más alta se reportó para ampicilina y moxifloxacino (77.47 y 72.89%, respetivamente). Cerca del 49% y del 27% de las cepas de E. coli y Klebsiella pneumoniae mostraron producción de betalactamasas de espectro extendido. CONCLUSIONES: Las infecciones de vías urinarias persisten como una de las formas más habituales de infección y afectan a todos los grupos de edad. En México, al igual que en otros países, E. coli se coloca en primer lugar de frecuencia, con el 67.28%.

Prognostic Value of Initial Left Ventricular Remodeling in Patients With Reperfused STEMI.

OBJECTIVES: This study sought to establish the best definition of left ventricular adverse remodeling (LVAR) to predict outcomes and determine whether its assessment adds prognostic information to that obtained by early cardiac magnetic resonance (CMR). BACKGROUND: LVAR, usually defined as an increase in left ventricular end-diastolic volume (LVEDV) is the main cause of heart failure after an ST-segment elevated myocardial infarction; however, the role of assessment of LVAR in predicting cardiovascular events remains controversial. METHODS: Patients with ST-segment elevated myocardial infarction who received percutaneous coronary intervention within 6 h of symptom onset were included (n = 498). CMR was performed during hospitalization (6.2 ± 2.6 days) and after 6 months (6.1 ± 1.8 months). The optimal threshold values of the LVEDV increase and the LV ejection fraction decrease associated with the primary endpoint were ascertained. Primary outcome was a composite of cardiovascular mortality, hospitalization for heart failure, or ventricular arrhythmia. RESULTS: The study was completed by 374 patients. Forty-nine patients presented the primary endpoint during follow-up (72.9 ± 42.8 months). Values that maximized the ability to identify patients with and without outcomes were a relative rise in LVEDV of 15% (hazard ratio [HR]: 2.1; p = 0.007) and a relative fall in LV ejection fraction of 3% (HR: 2.5; p = 0.001). However, the predictive model (using C-statistic analysis) failed to demonstrate that direct observation of LVAR at 6 months adds information to data from early CMR in predicting outcomes (C-statistic: 0.723 vs. 0.795). CONCLUSIONS: The definition of LVAR that best predicts adverse cardiovascular events should consider both the increase in LVEDV and the reduction in LV ejection fraction. However, assessment of LVAR does not improve information provided by the early CMR.

Reversible biomechano-responsive surface based on green fluorescent protein genetically modified with unnatural amino acids.

GFP has been genetically modified at two specific positions of its molecular architecture. These modifications allow its covalent attachment onto PEG brushes grafted on functionalized silicone surfaces. The stretching of this material leads to a reversible decrease of the fluorescence intensity due to stretch-induced forces applying on GFP molecules.

A new biomimetic route to engineer enzymatically active mechano-responsive materials.

Using modified ß-galactosidase covalently linked to cross-linked polyelectrolyte multilayers (PEM), catalytically active materials have been designed. Their enzymatic activity can be modulated, partially in a reversible way, simply by stretching. This strategy, based on enzyme conformational changes, constitutes a new tool for the development of biocatalytic mechano-responsive materials.

Resilience Processes, Engagement and Emotional Competencies, in Professionals Attending Elder People in Violence Situations in Saltillo, Coahuila and Monterrey, Nuevo León, Mexico / Procesos de Resiliencia, Engagement y Competencias Emocionales en profesionales de atención a población adulta mayor en situaciones de violencia en Saltillo, Coahuila y Monterrey, Nuevo León México

Abstract. In recent years, an increasing number of studies have investigated resilience, which is considered a phylogenetic process developed to increase survival (Stein, 2009; Aparecida dos Santos & Nunes Moreira, 2014). Resilience is a construct that has been the topic of many studies. The objective of this investigation is to identify the relationship between the five dimensions of resilience in professionals who tend to elderly people, labor engagement and the emotional competencies. Several linear regression models were used to investigate the levels of prediction between the independent and dependent variables. The main results show relationships among resilience and its different dimensions, engagement (B = .207; p = .005) and emotional competencies (B =.710; p =.000) including four of its five dimensions on the analysis (R2 = .724, F = 108.63, gl = 2, p = .000).

