Analysis of fetal heart rate fluctuations in women diagnosed with preeclampsia during the latent phase of labor.

Introduction: Fetal heart rate variability (fHRV) is a tool used to investigate the functioning of the fetal autonomic nervous system. Despite the significance of preeclampsia, fHRV during the latent phase of labor has not been extensively studied. This study aimed to evaluate fetal cardiac autonomic activity by using linear and nonlinear indices of fHRV analysis in women diagnosed with preeclampsia without hypertensive treatment during gestation, compared to normotensive women during the latent phase of labor. Methods: A cross-sectional and exploratory study was conducted among pregnant women in the latent phase of labor, forming three study groups: normotensive or control (C, 38.8 ± 1.3 weeks of pregnancy, n = 22), preeclampsia with moderate features (P, 37.6 ± 1.4 weeks of pregnancy n = 10), and preeclampsia with severe features (SP, 36.9 ± 1.2 weeks of pregnancy, n = 12). None of the participants received anti-hypertensive treatment during their pregnancy. Linear and nonlinear features of beat-to-beat fHRV, including temporal, frequency, symbolic dynamics, and entropy measures, were analyzed to compare normotensive and preeclamptic groups. Results: Significantly lower values of multiscale entropy (MSE) and short-term complexity index (Ci) were observed in the preeclamptic groups compared to the C group (p < 0.05). Additionally, higher values of SDNN (standard deviation of R-R intervals) and higher values of low-frequency power (LF) were found in the P group compared to the C group. Conclusion: Our findings indicate that changes in the complexity of fetal heart rate fluctuations may indicate possible disruptions in the autonomic nervous system of fetuses in groups affected by undiagnosed preeclampsia during pregnancy. Reduced complexity and shifts in fetal autonomic cardiac activity could be associated with preeclampsia's pathophysiological mechanisms during the latent phase of labor.

Pupil reflex as a marker of activity and prognosis in heart failure: a longitudinal and prospective study.

AIMS: Compensatory mechanisms in heart failure (HF) are triggered to maintain adequate cardiac output. Among them, hyperactivation of the sympathetic nervous system (SNS) is one of the main ones and carries a worse prognosis. The pupillary reflex depends on the SNS, and we can evaluate it through pupillometry. The aim of the study was to compare the differences in pupillary reflex between patients with acute HF and controls and to analyse whether these differences in pupillary reflex may offer a new and easy prognostic factor in such patients. METHODS AND RESULTS: We prospectively and consecutively included 107 patients admitted with decompensated HF. Quantitative pupillometry was performed with the NeuroOptics pupillometry during the first 24 h after admission and prior to discharge. The results were compared with those of a group of 100 healthy volunteers who also underwent pupillometry. The maximum baseline pupil size (MBPS) and the minimum pupil diameter (MPD) were measured. Patients with decompensated HF have a higher MBPS (3.64 ± 0.81) and higher MPD (2.60 ± 0.58) than HF patients at discharge and in the control group (P-value = 0.01 and 0.01, respectively). Also, HF patients presented an improvement in pupillometric values at discharge [MBPS (3.47 ± 0.79) and MPD (2.51 ± 0.58)] and showed no differences compared with the control group [MBPS (3.34 ± 0.82) and MPD (2.40 ± 0.53)] (P-value = 0.19 and 0.14, respectively). In addition, MBPS provides a good independent predictor of in-hospital and 1 month mortality in patients admitted with HF. Six patients (5.61%) died during hospital admission, and 11 patients (10.2%) died in the first month after discharge. Also, four patients (3.74%) were readmitted within 1 month of discharge. The receiver operating characteristic (ROC) curve for predicting in-hospital mortality through MBPS was 0.823. No patient with an MBPS < 3.7 mm died. The ROC curve for predicting combined mortality or readmission within the first month for MBPS was 0.698. CONCLUSIONS: Pupillometry may be a new, non-invasive, and simple tool to determine the status of SNS, help in the prognostic stratification of acute HF patients, and improve therapeutic management.

