The social stratification of internal migration and daily mobility during the COVID-19 pandemic.

This study leverages mobile data for 5.4 million users to unveil the complex dynamics of daily mobility and longer-term relocations in and from Santiago, Chile, during the COVID-19 pandemic, focusing on socioeconomic differentials. We estimated a relative increase in daily mobility, in 2020, for lower-income compared to higher-income regions. In contrast, longer-term relocation rose primarily among higher-income groups. These shifts indicate nuanced responses to the pandemic across socioeconomic classes. Compared to 2017, economic factors in 2020 had a stronger influence on the decision to relocate and the selection of destinations, suggesting transformations in mobility behaviors. Contrary to previously held beliefs, there was no evidence supporting a preference for rural over urban destinations, despite the surge in emigration from Santiago during the pandemic. This study enhances our understanding of how varying socioeconomic conditions interact with mobility decisions during crises and provides insights for policymakers aiming to enact fair and evidence-based measures in rapidly changing circumstances.

A dataset to assess mobility changes in Chile following local quarantines.

Fighting the COVID-19 pandemic, most countries have implemented non-pharmaceutical interventions like wearing masks, physical distancing, lockdown, and travel restrictions. Because of their economic and logistical effects, tracking mobility changes during quarantines is crucial in assessing their efficacy and predicting the virus spread. Unlike many other heavily affected countries, Chile implemented quarantines at a more localized level, shutting down small administrative zones, rather than the whole country or large regions. Given the non-obvious effects of these localized quarantines, tracking mobility becomes even more critical in Chile. To assess the impact on human mobility of the localized quarantines, we analyze a mobile phone dataset made available by Telefónica Chile, which comprises 31 billion eXtended Detail Records and 5.4 million users covering the period February 26th to September 20th, 2020. From these records, we derive three epidemiologically relevant metrics describing the mobility within and between comunas. The datasets made available may be useful to understand the effect of localized quarantines in containing the COVID-19 pandemic.

Adult diffuse midline gliomas H3 K27-altered: review of a redefined entity.

INTRODUCTION: Diffuse midline glioma (DMG) H3 K27-altered is a type of high-grade gliomas first recognized as a new entity in the 2016 World Health Organization Classification of Central Nervous System (CNS) Tumors as DMG H3 K27M-mutant, recently renamed in the new 2021 WHO classification. The aim of this review is to describe the characteristics of diffuse midline gliomas H3 K27-altered in the adult population. METHODS: We performed a review of the current literature regarding the genetic, clinical, imaging characteristics and management of diffuse midline gliomas H3 K27-altered in adult patients. RESULTS: The 2021 WHO classification now designates the previously recognized DMG H3K27M-mutant as DMG H3 K27-altered, recognizing the alternative mechanisms by which the pathogenic pathway can be altered. Thus, the diagnostic criteria for this entity consist of diffuse growth pattern, midline anatomic location, and H3 K27-specific neuroglial mutations. DMGs' characteristic midline location makes them difficult to surgically resect and biopsy, carrying high mortality and morbidity rates, with median survival ranging from 9 to 12 months in adult patients. CONCLUSION: The diagnosis of DMGs H3 K27-altered in adult patients should be considered upon neurological symptoms associated with an infiltrative midline brain tumor detected on imaging. Future studies are necessary to continue refining their characteristics in this age group.

Acute subdural hematoma recurrence during drain removal associated with spontaneous intracranial hypotension - A non-reported complication.

BACKGROUND: Spontaneous intracranial hypotension (SIH) is an uncommon, benign, and generally self-limiting condition caused by low cerebrospinal fluid (CSF) volume and pressure usually caused by a CSF leak. Patients with SIH have an increased incidence of subdural hematomas (SDH), which may be bilateral and recurrent. CASE DESCRIPTION: We report a unique case of a man presenting with SIH and bilateral SDH that were drained with bilateral craniotomies. During drain removal, the patient had an acute neurological deterioration and a CT scan showed SDH recurrence. The patient had two new recurrent SDH afterwards. After the third surgical intervention, the drain was removed in the OR with concomitant subdural saline infusion, there was no recurrence of SDH after that and the patient has had no further complications after a 2-year follow-up. CONCLUSION: Patients with intracranial hypotension are predisposed to form SDH. In this case, drain removal caused further decrease in intracranial pressure and triggered a new SDH formation, subdural saline irrigation masked atmospheric pressure and prevented this complication from happening again.

Spontaneous intracranial hypotension: key features for a frequently misdiagnosed disorder.

