Phlebotomine sand flies in rural Mayan communities of Southern Mexico: The heterogeneity of the ruralscape increases the entomological risk.

In the Yucatan Peninsula, tropical preserved forests harbor a high diversity of phlebotomine sand fly species, potential vectors of Leishmania. As a result, a significant risk of contracting localized cutaneous leishmaniasis (LCL) is associated with entry into these forest ecosystems. However, with the current trajectory of land use in the region, communities now live within modified landscapes which could increase their risk of contact with vectors. In this study, we characterized the sand fly fauna and its relationship with the characteristics of peridomestic habitats in two rural communities in Yucatan characterized by contrasting records of leishmaniasis. Five human dwellings in each community were randomly selected and the peridomestic landscape was characterized (i.e., type and percentage of land use). For the collection of sand flies, CDC traps were deployed in both the intra and peridomicile. Differences in alpha and beta diversity between communities and ecotopes were estimated considering three separate groups, all species together, zoophilic species, and anthropophilic species. In total, 1, 241 sand flies represented by eight species were collected from November 2021-March 2022. Both communities registered the presence of sand flies in the intra and peridomicile, and females were more abundant than males. However, the greatest diversity of species was recorded in the peridomicile of the community with the highest composition of land uses. Our study demonstrates that the transformation of the forest around the communities favors the abundance and richness of sand flies in the peridomestic environment. We discuss the limitations and implications of our findings regarding the potential risk of the emergence of peri­rural cycles of leishmaniasis in the region.

Variantes en la presentación clínica de la enfermedad por arañazo de gato en niños del hospital Garrahan / Variants in the clinical presentation of cat scratch disease in children at Garrahan Hospital

La infección por Bartonella henselae (BH) adopta diversas formas de presentación clínica en pediatría. Según la bibliografía la forma de presentación más frecuente en pacientes inmunocompetentes es la linfadenopatía única asociada a fiebre. En el 85 % de los casos se compromete un solo ganglio siendo los axilares y los epitrocleares los más frecuentemente involucrados. Existen otras formas de presentación menos frecuentes que debemos tener en consideración, para poder realizar un diagnóstico precoz e indicar un tratamiento adecuado si así lo requiere. El diagnóstico requiere de la sospecha clínica del equipo de salud tratante, junto al antecedente epidemiológico, los hallazgos clínicos del examen físico y la realización de serologías que incluyan el dosaje de inmunoglobulina M y G. Los objetivos del presente trabajo fueron reconocer las manifestaciones clínicas típicas y atípicas de la EAG por Bartonella henselae, describir la epidemiología, características clínicas y evolución de esta enfermedad que se presentaron en nuestro hospital. Se estudiaron un total de 187 pacientes. La media de edad fue de 7.6 años (rango 1-14); siendo 53.5% de género masculino. Las formas de presentación más frecuentes en nuestro trabajo fueron la adenitis y la fiebre. La mayoría recibió diversos esquemas de tratamiento antibiótico, secundario al retraso en el diagnóstico. La tasa de hospitalización fue muy baja, remitió con tratamiento ambulatorio con antibióticos o sin ellos (AU)

Bartonella henselae infection has different clinical presentations in pediatrics. According to the literature, the most common form of presentation in immunocompetent patients is single lymphadenopathy associated with fever. In 85 % of the cases a single lymph node is involved, with the axillary and epitrochlear nodes being the most commonly involved. There are other, less frequent, forms of presentation that should be taken into consideration in order to make an early diagnosis and indicate appropriate treatment if required. Diagnosis relies on clinical suspicion by the treating healthcare team, together with the epidemiological history, clinical findings on physical examination, and serology including immunoglobulin M and G dosage. The objectives of this study were to identify both the typical and atypical clinical manifestations of Bartonella henselae cat scratch disease, to describe the epidemiology, clinical characteristics, and outcomes of cases presenting at our hospital. A total of 187 patients were studied. The mean age was 7.6 years (range 1-14); 53.5% were male. The most frequent forms of presentation in our study were adenitis and fever. Most of them received different antibiotic treatment regimens due to delayed diagnosis. The hospitalization rate was very low and the disease typically resolved with outpatient treatment, with or without antibiotics (AU)

Biting rhythms and infection rates of anthropophilic sand fly species (Diptera: Phlebotominae) in sites with different land use in southern Mexico.

