Preliminary Bioactivity Assessment of Myrothecium Species (Stachybotryaceae) Crude Extracts against Aedes aegypti (Diptera: Culicidae): A First Approach from This Phytopathogenic Fungi.

Mosquitoes, as insect vectors, play a crucial role in transmitting viruses and parasites, leading to millions of human deaths in tropical and subtropical regions worldwide. This study aimed to evaluate the effects of ethanolic extracts of three species within the genus Myrothecium (M. roridum, M. dimerum, and M. nivale) on Aedes aegypti mosquito larvae to assess the inhibitory effect on growth and development, as well as to determine mortality. We quantify the average lethal concentrations and provide a qualitative characterization of the chemical groups responsible for their potential. Phytochemical screening revealed the presence of alkaloids, flavonoids, and terpenoids in the ethanolic extracts of the three fungal species. Tannins were found only in the extracts of M. dimerum and M. roridum. We observed a clear dependence of the effects of the crude extracts on mosquito larvae on the concentrations used and the duration of exposure. The toxic effect was observed after 48 h at a concentration of 800 ppm for both M. dimerum and M. nivale, while M. roridum showed effectiveness after 72 h. All three species within the genus Myrothecium exhibited 100% biological activity after 72 h of exposure at 600 ppm. At lower concentrations, there was moderate growth and development inhibitory activity in the insect life cycle. The study highlights the effectiveness of crude Myrothecium extracts in combating mosquito larvae, with effects becoming apparent between 48 and 72 h of exposure. This initial approach underscores the potential of the fungus's secondary metabolites for further in-depth analysis of their individual effects or synergies between them.

Cross-cultural comparison of the performance on the Five-Point test between highly educated comparable samples of Argentina and South Africa.

OBJECTIVE: The study aimed to carry out a cross-cultural analysis by comparing Five-Point test scores for two different countries. The Five-Point test measures design fluency, an executive function, and is an inexpensive test that makes it more accessible to assessment settings, including under-resourced settings. METHODS: Adults in Argentina (n = 90) and South Africa (n = 90) with tertiary levels of education were tested on the Five-Point Test. ANOVA was applied to compare the scores of the two groups on the total number of unique designs produced (Total Unique Designs). RESULTS: The study found no significant differences in the Total Unique Designs scores between the two groups (p = .13; η = 0.01). Correlations between demographic variables and the Total Unique Designs scores varied slightly across both samples. CONCLUSIONS: Despite large cultural differences between both samples (language, race, religion, income) scores on this test did not differ significantly. These findings provide initial evidence of scalar equivalence on the test across these samples. Norms for the Five-Point Test Total Unique Designs scores might be used interchangeably between these two highly educated groups from different countries.

Quality improvement collaborative to optimize heart failure care in patients from a network of clinics in Argentina during the COVID-19 pandemic.

Heart failure (HF) is a major clinical and public health problem associated with significant mortality, morbidity, and health-care costs. Despite the existence of evidence-based guidelines for the optimal treatment of HF, the quality of care remains suboptimal. Our aim was to increase the use a care bundle in 50% of enrolled subjects during their hospitalization and discharge and to reduce their readmission for HF causes by 10%. We conducted an uncontrolled before-after study in eight hospitals in Argentina to evaluate the effect of a quality improvement intervention on the use of an HF care bundle in patients with HF New York Heart Association (NYHA) Class II-III. The HF bundle of care included medication, continuum of care, lifestyle habits, and predischarge examinations. Training and follow-up of multidisciplinary teams in each center were performed through learning sessions and plan-do-study-act improvement cycles. Data collectors reviewed bundle compliance in the health records of recruited patients after their hospital discharge and verified readmissions through phone calls to patients within 30-40 days after discharge. We recruited 200 patients (83 before and 127 during the intervention phase), and bundle compliance increased from 9.6% to 28.3% [odds ratio 3.71, 95% confidence interval (8.46; 1.63); P = .002]. Despite a slow improvement during the first months, bundle compliance gained momentum near the end of the intervention surpassing 80%. We observed a non-significant decreased readmission rate within 30 days of discharge due to HF in the postintervention period [8.4% vs. 5.5%, odds ratio 0.63, 95% CI (1.88; 0.21); P = .410]. Qualitative analysis showed that members of the intervention teams acknowledged the improvement of work organization and standardization of care, teamwork, shared mental model, and health record completeness as well as the utility of training fellows. Despite the challenges related to the pandemic, better care of patients with HF NYHA Class II-III was possible through simple interventions and collaborative work. Graphical abstract.

Immune checkpoint inhibitor-associated thrombosis in patients with bladder and kidney cancer: a study of the Spanish Society of Medical Oncology (SEOM) thrombosis and cancer group.

