Intraventricular neurocytoma: A diagnostic challenge with prognostic value.

Intraventricular neurocytoma is a low incidence central nervous system tumor. It predominantly affects young adults with no apparent gender predilection. The main symptoms include headache, nausea and vomiting. These result from hydrocephalus due to the obstruction of cerebrospinal fluid flow. On diagnostic imaging, neurocytoma can be suspected by some features, such as peripheral cysts, lobulated contours and septa that bridge the ventricular wall, giving a "scalloped" appearance. There are other characteristics, but they are less specific for the diagnosis. The atypical variant of neurocytoma is even rarer and leads to a worst prognosis. Atypical neurocytomas develop higher proliferative potential identified by the Ki-67 biomarker and higher recurrence rate. There are few studies about the imaging characteristics of atypical neurocytomas. At this point, there are no reliable distinctive features to differentiate atypical neurocytomas, especially due to their low incidence. We present the case of a 20-year-old female patient with symptoms of intracraneal hypertension. CT and MRI of the brain revealed a mass occupying the body of the left lateral ventricle, adjacent to the foramen of Monro. The mass was primarily solid with discrete peripheral cyst and a few scalloped areas. It also showed signs of supratentorial obstructive hydrocephalus. The tumor was partially removed because of bleeding and compromise of vascular structures. Immunohistochemistry revealed positive synaptophysin, elevated Ki-67 (7%), increased number of blood vessels and moderate nuclear atypia. After surgery, the patient persisted with signs of intracranial hypertension, not improving with clinical management and requiring aggressive surgical procedures. While rare, atypical neurocytoma requires a better characterization, especially through imaging, to optimize immediate management and explore new therapeutic options.

Sugar-conditioned honey bees can be biased towards a nectarless dioecious crop.

The targeted pollination strategy has shown positive results in directing honey bees to crop flowers offering nectar along with pollen as reward. Kiwifruit is a functionally dioecious species, which relies on bees to transport pollen from staminate to pistillate nectarless flowers. Following the targeted pollination procedures recently validated, we first developed a mimic odor (KM) based on kiwifruit floral volatiles for which bees showed the highest level of generalization to the natural floral scent, although the response towards pistillate flowers was higher than towards staminate flowers. Then, in the field, feeding colonies KM-scented sucrose solution resulted in higher amounts of kiwifruit pollen collected by honey bees compared to control colonies fed unscented sucrose solution. Our results support the hypothesis that olfactory conditioning bees biases their foraging preferences in a nectarless crop, given the higher visitation to target flowers despite having provided the mimic odor paired with a sugar reward.

Cleft lip and palate surgery simulator: Open source simulation model.

Objective: Cleft lip and palate is the most common craniofacial birth anomaly and requires surgery in the first year of life. However, craniofacial surgery training opportunities are limited. The aim of this study was to present and evaluate an open-source cleft lip and palate hybrid (casting and three-dimensional (3D) printing) simulation model which can be replicated at low cost to facilitate the teaching and training of cleft surgery anatomy and techniques. Design: The soft tissue component of the cleft surgery training model was casted using a 3D printed 5-component mold and silicone. The bony structure was designed to simulate the facial anatomy and to hold the silicone soft tissue. Setting: Two groups, one group of trainees and one group of expert surgeons, at University Hospital Basel in Switzerland and Pontifical Catholic University of Chile in Santiago, Chile, tested the cleft lip and palate simulation model. Participants completed a Likert-based face and content validity questionnaire to assess the realism of the model and its usefulness in surgical training. Results: More than 70 % of the participants agreed that the model accurately simulated human tissues found in patients with unilateral cleft lip and palate. Over 60 % of the participants also agreed that the model realistically replicated surgical procedures. In addition, 80-90 % of the participants found the model to be a useful and appropriate tool for teaching the anatomy and surgical techniques involved in performing unilateral cleft lip and palate repair. Conclusion: This open-source protocol provides a cost-effective solution for surgeons to introduce the cleft morphology and surgical techniques to trainees on a regular basis. It addresses the current financial barrier that limits access to commercially available models during the early stages of surgeon training prior to specialization in the field.

Management of CRSwNP in Latin America: A multidisciplinary consensus from an expert working group.

Chronic rhinosinusitis with nasal polyps (CRSwNP) is an inflammatory condition of the nasal and paranasal tissues, characterized by the presence of bilateral nasal polyps. While etiology and pathogenetic mechanisms are heterogeneous and complex, in most patients, disease is mediated predominantly through type 2 inflammatory processes. Clinical management is challenging, and a multidisciplinary approach is preferred. Principal treatment approaches are the use of local/systemic corticosteroids and sinonasal surgery, although outcomes can be unsatisfactory. Recent availability of biological therapies targeting underlying inflammatory processes can offer effective treatment options in uncontrolled disease. Specialist guidelines greatly assist clinical decision-making, although as these are chiefly written from a global/international perspective, they may not wholly accommodate disease patterns and clinical practice at a regional level. An expert panel of specialists from Latin America was convened to develop regional guidance on the management of CRSwNP through a consensus approach. The present article presents the chief observations and recommendations which can provide guidance for clinicians in the Latin American region.