Could tropical forest conversion shape sand fly (Diptera: Phlebotominae) biting rhythms and Leishmania infection rates? Using a Shannon trap, we estimated the bite rate and infection prevalence among anthropophilic sand flies at sites with different land use in southern Mexico. We estimated the expected monthly infection rate of the Leishmania parasite along the gradient and generated information on the biting rhythm of sand flies in a poorly characterized cutaneous leishmaniasis endemic region. We used generalized mixed linear and mixed additives models to evaluate differences in the biting rate, nocturnal activity, and inoculation rate of female sand flies, as well as their relationship with the loss of forest cover and environmental disparities recorded throughout the study area. Our results show that the loss of forest cover influences the biting rhythm of sand fly species and the potential number of infectious bites with Leishmania, but the greatest entomological and potential epidemiological risk continues to be associated with sylvatic areas (amplification events). Despite this, we detected that the effect of forest cover (%) on the entomological exposure seems to be also dependent on the sand fly species, and that, albeit to a lesser extent, Leishmania parasite is circulating in disturbed landscapes through generalist and competent sand fly vector species. We also found that land use change did not affect the nocturnal activity, however we detected that important vector species were active most of the time. Contrary to our expectation, temperature and humidity did not shape the biting rhythm of sand fly species. We discuss the limitations and epidemiological implications of our findings regarding the risk of contracting leishmaniasis in southern Mexico.

High aluminum content in bone of marine mammals and its relation with source levels and origin.

Although aluminum is widely distributed in the earth's crust, its environmental availability and wildlife assimilation rates are only partially known. Here we analyze aluminum concentrations in bone from 10 species of marine mammals inhabiting 3 geographic areas subject to different aluminum inputs: the Río de la Plata estuary (Uruguay), the coastal waters of Mauritania and the Galapagos archipelago (Ecuador). Overall, concentrations were unusually high as compared to those of terrestrial animals, with lowest concentrations in the Galapagos archipelago, then the Río de la Plata estuary and finally Mauritania. The aluminum source varied between regions, prevailing anthropogenic sources in the Río de la Plata Estuary and natural sources (wind-blown dust) in Mauritanian waters. The type of source determined contamination levels: anthropogenic sources were most significant for coastal species and showed a decline with distance of habitat from shoreline, while natural sources had a higher influence on open waters because of the dearth of biogenic silica that eliminates aluminum from the water column. Since aluminum remains in bone for several decades, marine mammal bone reflects historical levels of aluminum and therefore is a good bioindicator of the aluminum concentration of the marine environment.

Hydrothermal synthesis of a photocatalyst based on Byrsonima crassifolia and TiO2 for degradation of crystal violet by UV and visible radiation.

This work presents a one-step synthesis methodology for preparing a hydrochar (HC) doped with TiO2 (HC-TiO2) for its application on the degradation of crystal violet (CV) using UV and visible radiation. Byrsonima crassifolia stones were used as precursors along with TiO2 particles. The HC-TiO2 sample was synthesized at 210 °C for 9 h using autogenous pressure. The photocatalyst was characterized to evaluate the TiO2 dispersion, specific surface area, graphitization degree, and band-gap value. Finally, the degradation of CV was investigated by varying the operating conditions of the system, the reuse of the catalyst, and the degradation mechanism. The physicochemical characterization of the HC-TiO2 composite showed good dispersion of TiO2 in the carbonaceous particle. The presence of TiO2 on the hydrochar surface yields a bandgap value of 1.17 eV, enhancing photocatalyst activation with visible radiation. The degradation results evidenced a synergistic effect with both types of radiation due to the hybridized π electrons in the sp2-hybridized structures in the HC surface. The degradation percentages were on average 20% higher using UV radiation than visible radiation under the following conditions: [CV] = 20 mg/L, 1 g/L of photocatalyst load, and pH = 7.0. The reusability experiments demonstrated the feasibility of reusing the HC-TiO2 material up to 5 times with a similar photodegradation percentage. Finally, the results indicated that the HC-TiO2 composite could be considered an efficient material for the photocatalytic treatment of water contaminated with CV.