PURPOSE: Both venous and arterial thrombotic events (VTE/AT) can be associated with immune checkpoint inhibitors (ICI). However, there is a paucity of information apropos patients in routine clinical practice. METHODS/PATIENTS: Retrospective, multicenter study promoted by the Thrombosis and Cancer Section of the Spanish Society of Medical Oncology (SEOM). Individuals with kidney or bladder cancer who initiated ICI between 01/01/2015 and 12/31/2020 were recruited. Minimum follow-up was 6 months (except in cases of demise). The primary objective was to calculate the incidence of ICI-associated VTE/AT and secondary objectives included to analyze their impact on survival and identify variables predictive of VTE/AT. RESULTS: 210 patients with kidney cancer were enrolled. The incidence of VTE/AT during follow-up (median 13 months) was 5.7%. Median overall survival (OS) was relatively lower among subjects with VTE/AT (16 months, 95% CI 0.01-34.2 vs. 27 months, 95% CI 22.6-31.4; p = 0.43). Multivariate analysis failed to reveal predictive variables for developing VTE/ AT. 197 patients with bladder were enrolled. There was a 9.1% incidence rate of VTE/AT during follow-up (median 8 months). Median OS was somewhat higher in patients with VTE/AT (28 months, 95% CI 18.4-37.6 vs 25 months, 95% CI 20.7-29.3; p = 0.821). Serum albumin levels < 3.5 g/dl were predictive of VTE/ AT (p < 0.05). CONCLUSIONS: There appears to be no association between developing VTE/AT and ICI use in patients with renal or bladder cancer. Serum albumin levels are a predictive factor in individuals with bladder cancer.

Oral granulomatosis with polyangiitis a systematic review.

OBJECTIVE: Granulomatosis with polyangiitis is an unusual multisystemic inflammatory disease, with vasculitis of small- and medium-sized vessels, with a predilection for upper lower airways and kidneys. The etiology remains unknown although it may originate from different stimuli, in genetically susceptible patients. MATERIALS AND METHODS: A detailed database search was performed. The variables were demographics, localization, histopathological findings, antineutrophil cytoplasmic autoantibody, cytoplasmic (c-ANCA) tests, treatment, and follow-up. RESULTS: Fifty-two cases were identified; the mean age was 49.6 years, with a range from 6 to 87 years. It was most frequently seen in females (57.7%). The most common race was white (59.6%). The most frequent location was in the maxillary gingiva (28.8%), followed by both the upper and lower gingiva (19.2%). The most common clinical presentation was "strawberry gingivitis" (61.5%). The main symptom was pain, in 50%. Regarding the c-ANCA test, it was positive in 71.2% of cases. The most common therapy was prednisone and cyclophosphamide, utilized in 51.9%. The average follow-up was 23.6 months, and 88.5% of patients were still alive at follow-up. CONCLUSION: The diagnosis initially was difficult to establish, an early diagnosis and treatment are mandatory. If untreated the disease can be associated with morbidity and mortality. For the oral clinician, this disease needs to be addressed in the differential diagnosis of oral lesions.

[Hip fracture due to osteomalacia secondary to celiac disease] / Fractura de cadera debida a osteomalacia secundaria a enfermedad celíaca

Background: Hip fracture in the young patient is uncommon, but it can have devastating consequences. This pathology in the context of minimal trauma obliges us to carry out a study on calcium metabolism to determine the primary cause. Material and methods: We present a clinical case about an 18-year-old male patient who suffered a subcapital fracture of the left hip due to minimal trauma while playing football. The patient was treated urgently by means of closed reduction and internal fixation with two spongy screws. Subsequently, the metabolism study showed a severe vitamin D deficiency (27.1 nmol/L - normal above 75 nmol/L) and high levels of anti-transglutaminase IgA antibodies (2502.40 U/mL). The digestive biopsy confirmed the diagnosis of celiac disease and was treated with a gluten-free diet and calcium and vitamin D supplements. Results: After two years of follow-up, the patient is pain free, with complete hip mobility. There have been no complications (failure of osteosynthesis, avascular necrosis or pseudoarthrosis) and serum levels of vitamin D as well as IgA antibodies against transglutaminase have normalized. Conclusion: In young patients with low energy trauma fractures, vitamin D deficiency must be considered as a possible etiology and the reason for such osteomalacia, such as celiac disease, must be identified.