Resumen. En los últimos años se han incrementado los estudios sobre la resiliencia como un proceso desarrollado filogenéticamente para la supervivencia (Stein, 2009; Aparecida dos Santos & Nunes Moreira, 2014). El objetivo de esta investigación fue identificar la relación existente entre las dimensiones de la resiliencia de profesionales que atienden adultos mayores y el engagement laboral y la relación con las competencias emocionales. Se elaboraron modelos de regresión lineal para establecer los niveles de predicción entre las variables independientes y dependiente. Los principales resultados arrojan una relación entre la resiliencia (así como sus diversas dimensiones), el engagement (B = .207; p =. 005) y las competencias emocionales (B =.710; p =.000) incluyendo cuatro de las cinco dimensiones en el análisis (R2= .724, F = 108.63, gl = 2, p = .000).

Chronically HIV-1 Infected Patients Exhibit Low Frequencies of CD25+ Regulatory T Cells.

The characterization of regulatory T cells (Treg) during HIV infection has become of particular interest considering their potential role in the pathogenesis of the acquired immunodeficiency syndrome. Different reports on Tregs in HIV-infected patients vary greatly, depending on the state of disease progression, anatomical compartment, and the phenotypic markers used to define this cell subpopulation. To determine the frequency of Tregs we included paired samples from peripheral blood and rectal biopsies from controls and chronic HIV patients with or without detectable viral load. Tregs were determined by flow cytometry using three different protocols: CD4(+)Foxp3(+); CD4(+)Foxp3(+)CD127(Low/-), and CD4(+)CD25(+)CD127(Low/-). In addition, and with the purpose to compare the different protocols we also characterized Tregs in peripheral blood of HIV negative individuals with influenza like symptoms. Here, we report that Treg characterization in HIV-infected patients as CD4(+)Foxp3(+) and CD4(+)Foxp3(+)CD127(Low/-) cells was similar, indicating that both protocols represent a suitable method to determine the frequency of Tregs in peripheral blood mononuclear cells (PBMC) and gut associated lymphoid tissue (GALT). In contrast, in HIV but not in flu-like patients, detection of Tregs as CD4(+)CD25(+)CD127(Low/- )cells resulted in a significantly lower percentage of these cells. In both, HIV patients and controls the frequency of Treg was significantly higher in GALT compared to PBMC. The frequency of Tregs in PBMC and GALT using CD4(+)Foxp3(+) and CD4(+)Foxp3(+)CD127(Low/-) was higher in HIV patients than in controls. Similarly, the frequency of Treg using any protocol was higher in flu-like patients compared to controls. The results suggest that relying on the expression of CD25 could be unsuitable to characterize Tregs in PBMC and GALT samples from a chronic infection such as HIV.

Asociación predictiva entre parámetros de condición física y dimensiones de calidad de vida relacionada con la salud en adultos mayores chilenos insertos en la comunidad / Association between physical fitness parameters and health related quality of life in Chilean community-dwelling older adults

Background: There is no conclusive evidence about the association between physical fitness (PF) and health related quality of life (HRQOL) in older adults. Aim: To seek for an association between PF and HRQOL in non-disabled community-dwelling Chilean older adults. Material and Methods: One hundred and sixteen subjects participated in the study. PF was assessed using the Senior Fitness Test (SFT) and hand grip strength (HGS). HRQOL was assessed using eight dimensions provided by the SF-12v2 questionnaire. Binary multivariate logistic regression models were carried out considering the potential influence of confounder variables. Results: Non-adjusted models, indicated that subjects with better performance in arm curl test (ACT) were more likely to score higher on vitality dimension (OR > 1) and those with higher HGS were more likely to score higher on physical functioning, bodily pain, vitality and mental health (OR > 1). The adjusted models consistently showed that ACT and HGS predicted a favorable perception of vitality and mental health dimensions respectively (OR > 1). Conclusions: HGS and ACT have a predictive value for certain dimensions of HRQOL.