Neuropsychiatric phenotypes of anti-NMDAR encephalitis: a prospective study.

BACKGROUND: Patients with anti-N-methyl-d-aspartate (NMDA) receptor encephalitis (ANMDARE) show a wide range of behavioral abnormalities and are often mistaken for primary psychiatric presentations. We aimed to determine the behavioral hallmarks of ANMDARE with the use of systematic neuropsychiatric and cognitive assessments. METHODS: A prospective study was conducted, with 160 patients admitted to the National Institute of Neurology and Neurosurgery of Mexico, who fulfilled criteria for possible autoimmune encephalitis and/or red flags along a time window of seven years. Cerebrospinal fluid (CSF) antibodies against the NR1 subunit of the NMDAR were processed with rat brain immunohistochemistry and cell-based assays with NMDA expressing cells. Systematic cognitive, neuropsychiatric, and functional assessments were conducted before knowing NMDAR antibodies results. A multivariate analysis was used to compare patients with and without definite ANMDARE according to antibodies in CSF. RESULTS: After obtaining the CSF antibodies results in 160 consecutive cases, 100 patients were positive and classified as having definite ANMDARE. The most frequent neuropsychiatric patterns were psychosis (81%), delirium (75%), catatonia (69%), anxiety-depression (65%), and mania (27%). Cognition was significantly impaired. A total of 34% of the patients had a predominantly neuropsychiatric presentation without seizures. After multivariate analysis, the clinical hallmarks of ANMDARE consisted of a catatonia-delirium comorbidity, tonic-clonic seizures, and orolingual dyskinesia. CONCLUSIONS: Our study supports the notion of a neurobehavioral phenotype of ANMDARE characterized by a fluctuating course with psychotic and affective symptoms, catatonic signs, and global cognitive dysfunction, often accompanied by seizures and dyskinesia. The catatonia-delirium comorbidity could be a distinctive neurobehavioral phenotype of ANMDARE.

Contribution of halloysite as nanotubular clay mineral on mechanism and adsorption rate of Cd(II) onto nanocomposites alginate-halloysite.

In this work nanocomposites based on alginate (Alg) and halloysite as a nanotubular clay (Hy) were developed. Characterization techniques reveal that Hy/Alg nanocomposites are cation exchangers with predominantly negative charge density and good thermal stability. The adsorption equilibrium of Cd(II) in aqueous solution onto Hy/Alg nanocomposites revealed that by increasing the mass of halloysite in the nanocomposite, the adsorption capacity diminished significantly due to the halloysite-alginate interactions. Maximum adsorption capacities of 8, 65, 88, and 132 mg/g of Cd(II) were obtained for samples Hy, Hy/Alg 50%, Hy/Alg 95%, and Alg, respectively. In addition, the adsorption equilibrium of Cd(II) on the Hy/Alg bionanocomposites was affected by the pH and temperature of the solution, demonstrating the presence of electrostatic interactions during adsorption and that this is an exothermic process. The controlling mechanism of adsorption was cation exchange influenced by electrostatic forces. The Cd(II) adsorption rate studies were interpreted by the diffusion-permeation model and reveal that the presence of Hy in the structure of the nanocomposites enhances the permeation coefficient, that is, the adsorption rate was increased. The values of the permeation coefficient varied from 1.95 × 10-7 to 8.50 × 10-7 cm2/s for Hy/Alg 50% and from 1.70 × 10-7 to 3.55 × 10-7 cm2/s for Hy/Alg 95%.

Effect of land use change on the phlebotomine sand fly assemblages in an emergent focus of cutaneous leishmaniasis in Yucatan, Mexico.