Antecedentes: La fractura de cadera en el paciente joven es infrecuente, pero puede tener unas consecuencias devastadoras. Esta patología en el contexto de un traumatismo mínimo nos obliga a realizar un estudio sobre el metabolismo del calcio para filiar la causa primaria. Material y método: Presentamos un caso clínico sobre un paciente varón de 18 años que sufrió una fractura subcapital de cadera izquierda debido a un traumatismo mínimo mientras jugaba al fútbol. El paciente fue tratado quirúrgicamente de urgencia mediante reducción cerrada y fijación interna con dos tornillos de esponjosa. Posteriormente, el estudio del metabolismo mostró una deficiencia grave de vitamina D (27.1 nmol/L ­ normal por encima de 75 nmol/L) y altos niveles de anticuerpos IgA antitransglutaminasa (2502.40 U/mL). La biopsia digestiva confirmó el diagnóstico de enfermedad celíaca por lo que fue tratado con una dieta libre de gluten y suplementos de calcio y vitamina D. Resultados: Tras dos años de seguimiento, el paciente está libre de dolor, con movilidad completa de la cadera. No ha habido complicaciones (fracaso de la osteosíntesis, necrosis avascular o pseudoartrosis) y los niveles séricos de vitamina D así como de los anticuerpos IgA antitransglutaminasa se han normalizado. Conclusión: En pacientes jóvenes que presentan fracturas por traumatismos de baja energía, se ha de tener en cuenta la deficiencia de vitamina D como posible etiología y se debe identificar el motivo de dicha osteomalacia, como es la enfermedad celíaca. Conclusión: En pacientes jóvenes que presentan fracturas por traumatismos de baja energía, se ha de tener en cuenta la deficiencia de vitamina D como posible etiología y se debe identificar el motivo de dicha osteomalacia, como es la enfermedad celíaca.

Safety of growth hormone replacement in survivors of cancer and intracranial and pituitary tumours: a consensus statement.

Growth hormone (GH) has been used for over 35 years, and its safety and efficacy has been studied extensively. Experimental studies showing the permissive role of GH/insulin-like growth factor 1 (IGF-I) in carcinogenesis have raised concerns regarding the safety of GH replacement in children and adults who have received treatment for cancer and those with intracranial and pituitary tumours. A consensus statement was produced to guide decision-making on GH replacement in children and adult survivors of cancer, in those treated for intracranial and pituitary tumours and in patients with increased cancer risk. With the support of the European Society of Endocrinology, the Growth Hormone Research Society convened a Workshop, where 55 international key opinion leaders representing 10 professional societies were invited to participate. This consensus statement utilized: (1) a critical review paper produced before the Workshop, (2) five plenary talks, (3) evidence-based comments from four breakout groups, and (4) discussions during report-back sessions. Current evidence reviewed from the proceedings from the Workshop does not support an association between GH replacement and primary tumour or cancer recurrence. The effect of GH replacement on secondary neoplasia risk is minor compared to host- and tumour treatment-related factors. There is no evidence for an association between GH replacement and increased mortality from cancer amongst GH-deficient childhood cancer survivors. Patients with pituitary tumour or craniopharyngioma remnants receiving GH replacement do not need to be treated or monitored differently than those not receiving GH. GH replacement might be considered in GH-deficient adult cancer survivors in remission after careful individual risk/benefit analysis. In children with cancer predisposition syndromes, GH treatment is generally contraindicated but may be considered cautiously in select patients.

Tratamiento al alta en insuficiencia cardiaca ¿cumplimos con las guías? Subanálisis del registro ARGEN-IC / Heart Failure Treatment at Hospital Discharge. Do we Adhere to Guidelines? A Sub-analysis of the ARGEN-IC Registry

RESUMEN Introducción: La insuficiencia cardiaca (IC) se puede clasificar de diferentes maneras. La más utilizada, según la fracción de eyección ventricular izquierda (FEVI), distingue a grupos con opciones terapéuticas que impactan en la morbimortalidad. Existe información sobre adherencia a las recomendaciones de tratamiento específico al alta de la internación por IC en otros países, pero carecemos de ésta en el nuestro. Objetivos: Evaluar la prescripción de drogas específicas para IC con FEVI reducida (ICFER) al alta de pacientes internados por insuficiencia cardiaca aguda (ICA), así como los parámetros clínicos relacionados con la indicación. Materiales y métodos: Pacientes incorporados al registro prospectivo ARGEN-IC, con diagnóstico de ICA. Se definió FEVI deteriorada a la ≤40%; se analizó la prescripción de drogas recomendadas para ICFER al alta, y su relación con parámetros clínicos. Datos incorporados a la base Survey Monkey y analizados con el programa STATA 14. Se utilizó el test de t o chi cuadrado según la variable utilizada. Resultados: 871 pacientes incluidos, edad 68,1 años y 72,4% varones. FEVI reducida en el 53,3%. La estadía hospitalaria fue 8 días (RIC 5-12) y la mortalidad 7,32%. El 12,6% egresó con tensión arterial sistólica >130 mmHg y el 64,4% con frecuencia cardíaca >70 latidos por minuto. El 22,5% egresó sin betabloqueantes, el 29,1% sin vasodilatadores y el 43,7% sin antialdosterónicos. Entre las probables contraindicaciones, observamos 12,6% de enfermedad pulmonar obstructiva crónica (EPOC), 12,5% de índice de filtrado glomerular menor de 30 ml/min, 8,9% de creatinina mayor de 25 mg/dL y 0,44% hiperkalemia. Conclusiones: Constatamos prescripción subóptima y pobre cumplimiento de las recomendaciones; por ello es de vital importancia implementar estrategias para cambiar la realidad en nuestra región.

