Effectiveness and safety of non-invasive ventilation in the management of cardiogenic shock.

INTRODUCTION AND OBJECTIVES: Cardiogenic shock (CS) has long been considered a contraindication for the use of non-invasive ventilation (NIV). The main objective of this study was to analyze the effectiveness, measured as NIV success, in patients with respiratory failure due to CS. As secondary objective, we studied risk factors for NIV failure and compared the outcome of patients treated with NIV versus invasive mechanical ventilation (IMV). METHODS: Retrospective study on a prospective database, over a period of 25 years, of all consecutively patients admitted to an intensive care unit, with a diagnosis of CS and treated with NIV. A comparison was made between patients on NIV and patients on IMV using propensity score matching analysis. RESULTS: Three hundred patients were included, mean age 73.8 years, mean SAPS II 49. The main cause of CS was acute myocardial infarction (AMI): 164 (54.7%). NIV failure occurred in 153 (51%) cases. Independent factors for NIV failure included D/E stages of CS, AMI, NIV related complications, and being transferred from the ward. In the propensity analysis, hospital mortality (OR 1.69, 95% CI 1.09-2.63) and 1 year mortality (OR 1.61, 95% CI 1.04-2.51) was higher in IMV. Mortality was lower with NIV (vs. EIT-IMV) in C stage (10.1% vs. 32.9%; p<0.001) but did not differ in D stage or E stage. CONCLUSIONS: NIV seems to be relatively effective and safe in the treatment of early-stage CS.

Correction of Lacrimal Gland Ptosis in Blepharoplasty: A Systematic Review.

PURPOSE: Lacrimal gland ptosis has a prevalence of 10% to 15% in Caucasian patients, reaching up to 60% in older age. Its involuntary resection during blepharoplasty carries the potential risk of compromising corneal lubrication. The purpose of this systematic review is to check whether there is a consensus in the literature regarding the surgical procedure of choice and which outcomes and complications have been observed. METHODS: A systematic review was carried out following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. A search was carried out in the Medline, Scopus, and Cochrane databases in March 2022. RESULTS: A total of 16 studies involving 483 patients with lacrimal gland ptosis have been included. In 90.06% of patients, resuspension or direct refixation of the gland to the lacrimal fossa with suture to the orbital periosteum was performed. Follow up has been inconsistent, with an average of 18 months. Regarding complications, 5 recurrences and only 2 patients with persistent dry eye were observed. CONCLUSIONS: In general, the evidence is sparse. Nevertheless, repair of lacrimal gland ptosis is a relatively simple, reproducible, and safe surgical technique, with a low likelihood of recurrence, severe, or persistent complications. A classification is proposed for both the grading of ptosis and its treatment.

Evaluación del riesgo de caídas en los adultos mayores, durante el periodo de confinamiento 2020 / Assessment of the risk of falls in the elderly, during the confinement period 2020 / Avaliação do risco de quedas em idosos, durante o período de confinamento de 2020

Los adultos mayores, por naturaleza presentan deterioro progresivo de las capacidades físico-cognitivas, donde se ven afectadas facultades como el equilibrio, la marcha, la fuerza y la movilidad funcional. El confinamiento y distanciamiento social pueden llevar a que estas personas pierdan ciertas rutinas y aumenten en ellos el riesgo de sufrir caídas y lesiones músculo esqueléticas. Objetivo. Determinar el riesgo de caídas en los adultos mayores durante el periodo de confinamiento. Materiales y métodos. Estudio de enfoque cuantitativo, alcance descriptivo, diseño no experimental y de cohorte transversal; muestra poblacional de 42 adultos mayores en la ciudad de Guayaquil, que cumplen con los criterios de inclusión, a quienes se evalúan mediante historia clínica, las pruebas Timed Up & go, Tinetti, Downton y Falls Efficacy. Resultados. Predominio del grupo poblacional de sexo femenino con edades comprendidas entre 80 y 91 años, el Test Timed Up & Go denota que el 76% presentan déficit moderado y variable de la movilidad funcional, el test de Tinetti evidencia un alto riesgo de caídas en 83% de adultos mayores, mientras que las escalas de Downton y Falls Efficacy, muestran que un 50% requiere cuidados específicos y el 48% tienen temor de caer. Conclusiones. El grupo de adultos mayores evaluados muestra una alta predisposición al riesgo de caídas, producto del déficit de la movilidad, alteración del equilibrio y marcha, como respuesta a la falta de actividad física y distanciamiento social generada durante el periodo de confinamiento de marzo a junio 2020.