As land use intensifies in tropical forests, it is expected that species assemblages will be modified and that key functions of these ecosystems will be affected. The latter scenario is important from a public health perspective, because the land use change has been linked the outbreaks of vector-borne diseases. In this study, we evaluated the response of Phlebotominae (Diptera: Psychodidae) assemblages and their pattern of co-occurrence in four sites with different land use in an emerging cutaneous leishmaniasis focus in Yucatan, Mexico. Our hypothesis is that the conservation status (as forest cover) will positively influence the structure and composition of sand flies' assemblages. Using three different traps over a period of five months, a sampling effort of 1, 440 night-traps was performed. A total of 7, 897 sand fly specimens belonging to six genera and 10 species were collected. Our hypothesis was partially achieved since sand fly diversity increased as forest cover increased and vice versa, however random patterns of co-occurrence in assemblages were detected among sites. Even though the high abundance of sand flies in the forest fragment suggests an amplification effect, our results show that different vector species directly dominate in each site. We discuss the potential implications of the nestedness of species dominance. We suggest that in this emerging focus and under the land use gradient, Lutzomyia cruciata and Psathyromyia cratifer could play a pivotal role in maintaining the transmission cycles of Leishmania. The apparent generalist or colonialist profile of Lu. cruciata in disturbed areas deserves attention, due to the potential risk of leishmaniasis "domiciliation". This information is essential to understand the eco-epidemiology of leishmaniasis and the factors associated with its emergence in Yucatan, Mexico.

Reutilization of waste biomass from sugarcane bagasse and orange peel to obtain carbon foams: Applications in the metal ions removal.

The high levels of heavy metals contained in residual water and the pollution generated by a large amount of unexploited agro-industrial waste are a serious problem for the environment and mankind. Therefore, in the present work, with the aim of treating and reducing the pollution caused by heavy metal ions (Pb, Cd, Zn and Cu), activated carbons (ACs) were synthesized from sugarcane bagasse (SCB) and orange peel (OP) by means of physical - chemical activation method in an acid medium (H3PO4, 85 wt%) followed by an activation at high temperature (500 and 700 °C). Thereafter, these materials were used to produce carbon foams (CF) by the replica method and to evaluate their adsorbent capacity for the removal of heavy metals from synthetic water. XRD, FTIR, DLS, BET, Zeta Potential (ζ), SEM-EDS and AAS were used to investigate their structures, surface area, pore size, morphology, and adsorption capacity. The results show that as-prepared CF have a second level mesoporous structure and AC present a micro-mesoporous structure with a pore diameter between 3 and 4 nm. The experimental adsorption capacities of heavy metals showed that the CF from OP present a better elimination of heavy metals compared to the AC; exhibiting a removal capacity of 95.2 ± 3.96% (Pb) and 94.7 ± 4.88% (Cu) at pH = 5. The adsorption values showed that the optimal parameters to reach a high metal removal are pH values above 5. In the best of cases, the minimum remaining concentration of lead and copper were 2.4 and 2.6 mg L-1, respectively. The experimental data for carbon adsorbents are in accordance with the Langmuir and BET isotherms, with R2 = 0.99 and the maximum homogenous biosorption capacity for lead and copper was Qmax = 968.72 and 754.14 mg g-1, respectively. This study showed that agro-industrial wastes can be effectively retrieved to produce adsorbents materials for wastewater treatment applications.

Organic matter removal in a simultaneous nitrification-denitrification process using fixed-film system.

Swine wastewater treatment is a complex challenge, due to the high organic matter (OM) and nitrogen (N) concentrations which require an efficient process. This study focused on evaluating two different support media for OM and N removal from an Upflow Anaerobic Sludge Blanket (UASB) reactor fed with swine wastewater. Maximum specific nitrification (MSNA) and denitrification (MSDA) activity test for both biofilm and suspended biomass were carried out using as supports: polyurethane foam (R1) and polyethylene rings (R2). The results showed that R2 system was more efficiently than R1, reaching OM removal of 77 ± 8% and N of 98 ± 4%, attributed to higher specific denitrifying activity recorded (5.3 ± 0.34 g NO3-N/g TVS∙h). Furthermore, 40 ± 5% of the initial N in the wastewater could have been transformed into molecular nitrogen through SND, of which only 10 ± 1% was volatilized. In this sense, MSDA tests indicated that suspended biomass was responsible for at least 70% of N removal and only 20% can be attributed to biofilm. SND could be confirmed with the analysis of microbial diversity, due to the presence of the genus Pseudomonas dominated the prokaryotic community of the system in 54.4%.