Spontaneous intracranial hypotension (SIH) is a rare neurological condition caused by low cerebrospinal fluid (CSF) volume, most commonly due to a CSF leak. The most common presenting symptom is an orthostatic headache, but some patients may present with atypical neurological manifestations such as cranial nerve palsies, an altered mental status, and movement disorders, which complicate the clinical diagnosis. Therefore, the diagnosis is based on the combination of clinical signs and symptoms, neuroimaging, and/or a low cerebrospinal fluid pressure. In this review, we describe the wide variety of neurological manifestations and complications seen in patients with SIH as well as the most common features described on imaging studies, including both subjective and objective measurements, in order to lead the clinician to a correct diagnosis. The prompt and correct management of patients with SIH will help prevent the development of life-threatening complications, such as subdural hematomas, cerebral venous thrombosis, and coma, and avoid unnecessary invasive procedures.

Nonhospice Palliative Care Within the Treatment of End-Stage Liver Disease.

Palliative care (PC) that has evolved from a focus on end-of-life care to an expanded form of holistic care at an early stage for patients with serious illnesses and their families is commonly referred to as nonhospice PC (or early PC). Patients with end-stage liver disease (ESLD) suffer from a high symptom burden and a deteriorated quality of life (QOL), with uncertain prognosis and limited treatment options. Caregivers of these patients also bear an emotional and physical burden similar to that of caregivers for patients with cancer. Despite the proven benefits of nonhospice PC for other serious illnesses and cancer, there are no evidence-based structures and processes to support its integration within the routine care of patients with ESLD and their caregivers. In this article, we review the current state of PC for ESLD and propose key structures and processes to integrate nonhospice PC within routine hepatology practice. Results found that PC is highly underutilized within ESLD care, and limited prospective studies are available to demonstrate methods to integrate PC within routine hepatology practices. Hepatology providers report lack of training to deliver PC along with no clear prognostic criteria on when to initiate PC. A well-informed model with key structures and processes for nonhospice PC integration would allow hepatology providers to improve clinical outcomes and QOL for patients with ESLD and reduce health care costs. Educating hepatology providers about PC principles and developing clear prognostic criteria for when and how to integrate PC on the basis of individual patient needs are the initial steps to inform the integration. The fields of nonhospice PC and hepatology have ample opportunities to partner clinically and academically.

Antimicrobial, Antioxidant Activities, and HPLC Determination of the Major Components of Verbena carolina (Verbenaceae).

Verbena carolina L. (Verbenaceae) is used as a decoction in Mexican folk medicine with applications against digestive problems and for dermatological infections. The present work firstly reported HPLC analysis, as well as the free radical scavenging capacity of the extracts and isolated compounds. Antimicrobial analyses of these substances against the bacteria Staphylococcus aureus, Enterococcus faecalis, Escherichia coli and Salmonella typhi and the fungi Candida albicans, Trichophyton mentagrophytes and T. rubrum were also tested, as well as the acute oral toxicity in mice of aqueous extracts. Major secondary metabolites in V. carolina extracts were isolated by conventional phytochemical methods which consisted of three terpenoids ((1), (3) and (4)) and four phenolic compounds ((2), (4)-(6)). Their contents were determined by HPLC in six different samples from different locations. The results indicated that ursolic acid (1), hispidulin (2), verbenaline (3), hastatoside (4), verbascoside (5), hispidulin 7-O-ß-d-glucuronopyranoside (6) and pectolinaringenin-7-O-α-d-glucuronopyranoside (7) were the main constituents and ranged from 0.17 to 3.37 mg/g of dried plant, with verbascoside being the most abundant and with a significant antioxidant activity in reactive oxygen species (ROS). Hispidulin was the only active compound against T. mentagrophytes and T. rubrum. The aqueous extract showed no significant toxicity (LD50: > 5000 mg/mL). To our knowledge, this is the first comprehensive report of the chemical characterization of V. carolina and also of the activity of its constituents towards reactive oxygen species and dermatophytes, and its safety for consumption.

Intraventricular hemorrhage and posthemorrhagic hydrocephalus in preterm infants: diagnosis, classification, and treatment options.