Labeled dataset for training despeckling filters for SAR imagery.

When training Artificial Intelligence and Deep Learning models, especially by using Supervised Learning techniques, a labeled dataset is required to have an input with data and its corresponding labeled output data. In the case of images, for classification, segmentation, or other processing tasks, a pair of images is required in the same sense, one image as an input (the noisy image) and the desired (the denoised image) one as an output. For SAR despeckling applications, the common approach is to have a set of optical images that then are corrupted with synthetic noise, since there is no ground truth available. The corrupted image is considered the input and the optical one is the noiseless one (ground truth). In this paper, we provide a dataset based on actual SAR images. The ground truth was obtained from SAR images of Sentinel 1 of the same region in different instants of time and then they were processed and merged into one single image that serves as the output of the dataset. Every SAR image (noisy and ground truth) was split into 1600 images of 512 × 512 pixels, so a total of 3200 images were obtained. The dataset was also split into 3000 for training and 200 for validation, all of them available in four labeled folders.

Study of the Direct Costs of Asthma at a Healthcare Service Provider in Bogotá, Colombia.

OBJECTIVES: This study aimed to describe clinical characteristics and direct medical costs associated with disease treatment in Colombia patients with asthma from 1 healthcare provider. METHODS: This was a descriptive study with a retrospective data collection from a healthcare provider's electronic medical records in Colombia. A clinical, demographic, and healthcare resource utilization profile was developed over a 12-month observation period after the identification of eligible patients. To determine the mean cost per patient per year, the total frequencies of resource utilization were added, and the result was multiplied by the unit cost of each of them. RESULTS: A total of 7919 patients were included in the analysis. The mean ± SD cost per patient per year ranged from $189.5 ± $1.900.6 to $240.2 ± $1.903.6 depending on the price guidebook. The total cost had been driven by the medication use (79% of total cost) and by the outpatient visits (20% of total cost). CONCLUSIONS: In the population analyzed, the mean total direct cost per patient per year of asthma was $189.5 and $240.2, depending on the cost source. Direct medical costs were higher in cases classified as severe and in the adult and elderly population. When comparing the sources of resource utilization, it was found that the mean cost per patient obtained from real-life data is lower than the theoretical cost obtained from the bottom-up method with quantification of resources from experts. It is important to consider limitations related to study design and the evolving landscape of asthma treatments.

Revisão bioética sobre a legalidade da morte assistida no Equador / Bioethical review on the legality of assisted dying in Ecuador / Revisión bioética acerca de la legalidad de la muerte asistida en el Ecuador

Resumo A legalidade da morte assistida é controversa em todo o mundo devido a aspectos bioéticos. Em países como Luxemburgo e Canadá, a eutanásia foi aprovada, gerando impactos positivos na qualidade de vida de pacientes; entretanto, há aspectos negativos, como o abandono de opções paliativas. Esta revisão bibliográfica descritiva considerou publicações dos últimos cinco anos com enfoques bioéticos a favor da morte assistida, com base na importância de aliviar definitivamente a sintomatologia do paciente, além de proporcionar qualidade de vida, mas referiu também que a longo prazo a legalidade desse procedimento pode acarretar desumanização médica. O Código Orgânico Integral Penal Integral do Equador apresenta artigos ambíguos a favor e contra a morte assistida, com brechas legais que não permitem sua aplicação no sistema de saúde. Embora haja argumentos sólidos a favor e contra a eutanásia, a decisão deve ser adaptada ao contexto do paciente e do sistema de saúde.

Abstract The legality of assisted dying is a controversial matter worldwide due to bioethical aspects. In countries such as Luxembourg and Canada, euthanasia was approved, with positive impacts on the quality of life of patients; however, there are negative aspects, such as not taking palliative options into consideration. This descriptive literature review considered publications from the last five years with bioethical approaches in favor of assisted dying, based on the importance of definitively alleviating patient symptomatology, in addition to providing quality of life, but also noting that in the long term the legality of this procedure may lead to medical dehumanization. Ecuador's Comprehensive Organic Criminal Code presents ambiguous articles for and against assisted dying, with legal loopholes that preclude its application in the health care system. Despite solid arguments for and against euthanasia, the decision must be adapted to the context of the patient and health care system.

Resumen La legalidad de la muerte asistida es controvertida en todo el mundo debido a aspectos bioéticos. En países como Luxemburgo y Canadá, la eutanasia ha sido aprobada, generando impactos positivos en la calidad de vida de pacientes; sin embargo, hay aspectos negativos, como el abandono de opciones paliativas. Esta revisión bibliográfica descriptiva consideró publicaciones de los últimos cinco años con enfoques bioéticos a favor de la muerte asistida, con base en la importancia de aliviar definitivamente la sintomatología del paciente, además de proporcionar calidad de vida, pero refirió también que, a largo plazo, la legalidad de este procedimiento puede acarrear la deshumanización médica. El Código Orgánico Integral Penal del Ecuador presenta artículos ambiguos a favor y en contra de la muerte asistida, con brechas legales que no permiten su aplicación en el sistema de salud. Aunque existan argumentos sólidos a favor y en contra de la eutanasia, la decisión debe ser adaptada al contexto del paciente y del sistema de salud.