ABSTRACT Background: Heart failure (HF) can be classified in different ways. The most used classification is based on left ventricular ejection fraction (LVEF) and involves groups with therapeutic options that impact on morbidity and mortality. The information about adherence to the recommendation of specific treatment at hospital discharge for HF comes from other countries but not ours. Objectives: To evaluate the prescription of specific drugs for HF with reduced LVEF (HFrEF) at discharge in hospitalized patients for acute heart failure (AHF), as well as the clinical parameters related to the indication. Methods: Patients with diagnosis of AHF incorporated to the prospective ARGEN-IC registry were included. Reduced LVEF was defined as that ≤40%. Prescription rate of drugs recommended for HFrEF at discharge and its association with clinical parameters was analyzed. Data was incorporated to the Survey Monkey electronic database and analyzed using STATA® software package. The Student's t test or chi-square test were used, as applicable. Results: A total of 871 patients were included; mean age was 68.1 years and 72.4% were men. LEVF was reduced in 53.3%. Length of hospital stay was 8 days (IQR 5-12) and mortality rate was 7.32%. At discharge, systolic blood pressure was >130 mm Hg in 12.6% of the patients and 64.4% had heart rate >70 beats per minute; 22.5% were discharged without beta-blockers, 29.1% without vasodilators and 43.7% without aldosterone antagonists. Comorbidities included chronic obstructive pulmonary disease (COPD) in 12.6%, glomerular filtration rate <30 mL/min in 12.5 %, serum creatinine >2.5 mg/dL in 8,9% and hyperkalemia in 0.44%. Conclusions: We documented suboptimal prescription rate and poor adherence to the recommendations; thus, it is extremely important to implement strategies to change the reality in our region.

Reading fluency as a measure of educational level.

Education exerts a powerful influence on the performance on neuropsychological tests. Recently, the number of years that a person attends school has been the preferred method to operationalize educational level (EL). However, reading fluency (RF) has emerged as an alternative method that can define the quality of education. OBJECTIVE: To compare the influence of the number of years of education with RF on the cognitive performance in a control sample. METHODS: Fifty-six control participants with varying ages (17-87 years) and levels of education (3-19 years of formal schooling) were administered a neuropsychological scale along with an RF task. This scale measured attention, memory, language, executive functions, and constructional praxis. The RF task consisted of a short text. The score was the number of words read correctly per minute. Pearson's r was used to compute correlations. RESULTS: Results showed that RF had a higher correlation (0.53) than the years of schooling (0.38) with the scores of the neuropsychological scale. CONCLUSIONS: Reading fluency is a short, practical task that is easy to use in different languages and is a promising tool for EL assessment. It is also an adequate alternative to the reading of irregular words as a qualitative measure of EL.

A educação exerce uma poderosa influência no desempenho em testes neuropsicológicos. Até o momento, o número de anos que uma pessoa frequenta a escola tem sido o método preferido para operacionalizar o nível educacional (NE). No entanto, a fluência de leitura (FL) surge como um método alternativo que pode informar a qualidade do ensino. OBJETIVO: comparar a influência do número de anos de estudo versus FL no desempenho cognitivo em uma amostra controle. MÉTODOS: Administrou-se uma escala neuropsicológica juntamente com uma tarefa de FL a 56 participantes-controle com idades variáveis (17­87) e diferentes níveis de educação (3­19 anos de escolaridade formal). A escala mediu atenção, memória, linguagem, funções executivas e práxis construtiva. A tarefa de FL consistiu em um texto curto. A pontuação foi o número de palavras lidas corretamente por minuto. O r de Pearson foi usado para calcular correlações. RESULTADOS: Os resultados mostraram que a FL tinha uma correlação mais elevada (0,53) do que anos de escola (0,38) com as pontuações da escala neuropsicológica. CONCLUSÕES: A fluência de leitura é uma tarefa prática, curta e de fácil aplicação em diferentes idiomas, que se destaca como uma ferramenta promissora para a avaliação do NE. Também é uma alternativa adequada à leitura de palavras irregulares como uma medida qualitativa de NE.