Well-defined Cu(I) complexes based on [N,P]-pyrrole ligands catalyzed a highly endoselective 1,3-dipolar cycloaddition.

We herein report the synthesis and catalytic application of a new family of dinuclear Cu(I) complexes based on [N,P]-pyrrole ligands. The Cu(I) complexes (4a-d) were obtained in good yields and their catalytic properties were evaluated in the1,3-dipolar cycloaddition of azomethine ylides and electron-deficient alkenes. The air-stable complexes 4a-d exhibited high endo-diasteroselectivity to obtain substituted pyrrolidines, and the catalytic system showed excellent reactivity and wide substitution tolerance.

Assessing the effects of oxytocin in changes of core body temperature during LPS-induced endotoxemia: A novel approach using Extended Poincaré Plot Analysis.

Oxytocin has shown cardioprotective effects during inflammation and may modify the core body temperature changes in LPS-induced endotoxemia. Notably, the time series analysis of core body temperature fluctuations may indicate thermoregulation alterations. This study aims to assess the effects of oxytocin on changes in the core body temperature by analyzing the fluctuations of the temperature time series of endotoxemic rats. Twelve hours of continuous core body temperature fluctuations time series were obtained from adult male Dark Agouti rats implanted with a telemetric transmitter under the following treatment: lipopolysaccharide (LPS); oxytocin (O); lipopolysaccharide + oxytocin (LPS + O), and vehicle or control (C). The temperature fluctuations time series were analyzed using the Extended Poincaré Plot Analysis (EPPA), a novel approach for measuring nonlinear features, to compute the autocorrelation by Pearson's correlation coefficient r, the standard deviation perpendicular to the line of identity (SD1), and the standard deviation parallel to the line of identity (SD2). The autocorrelation of the temperature fluctuations assessed by Pearson's coefficient was significantly higher in the LPS group compared to control rats (C). Likewise, the co-administration of oxytocin during endotoxemia (LPS + O) significantly reduced the autocorrelation and increased the short-term variability (SD1) of temperature fluctuations compared to those recorded with a single dose of LPS. Thus, we concluded that oxytocin may introduce thermoregulatory changes under LPS-induced endotoxemia. The EPPA is a simple and powerful approach to assess physiological variability that can provide valuable insights into changes in thermoregulation.

Differential Study of Retinal Thicknesses in the Eyes of Alzheimer's Patients, Multiple Sclerosis Patients and Healthy Subjects.

Multiple sclerosis (MS) and Alzheimer's disease (AD) cause retinal thinning that is detectable in vivo using optical coherence tomography (OCT). To date, no papers have compared the two diseases in terms of the structural differences they produce in the retina. The purpose of this study is to analyse and compare the neuroretinal structure in MS patients, AD patients and healthy subjects using OCT. Spectral domain OCT was performed on 21 AD patients, 33 MS patients and 19 control subjects using the Posterior Pole protocol. The area under the receiver operating characteristic (AUROC) curve was used to analyse the differences between the cohorts in nine regions of the retinal nerve fibre layer (RNFL), ganglion cell layer (GCL), inner plexiform layer (IPL) and outer nuclear layer (ONL). The main differences between MS and AD are found in the ONL, in practically all the regions analysed (AUROCFOVEAL = 0.80, AUROCPARAFOVEAL = 0.85, AUROCPERIFOVEAL = 0.80, AUROC_PMB = 0.77, AUROCPARAMACULAR = 0.85, AUROCINFERO_NASAL = 0.75, AUROCINFERO_TEMPORAL = 0.83), and in the paramacular zone (AUROCPARAMACULAR = 0.75) and infero-temporal quadrant (AUROCINFERO_TEMPORAL = 0.80) of the GCL. In conclusion, our findings suggest that OCT data analysis could facilitate the differential diagnosis of MS and AD.