Workplace health promotion programs among health workers: a systematic literature review

Objective: To identify the effect of workplace health promotion activities (WHPA) on the health status of health personnel. Methodology: A systematic literature review was performed. Six computerized databases were used to search for studies on the effect of at least one health promotion activity on the health status of health personnel. Studies were included if they were published in peer-reviewed and indexed journals and were written either in English, Spanish, or Portuguese. Information such as study population, sample size, type of study, outcome, and health promotion activities performed were extracted from each publication. All the included articles were measured in terms of their methodological quality, including the risk of bias. Results: Lower scores on perceived stress, emotional exhaustion, and mood symptoms were reported. An improvement in sleep hours and quality and a reduction in dietary sodium intake were informed. Improvements in participants' dietary habits, weight loss, and body fat percentage, along with increased physical activity and a reduction in pain levels were reported. A reduction in the prevalence of cigarette smoking was found. Conclusions: WHPAs can enhance physical and mental health, and overall well-being, and encouraging healthier behaviors among health personnel. Most of the studies targeting mental health focused their efforts primarily on reducing healthcare workers' perceived stress. WHPAs that addressed both diet and physical activity behaviors were more effective at improving weight outcomes than those that used only one approximation. Overall, this study offers valuable information on the impact of worksite-based health promotion interventions, including the effect of different strategies applied.

Objetivo: Identificar el efecto de las actividades de promoción de la salud en el lugar de trabajo (APST) sobre el estado de salud del personal sanitario. Metodología: Se realizó una revisión sistemática de la literatura. Se utilizaron seis bases de datos computarizadas para buscar estudios sobre el efecto de al menos una actividad de promoción de la salud en el estado de salud del personal sanitario. Se incluyeron los estudios publicados en revistas revisadas por pares e indexadas y escritos en inglés, español o portugués. De cada publicación se extrajo información como la población del estudio, el tamaño de la muestra, el tipo de estudio, el resultado y las actividades de promoción de la salud realizadas. Se analizaron todos los artículos incluidos en términos de su calidad metodológica, teniendo en cuenta el riesgo de sesgo. Resultados: Se registraron puntuaciones menos elevadas en el estrés percibido, agotamiento emocional y alteración del estado de ánimo. Se informó de una mejoría en las horas y la calidad del sueño, y de una reducción de la ingesta de sodio en la dieta. Se registraron mejorías en los hábitos alimentarios de los participantes, pérdida de peso y porcentaje de grasa corporal, así como un aumento de la actividad física y una reducción de los niveles de dolor. Se observó una reducción de la prevalencia del tabaquismo. Conclusiones: Las AMPS pueden mejorar la salud física y mental, así como el bienestar general, y fomentar comportamientos más saludables entre el personal sanitario. La mayoría de los estudios dirigidos a la salud mental centraron sus esfuerzos principalmente en reducir el estrés percibido por el personal sanitario. Las AMPS que abordaron tanto los comportamientos relacionados con la alimentación como con la actividad física fueron más eficaces a la hora de mejorar los resultados en cuanto al peso que las que sólo utilizaron una aproximación. En general, este estudio ofrece información valiosa sobre el impacto de las intervenciones de promoción de la salud en el lugar de trabajo, así como el efecto de las distintas estrategias aplicadas

Objetivo: Identificar o efeito das atividades de promoção da saúde no local de trabalho (APST) sobre o estado de saúde do pessoal sanitário. Metodologia: Realizou-se uma revisão sistemática da literatura. Utilizaram-se seis bases de dados computadorizadas para procurar estudos sobre o efeito de pelo menos uma atividade de promoção da saúde no estado da saúde do pessoal sanitário. Incluíram-se os estudos publicados em revistas revisadas por pares e indexadas e escritos em inglês, espanhol ou português. De cada publicação coletou-se informação como a população do estudo, o tamanho da amostra, o tipo de estudo, o resultado e as atividades de promoção da saúde realizadas. Analisaram-se todos os artigos incluídos em termos de sua qualidade metodológica, levando em consideração o risco de viés. Resultados: Registraram-se números menos elevados no estresse percebido, esgotamento emocional e alteração do estado de ânimo. Foi informada uma melhora nas horas e na qualidade do sono, e uma redução da ingesta de sódio na dieta. Registraram-se melhoras nos mejorías en los hábitos alimentarios de los participantes, pérdida de peso y porcentaje de grasa corporal, así como un aumento de la actividad física y una reducción de los niveles de dolor. Se observó una reducción de la prevalencia del tabaquismo. Conclusiones: Las APST pueden mejorar la salud física y mental, así como el bienestar general, y fomentar comportamientos más saludables entre el personal sanitario. La mayoría de los estudios dirigidos a la salud mental centraron sus esfuerzos principalmente en reducir el estrés percibido por el personal sanitario. Las APST que abordaron tanto los comportamientos relacionados con la alimentación como con la actividad física fueron más eficaces a la hora de mejorar los resultados en cuanto al peso que las que sólo utilizaron una aproximación. En general, este estudio ofrece información valiosa sobre el impacto de las intervenciones de promoción de la salud en el lugar de trabajo, así como el efecto de las distintas estrategias aplicadas.