Reading fluency as a measure of educational level / Fluência de leitura como medida do nível educacional

ABSTRACT Education exerts a powerful influence on the performance on neuropsychological tests. Recently, the number of years that a person attends school has been the preferred method to operationalize educational level (EL). However, reading fluency (RF) has emerged as an alternative method that can define the quality of education. Objective: To compare the influence of the number of years of education with RF on the cognitive performance in a control sample. Methods: Fifty-six control participants with varying ages (17-87 years) and levels of education (3-19 years of formal schooling) were administered a neuropsychological scale along with an RF task. This scale measured attention, memory, language, executive functions, and constructional praxis. The RF task consisted of a short text. The score was the number of words read correctly per minute. Pearson's r was used to compute correlations. Results: Results showed that RF had a higher correlation (0.53) than the years of schooling (0.38) with the scores of the neuropsychological scale. Conclusions: Reading fluency is a short, practical task that is easy to use in different languages and is a promising tool for EL assessment. It is also an adequate alternative to the reading of irregular words as a qualitative measure of EL.

RESUMO A educação exerce uma poderosa influência no desempenho em testes neuropsicológicos. Até o momento, o número de anos que uma pessoa frequenta a escola tem sido o método preferido para operacionalizar o nível educacional (NE). No entanto, a fluência de leitura (FL) surge como um método alternativo que pode informar a qualidade do ensino. Objetivo: comparar a influência do número de anos de estudo versus FL no desempenho cognitivo em uma amostra controle. Métodos: Administrou-se uma escala neuropsicológica juntamente com uma tarefa de FL a 56 participantes-controle com idades variáveis (17-87) e diferentes níveis de educação (3-19 anos de escolaridade formal). A escala mediu atenção, memória, linguagem, funções executivas e práxis construtiva. A tarefa de FL consistiu em um texto curto. A pontuação foi o número de palavras lidas corretamente por minuto. O r de Pearson foi usado para calcular correlações. Resultados: Os resultados mostraram que a FL tinha uma correlação mais elevada (0,53) do que anos de escola (0,38) com as pontuações da escala neuropsicológica. Conclusões: A fluência de leitura é uma tarefa prática, curta e de fácil aplicação em diferentes idiomas, que se destaca como uma ferramenta promissora para a avaliação do NE. Também é uma alternativa adequada à leitura de palavras irregulares como uma medida qualitativa de NE.

Registro ARGEN-IC en la era COVID. Realidad en tiempos de pandemia / Argentine Registry of Acute Heart Failure (ARGEN-IC) "Reality in pandemic times"

RESUMEN Introducción: El registro ARGEN-IC permitió conocer las características clínicas y epidemiológicas de la insuficiencia cardíaca aguda (ICA) en nuestro país; sin embargo, no contamos con datos nacionales de las consecuencias sobre la ICA de la implementación del distanciamiento social, preventivo y obligatorio a causa de la pandemia por SARS-CoV-2. Objetivo: Evaluar las características clínicas y epidemiológicas de los pacientes ingresados al registro ARGEN-IC durante el confinamiento y distanciamiento social debido a la pandemia por SARS-CoV-2. Materiales y métodos: Se compararon pacientes (p) incorporados al registro ARGEN-IC durante marzo-junio de 2019 (grupo A: Era No COVID) con los ingresados en igual período de 2020 (grupo B: Era COVID). Se registraron los datos de filiación, las características clínicas, bioquímicas, imagenológicas y terapéuticas durante la hospitalización y las respectivas complicaciones (mortalidad cardiovascular y no cardiovascular). Resultados: Se incluyeron 361 p, 222 en el grupo A y 139 en el grupo B. Se observaron diferencias significativas entre ambas poblaciones en cuanto a edad, grupo A 70,9 ± 14,8 años vs. grupo B 75 ± 13,3 (p = 0,008); antecedente de hipertensión arterial, grupo A 70,2% vs. grupo B 87,7% (p <0,001); antecedente de accidente cerebrovascular isquémico, grupo A 4,5% vs. grupo B 10,07% (p = 0,039); e hipertrofia ventricular izquierda, grupo A 4,9% vs. grupo B 1,5% (p = 0,021). En relación con otras variables como etiología, factores desencadenantes y forma de presentación clínica, no se hallaron diferencias significativas entre ambas poblaciones, aunque hubo una tendencia a mayor antecedente de depresión en el grupo B. No hubo diferencia en la duración de la estadía hospitalaria ni en la mortalidad. Conclusiones: Durante el distanciamiento social y obligatorio en nuestro país, observamos una disminución de las internaciones por ICA en 2020 respecto de las registradas en el mismo período de 2019. Entre aquellos que requirieron internación, hallamos un perfil de paciente más añoso, con más comorbilidades. No se observaron diferencias en la mortalidad total y cardiovascular, ni en la estadía hospitalaria.