Design of Experiments to Compare the Mechanical Properties of Polylactic Acid Using Material Extrusion Three-Dimensional-Printing Thermal Parameters Based on a Cyber-Physical Production System.

The material extrusion 3D printing process known as fused deposition modeling (FDM) has recently gained relevance in the additive manufacturing industry for large-scale part production. However, improving the real-time monitoring of the process in terms of its mechanical properties remains important to extend the lifespan of numerous critical applications. To enhance the monitoring of mechanical properties during printing, it is necessary to understand the relationship between temperature profiles and ultimate tensile strength (UTS). This study uses a cyber-physical production system (CPPS) to analyze the impact of four key thermal parameters on the tensile properties of polylactic acid (PLA). Layer thickness, printing speed, and extrusion temperature are the most influential factors, while bed temperature has less impact. The Taguchi L-9 array and the full factorial design of experiments were implemented along with the deposited line's local fused temperature profile analysis. Furthermore, correlations between temperature profiles with the bonding strength during layer adhesion and part solidification can be stated. The results showed that layer thickness is the most important factor, followed by printing speed and extrusion temperature, with very close influence between each other. The lowest impact is attributed to bed temperature. In the experiments, the UTS values varied from 46.38 MPa to 56.19 MPa. This represents an increase in the UTS of around 17% from the same material and printing design conditions but different temperature profiles. Additionally, it was possible to observe that the influence of the parameter variations was not linear in terms of the UTS value or temperature profiles. For example, the increase in the UTS at the 0.6 mm layer thickness was around four times greater than the increase at 0.4 mm. Finally, even when it was found that an increase in the layer temperature led to an increase in the value of the UTS, for some of the parameters, it could be observed that it was not the main factor that caused the UTS to increase. From the monitoring conditions analyzed, it was concluded that the material requires an optimal thermal transition between deposition, adhesion, and layer solidification in order to result in part components with good mechanical properties. A tracking or monitoring system, such as the one designed, can serve as a potential tool for reducing the anisotropy in part production in 3D printing systems.

Changes in the autonomic cardiorespiratory activity in parturient women with severe and moderate features of preeclampsia.

Background: Cardiorespiratory coupling (CRC) is a physiological phenomenon that reflects the mutual interaction between the cardiac and respiratory control systems. It is mainly associated with efferent vagal activity from the central autonomic network. Few studies have explored the autonomic changes of CRC in preeclampsia, a critical obstetric complication related to possible autonomic dysfunctions and inflammatory disturbances. This study examined the autonomic mechanisms of CRC in women with severe and moderate preeclampsia and healthy controls by applying nonlinear methods based on information theory, such as mutual information (MI) and Renyi's mutual information (RMI) and the linear and nonlinear analysis of the Pulse-Respiration Quotient (PRQ). Methods: We studied three groups of parturient women in the third trimester of pregnancy with a clinical diagnosis of preeclampsia without severe symptoms (P, 38.5 ± 1.4 weeks of pregnancy, n=19), preeclampsia with severe symptoms (SP, 37.5 ± 0.9 weeks of pregnancy, n=22), and normotensive control women (C, 39.1 ± 1.3 weeks of pregnancy, n=20). 10-minutes of abdominal electrocardiograms (ECG) and respiratory signals (RESP) were recorded in all the participants. Subsequently, we obtained the maternal beat-to-beat (RR) and breath-to-breath (BB) time series from ECG and RESP, respectively. The CRC between RR and BB was quantified by nonlinear methods based on information theory, such as MI and RMI, along with the analysis of the novel index of PRQ. Subsequently, we computed the mean PRQ (mPRQ) and the normalized permutation entropy (nPermEn_PRQ) from the PRQ time series generated from BB and RR. In addition, we examined the vagal activity in the three groups by the logarithm of the median of the distribution of the absolute values of successive RR differences (logRSA). Results: The MI and RMI values were significantly lower (p<0.05) in the preeclamptic groups compared to the control group. However, no significant differences were found between the preeclamptic groups. The logRSA and nPermEn_PRQ indices were significantly lower (p<0.05) in SP compared to C and P. Conclusion: Our data suggest that parturient women with severe and mild preeclampsia may manifest an altered cardiorespiratory coupling compared with normotensive control women. Disrupted CRC in severe preeclampsia could be associated with vagal withdrawal and less complex cardiorespiratory dynamics. The difference in vagal activity between the preeclamptic groups may suggest a further reduction in vagal activity associated with the severity of the disease.