Third National Registry of Cardiac Rehabilitation Programs in Mexico (RENAPREC III-2022) / Tercer Registro Nacional de Programas de Rehabilitación Cardiaca en México (RENAPREC III-2022)

Abstract Introduction: In Mexico, cardiac rehabilitation (CR) as an interdisciplinary intervention with therapeutic impact in patients with heart disease is growing. There is the need to know actual conditions of CR in our country. Objectives: The objective of this National Registry is to follow-up those existing and new CR units in Mexico through the comparison between the two previous registries, RENAPREC-2009 and RENAPREC II-2015 studies. This is a descriptive study focused on diverse CR activities such as assistance training, and certification of health professionals, barriers, reference, population attended, interdisciplinarity, permanence over time, growth prospects, regulations, post-pandemic condition, integrative characteristics, and scientific research. Results: Data were collected from 45 CR centers in the 32 states, 75.5% are private practice units, 67% are new, 33% were part of RENAPREC II-2015, and 17 have continued since 2009. With a better distribution of CR units along the territory, the median reference of candidates for CR programs is 9% with a significant reduction into tiempo of enrollment to Phase II admission (19 ± 11 days). Regarding to previous registries, the coverance of Phases I, II, and III is 71%, 100%, and 93%, respectively; and a coverance increases in evaluation, risk stratification, and prescription, more comprehensive attendance and prevention strategies. Conclusions: CR in Mexico has grown in the past 7 years. Even there is still low reference and heterogeneity in specific processes, there are strengths such as interdisciplinarity, scientific professionalization of specialists, national diversification, and an official society that are consolidated over time.

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In vitro toxicity of fine and coarse particulate matter on the skin, ocular and lung microphysiological cell-culture systems.

Particulate matter (PM) has been associated with adverse effects on human health, causing allergies, skin and eye irritation and corrosion, respiratory tract irritation, headaches, bronchoconstriction, cardiopulmonary diseases such as asthma, chronic obstructive pulmonary disease (COPD), lung cancer, reproductive problems, premature deaths, and epigenetic changes that lead to a wide variety of cancers, among other health conditions. The air quality in the Medellín - Colombia presents fluctuations that oscillate between the maximum permissible levels established at the national level and by the WHO, which represents a latent risk to people's health. Although important efforts have been made to quantify the different levels of pollution and administrative measures have been established to mitigate air pollution, little research work has been done to establish the relationship between these levels of pollutants and the effects on biological systems. The objective of the present research was to make a morphological and chemical characterization of particulate matter (PM) captured with a commercial air filter and a electrospun nanofiber membrane and evaluate the cytotoxicity of the each PM extracts in monolayer and co-culture models which recreate microphysiological systems of lung, skin and cornea and propose the possible cellular interactions that lead the cytotoxic response of the chemical compounds found in particulate matter in cities. The morphology and elemental chemical characterization were done with scanning electron microscopy coupled with energy dispersive X-ray spectroscopy (SEM - EDS). For the polycyclic aromatic hydrocarbons detection was made with a chromatographic method accoupled to mass spectrometer. Finally, the cytotoxicity was made in monolayers of A549, HEK001, and SIRC cell lines and microphysiological systems consisting of two-cell layer construct to resemble the interaction between fibroblast and epithelial cells that comprises naturally the corneal, skin and lung tissue. We performed three different cocultures models with BALB/3T3 clone A31 as a feeder layer, using porous Transwell® inserts in the in-contact and non-contact way. Monolayer and co-culture models were exposed to coarse and fine PM (1, 2, and 5 mg/mL) and the cell viability was evaluated at 24 h using an MTT assay. The electrospun nanofibers membranes demonstrates higher efficiency to capture PM with different sizes and high concentration of polycyclic aromatic hydrocarbons, heavy metals, and other chemical compounds responsible of many human diseases. Cytotoxic effects of MP were observed in all models at higher concentration; however, models exposed to fine PM exhibited a significant reduction in cell viability compared to those exposed to coarse PM. In addition, multilayer models are more resistant to PM exposure than monolayer models. Furthermore, the study indicated that, depending on the seeding strategy, different results might be observed: the non-contact model showed higher resistance to PM exposure than in-contact for SIRC and HEK001, but A549 monolayers showed the highest viability response. This study demonstrates the usefulness of applying co-culture models to assess environmental pollutant toxicity, in addition to being a potential alternative method to animal testing for risk assessment.