ABSTRACT Introduction: The ARGEN-IC registry allowed knowing the clinical and epidemiological characteristics of acute heart failure (AHF) in our country; however, there are no available national data of the consequences on AHF of social, preventive and mandatory distancing due to the SARS-CoV-2 pandemic. Objective: The aim of this study was to evaluate the clinical and epidemiological characteristics of patients admitted to the ARGEN-IC registry during confinement and social distancing due to the SARS-CoV-2 pandemic. Methods: Patients included in the ARGEN-IC registry during March-June 2019 (group A: Non-COVID era) were compared with those admitted in the same period of 2020 (group B: COVID era). Affiliation data, clinical, biochemical, imaging and therapeutic characteristics during hospitalization and the associated complications (cardiovascular and non-cardiovascular mortality) were recorded. Results: A total of 361 patients were included in the study: 222 in group A and 139 in group B. Significant differences were observed between both populations in terms of age (group A: 70.9 ± 14.8 years vs. group B: 75 ± 13.3, p = 0.008), history of hypertension (group A: 70.2 % vs. group B: 87.7%, p <0.001), history of ischemic stroke (group A: 4.5% vs. group B: 10.07%, p = 0.039), and left ventricular hypertrophy (group A: 4.9 % vs. group B: 1.5 %, p = 0.021). No significant differences were found between the two populations regarding other variables such as etiology, triggering factors, and forms of clinical presentation, although there was a trend towards greater history of depression in group B. There was no difference in the length of hospital stay or mortality. Conclusions: During compulsory social distancing in our country, we observed a decrease in hospitalizations for AHF in 2020 compared with those registered in the same period of 2019, but the population requiring hospitalization was older and with more comorbidities. No differences were observed in overall and cardiovascular mortality, or in the length of hospital stay.

Imágenes en la amiloidosis cardíaca / Imaging in Cardiac Amyloidosis

RESUMEN La amiloidosis es un desorden sistémico producido por el depósito de fibrillas de proteínas insolubles que se pliegan y depositan en el miocardio. Los pacientes con amiloidosis y compromiso cardíaco tienen mayor mortalidad respecto a pacientes sin compromiso cardíaco. Las dos formas de amiloidosis más prevalentes que se asocian con compromiso cardíaco son la amiloidosis AL, por el depósito de las cadenas livianas de las inmunoglobulinas, y la amiloidosis ATTR, por el depósito de la proteína transtiretina (TTR) en forma mutada o senil. Este artículo tiene el objetivo de revisar las diferentes modalidades de imágenes cardíacas (ecocardiografía, resonancia magnética cardiaca, medicina nuclear y tomografía) que permiten determinar la severidad del compromiso cardíaco en pacientes con amiloidosis, el tipo de amiloidosis y su pronóstico. Finalmente, se sugiere un algoritmo diagnóstico para determinar el compromiso cardíaco en la amiloidosis adaptado a las herramientas diagnósticas disponibles localmente, con un enfoque práctico y clínico.

ABSTRACT Cardiac amyloidosis is a systemic disorder caused by the extracellular deposition of fibrils of insoluble proteins that misfold and deposit in the myocardium. Patients with amyloidosis and cardiac involvement have higher mortality rate than those without cardiac involvement. The two most prevalent types are amyloidosis with cardiac involvement are light-chain amyloidosis (AL) due to immunoglobulin light chain deposition and transthyretin amyloidosis (ATTR) due to deposition of mutated or senile forms of the transthyretin (TTR) protein. The aim of this paper is to review the different modalities of cardiac imaging tests (echocardiography, cardiac magnetic resonance imaging, nuclear medicine images and computed tomography scan) that can determine the severity of cardiac involvement in patients with amyloidosis, the type of amyloidosis and its prognosis. Finally, a diagnostic algorithm is proposed to determine cardiac involvement in amyloidosis, tailored to the diagnostic tools locally available with a practical and clinical approach.

An Adaptable, Open-Access Test Battery to Study the Fractionation of Executive-Functions in Diverse Populations.

The umbrella-term 'executive functions' (EF) includes various domain-general, goal-directed cognitive abilities responsible for behavioral self-regulation. The influential unity and diversity model of EF posits the existence of three correlated yet separable executive domains: inhibition, shifting and updating. These domains may be influenced by factors such as socioeconomic status (SES) and culture, possibly due to the way EF tasks are devised and to biased choice of stimuli, focusing on first-world testees. Here, we propose a FREE (Free Research Executive Function Evaluation) test battery that includes two open-access tasks for each of the three abovementioned executive domains to allow latent variables to be obtained. The tasks were selected from those that have been shown to be representative of each domain, that are not copyrighted and do not require special hardware/software to be administered. These tasks were adapted for use in populations with varying SES/schooling levels by simplifying tasks/instructions and using easily recognized stimuli such as pictures. Items are answered verbally and tasks are self-paced to minimize interference from individual differences in psychomotor and perceptual speed, to better isolate executive from other cognitive abilities. We tested these tasks on 146 early adolescents (aged 9-15 years) of both sexes and varying SES, because this is the age group in which the executive domains of interest become distinguishable and in order to confirm that SES effects were minimized. Performance was determined by Rate Correct Scores (correct answers divided by total time taken to complete blocks/trial), which consider speed-accuracy trade-offs. Scores were sensitive to the expected improvement in performance with age and rarely/inconsistently affected by sex and SES, as expected, with no floor or ceiling effects, or skewed distribution, thus suggesting their adequacy for diverse populations in these respects. Using structural equation modeling, evidence based on internal structure was obtained by replicating the three correlated-factor solution proposed by the authors of the model. We conclude that the FREE test battery, which is open access and described in detail, holds promise as a tool for research that can be adapted for a wide range of populations, as well as altered and/or complemented in coming studies.