Histologic margin status is a predictor of relapse in lentigo maligna melanoma.

BACKGROUND: Most surgical margins for lentigo maligna melanomas reported in the literature are clinical and not histologic. OBJECTIVES: We sought to determine whether histologic margin status is an independent predictor of progression. METHODS: Clinicopathologic information of 268 invasive lentigo maligna melanomas diagnosed from 1990-2019 were analyzed. Statistical analyses were performed using Cox proportional hazards model and Boruta method. RESULTS: A total of 75% of the lesions were located on the head and neck. The range of follow-up for all patients was 0 to 31.8 years (median, 10.2 years). Time to local recurrence ranges from 0 to 20 years (median, 3 years). Progression developed in 54 (20.1%) of 268 patients. Local recurrence was seen only in 36 (13.4%), both local recurrence and subsequent metastasis in 7 (2.6%), and only metastasis in 11 (4.1%) of 268 patients. Histologic margin status (positive and close/<3 mm) and tumor site (head and neck location) significantly correlated with worse progression-free survival. LIMITATIONS: Single institution and retrospective study. CONCLUSIONS: Histologic margin status is the strongest predictor of progression for lentigo maligna melanoma. Patients with positive or close/<3 mm histologic margins should consider a re-excision due to the increased risk of relapse.

Ozone Efficacy for the Disinfection of Ambulances Used to Transport Patients during the COVID-19 Pandemic in Peru.

We assessed the disinfection efficacy of an ozone generator prototype in ambulances used to transport patients with coronavirus disease (COVID-19). This research consisted of three stages: in vitro tests using microbial indicators, such as Candida albicans, Escherichia coli, Staphylococcus aureus and Salmonella phage, which were experimentally inoculated onto polystyrene crystal surfaces within a 23 m3 enclosure. They were then exposed to ozone at a 25 ppm concentration using the ozone generator (Tecnofood SAC) portable prototype, and the decimal reduction time (D) was estimated for each indicator. The second stage involved the experimental inoculation of the same microbial indicators on a variety of surfaces inside conventional ambulances. The third stage consisted of exploratory field testing in ambulances used to transport patients with suspected COVID-19. During the second and third stages, samples were collected by swabbing different surfaces before and after 25 ppm ozonisation for 30 min. Results suggested that ozone was most effective on Candida albicans (D = 2.65 min), followed by Escherichia coli (D = 3.14 min), Salmonella phage (D = 5.01 min) and Staphylococcus aureus (D = 5.40 min). Up to 5% of the microbes survived following ozonisation of conventional ambulances. Of the 126 surface samples collected from ambulances transporting patients with COVID-19, 7 were positive (5.6%) for SARS-related coronavirus as determined on reverse transcription quantitative real-time polymerase chain reaction (RT-qPCR). Ozone exposure from the ozone generator prototype inside ambulances at a concentration of 25 ppm for 30 min can eliminate gram positive and negative bacteria, yeasts, and viruses.

Stakeholder pressure and innovation capacity of SMEs in the COVID-19 pandemic: Mediating and multigroup analysis.