Comparación de protocolos de vacunación contra el virus del papiloma humano en Ecuador y América Latina / Comparation of vaccination protocols against the human papillomavirus in Ecuador and Latin America

INTRODUCCIÓN: El virus del papiloma humano (VPH), con más de 100 tipos, es de transmisión sexual. Varios países de América Latina han introducido las vacunas contra el VPH. Aunque América Latina es la región que más rápido avanzó en la vacunación contra el VPH, sus sistemas de seguimiento y vigilancia son aún deficientes. OBJETIVO: Comparar las diferentes estrategias de vacunación contra el VPH en Ecuador y América Latina. MÉTODO: Revisión bibliográfica, en la que se obtuvo información de documentos gubernamentales y artículos indexados en los últimos 5 años sobre las estrategias de vacunación contra el VPH en Ecuador y América Latina. RESULTADOS: La mayoría de los países de América Latina han logrado introducir la vacuna contra el VPH, excepto Venezuela, Martinica, Haití, Nicaragua y Cuba. CONCLUSIONES: Los protocolos de vacunación de Ecuador y América Latina necesitan mejorar sus sistemas de seguimiento y aumentar la expansión de datos de cobertura disponibles de manera consistente. Actualmente siguen existiendo desafíos para introducir las vacunas, lograr una alta cobertura y fortalecer el seguimiento, la evaluación y la notificación.

INTRODUCTION: The human papilloma virus (HPV), with more than 100 types, is a sexual transmission infection. Many Latin American countries have introduced the vaccines against the HPV. Although Latin América is the region which advanced faster against the HPV, its surveillance and follow-up systems are yet deficient. OBJECTIVE: To compare the different strategies to assume the vaccination against the HPV in Ecuador and Latin America. METHOD: Bibliographic review, in which information was obtained from government documents and articles indexed in the last five years on vaccination strategies against HPV in Ecuador and Latin America. RESULTS: Most Latin American countries have managed to introduce the vaccine against the HPV, except Venezuela, Martinica, Haiti, Nicaragua and Cuba. CONCLUSIONS: The vaccination protocols of Ecuador and Latin América need to improve their systems of follow-up and monitoring, and increase the expansion of available data in a consistent manner. Now, there are still existing challenges to introduce the vaccines, manage a high reach and fortify the follow-up, the evaluation, and the notification.

Two novel symbiovars of Bradyrhizobium yuanmingense, americaense and caribense, the symbiovar tropici of Bradyrhizobium pachyrhizi and the symbiovar cajani of Bradyrhizobium cajani are microsymbionts of the legume Cajanus cajan in Dominican Republic.

Cajanus cajan L. (guandul) is commonly cultivated in Dominican Republic where this legume is a subsistence crop. Here we identified through MALDI-TOF MS several rhizobial strains nodulating C. cajan in two Dominican locations as Bradyrhizobium yuanmingense. The phylogenetic analysis of recA and glnII housekeeping genes showed that these strains belong to a wide cluster together with the type strain of B. yuanmingense and other C. cajan nodulating strains previously isolated in Dominican Republic. The comparison of genomes from strains representative of different lineages within this cluster support the existence of several genospecies within B. yuanmingense, which is the major microsymbiont of C. cajan in Dominican Republic where it is also nodulated by Bradyrhizobium cajani and Bradyrhizobium pachyrhizi. The analysis of the symbiotic nodC gene showed that the C. cajan nodulating strains from the B. yuanmingense complex belong to two clusters with less than 90% similarity between them. The strains from these two clusters showed nodC gene similarity values lower than 90% with respect to the remaining Bradyrhizobium symbiovars and then they correspond to two new symbiovars for which we propose the names americaense and caribense. The results of the nodC gene analysis also showed that C. cajan is nodulated by the symbiovar tropici, which has been found by first time in this work within the species Bradyrhizobium pachyrhizi. These results confirmed the high promiscuity degree of C. cajan, which is also nodulated by the symbiovar cajani of Bradyrhizobium cajani in Dominican Republic.

[Third National Registry of Cardiac Rehabilitation Programs in Mexico (RENAPREC III-2022)]. / Tercer Registro Nacional de Programas de Rehabilitación Cardiaca en México (RENAPREC III-2022).

Introduction: In Mexico, cardiac rehabilitation (CR) as an interdisciplinary intervention with therapeutic impact in patients with heart disease is growing. There is the need to know actual conditions of CR in our country. Objectives: The objective of this National Registry is to follow-up those existing and new CR units in Mexico through the comparison between the two previous registries, RENAPREC-2009 and RENAPREC II-2015 studies. This is a descriptive study focused on diverse CR activities such as assistance training, and certification of health professionals, barriers, reference, population attended, interdisciplinarity, permanence over time, growth prospects, regulations, post-pandemic condition, integrative characteristics, and scientific research. Results: Data were collected from 45 CR centers in the 32 states, 75.5% are private practice units, 67% are new, 33% were part of RENAPREC II-2015, and 17 have continued since 2009. With a better distribution of CR units along the territory, the median reference of candidates for CR programs is 9% with a significant reduction into tiempo of enrollment to Phase II admission (19 ± 11 days). Regarding to previous registries, the coverance of Phases I, II, and III is 71%, 100%, and 93%, respectively; and a coverance increases in evaluation, risk stratification, and prescription, more comprehensive attendance and prevention strategies. Conclusions: CR in Mexico has grown in the past 7 years. Even there is still low reference and heterogeneity in specific processes, there are strengths such as interdisciplinarity, scientific professionalization of specialists, national diversification, and an official society that are consolidated over time.