The Neural Substrate of Speech Act Recognition.

Pragmatic competence demands linguistic, but also communicative, social and cognitive competence. Successful use of language in social interaction requires mutual understanding of the speaker's intentions; without it, a conversation cannot proceed. The term speech act refers to what a speaker intends to accomplish when saying something. The purpose of this study was to contribute to the identification of the neural substrate of speech act recognition and to the characterization of the cognitive processes that may be involved. The recognition of speech acts resulted in greater activation of frontal regions, precuneus and posterior cingulate gyrus. From all cognitive and behavioral measures obtained, only the scores in mental flexibility predicted the change in blood oxygen level dependent (BOLD) signal in the precuneus. These results, support the idea that speech act recognition requires the inference of intention, executive functions, including memory and entails the activation of areas of social cognition that participate in several brain networks i.e., the Intention Processing, the Default Mode and Theory of Mind networks, and areas involved in planning and guiding behavior.

First record of larval microhabitats of sandflies in Mexico with the description of the fourth instar larva of Brumptomyia hamata.

Despite the medical importance of sandflies as vectors (Diptera: Phlebotominae) of Leishmania spp., immature stages of phlebotomine sandflies have never been found in the wild in Mexico. In the present investigation, we sought to identify specific microhabitats associated with the presence of sandfly immature stages. Field work was conducted in 11 localities of the Yucatan Peninsula and we collected soil samples from each site during two periods (November 2007 to April 2008, November 2008). Soil samples were transported to our base camp and were processed using the Berlese's funnels. We processed a total 242 soil samples with an average weight of 362 ± (SD) 317 gr. From these samples, we were able to recover 51 phlebotomine larvae in five different microhabitats and largest number was obtained from mammal burrows (88%) and from tree-buttresses of Brosimium alicastrum (Berg) (6%). We identified larval microhabitat for Brumptomyia hamata (Fairchild & Hertig) and those specimens provided the material to describe for the first time the fourth instar larva. We also include information of a larval microhabitat of Lutzomyia cruciata (Coquillett). In addition, we recorded a total of 4872 arthropods from 15 taxa in all those soil samples in which sandfly larvae were found, being Collembola (76%) and Acari (10%) the most abundant.

Pattern of climate connectivity and equivalent niche of Triatominae species of the Phyllosoma complex.

The Phyllosoma complex is a Triatominae (Hemiptera: Reduviidae) group of medical importance involved in Trypanosoma cruzi (Kinetoplastida: Trypanosomatidae) transmission. Most of the members of this group are endemic and sympatric species with distribution in Mexico and the southern U.S.A. We employed MaxEnt to construct ecological niche models of nine species of Triatominae to test three hypothesis: (a) whether species with a broad climatic niche breadth occupy a broader geographical range than species with a narrow climatic breadth, (b) whether species with broad distribution present high degree of climatic fragmentation/isolation, which was tested through landscape metrics; and (c) whether the species share the same climatic niche space (niche conservatism) considered through an equivalence test implemented in ENMtools. Overall, our results suggest that the geographical distribution of this complex is influenced mainly by temperature seasonality where all suitable areas are places of current and potential transmission of T. cruzi. Niche breadth in the Phyllosoma complex is associated with the geographical distribution range, and the geographical range affects the climatic connectivity. We found no strong evidence of niche climatic divergence in members of this complex. We discuss the epidemiological implications of these results.