Older adults, by nature, present progressive deterioration of physical cognitive capacities, where faculties such as balance, gait, strength and functional mobility are affected. Confinement and social distancing can lead to these people losing certain routines and increasing their risk of falls and musculoskeletal injuries. Objective. To determine the risk of falls in the elderly during the confinement period. Materials and methods. Study with a quantitative approach, descriptive scope, non-experimental design and a cross-sectional cohort; The population sample is of 42 older adults in the city of Guayaquil, who meet the inclusion criteria, who are evaluated through a clinical history and the tests, Timed Up & go, Tinetti, Downton and Falls Efficacy. Results. Predominance of the female population group aged between 80 and 91 years, the Timed Up & Go Test denotes that 76% present moderate and variable deficiency of functional mobility, the Tinetti test shows a high risk of falls in 83% of older adults, while the Downton and Falls Efficacy scales show that 50% require specific care and 48% are afraid of falling. Conclusions. The group of older adults evaluated shows a high predisposition to the risk of falls, product of the mobility deficit, alteration of balance and gait, in response to the lack of physical activity and social distancing generated during the confinement period from March to June 2020.

Os adultos mais velhos, por natureza, apresentam deterioração progressiva das capacidades físico-cognitivas, onde faculdades como equilíbrio, marcha, força e mobilidade funcional são afetadas. O confinamento e o distanciamento social podem levar essas pessoas a perder certas rotinas e aumentar o risco de quedas e lesões musculoesqueléticas. Objetivo. Determinar o risco de quedas em idosos durante o período de confinamento. Materiais e métodos. Estudo com abordagem quantitativa, de escopo descritivo, não experimental e com delineamento de coorte transversal; A amostra populacional é composta por 42 idosos na cidade de Guayaquil, que atendem aos critérios de inclusão, que são avaliados por meio de um histórico médico e dos testes de eficácia Timed Up & go, Tinetti, Downton e Falls. Resultados. Predominância da população feminina na faixa etária de 80 a 91 anos, o Teste Timed Up & Go denota que 76% apresentam déficit moderado e variável de mobilidade funcional, o teste de Tinetti mostra alto risco de quedas em 83% dos idosos, enquanto as escalas de Downton e Falls Efficacy mostram que 50% requerem cuidados específicos e 48% têm medo de cair. Conclusões. O grupo de adultos mais velhos avaliados apresenta elevada predisposição ao risco de quedas, produto do déficit de mobilidade, alteração do equilíbrio e marcha, em resposta à inatividade física e distanciamento social gerado durante o período de confinamento de março a junho de 2020.

Deciphering the introduction and transmission of SARS-CoV-2 in the Colombian Amazon Basin.

BACKGROUND: The SARS-CoV-2 pandemic has forced health authorities across the world to take important decisions to curtail its spread. Genomic epidemiology has emerged as a valuable tool to understand introductions and spread of the virus in a specific geographic location. METHODOLOGY/PRINCIPAL FINDINGS: Here, we report the sequences of 59 SARS-CoV-2 samples from inhabitants of the Colombian Amazonas department. The viral genomes were distributed in two robust clusters within the distinct GISAID clades GH and G. Spatial-temporal analyses revealed two independent introductions of SARS-CoV-2 in the region, one around April 1, 2020 associated with a local transmission, and one around April 2, 2020 associated with other South American genomes (Uruguay and Brazil). We also identified ten lineages circulating in the Amazonas department including the P.1 variant of concern (VOC). CONCLUSIONS/SIGNIFICANCE: This study represents the first genomic epidemiology investigation of SARS-CoV-2 in one of the territories with the highest report of indigenous communities of the country. Such findings are essential to decipher viral transmission, inform on global spread and to direct implementation of infection prevention and control measures for these vulnerable populations, especially, due to the recent circulation of one of the variants of concern (P.1) associated with major transmissibility and possible reinfections.