Introducción: En México, la Rehabilitación Cardíaca (RC) como intervención interdisciplinaria con impacto terapéutico en paciente con cardiopatía está en crecimiento. Existe la necesidad de conocer las condiciones actuales de la RC en nuestro país. Objetivo: El objetivo de este Registro es dar seguimiento comparativo de las unidades nuevas y existentes entre los registros anteriores, RENAPREC-2009 y RENAPREC II-2015. Se trata de un estudio descriptivo centrado en diversas actividades de la RC: formación asistencial y certificación de sus profesionales, barreras, referencia, población atendida, interdisciplinariedad, permanencia en el tiempo, perspectivas de crecimiento, normativa, condición pospandemia, características integradoras e investigación. Resultados: Se recolectaron datos de 45 centros en los 32 estados, 67% son nuevos 75.5% son de práctica privada, 33% fueron parte de RENAPREC II-2015 y 17 desde 2009. Con una mejor distribución de las unidades de RC a lo largo del territorio, la mediana de referencia de pacientes candidatos a RC es ahora del 9% con reducción significativa del tiempo de admisión a Fase II (19 ± 11 días). Respecto a registros anteriores las coberturas de las Fases I, II y III son del 71%, 100% y 93%, respectivamente; con un aumento de la cobertura en evaluación, estratificación de riesgo y prescripción, atención más integral y estrategias de prevención. Conclusiones: La RC en México ha crecido en los últimos 7 años. Si bien aún existe baja referencia y heterogeneidad en procesos específicos, existen fortalezas como la interdisciplinariedad, la profesionalización científica de los especialistas, la diversificación nacional y una sociedad oficial que se consolida en el tiempo.

Metal bioaccumulation and genotoxicity in Oreochromis niloticus reared in farming pools influenced by mining activities in Napo, in the Ecuadorian Amazonia.

Mining areas may suffer long-term metal contamination and represent harmful remnants of former mining activities. In the northern Amazon of Ecuador, former mining waste pits are used in Oreochromis niloticus (Nile tilapia) fish farming. Given the high consumption of this species by the local population, we aimed to estimate human consumption risks by determining Cd, Cu, Cr, Pb, and Zn tissue bioaccumulation (liver, gills, and muscle) and genotoxicity (micronucleus essay) in tilapia cultivated in one former mining waste pit (S3) and compare the findings to tilapias reared in two non-mining areas (S1 and S2); 15 fish total. Tissue metal content was not significantly higher in S3 than in non-mining areas. Cu and Cd were higher in the gills of tilapias from S1 compared to the other study sites. Higher Cd and Zn were detected in the liver of tilapias from S1 compared to the other sampling sites. Cu was higher in the liver of fish from S1 and S2, and Cr, in the gills of fish from S1. The highest frequency of nuclear abnormalities was observed in fish from S3, indicating chronic exposure to metals at this sampling site. The consumption of fish reared at the three sampling sites results in a 200-fold higher Pb and Cd ingestion than their maximum tolerable intake thresholds. Calculated estimated weekly intakes (EWI), hazard quotients (THQ), and Carcinogenic Slope Factors (CSFing) denote potential human health risks, indicating the need for continuous monitoring in this area to ensure food safety not only in areas affected by mining, but in general farms in the region.

Estimulación de nervio vago en epilepsia refractaria y callosotomía previa sin mejoría. Reporte de caso / Vagus nerve stimulation in refractory epilepsy and previous callosotomy without vimprovement. Case report / Estimulação do nervo vago em epilepsia refratária e calosotomia prévia sem melhora. Relato de caso

La epilepsia refractaria tanto generalizada como focal, es una patología sumamente incapacitante, para el tratamiento de la misma se ha establecido a la callosotomía desde hace décadas como primera línea quirúrgica para su control, la cual puede presentar efectos secundarios importantes como síndrome de desconexión y pérdida de memoria, sin embargo, existen pacientes que no responden a la callosotomía y necesitan nuevas líneas de tratamiento, buscando en la estimulación de nervio vago una respuesta a su condición. Descripción del caso de estudio. Se presenta el caso de paciente masculino de 24 años de edad con antecedente patológico de convulsiones tipo tónico clónicas generalizadas confirmadas por video electroencefalograma de 24 horas, de predominio nocturno de 13 años de evolución, es sometido a 2 regímenes farmacológicos antiepilépticos diferentes en un período de 7 años de duración, posteriormente diagnosticado con epilepsia refractaria, por lo que se realiza callosotomía sin control de su cuadro clínico, el mismo año se realiza estimulación de nervio vago, presentando resultados favorables en su evolución. Conclusión. Luego de evidenciar el presente caso de estudio se concluye que el tratamiento de epilepsia refractaria con la colocación de un estimulador de nervio vago izquierdo asociado a un correcto régimen FAE es una alternativa muy eficaz para considerar en estos pacientes.