Resiliencia de la cobertura vegetal en el Suroeste de México ante los efectos del cambio climático / Resilience of vegetation cover in Southwest Mexico to the climate change effects

Resumen El modelado de escenarios de cambios climáticos utilizando sistemas de información geográfica para estimar la resiliencia de la cobertura vegetal es una herramienta útil para proyectar impactos futuros e implementar estrategias de conservación o manejo. En el presente trabajo asociamos espacialmente la biodiversidad de la cobertura vegetal del Suroeste de México con su capacidad para adaptarse a los efectos del cambio climático. Para analizar esta asociación se estimaron índices de riqueza y diversidad de especies, y su relación con escenarios de clima futuro. Se utilizaron los registros geográficos del Inventario Nacional Forestal y de Suelos para ocho comunidades vegetales (arbórea, arbustiva, herbácea, palma, cactus, bejucos, helechos y xerófita) distribuidas entre Guerrero, Oaxaca y Chiapas. La proyección climática fue al 2050, con modelos de circulación global A2 (promedio CCCMA, HADCM3 y CSIRO), 19 variables bioclimáticas y una resolución de 2.5 minutos. Los escenarios de cambio climático se modelaron con el algoritmo MaxEnt y la riqueza de especies, índice de diversidad y regresiones espaciales con el software Diva-GIS v7.5. Los modelos de regresión espacial estimaron que a mayor riqueza y diversidad de especies mayor seria la resiliencia que mostraría el ecosistema. Las comunidades vegetales cactus, palma y xerófita mostraron mayor vulnerabilidad al cambio climático. Las variaciones en la estacionalidad de la temperatura resultó ser el factor que condicionaría su distribución futura. Por lo que, las estrategias de conservación o manejo deberían considerar a la diversidad como un agente del ecosistema que amortiguaría a los efectos negativos del clima futuro.

Abstract The scenarios modeling of climate changes using geographic information systems to estimate the vegetation cover resilience is a useful tool to project future impacts and implement conservation or management strategies. We associate spatially the biodiversity of the vegetation cover of Southwest Mexico with its ability to adapt to the effects of climate change. We analysis this association estimating species richness and diversity indices, and its relationship with scenarios of future climate. Geographical records of the National Forest and Soil Inventory were obtained for eight plant communities (arboreal, shrubby, herbaceous, palm, cactus, vines, ferns, and xerophyte) distributed in Guerrero, Oaxaca, and Chiapas. The climatic projection was to 2050, with global circulation A2 models (CCCMA, HADCM3 and CSIRO average), 19 bioclimatic variables and a resolution of 2.5 minutes. Climate change scenarios were modelled with the MaxEnt algorithm and species richness, diversity index, and spatial regressions with Diva-GIS v7.5 software. The spatial regression models estimated that higher richness and species diversity, the greater resilience that the ecosystem would show. The cactus, palm, and xerophytic plant communities presented greater vulnerability to climate change. Variations in temperature seasonality turned out to be the factor that would condition its future distribution. Therefore, in conservation or management strategies, diversity should be considered as an agent of the ecosystem that cushions the negative effects of future climate.

Acute rupture of distal biceps: Repair using a single anterior approach and cortical anchoring device / [Rotura aguda de bíceps distal: reparación mediante abordaje único anterior y dispositivo de anclaje cortical]

Background: Rupture of the distal tendon of the biceps is a pathology with an increasing incidence, which can cause important functional alterations. When the rupture is complete and the patient is active, surgical treatment is of choice. Material and method: 47-year-old man with sudden and intense pain in the left antecubital fossa while lifting weight. On examination, impotence for flexion and active supination of the left arm with loss of the biceps silhouette. Ultrasonography confirms the diagnosis of complete rupture of the distal biceps tendon. Surgical treatment was decided, performing a single anterior approach and reinserting the tendon in its radial footprint with the help of a cortical anchorage device. Results: At 12 months, the patient presented flexo-extension and complete prone supination, without encountering difficulties in carrying out the activities of his daily and work life, with a score of 100 points in the Mayo Elbow Performance Score (MEPS). Conclusion: Rupture of the distal biceps is a typical injury in active patients with an increasing incidence. Although there have been no significant differences between the different repair options, in our experience the use of cortical anchorage devices with a single anterior approach provides very satisfactory results.