Influência de fatores abióticos sob miogênese de peixes teleósteos / Abiotic influence in myogenesis of teleost fishes / Influencia abiótica en la miogénesis de peces teleósteos

Resumo Os peixes teleósteos são organismos que, geralmente, apresentam limite de crescimento indeterminado e estão presentes em diferentes biomas com diversas características ambientais. Os teleósteos possuem até 80% de sua composição corporal formado por tecido muscular, composto por fibras musculares e células satélites indiferenciadas, formando um tecido muscular complexo cuja forma é muito variada em função das espécies que compõem este grupo de animais. Um ponto importante a ser considerado é que o crescimento muscular dos peixes é influenciado pelas condições ambientais em que estão inseridos. Esta influência ocorre à nível molecular afetando a transcrição e funcionalidade de diferentes transcritos relacionados à miogênese em diferentes fases do desenvolvimento dos peixes. Esta revisão tem o objetivo de discutir alguns dos pontos chave sobre a influência dos fatores ambientais sobre o desenvolvimento e crescimento muscular dos peixes.

Abstract Teleost fish are organisms that generally show an indeterminate growth limit and are present in different biomes with different environmental conditions. Approximately up to 80% of the body composition of fish is formed by muscle tissue. Muscle tissue is composed of muscle fibers and undifferentiated satellite cells, forming a complex tissue that shows a widely varied shape depending on the species which form this group of animals. An important point to be considered is that the muscle growth of the fish is influenced by the environmental conditions in which they are inserted. This influence occurs at the molecular level, affecting the transcription and functionality of different transcripts related to myogenesis at different stages of fish development. This review aims to discuss some of the key aspects about the influence of environmental factors on the development and muscle growth of teleost fish.

Resumen Los peces teleósteos son organismos que generalmente tienen un límite de crecimiento indeterminado y están presentes en diferentes biomas con diferentes características ambientales. Los teleósteos poseen hasta el 80% de su composición corporal compuesta de tejido muscular, compuesto por fibras musculares y células satélite indiferenciadas, formando un tejido muscular complejo cuya forma es muy variada dependiendo de las especies que componen este grupo de animales. Un punto importante por considerar es que el crecimiento muscular de los peces está influenciado por las condiciones ambientales en que están inseridos. Esta influencia ocurre a nivel molecular, afectando la transcripción y la funcionalidad de diferentes transcripciones relacionadas con la miogénesis en diferentes etapas del desarrollo de los peces. Esta revisión tiene como objetivo discutir algunos de los puntos clave sobre la influencia de los factores ambientales en el desarrollo y el crecimiento muscular de los peces.

Isothioureas, Ureas, and Their N-Methyl Amides from 2-Aminobenzothiazole and Chiral Amino Acids.

In this investigation, the reaction of 2-dithiomethylcarboimidatebenzothiazole with a series of six chiral amino-acids was studied. The reaction proceeds through the isolable sodium salt of SMe-isothiourea carboxylates as intermediates, whose reaction with methyl iodide in stirring DMF as solvent affords SMe-isothiourea methyl esters. The presence of water in the reaction leads to the corresponding urea carboxylates as isolable intermediates, whose methyl esters were obtained. Finally, the urea N-methyl amide derivatives were isolated when SMe-isothiourea or urea methyl esters were reacted with methylamine in the presence of water. The structures of synthesized compounds were established by 1H and 13C nuclear magnetic resonance and the structures of SMe-isothiourea methyl esters derived from (l)-glycine, (l)-alanine, (l)-phenylglycine, and (l)-leucine, by X-ray diffraction analysis. This methodology allows to functionalize 2-aminobenzothiazole with SMe-isothiourea, urea, and methylamide groups derived from chiral amino acids to get benzothiazole derivatives containing coordination sites and hydrogen bonding groups. Further research on the biological activities of some of these derivatives is ongoing.

Timberlake's behavior systems: A paradigm shift toward an ecological approach.