Fuerza prensil de mano y su asociación con la edad, género y dominancia de extremidad superior en adultos mayores autovalentes insertos en la comunidad: Un estudio exploratorio / Association of grip strength with gender age and handedness in 116 older people

Background: Hand grip strength could be influenced by gender, age and handedness. Aim: To describe differences in grip strength for age, gender and upper extremity handedness in non-disabled community-dwelling older adults. Material and Methods: We studied 47 males aged 72.3 ± 5.6 years and 69 females 72.4 ± 6.0 years who were divided in two age groups (65-70 and ≥ 71 years old). Grip strength was determined by a standardized protocol using a hand dynamometer. Results: There was an inverse correlation between grip strength and age in both hands only among men (p ≤ 0.05). When analyzing both genders, there was a significant inverse correlation between grip strength and age only in the dominant hand (p ≤ 0.05). Strength was higher in the dominant hand in both genders (p ≤ 0.05). It was also higher in men, compared to women in the two age groups studied (p ≤ 0.05). Conclusions: Grip strength is higher in men than women, it decreases with age and is higher in the dominant hand.

Diverticulitis cecal simulando apendicitis aguda / Cecal diverticulitis mimicking acute appendicitis

Se describen cinco casos de diverticulitis cecal: todos presentaban dolor leve a moderado en fosa iliaca derecha sin otros signos de toxicidad. Todos fueron intervenidos con diagnóstico inicial de apendicitis aguda. Tres casos no presentaron duda de ser diverticulitis cecal durante cirugía y se realizó diverticulectomía, en los otros dos se realizó colectomía derecha y anastomosis (por importante proceso inflamatorio y sospecha de cáncer). Uno de los casos con colectomía presentó dehiscencia, falla multiorgánica y óbito.

We describe five cases of cecal diverticulitis: all of them present with mild or moderate pain in right lower quadrant without other toxicity sign. In all of them the initial diagnosis was acute appendicitis. At the surgery, three cases present no doubt of cecal diverticulitis and diverticulectomy was made, in the two others right colectomy with anastomosis was perform (because of important inflammation and suspicious of cancer). One of the colectomy cases present dehiscence, organ failure and death.

Prevalencias de hemorragias digestivas en el Hospital de Clínicas, Asunción, Paraguay / Prevalence of gastrointestinal bleeding at Hospital de Clínicas, Asución, Paraguay

Las hemorragias digestivas (HD) constituyen una emergencia de soporte médico. Objetivo: demostrar la prevalencia de las HD, en un Hospital paraguayo de referencia. Se realiza un estudio observacional, descriptivo, de corte transversal y con componente analítico de las terapéuticas instituidas. La población concurrente al Departamento de Urgencias fue de 14.475 pacientes y el total de ingresos a recuperaciones 3.300 pacientes. El total de HD fue de 207 casos (6,27 por ciento). Al ingreso se constataron 123 casos de hematemesis y melena (59,42 por ciento). Hemorragia digestiva alta se presentó en 133 casos (64,25 por ciento); hemorragia digestiva baja en 46 casos (22,22 por ciento) e ignorados en 28 casos. Endoscopia digestiva se realizó en 133 casos (64,25 por ciento). Presentaron hemodinamia inestable 48 pacientes. Fueron internados 105 pacientes, dados de alta 90 pacientes. La mortalidad global fue de 15 pacientes (7,24 por ciento). Se realizaron 19 cirugías con mortalidad de 5 (26,31 por ciento). La hemorragia digestiva alta fue la más frecuente con 133 casos (64,25 por ciento). La terapéutica quirúrgica se realizó en 9,17 por ciento y la terapéutica médica conservadora fue la más empleada

Carcinoma insular de tiroides / Insular carcinoma of thyrid

Determina la prevalencia del carcinoma insular de tiroides en relación a todos los carcinomas de la glándula tiroides, carcterísticas clínicas, metodología diagnóstica y tratamientos empleados con análisis de sus resultados