Refractory epilepsy, both generalized and focal, is an extremely disabling pathology. For its treatment, callosotomy has been established for decades as the first surgical line for its control, which can present important side effects such as disconnection and loss syndrome. by heart, however, there are patients who do not respond to callosotomy and need new lines of treatment, looking for an answer to their condition in vagus nerve stimulation. Description of the case study. We present the case of a 24-year-old male patient with a pathological history of generalized tonic-clonic seizures confirmed by a 24-hour video electroencephalogram, predominantly nocturnal for 13 years, undergoing 2 different antiepileptic pharmacological mechanisms over a period of 7 years in duration, later diagnosed with refractory epilepsy, for which callosotomy was performed without control of its clinical picture, the same year vagus nerve stimulation was performed, presenting favorable results in its evolution. Conclution. After evidencing the present case study, it is concluded that the treatment of refractory epilepsy with the placement of a left vagus nerve stimulator associated with a correct AED regimen is a very effective alternative to consider in these patients.

A epilepsia refratária, tanto generalizada quanto focal, é uma patologia extremamente incapacitante. Para seu tratamento, a calosotomia se estabeleceu há décadas como a primeira linha cirúrgica para seu controle, que pode apresentar importantes efeitos colaterais como desconexão e síndrome de perda., há pacientes que não respondem à calosotomia e precisam de novas linhas de tratamento, buscando resposta para sua condição na estimulação do nervo vago. Descrição do estudo de caso. Apresentamos o caso de um doente do sexo masculino, 24 anos, com antecedentes patológicos de crises tónico-clónicas generalizadas confirmadas por videoeletroencefalograma de 24 horas, predominantemente nocturnas há 13 anos, submetido a 2 mecanismos farmacológicos antiepilépticos diferentes ao longo de 7 anos de duração, posteriormente diagnosticada com epilepsia refratária, para a qual foi realizada calosotomia sem controle de seu quadro clínico, no mesmo ano foi realizada estimulação do nervo vago, apresentando resultados favoráveis em sua evolução. Conclusão. Depois de evidenciar o presente estudo de caso, conclui-se que o tratamento da epilepsia refratária com a colocação de um estimulador de nervo vago esquerdo associado a um esquema correto de DEA é uma alternativa muito eficaz a ser considerada nesses pacientes.

Human health risk assessment of metals and metalloids in mining areas of the Northeast Andean foothills of the Ecuadorian Amazon.

Gold mining (GM) is a major source of metals and metalloids in rivers, causing severe environmental pollution and increasing the exposure risks to the residents of surrounding areas. Mining in Ecuadorian Amazonia has dramatically increased in recent years, but its impacts on Indigenous local populations that make use of rivers are still unknown. The aim of this study was to assess the risks to adults and children caused by the exposure to metals and metalloids in freshwater ecosystems contaminated with tailings released by GM activities in 11 sites of the upper Napo River basin, Ecuador. We selected a carcinogenic and a noncarcinogenic risk assessment method to estimate the hazard index (HI) and total cancer risk (TCR). The concentration of Ag, Al, As, Cd, Cu, Fe, Mn, Pb, Zn, B, and V in water and sediment samples was considered to assess the risks to human health. The calculated HI was 23-352 times greater than the acceptable limits in all sites for both children and adults. Mn and Fe were the main contributors (75% in water and 99% in sediment) to the total calculated risk based on the HI. The calculated TCR for children and adults exceeded approximately one to three times the permissible threshold in all sites. As and Pb contributed up to 93% of the total calculated risk based on TCR for both children and adults. This study demonstrates that the emission and mobilization of metals and metalloids caused by mining activities increase the risk to human health, to which we recommend further monitoring of freshwater contamination in the area and the implementation of preventive health management measures. Integr Environ Assess Manag 2023;19:706-716. © 2022 The Authors. Integrated Environmental Assessment and Management published by Wiley Periodicals LLC on behalf of Society of Environmental Toxicology & Chemistry (SETAC).

Complications associated with the use of radial arterial catheters in relation to their length: Does size matter?

BACKGROUND: Radial arterial catheters (RAC) are commonly used in emergency services and intensive care units (ICU) for continuous invasive monitoring of blood pressure and arterial blood gas sampling. Complications associated with RAC are rare. Regarding length of RAC catheters and complications, few studies were found in the literature. The present study seeks to provide health care professionals with scientific evidence to select an optimal length of RAC, based on the difference in the incidence of complications between ultrasound-guided catheters of the same diameter but different lengths. METHODS: Observational, descriptive, retrospective study. Patients older than 17 years admitted to the emergency department or ICU were included. RAC were placed with diameters of 20 gauge, between 5 and 8 cm (Arrow-Teleflex), and 22 gauge diameters between 4 and 8 cm (Vygon). Univariate analysis was made to determine behavior of the numerical variables. Normality of variables was determined through a Shapiro-Wilk-test. Qualitative variables were expressed in percentages, quantitative variables in means and standard deviation, or with median and quartiles in the case of a non-normal distribution. Chi-square or Fisher method was used for qualitative variables and the t-test for symmetric quantitative variables. Asymmetric distributions were processed with the Mann-Whitney U test. A value p < 0.05 was considered statistically significant. The statistical analysis was performed with Stata 14.1 program. RESULTS: About 793 RAC were placed between 2016 and 2019 were included, median age was 60 (37-73) (RIQ) years, 49% male. Complications were reported in all groups on average 17.5%, the most frequent being dysfunction/occlusion of the catheter. Given complications of the same diameter and different catheter lengths, there were no statistical differences between groups. CONCLUSION: Selecting one length or another with a catheter of the same diameter does not have statistically significant differences, in terms of the complications this device may cause-meaning that size does not matter.