PURPOSE: Intraventricular hemorrhage is the most important adverse neurologic event for preterm and very low weight birth infants in the neonatal period. This pathology can lead to various delays in motor, language, and cognition development. The aim of this article is to give an overview of the knowledge in diagnosis, classification, and treatment options of this pathology. METHOD: A systematic review has been made. RESULTS: The cranial ultrasound can be used to identify the hemorrhage and grade it according to the modified Papile grading system. There is no standardized protocol of intervention as there are controversial results on which of the temporizing neurosurgical procedures is best and about the appropriate parameters to consider a conversion to ventriculoperitoneal shunt. However, it has been established that the most important prognosis factor is the involvement and damage of the white matter. CONCLUSION: More evidence is required to create a standardized protocol that can ensure the best possible outcome for these patients.

Reproducibility of TEG Parameters in Stable Cirrhotics.

BACKGROUND: Thromboelastography (TEG) has become the standard of care in liver-transplant surgery to identify real-time abnormalities in the coagulation cascade. To our knowledge, no studies have been performed to measure the intrasubject reproducibility of TEG parameters in cirrhotic patients. OBJECTIVE: To perform a validation study to determine the reproducibility of TEG in cirrhosis. METHODS: We recruited 30 patients with stable cirrhosis and tested 25 of them. Two blood specimens were drawn 1 hour apart; we measured the TEG parameters R time, K time, angle, maximum amplitude (MA), and functional fibrinogen (FF), along with conventional coagulation parameters. Reproducibility was assessed using the intraclass coefficient test. The TEG parameters were then compared with conventional coagulation test results. RESULTS: The K time, angle, MA, and FF results showed excellent reproducibility (r > 0.7; P <.001). Platelets and fibrinogen correlated with MA and K time; prothrombin time (PT) and activated partial thromboplastin time (aPTT) were inversely correlated with MA. CONCLUSION: All parameters were reproducible when measured 1 hour apart. TEG may be suitable to investigate coagulation characteristics in patients with clinically stable cirrhosis; however, further studies are needed in patients with more advanced cirrhosis, in whomblood product use may be more prevalent.

Liver injury from herbal and dietary supplements.

Herbal and dietary supplements (HDS) are used increasingly both in the United States and worldwide, and HDS-induced liver injury in the United States has increased proportionally. Current challenges in the diagnosis and management of HDS-induced liver injury were the focus of a 2-day research symposium sponsored by the American Association for the Study of Liver Disease and the National Institutes of Health. HDS-induced liver injury now accounts for 20% of cases of hepatotoxicity in the United States based on research data. The major implicated agents include anabolic steroids, green tea extract, and multi-ingredient nutritional supplements. Anabolic steroids marketed as bodybuilding supplements typically induce a prolonged cholestatic but ultimately self-limiting liver injury that has a distinctive serum biochemical as well as histological phenotype. Green tea extract and many other products, in contrast, tend to cause an acute hepatitis-like injury. Currently, however, the majority of cases of HDS-associated liver injury are due to multi-ingredient nutritional supplements, and the component responsible for the toxicity is usually unknown or can only be suspected. HDS-induced liver injury presents many clinical and research challenges in diagnosis, identification of the responsible constituents, treatment, and prevention. Also important are improvements in regulatory oversight of nonprescription products to guarantee their constituents and ensure purity and safety. The confident identification of injurious ingredients within HDS will require strategic alignments among clinicians, chemists, and toxicologists. The ultimate goal should be to prohibit or more closely regulate potentially injurious ingredients and thus promote public safety. (Hepatology 2017;65:363-373).

Preventing the recovery of extinguished ethanol tolerance.

There is substantial evidence that drug-paired cues become associated with drug effects. From a Pavlovian perspective, these cues act as conditioned stimuli and elicit conditioned compensatory responses that contribute to drug tolerance. Here we report two experiments with rats in which we studied the extinction of the associative tolerance to the ataxic effect of ethanol. Experiment 1 evaluated whether changes in the temporal and physical contexts after extinction training provoke recovery of the extinguished tolerance. The results showed successful extinction, spontaneous recovery and renewal of the extinguished tolerance, but no summation of renewal and spontaneous recovery. Experiment 2 evaluated whether using massive extinction trials and delivering extinction in multiple contexts attenuates the renewal effect. The results showed that both manipulations reduced renewal of the extinguished tolerance to the ataxic effect of ethanol; however, these manipulations used in combination did not appear to be more effective in reducing recovery than each by itself. The present results may help guide further research that evaluates behavioral ploys to prevent the recovery of extinguished responses.

Liver injury from herbals and dietary supplements in the U.S. Drug-Induced Liver Injury Network.