During environmental crises, it has always been particularly interesting to investigate how companies, specifically small- and mid-sized enterprises (SMEs), find solutions to survive and learn how to act in adverse situations. We conducted our study during the current coronavirus pandemic to analyse how stakeholder pressure affects both the innovation capabilities of SMEs and their firm performance. On the one hand, we examine whether the market and financial performance are better in the presence of less stakeholder pressure. On the other hand, we analyse whether SMEs implement internal mechanisms that enhance their innovation capacity to solve external problems caused by greater stakeholder pressure, which in turn affects firm performance. Our main findings show that during the pandemic, stakeholder pressure is related to the innovative capacity of SMEs; therefore, the higher the pressure, the more important the innovative response of SMEs. However, with higher pressure, the company's performance would be directly reduced in the short term, as the conditions set would be more unfavourable. Innovation capacity also plays a mediating role in preventing poor business performance because of increased stakeholder pressure. Owing to the importance of the chief executive officer (CEO) in SMEs, we test, through multigroup analysis, the differences based on the CEO's educational level. For example, commitment to innovation in SMEs may be more important for managers with higher education. Finally, our findings show how managers can learn to face new challenges in unfavourable environments.

Prediction of significant coronary artery disease in acute chest pain without infarction in emergency department: MAPAC Cardio-PreTest model.

Acute nontraumatic chest pain is a frequent reaso n for consultation in emergency departments and represents a diagnostic challenge. The objective is to estimate the risk of significant coronary artery disease (CAD) in patients with cardiogenic acute chest pain for whom the diagnosis of infarction was ruled out in the emergency department with a nondiagnostic ECG and negative high-sensitivity troponins. We prospectively recruited 1625 patients from emergency departments of seven Spanish hospitals. The outcome was presence of significant CAD determined by presence of ischaemia in functional tests or more than 70% stenosis in imaging tests. In this study, we developed a predictive model and evaluated its performance and clinical utility. The prevalence of significant CAD was 14% [227/1625; 95% confidence interval (CI), 12-16]. MAPAC Cardio-PreTest model included seven predictors: age, sex, smoking, history of hypertension, family history of CAD, history of hyperuricaemia, and type of chest pain. The optimism-adjusted model discrimination was C-statistic 0.654 (95% CI, 0.618-0.693). Calibration plot showed good agreement between the predicted and observed risks, and calibration slope was 0.880 (95% CI, 0.731-1.108) and calibration-in-the-large -0.001 (95% CI, -0.141 to 0.132). The model increased net benefit and improved risk classification over the recommended approach by the European Society of Cardiology [Net Reclassification Index (NRI) of events = 5.3%, NRI of nonevents = 7.0%]. MAPAC Cardio-PreTest model is an online prediction tool to estimate the individualised probability of significant CAD in patients with acute chest pain without a diagnosis of infarction in emergency department. The model was more useful than the current alternatives in helping patients and clinicians make individually tailored choices about the intensity of monitoring or additional coronary tests.

[Tuberculosis: the counterpoint of progress]. / Tuberculosis: el contrapunto del progreso.

Along history, infectious diseases have had a direct influence in the development of humanity, with tuberculosis showing a leading role. Despite this disease being the main cause of mortality among infectious diseases, it remains neglected and constitutes a serious public health problem, especially among the poorest countries in the world. Tuberculosis greatest importance goes beyond Medicine, and a holistic view of the disease allows us to comprehend the economic and social development of a nation. Despite a historically successful control program in Chile, current figures are not auspicious and force upon us the need to address this problem with a multidisciplinary approach. The medical physician is required to put again into practice the fundamental principle of Medicine, Semiology to contribute to the control of tuberculosis.

Prevalence of Glucose-6-Phosphate Dehydrogenase Deficiency in Newborns in Northeast Mexico.