Humanización de la atención en la unidad de terapia intermedia del servicio de neumología / Humanization of care in the intermediate therapy unitof the pneumology service

PREGUNTA DE INVESTIGACIÓN: ¿Qué identifica a los integrantes del equipo de salud que proporcionan atención humanizada en la unidad de terapia Intermedia del servicio de neumología en el Hospital del Tórax de la ciudad de La Paz? OBJETIVO: conocer las vivencias de las personas que enfrentan una situación de hospitalización en la unidad de terapia intermedia en el servicio de neumología del Hospital del Tórax de la ciudad de La Paz, para distinguir que identifica a los integrantes del equipo de salud que les proporcionan atención humanizada. MATERIAL Y MÉTODOS: diseño cualitativo, análisis hermenéutico. RESULTADOS: el descubrimiento más significativo fue que los integrantes del equipo de salud que proporcionan atención humanizada y demuestran mayor disposición de ayuda al prójimo, son los que en su experiencia de vida tuvieron la necesidad de atravesar por una situación similar al estar en el rol de beneficiarios (al ser atendidos o acompañar en el proceso de recuperación a otra persona) y conocieron de cerca esta situación en la que se espera recibir una atención humanizada que no siempre se encuentra. CONCLUSIONES: la concepción de atención humanizada no solo se reduce a la amabilidad, se debe considerar al ser humano de manera integral y como parte de este trato integral implícitamente también se comprende el proporcionar excelencia técnica para atender al ser humano y no solo a la enfermedad. A veces desde una perspectiva excesivamente biomédica se descuida el aspecto psicosocial del que nadie, sano o enfermo, puede desprenderse.

RESEARCH QUESTION: ¿What identifies the members of the health team that provide humanized care in the intermediate therapy unit of the pneumology service at the Hospital of the Thorax in the city of La Paz? OBJECTIVE: to know the experiences of people facing a hospitalization situation in the intermediate therapy unit in the peumology service of the Hospital del Tórax in the city of La Paz, in order to distinguish that it identifies the members of the health team that provide them with humanized care. MATERIAL AND METHODS: qualitative design, hermeneutical analysis. RESULTS: the most significant discovery was that the members of the health team that provide humanized care and demonstrate greater willingness to help others, are those who in their life experience had the need to go through a similar situation as they were in the role of beneficiaries (when being treated or accompanying someone else in the recovery process) and they got to know this situation closely, in which it is expected to receive humanized attention that is not always found. CONCLUSIONS: the concept of humanized care is not only reduced to kindness, the human being must be considered in an integral way and as part of this integral treatment it is also implicitly understood to provide technical excellence to attend to the human being and not only to the disease. Sometimes from an excessively biomedical perspective, the psychosocial aspect is neglected, from which no one, healthy or ill, can discard.

Malnutrition in all its forms and socioeconomic status in Bolivia.

OBJECTIVE: To estimate the prevalence of malnutrition (undernutrition and excess BMI) among children under the age of 5 years and women of reproductive age in Bolivia considering three socioeconomic indicators: wealth, education and ethnicity. DESIGN: We used the 2008 nationally representative Bolivian Demographic and Health Survey (DHS). Malnutrition's prevalence was estimated by wealth, ethnicity and educational level. Wealth index was measured based on the DHS methodology and nutritional status by using WHO standards and indicators. Education level (EL) was categorized by years of formal education. SETTING: Bolivia. PARTICIPANTS: In total, 5·903 children <5 years, 3·345 adolescent women (15-19 years) and 12·297 women (20-49 years) with available information on anthropometric measurements·. RESULTS: A disproportionate prevalence of malnutrition was observed among different wealth groups: lower wealth tertiles show the higher prevalence of stunting (>30 %) and anaemia (>40 %) in all ages· The prevalence of overweight and obesity tends to rise with age from childhood (10·02-11·60) to adolescence (27·9-31·03), reaching highest levels in women of reproductive age (56·02-57·76). According to wealth tertiles, higher prevalence of overweight and obesity was found in children of high tertile (12·23), adolescent women of low (32·56) and adult women of medium tertile (63·08). CONCLUSIONS: The present study shows that currently Bolivia is in a transitional stage, faces not only the problem of undernutrition but also those of overnutrition, showing strong inequalities according to socioeconomic and education status. This study calls for state-specific policies keeping in view of the nature of inequality in malnutrition in the country and its differential characteristics across wealth status.

On the stability of Cu x Te polytypes: phase transitions, vibrational and electronic properties.