UNLABELLED: The Drug-Induced Liver Injury Network (DILIN) studies hepatotoxicity caused by conventional medications as well as herbals and dietary supplements (HDS). To characterize hepatotoxicity and its outcomes from HDS versus medications, patients with hepatotoxicity attributed to medications or HDS were enrolled prospectively between 2004 and 2013. The study took place among eight U.S. referral centers that are part of the DILIN. Consecutive patients with liver injury referred to a DILIN center were eligible. The final sample comprised 130 (15.5%) of all subjects enrolled (839) who were judged to have experienced liver injury caused by HDS. Hepatotoxicity caused by HDS was evaluated by expert opinion. Demographic and clinical characteristics and outcome assessments, including death and liver transplantation (LT), were ascertained. Cases were stratified and compared according to the type of agent implicated in liver injury; 45 had injury caused by bodybuilding HDS, 85 by nonbodybuilding HDS, and 709 by medications. Liver injury caused by HDS increased from 7% to 20% (P < 0.001) during the study period. Bodybuilding HDS caused prolonged jaundice (median, 91 days) in young men, but did not result in any fatalities or LT. The remaining HDS cases presented as hepatocellular injury, predominantly in middle-aged women, and, more frequently, led to death or transplantation, compared to injury from medications (13% vs. 3%; P < 0.05). CONCLUSIONS: The proportion of liver injury cases attributed to HDS in DILIN has increased significantly. Liver injury from nonbodybuilding HDS is more severe than from bodybuilding HDS or medications, as evidenced by differences in unfavorable outcomes (death and transplantation). (Hepatology 2014;60:1399-1408).

Delusional disorder: no gender differences in age at onset, suicidal ideation, or suicidal behavior

Objective: To investigate gender differences in age at onset, psychopathology, and suicidal behavior rates in delusional disorder (DD). Methods: We conducted a prospective longitudinal study of 97 patients with DD. Demographic and clinical data at baseline were recorded. Gender differences were investigated by applying analysis of covariance, using age at onset and age at first psychiatric consultation as dependent variables, comorbid depression and gender as between-subject factors, and employment status, social support, and DD types as covariates. Results: Seventy-six percent of the patients were women. The average age at onset was 48.76±12.67 years, mean age at first psychiatric consultation was 54.13±13.67 years, and men were more likely to be employed than women (p = 0.041). Despite the earlier age at onset and at first psychiatric consultation in men, these differences tended to disappear when adjusted for potential confounders. There were no significant gender differences in depressive comorbidity, presence of suicidal ideation and behavior, or compliance rates at follow-up. Conclusions: Our findings could not confirm that male and female DD patients differ in age at onset, age at first psychiatric consultation, or suicidal ideation and behavior, even after controlling for potential confounders. .

Delusional disorder: no gender differences in age at onset, suicidal ideation, or suicidal behavior.

OBJECTIVE: To investigate gender differences in age at onset, psychopathology, and suicidal behavior rates in delusional disorder (DD). METHODS: We conducted a prospective longitudinal study of 97 patients with DD. Demographic and clinical data at baseline were recorded. Gender differences were investigated by applying analysis of covariance, using age at onset and age at first psychiatric consultation as dependent variables, comorbid depression and gender as between-subject factors, and employment status, social support, and DD types as covariates. RESULTS: Seventy-six percent of the patients were women. The average age at onset was 48.76 ± 12.67 years, mean age at first psychiatric consultation was 54.13 ± 13.67 years, and men were more likely to be employed than women (p = 0.041). Despite the earlier age at onset and at first psychiatric consultation in men, these differences tended to disappear when adjusted for potential confounders. There were no significant gender differences in depressive comorbidity, presence of suicidal ideation and behavior, or compliance rates at follow-up. CONCLUSIONS: Our findings could not confirm that male and female DD patients differ in age at onset, age at first psychiatric consultation, or suicidal ideation and behavior, even after controlling for potential confounders.

Sleep enhances inhibitory behavioral control in discrimination learning in rats.

Sleep supports the consolidation of memory, and it has been proposed that this enhancing effect of sleep pertains in particular to memories which are encoded under control of prefrontal-hippocampal circuitry into an episodic memory system. Furthermore, repeated reactivation and transformation of such memories during sleep are thought to promote the de-contextualization of these memories. Here, we aimed to establish a behavioral model for the study of such sleep-dependent system consolidation in rats, using a go/nogo conditional discrimination learning task known to essentially depend on prefrontal-hippocampal function. Different groups of rats were trained to criterion on this task and, then, subjected to 80-min retention intervals filled with spontaneous morning sleep, sleep deprivation, or spontaneous evening wakefulness. In a subsequent test phase, the speed of relearning of the discrimination task was examined as indicator of memory, whereby rats were either tested in the same context as during training or in a different context. Sleep promoted relearning of the conditional discrimination task, and this effect was similar for testing memory in the same or different context (p < 0.001). Independent of sleep and wakefulness during the retention interval, animals showed faster relearning when tested in the same context as during learning, compared with testing in a different context (p < 0.001). The benefitting effect of sleep on discrimination learning was primarily due to an enhancing effect on response suppression during the nogo stimulus. We infer from these results that sleep enhances memory for inhibitory behavioral control in a generalized context-independent manner and thereby might eventually also contribute to the abstraction of schema-like representations.