OBJECTIVE: Glucose-6-phosphate dehydrogenase deficiency (G6PDd) is the most common enzymatic disease worldwide and the prevalence is not well established because of the lack of screening. This study aimed to estimate the prevalence of G6PDd in a Hispanic population from Northeast Mexico. STUDY DESIGN: In this retrospective study, a database was used to analyze the G6PDd in neonates included in the expanded newborn metabolic screening of inherited metabolic disorders during a period of 4 years through the GSP Neonatal G6 kit (PerkinElmer). RESULTS: Among 96,152 (48,462 male) neonates screened for G6PD enzyme activity, a total of 566 (0.58%) cases were deficient for G6PD. Of those 566 patients, 469 (82.8%) attended the second test and the other 97 (17.2%) patients were lost. Of those 469 who did attend, 384 (81.9%) neonates were deficient in the second test and 85 (18.1%) were normal. With the data collected, 384 neonates were confirmed with G6PDd, 348 (88.6%) were male and 36 (11.4%) patients were female. The calculated prevalence for this population was 0.72 cases per 100 male newborns. CONCLUSION: The prevalence of G6PDd in the Northeastern Mexican population is high. Since migration is increasing in the United States, pediatricians should be aware of the need to search for G6PDd in newborns and the wide clinical manifestations they can present. KEY POINTS: · The calculated prevalence of glucose-6-phosphate dehydrogenase deficiency in Northeast Mexico is 3.99 cases per 1,000 newborns.. · Glucose-6-phosphate dehydrogenase deficiency screenings should be included in all newborn metabolic screenings.. · Glucose-6-phosphate dehydrogenase deficiency is a common erythroenzymopathy that must be addressed as a public health concern. To anticipate clinical complications, target population monitoring is required..

The role of progressive, therapeutic exercise in the management of upper limb tendinopathies: A systematic review and meta-analysis.

BACKGROUND: Among upper limb tendinopathies, rotator cuff-related shoulder pain and lateral elbow tendinopathy are the most representative disorders. Therapeutic exercise arises as an effective approach, but there is no consensus about the optimal progression criteria. OBJECTIVE: To compare progression criteria and effectiveness of isolated, progressive exercises in the management of upper limb tendinopathies. Additionally, to perform a meta-analysis of pain/function for the selected programs. DESIGN: Systematic Review and Meta-Analysis. METHOD: Database search of randomized-controlled-trials including progressive exercise was conducted in PubMed and Scopus until October 2020. Meta-analysis' inclusion criteria were: no data duplicity; 3-months follow-up; comparison between any type of progressive exercise program. Risk of bias was assessed with PEDro score, and level of evidence followed GRADE guidelines. Effect size was calculated with Cohen's d. RESULTS: Eleven studies were included. GRADE revealed low-quality evidence for meta-analysis of pain during activity (d = 0.29) and function (d = 0.33) at 3 months. Progression criteria were categorised into two divisions, being pain the central concept. Pain (rest/activity/night) and function improved significantly within-group, but between-group changes were heterogeneous. Meta-analysis regarding pain showed good homogeneity with significant, moderate effects (I2 = 20%; p = 0.005; mean d = 0.29); function yielded important heterogeneity with non-significant, moderate effects (I2 = 81%; p = 0.17; mean d = 0.33). CONCLUSIONS: Pain was the most frequent benchmark when modulating and progressing the exercises, although other criteria were found such as fatigue or self-perceived ability. Progressive exercise seems effective to manage upper limb tendinopathies, but the superiority of a progression criterion against others remains unclear. Low-quality evidence supported progressive exercise with eccentric components in adding a significant and moderate effect on pain/function at short-term.

Seed and seedling interactions in three tree species from Mediterranean forests as a knowledge base for ecological restoration.