Effect of sleep quality and duration on Jitter, Shimmer, and Harmonics-to-noise ratio among colombian university professors / Efecto de la calidad y duración del sueño sobre el Jitter, Shimmer y la relación Armónicos-Ruido en profesores universitarios colombianos

Professorswho sleep 6 or fewer hours are more likely to report voice symptoms. However, only three studies have been published on this topic, basingtheir conclusions on self-reported surveysand displayingan overall weak methodological quality, which hindersthe generalization of these results. This exploratory, correlational, and longitudinal study aimed to determine the association between sleep quality and duration andthree acoustic parameters linkedto voiceharmonicity and quality (jitter, shimmer, and Harmonics-to-Noise Ratio [HNR]) among 24 Colombian universityprofessors. Generalized linear models with gamma distribution were used to analyzethis association. Our results indicate that the professors who reported good sleep quality had significantly lower HNR values compared with thosewho had alow sleep quality. Additionally, increased jitter (B= 0.10)and shimmer (B= 0.10), and decreased HNR (B= -0.05) values were found when the duration of sleep increased. In contrast, participantswith good self-perceived sleep quality and a shorter sleep durationpresented lower voice harmonicity compared to those with bad sleep quality and shorter sleep duration, which may be associated with the physiological and emotional effects of sleep on voice production. Considering the multifactorial nature of voice production and the exploratory nature of the present study, it is important to note that a statistically significant correlationbetween sleep quality and duration andvoice harmonicity does not necessarily imply that sleep directly causes voice disorders, but rather suggests that sleep is a variable tobe considered when analyzing and treating individuals with voice issues. These findings provide insight into the complex interplay of variablesthat may contribute to voice disorders andhighlight the importance of considering sleep as a potential contributing factorin the assessment and management of individuals with voice issues.

Los profesores que duermen 6 horas o menos tienen más probabilidades de reportar síntomas de voz. Sin embargo, solo se han publicado tres estudios sobre este tema, los cuales basan sus conclusiones solo en auto reportes, lo que dificulta la generalización de esta relación. Este estudio exploratorio, correlacional y longitudinal tuvo como objetivo determinar la asociación entre la calidad y la duración del sueño con tres parámetros acústicos relacionados con la armonía y la calidad de la voz (jitter, shimmer y relación armónicos-ruido (HNR) en 24 profesores universitarios colombianos. Se utilizaron modelos lineales generalizados con distribución gamma para determinar la asociación de estas variables con los parámetros acústicos de la voz. Nuestros resultados indican que los profesores con buena calidad de sueño tenían valores de HNR significativamente más bajos en comparación con aquellos con menor calidad del sueño. Específicamente, hubo un aumento del jitter (B= 0,10), shimmer (B= 0,10) y disminución del HNR (B= -0,05) al incrementar la duración del sueño. Por su parte, los profesores con una buena calidad del sueño y con una corta duración de este (medida a través de auto-reporte) tenían menos armonía vocal que aquellos con una mala calidad y una duración del sueño corta, lo que puede estar asociado con los efectos fisiológicosy emocionales del sueño en la producción vocal. Teniendo en cuenta la naturaleza multifactorial de la producción de voz y la naturaleza exploratoria del presente estudio, es importante destacar que una asociación estadísticamente significativa entre la calidad y duración del sueño con la armonía vocal no implica necesariamente que la mala calidad o corta duración del sueño causen directamente trastornos de voz. Más bien, sugiere que el sueño es una variable que debe considerarse al analizar y tratar a personas con problemas de voz. Estos resultados proporcionan información sobre la compleja interacción de factores que pueden contribuir a los trastornos de voz y resaltan la importancia de considerar el sueño como un factor potencial que contribuye en la evaluación y tratamiento de las personas con dichos trastornos.

Acute Toxicity of Daphnia magna Neonates Exposed to Single and Composite Mixtures of Four Emerging Contaminants.

The effects of emerging contaminants on environmental health are of high concern, especially those potentially induced by mixtures. We assessed single and composite mixtures of triclosan (T), 17ß-estradiol (E2), sulfamethoxazole (SMX), and nicotine (N) at various concentrations, on neonates of Daphnia magna. When used in single exposure, T and N induced high toxicity (100% immobility, each one), compared to SMX and E2 (2.5% and 10% immobility, respectively). When T, E2, SMX and N were in mixture, T had the highest contribution to the overall toxicity in mixture exposures. The N toxicity lowered when in a fourfold exposure (85% immobility in fourfold exposure). Due to the high toxicity of T and N, both alone and in the mixtures, our results can serve as a warning about the use of these substances and their release in the aquatic ecosystem.