Timberlake's Behavior Systems model constitutes a discontinuity in theoretical and empirical consequences of traditional approaches to the experimental study of behavior, such as operant as well as classical conditioning. Here we consider the synergy of an animal-centered approach and acknowledge that niche-related behaviors as functional activities create synergy with Gibson's ecological approach, in at least three terms. These are: an ecological stance for learning and behavior, hierarchical organization of behavior systems, and affordances implied in the process of tuning experimental procedures. The ideas expressed herein favor a paradigm shift toward an ecological approach to behavioral science.

Interplay Between Mitochondrial Oxidative Disorders and Proteostasis in Alzheimer's Disease.

Although the basis of Alzheimer's disease (AD) etiology remains unknown, oxidative stress (OS) has been recognized as a prodromal factor associated to its progression. OS refers to an imbalance between oxidant and antioxidant systems, which usually consist in an overproduction of reactive oxygen species (ROS) and reactive nitrogen species (RNS) which overwhelms the intrinsic antioxidant defenses. Due to this increased production of ROS and RNS, several biological functions such as glucose metabolism or synaptic activity are impaired. In AD, growing evidence links the ROS-mediated damages with molecular targets including mitochondrial dynamics and function, protein quality control system, and autophagic pathways, affecting the proteostasis balance. In this scenario, OS should be considered as not only a major feature in the pathophysiology of AD but also a potential target to combat the progression of the disease. In this review, we will discuss the role of OS in mitochondrial dysfunction, protein quality control systems, and autophagy associated to AD and suggest innovative therapeutic strategies based on a better understanding of the role of OS and proteostasis.

Malaria intensity in Colombia by regions and populations.

Determining the distribution of disease prevalence among heterogeneous populations at the national scale is fundamental for epidemiology and public health. Here, we use a combination of methods (spatial scan statistic, topological data analysis and epidemic profile) to study measurable differences in malaria intensity by regions and populations of Colombia. This study explores three main questions: What are the regions of Colombia where malaria is epidemic? What are the regions and populations in Colombia where malaria is endemic? What associations exist between epidemic outbreaks between regions in Colombia? Plasmodium falciparum is most prevalent in the Pacific Coast, some regions of the Amazon Basin, and some regions of the Magdalena Basin. Plasmodium vivax is the most prevalent parasite in Colombia, particularly in the Northern Amazon Basin, the Caribbean, and municipalities of Sucre, Antioquia and Cordoba. We find an acute peak of malarial infection at 25 years of age. Indigenous and Afrocolombian populations experience endemic malaria (with household transmission). We find that Plasmodium vivax decreased in the most important hotspots, often with moderate urbanization rate, and was re-introduced to locations with moderate but sustained deforestation. Infection by Plasmodium falciparum, on the other hand, steadily increased in incidence in locations where it was introduced in the 2009-2010 generalized epidemic. Our findings suggest that Colombia is entering an unstable transmission state, where rapid decreases in one location of the country are interconnected with rapid increases in other parts of the country.

The effect of lever height on the microstructure of operant behavior.

The effect of lever height on the temporal organization of reinforced lever pressing was examined. Lever pressing was reinforced on a variable-interval 30-s schedule in rats, with lever height manipulated across six successive conditions. Parameters of the organization of responses in bouts (bout length distribution, bout-initiation rate, within-bout rate, and sequential dependency) were estimated. These estimates revealed (1) a qualitative change in the distribution of IRTs and their sequential dependency when the lever was too high, (2) a mixture of geometrically-distributed bout lengths at all lever heights, and (3) longer bouts at lower and intermediate lever heights. In accordance with previous data, these findings suggest that lower and intermediate lever heights favored lever pressing with longer bout lengths, faster bout initiation, faster within-bout responding, and more sequentially dependent timing. These results underscore the disociability of motoric capacity in operant performance, and may reflect the influence of the body size on the temporal organization of the operant.