Based on the experimental structures reported for the Cu x Te (1 ⩽ x ⩽ 2) system, a theoretical study on stability and phase transitions has been performed. Three theoretical structures derived from rickardite (Cu1.5Te) were considered to represent different Cu/Te ratios (1, 1.5 and 2). The structural, electronic, and vibrational properties were calculated by density functional theory and compared to the experimental data available to date. This analysis showed that the proposed CuTe and Cu1.5Te structures are energetically and dynamically stable (unlike Cu2Te), and that their vibrational modes may play an important role in the reported Raman spectra for Cu x Te films. As well, it was found that being vulcanite the most stable phase for x = 1, the addition of Cu atoms to this structure induces a gradual flattening of the Cu planes, producing significant changes in the electronic band structure. A thorough review of the experimental reports on the electrical properties of the system was carried out. The experimental data showed that, in agreement with the calculations, the electrical conductivity is higher for phases with x ⩽ 1.5, decreasing as x gets closer to 2. Hence, the low-copper concentration phases are the best choice for solar cell applications due to their electrical properties and stability.

Awareness of obstetric warning signs in Ecuador: a cross-sectional study.

OBJECTIVE: In Ecuador, the reported maternal death rate was 45.71 per 100,000 live births in 2013. This may be partly due to a lack of maternal knowledge of obstetric warning signs during pregnancy, delivery and the post-partum period. This study sought to evaluate awareness of obstetric warning signs among pregnant women in relation to individual demographic and area-level socio-economic indicators. STUDY DESIGN: We conducted a cross-sectional analysis of data collected by Ecuador's Ministry of Health at the conclusion of a national maternal health campaign (2014-2015). A nationally representative sample of 3435 pregnant women from the nine administrative zones completed surveys regarding basic demographics and their awareness of obstetric warning signs. METHODS: We defined eight obstetrical warning signs according to the literature and Ecuadorian practice that could occur during pregnancy, delivery and the post-partum period (severe headache, strong abdominal ache, bleeding or presence of malodorous secretion, rupture of the amniotic sac, high fever, abnormal presentation of the baby, decrease in baby's movements and delayed labour). A woman was considered 'aware' if she recognised at least four of the eight warning signs and stated she would seek immediate healthcare at their presentation. For each administrative zone, four socio-economic indicators (poverty, illiteracy, unemployment and subemployment) were obtained from the National Institute of Statistics and Census. Correlates of awareness of the obstetric warning signs were evaluated using hierarchical logistic models clustered by the administrative zone. RESULTS: Nationally, 86.9% of women were 'aware' of obstetric warning signs. After adjustment for age, socio-economic indicators and clustering, indigenous participants were 59% less likely to be aware of obstetric warning signs than mestizos (odds ratio [OR] = 0.41, 95% confidence interval [CI] = 0.28-0.59). For every 1% increase in area poverty, participants had a 5% decreased likelihood of being aware of obstetric warning signs (OR = 0.95, 95% CI = 0.93-0.96), adjusting for age, ethnicity and other socio-economic indicators. The most effective source of campaign information about obstetric warning signs was personal communication with a healthcare professional, as opposed to mass media advertisements (OR = 1.90, 95% CI = 1.34-2.71). CONCLUSIONS: A majority of Ecuadorian pregnant and post-partum women are aware of obstetric warning signs. Indigenous ethnicity and area-level poverty are associated with a lack of awareness. Personal communication with a healthcare professional was the most effective source of information. These findings have implications for improvement of maternal awareness of warning signs.

[Primary central nervous system lymphoma: clinical experience in a neurological center]. / Linfoma primario del sistema nervioso central: experiencia clinica en un centro neurologico.

INTRODUCTION: Primary lymphoma of the central nervous system is a variety of non-Hodgkin's lymphoma that accounts for 4-5% of intracranial tumours and 5% of all lymphomas. It has its origin in the brain, the eyes, the leptomeninges and the spinal cord with no systemic evidence of lymphomatoid activity; the subtype of lymphoma is predominantly of B-type cells. PATIENTS AND METHODS: We conducted a descriptive study of the patients diagnosed with primary brain lymphoma who were attended to at third-level centres in Mexico between the years 1980 and 2016. Patients who had been screened for systemic lymphoma were included. The results were analysed by means of simple frequencies, and disease-free and overall survival time was analysed by Kaplan-Meier curves; the differences among curves were analysed by means of log rank. RESULTS: Of a total of 215 patients, there were only 74 cases. By sex, 45% were females and 55% were males. Regarding age, 36.7% were over 60 years old. The most frequent clinical manifestations were motor loss (60%) and cognitive disorders (52%). Most patients received some form of chemotherapy (89%). The only significant factor for radiological response and clinical prognosis was the combined use of radiochemotherapy (p = 0.04493). CONCLUSION: Lymphoma is a tumorous condition with a high clinicoradiological response to treatment, although the response is not long-lasting. Its early identification and multidisciplinary management are essential for a more favourable prognosis in these patients.