The ecosystems of the Mediterranean regions are severely threatened by human activity, and although we have made progress in physical restoration measures, little is known about the interactions between the plants of these biomes. The objective of this study is to contribute to document interactions between seeds and seedlings of three woody species native to Chile (P. chilensis, Q. saponaria and A. caven), which could be used for restoration actions (e.g., after forest fires). In a first experiment, we evaluated the germination response, the initial elongation and the interactions between the seedlings that germinate exposed to the chemical compounds of the other species. In a second experiment, we compared the survival and growth of seedlings in monospecific versus bispecific mixtures, using a substrate similar to that which is present after a wildfire. Seed extracts of teguments promoted germination of P. chilensis, but cotyledons and whole seed extracts inhibited germination of only one species, Q. saponaria, with very high intensity. The effects of the extracts on initial seedling elongation were more variable, including five inhibitions and one facilitation. Negative effects on germination and elongation included two cases of autotoxicity. The survival of seedlings grown in mixtures showed only two differences between monospecific and bispecific mixtures, both positive, constituting a reciprocal effect between two species. Only in one case was there a significant difference in seedling growth, which was root growth inhibition. Indeed, these results reveal an interaction between species, the type and intensity of which varies according to the condition of the seed or seedling. The negative effect found in seedling root growth reflects an allelopathic interaction that conditions a vital aspect for the establishment of these species, so this information is an opportunity to improve the establishment conditions in future reforestation projects, by avoiding particular species or promoting their proportion in plantation mixtures, either by planting or direct seeding.

Vaginal Microbiota Is Stable and Mainly Dominated by Lactobacillus at Third Trimester of Pregnancy and Active Childbirth: A Longitudinal Study of Ten Mexican Women.

In healthy women at reproductive age, the vaginal microbiota is mainly dominated by Lactobacillus bacteria during pregnancy and non-pregnancy stages. However, little is known about longitudinal changes within the vaginal microbiota composition from the third trimester of pregnancy to childbirth in healthy women. Thus, we conducted an exploratory longitudinal study of vaginal microbiota composition of 10 Mexican pregnant women, sampling from the same volunteer at two-time points: third trimester of pregnancy and active childbirth. Vaginal bacterial microbiota was characterized by V3-16S rDNA libraries by high-throughput sequencing and bioinformatics methods. Out of ten, vaginal microbiota from eight women was dominated by the Lactobacillus genus at both time points, whereas the other two women showed vaginal microbiota composition with high abundance of genera Gardnerella, Prevotella, and members of the Atopobiaceae family, without any preterm birth correlation. Importantly, we found no statistically significant differences in relative abundances, absolute reads count, alpha and beta diversity between the third trimester of pregnancy, and active childbirth time points. However, compared to the third trimester of pregnancy, we observed a trend with higher absolute reads counts for Gardnerella, Faecalibaculum, Ileibacterium, and Lactococcus genus at active childbirth and lower absolute reads count of Lactobacillus genus. Our results suggest that the vaginal microbiota composition is stable, and Lactobacillus genus is the dominant taxa in Mexican women's vagina at the third trimester of pregnancy and childbirth.

Tuberculosis: el contrapunto del progreso / Tuberculosis: the counterpoint of progress

Resumen A lo largo de la historia, las enfermedades infecciosas han influido directamente en el desarrollo de la humanidad y en este proceso, la tuberculosis ha tenido un rol protagónico. Esta enfermedad mata más seres humanos que cualquier otra de causa infecciosa y, a pesar de esto, continúa siendo una entidad olvidada y un grave problema de salud pública, sobre todo en las naciones más pobres. La trascendencia de la tuberculosis va más allá del ámbito médico y una visión holística de ella nos permite comprender el grado de desarrollo económico y social de un Estado. Si bien Chile mantenía un programa de control históricamente exitoso, las cifras actuales no son auspiciosas y obligan a analizar el problema desde una mirada multidisciplinaria. Es en este marco que planteamos que el médico clínico, para aportar en el control de la enfermedad, debe poner nuevamente en práctica uno de los principios básicos de la Medicina: la semiología.

Abstract Along history, infectious diseases have had a direct influence in the development of humanity, with tuberculosis showing a leading role. Despite this disease being the main cause of mortality among infectious diseases, it remains neglected and constitutes a serious public health problem, especially among the poorest countries in the world. Tuberculosis greatest importance goes beyond Medicine, and a holistic view of the disease allows us to comprehend the economic and social development of a nation. Despite a historically successful control program in Chile, current figures are not auspicious and force upon us the need to address this problem with a multidisciplinary approach. The medical physician is required to put again into practice the fundamental principle of Medicine, Semiology to contribute to the control of tuberculosis.