Plan prospectivo para el desarrollo agrario en las regiones colombianas a partir del posconflicto al año 2025 / Prospective plan for the agricultural development in the Colombian regions starting from the post-conflict up to the year 2025

El presente texto derivado de investigación, presenta los resultados del análisis prospectivo para el desarrollo agrario de las regiones colombianas, de cara a un posible acuerdo fruto de las actuales (2014) negociaciones de Paz entre la guerrilla de las Farc-EP y el Gobierno Colombiano, acuerdo que de firmarse permitiría a la sociedad Colombiana entrar en lo que por ahora se ha denominado posconflicto. En este texto se proyectan posibles escenarios al año 2025; nos planteamos 4 posibles escenarios, dos alternos identificados como: Bienestar a Media y Sobreviviendo, un escenario catastrófico denominado Pobreza Absoluta y nuestro escenario apuesta: Paz y Prosperidad.

The current text, which was derived from research, introduces t he results of the prospective analysis for the agricultural development in the Colombian regions, with a view of a possible agreement, as a result of the current (2014) peace negotiations between the FARC-EP guerrilla forces and the Colombian government, an agreement which, in the event of its being signed, would let the Colombian society enter into what by now has been called post-conflict. In this text, some possible scenarios are projected to the year 2025; four possible scenarios, two alternate ones, which are identified as: Average Welfare and Surviving, a catastrophic scenario known asAbsolute Poverty, and our bet stage: Peace and Prosperity.

An affordance analysis of unconditioned lever pressing in rats and hamsters.

Two experiments were conducted to assess the effect of lever height on lever pressing that was not explicitly reinforced - i.e., operant-level responding. Two rodent species were used as subjects, rats (Experiment 1) and hamsters (Experiment 2), aiming to compare the behavioral support offered by one lever at various heights relative to the subjects' body size. Results showed that lever height had a substantial effect on response rate. The rate of lever pressing varied similarly for rats and hamsters as a function of lever height, when lever height was re-scaled relative to body size. The distribution of inter-response times showed that lever pressing was organized in bouts separated by pauses. This pattern of responding was accurately described in both experiments by a mixture of two exponential distributions. These findings support an analysis of affordances in non-human species.

Neumotórax secundario a ventilación jet ranstraqueal en un paciente pediátrico / Secondary chokes to ventilation ranstraqueal jet in a pediátrico patient

El hemangioma subglótico congénito es una entidad rara, que ocupa el 1.5 por ciento de las lesiones laríngeas congénitas. En aquellos casos en los cuales está indicada la resección quirúrgica, se debe realizar un plan de manejo de la vía aérea y disponer de varias alternativas para asegurar una ventilación efectiva, mientras se tiene libre el campo quirúrgico. La ventilación jet transtraqueal (VJTT) es una técnica de ventilación controlada, que permite mantener permeable la vía aérea mientras se provee oxigenación durante la microcirugía de larínge. En este artículo, se presenta el caso de un paciente pediátrico con diagnóstico de hemangioma subglótico, programado para infiltración de la lesión bajo visión directa con microlaringoscopia, quien presentó un neumotórax secundario a la ventilación jet transtraqueal...

[Patient evolution in different stages of hepatic failure submitted to eradication of esophageal varices with endoscopic ligation]. / Evolución de los pacientes en diferentes estadios de insuficiencia hepática sometidos a erradicación de várices esofágicas con ligaduras endoscópicas.