TITLE: Linfoma primario del sistema nervioso central: experiencia clinica en un centro neurologico.Introduccion. El linfoma primario del sistema nervioso central es una variedad de linfoma no Hodgkin que representa el 4-5% de los tumores intracraneales y el 5% de todos los linfomas. Se origina en el encefalo, los ojos, la leptomeninge y la medula espinal sin evidencia sistemica de actividad linfomatoide; el subtipo de linfoma mayoritariamente es de celulas de tipo B. Pacientes y metodos. Estudio descriptivo de los pacientes diagnosticados con linfoma cerebral primario que fueron atendidos en centros de tercer nivel en Mexico entre los años 1980 y 2016. Se incluyo a los pacientes que contaran con cribado para busqueda de linfoma sistemico. Los resultados se analizaron mediante frecuencias simples; en el caso del tiempo libre de enfermedad y supervivencia global, mediante curvas de Kaplan-Meier, y las diferencias entre curvas, mediante log rank. Resultados. En un total de 215 pacientes solo hubo 74 casos. El 45% fueron mujeres y el 55%, hombres. El 36,7% eran mayores de 60 años. Las manifestaciones clinicas mas frecuentes fueron deficit motor (60%) y alteraciones cognitivas (52%). La mayoria recibio alguna forma de quimioterapia (89%). El unico factor significativo para respuesta radiologica y pronostico clinico era el uso combinado de radioquimioterapia (p = 0,04493). Conclusion. El linfoma representa una patologia tumoral con alta respuesta clinicorradiologica al tratamiento, aunque la respuesta no es duradera. Es fundamental su identificacion temprana y el tratamiento multidisciplinario para el mejor pronostico de estos pacientes.

Evaluation of a vaccination regimen and care in relation to follow-up and treatment of patients with inflammatory bowel disease. / Evaluación del esquema de vacunación y cuidados con relación al seguimiento y tratamiento de los pacientes con enfermedad inflamatoria intestinal.

INTRODUCTION AND AIMS: During the clinical course of inflammatory bowel disease, different causes can compromise kidney, liver, and bone marrow function and increase the risk for osteoporosis, infections, and neoplasias. The aim of the present study was to describe the follow-up of Mexican patients with inflammatory bowel disease in relation to their vaccination regimen, treatment-associated risks, and cancer screening. MATERIALS AND METHODS: A retrospective cross-sectional study was conducted within the time frame of February and June 2017. One hundred patients that had a histopathologic diagnosis of inflammatory bowel disease were surveyed about their follow-up vaccination regimen, treatment-associated risks, and cancer screening. SPSS v24 software was employed for the statistical analysis. RESULTS: One hundred patients with inflammatory bowel disease were studied (90% with ulcerative colitis and 10% with Crohn's disease; 60% women, 40% men): 75% stated that they had no vaccination regimen. A total of 71.4% of the women had at least one Pap smear in their lives and 28.6% did not have them done annually. Twenty-four percent of the patients wore sun block daily. A total of 18.2% of the patients with more than a 10-year progression of ulcerative colitis had an annual colonoscopy. Yearly kidney function was registered in 57.1% of the patients, 92.9% had a yearly complete blood count, and 78.6% had yearly liver function tests. A total of 34.8% of patients had no bone densitometry in their case records. CONCLUSIONS: These results are a red flag suggesting the need to reinforce the role of the primary healthcare providers in relation to vaccination follow-up and the need to improve the education of the patient in relation to inflammatory bowel disease.