Reducing case fatality from acute myocardial infarction in Cienfuegos, Cuba, 1994-2009.

Between 1994 and 2009, the Dr Gustavo Aldereguía University Hospital of Cienfuegos, Cuba implemented a series of interventions that reduced acute myocardial infarction case fatality rate from 47% to 15%. These interventions were part of an institutional plan for myocardial infarction included in the hospital's overall quality assurance strategy. Outcomes resulted primarily from organizational changes (from upgrading of the hospital emergency department and provincial emergency system to creation of a comprehensive coronary care unit and a chest pain center); optimizing use of effective drugs (streptokinase, aspirin, ACE inhibitors and beta blockers); adherence to clinical practice guidelines; and continual and participatory evaluation and adjustment.

Inhibition of LDL-oxidation and antioxidant properties related to polyphenol content of hydrophilic fractions from seaweed Halimeda Incrassata (Ellis) Lamouroux

LDL oxidation and oxidative stress are closely related to atherosclerosis. Therefore, natural antioxidants have been studied as promising candidates. In the present study, the LDL oxidation inhibition activity of bioactive compounds from Halimeda incrassata seaweed. associated to antioxidant capacity, was evaluated in vitro. Experimental work was conducted with lyophilized aqueous extract and phenolic-rich fractions of the seaweed and their effect on LDL oxidation was evaluated using heparin-precipitated LDL (hep-LDL) with exposure to Cu2+ ions and AAPH as the free radical generator. H. incrassata had a protective effect for hep-LDL in both systems and the presence of phenolic compounds contributed to the activity where phenolic-rich fractions showed significant capacity for inhibition of oxidation mediated by Cu2+ ions. The observed effect could be related to the antioxidant potential of polar fractions evidenced by reducing activity and DPPH• radical scavenging. The results obtained in vitro further support the antioxidant and LDL oxidation inhibition properties of H. incrassata and further knowledge toward future phytotherapeutic application of the seaweed.

A oxidação da LDL e o estresse oxidativo estão intimamente relacionados com a aterosclerose. Por isso, os antioxidantes naturais têm sido estudados como candidatos promissores. No presente trabalho foi avaliada in vitro a capacidade de inibição da oxidação da LDL pelos compostos bioativos da alga Halimeda incrassata em associação à capacidade antioxidante. O trabalho experimental foi conduzido com extratos polares (extrato aquoso liofilizado e frações ricas em fenólicos) e seu efeito na oxidação da LDL foi avaliado usando LDL precipitada com heparina (hep-LDL), oxidada com íons de Cu2+ e AAPH, como geradores de radicais livres. A H. incrassata apresentou efeito protetor para hep-LDL em ambos sistemas e a presença de compostos fenólicos contribuiu para a atividade em que as frações ricas em fenólicos demonstram capacidade significativa em inibir a oxidação mediada pelos íons de Cu2+. O efeito observado deve estar relacionado com o potencial antioxidante das frações polares medido pela atividade redutora e varredura do radical DPPH. Os resultados obtidos demonstram as propriedades antioxidantes e de inibição da oxidação da LDL da H. incrassata e podem contribuir para as evidências de futuras aplicações fitoterapêuticas desta alga.

A look at Mayan artificial cranial deformation practices: morphological and cultural aspects.

Induced deformation of the cranial vault is one form of permanent alteration of the body that has been performed by human beings from the beginning of history as a way of differentiating from others. These procedures have been observed in different cultures, but were particularly widespread in Mesoamerica. The authors examined and reviewed the historical and anthropological literature of intentional deformation practices in Mayan culture. The Mayans performed different types of cranial deformations and used different techniques and instruments to deform children's heads. The most remarkable morphological alteration is seen in the flattening of the frontal bone. Some archeological investigations link deformation types with specific periods. This article provides a glance at the cultural environment of the Mayans and demonstrates the heterogeneity of this interesting cultural phenomenon, which has changed over time.