OBJECTIVE: To know the patients' progress with distinct stages of hepatic failure, according to the Child Pugh classification, who underwent esophageal varices eradication with the use of endoscopic band ligation. DESIGN: Descriptive, longitudinal, prospective and comparative study. CENTRE: Endoscopy Department of the Central Military Hospital, Mexico, D.F. METHODS: One-hundred twenty-four patients with esophageal varices and a history of bleeding, were submitted to various band ligation sessions every 4 weeks until the varices were eradicated and control sessions every 3 months. RESULTS: A total of 425 endoscopy sessions were performed of which 239 were ligature applications and 187 control sessions. Eradication of varices was achieved in 100% of the patients. Of the Child A, 2/3 of them were eradicated in one session and the other 1/3 with 2 sessions. The patients of the Child B class, 66% of varices were effaced in one session, 22% in two and 12% in three sessions. In the Child C group, 50% were obliterated in two sessions, 47% with three, 2% needed 4 sessions. The follow-up period was from 4 months being the minimum and 13 months the maximum (mean of 7 months). In 15% of the patients varices recurred. None were from the Child A group. Those pertaining to the Child B group varices reappeared in 7.3% of which 2/3 required another ligation session to eradicate them once again and the other 1/3 were removed in two sessions. In the Child C group the incidence of recidivation was 28%, 43% of these needing one session to eliminate them once again, 50% two sessions and 7% three sessions for complete eradication. Rebleeding appeared in 7.7% of the sample, all of them were from the Child C class. The occurrence of congestive gastropathy before ligature was 42%, and 73% at the conclusion of the follow-up period. Congestive gastropathy developed in 11% of the Child A patients after eradication, 34% of the Child B group and 38.5% of the Child C group. The incidence of gastric varices was 21% before ligature and at the end of the follow-up period 17% more developed gastric varices. None of the Child A patients developed gastric varices, 12% of group B and 24% of group C. From the (n = 124) 22.5% presented dysphagia as a complication which lasted less than one week and in 0.8% mucosal ulcer CONCLUSION: It is possible to eradicate esophageal varices by band ligation independently of the hepatic function reserve. A greater number of sessions is required to eradicate varices in the poor hepatic function group and the incidence of recidivation, rebleeding, and complications that developed such as gastric varices and gastropathy are more frequent in patients with poor hepatic function reserve.

[Endoscopic management of variceal bleeding]. / Manejo endoscópico del sangrado variceal.

For the primary prophilaxis of the variceal bleeding, non selective beta-blockers (propanolol, nadolol) are still the mainstay of treatment but endoscopic ligation are becoming more popular Thanks to modern control procedures the acute bleeding mortality has been reduced. Endoscopic ligation is the prefered method for esophageal varices and the cyanoacrylate injection is the better method for fundic varices. Pharmacological therapy with octreotide or terlipresine seems to be effective, specially if endoscopic treatment is not available. TIPS is a good salvage option in case of endoscopic or pharmacologic failure. Endoscopic ligation seems to be the prefered method for secondary prophylaxis, specially compared with sclerotherapy. Some drugs that reduce portal hypertension are a good alternative. It is still very necessary to define technique and criteria of endoscopic variceal eradication to reduce the great variability reported in published trials.

Herpes virus infection in peritoneal fluid: a case report and review of literature.

Herpetic infections in body cavity fluids are unusual and are rarely reported in the cytology literature. We report a case of a 74-yr-old woman who developed ascites after undergoing an elective laparoscopic cholecystectomy for biliary colic. Cytology of peritoneal fluid revealed changes in a herpes simplex virus (HSV) infection that was confirmed by immunocytological staining.

[Cardias mucosa plication with endoluminal sutures by endoscopy in gastroesophageal reflux disease treatment]. / Plicación de la mucosa del cardias con suturas intraluminales aplicadas por endoscopia en el tratamiento de la enfermedad por reflujo gastroesofágico.

INTRODUCTION: Gastro-esophageal reflux disease is very common among general population, today's standard treatments are medical with proton pump inhibitors and laparoscopic antireflux surgery. Endoscopic gastric plication has been described recently for the treatment of this disease. OBJECTIVE: Review recent advances of the endoscopic gastric plication procedures for the management of gastro-esophageal reflux disease and report our experience. METHODS: Patients with symptomatic gastro-esophageal reflux disease are selected, with esophagitis A and B according to Los Angeles classification and with a De Meester score higher than 26 in 24 hour pH determination. Patients younger than 18 or older than 60 years old are excluded as well as patients with a hiatal hernia greater than 3 cm, previous esophageal or gastric surgery, associated esophageal pathology or a C or D esophagitis. RESULTS: After this procedure the lower esophageal sphincter increases its length, nevertheless there are minimal changes in its pressure, it also diminishes esophageal acid exposure time. Most studies show improvement in symptoms and less drug requirements. In studies with greater follow up period only a minority of patients persists with a good complete response with this treatment. CONCLUSIONS: Prospective randomized trials are needed to determine the real utility of this procedure, aside from these protocols there are no true indications to do this procedure in the general population.