Antecedentes: La rotura del tendón distal del bíceps braquial es una patología con una incidencia creciente, que puede ocasionar importantes alteraciones funcionales. Cuando la rotura es completa y el paciente activo, el tratamiento quirúrgico es de elección. Resultados: A los 12 meses, el paciente presenta flexo-extensión y prono-supinación completa, sin encontrar dificultades para realizar las actividades de su vida diaria y laboral, con puntación de 100 puntos en el Mayo Elbow Performance Score (MEPS). Material y método: Varón de 47 años con dolor intenso y súbito en la fosa antecubital izquierda mientras levantaba peso. A la exploración, impotencia para la flexión y supinación activa del brazo izquierdo con pérdida de la silueta del bíceps braquial. La ecografía confirma el diagnóstico de rotura completa del tendón distal del bíceps braquial. Se decide tratamiento quirúrgico, realizando un abordaje único anterior  y reinsertando el tendón en su "footprint" radial con ayuda de un dispositivo de anclaje cortical. Conclusión: La rotura del bíceps distal es una lesión típica de pacientes activos con una incidencia creciente. Aunque no se han evidenciado diferencias significativas entre las distintas opciones de reparación, en nuestra experiencia la utilización de dispositivos de anclaje cortical con un abordaje único anterior aporta unos resultados muy satisfactorios.

Care bundle to reduce readmission in patients with heart failure: a modified Delphi consensus panel in Argentina.

OBJECTIVES: The aim of this study was to develop consensus among Argentine cardiologists on a care bundle to reduce readmissions of patients with heart failure (HF). SETTING: Hospitals and cardiology clinics in Argentina that provide in-hospital care for patients with HF. PARTICIPANTS: Twenty-four cardiology experts participated in the two online rounds and 18 (75%) of them participated in the third-round meeting. METHODS: This study used a mixed-method design; it was conducted between August 2019 and January 2020. The development of a care bundle (a set of evidence-based interventions applied to improve clinical outcomes) involved three phases: (1) a literature review to define the list of interventions to be evaluated; (2) a modified Delphi panel to select interventions for the bundle and (3) definition of the HF care bundle. Also, the process included three rounds of scoring. RESULTS: Twenty-six interventions were evaluated. The interventions in the final bundle covered four categories: medication, continuum of care, lifestyle habits, predischarge tests. These were: medication: beta-blockers, angiotensin receptor neprilysin inhibitors or ACE-inhibitors, furosemide and antimineralocorticoids; continuum of care: follow-up appointment, daily weight monitoring; lifestyle habits: smoking cessation counselling and low-sodium diet; predischarge tests: renal function, ionogram, blood pressure control, echocardiogram and determination of decompensating cause. CONCLUSION: Following a systematic mixed-method approach, we have developed a care bundle of interventions that could decrease readmission of patients with HF. The application of this bundle could contribute to scale evidence-based interventions.

Raman Spectroscopy Studies on the Barocaloric Hybrid Perovskite [(CH3)4N][Cd(N3)3].

Temperature-dependent Raman scattering and differential scanning calorimetry were applied to the study of the hybrid organic-inorganic azide-perovskite [(CH3)4N][Cd(N3)3], a compound with multiple structural phase transitions as a function of temperature. A significant entropy variation was observed associated to such phase transitions, |∆S| ~ 62.09 J·kg-1 K-1, together with both a positive high barocaloric (BC) coefficient |δTt/δP| ~ 12.39 K kbar-1 and an inverse barocaloric (BC) coefficient |δTt/δP| ~ -6.52 kbar-1, features that render this compound interesting for barocaloric applications. As for the obtained Raman spectra, they revealed that molecular vibrations associated to the NC4, N3- and CH3 molecular groups exhibit clear anomalies during the phase transitions, which include splits and discontinuity in the phonon wavenumber and lifetime. Furthermore, variation of the TMA+ and N3- modes with temperature revealed that while some modes follow the conventional red shift upon heating, others exhibit an unconventional blue shift, a result which was related to the weakening of the intermolecular interactions between the TMA (tetramethylammonium) cations and the azide ligands and the concomitant strengthening of the intramolecular bondings. Therefore, these studies show that Raman spectroscopy is a powerful tool to gain information about phase transitions, structures and intermolecular interactions between the A-cation and the framework, even in complex hybrid organic-inorganic perovskites with highly disordered phases.

Beyond Intracellular Accumulation of Polyhydroxyalkanoates: Chiral Hydroxyalkanoic Acids and Polymer Secretion.

Polyhydroxyalkanoates (PHAs) are ubiquitous prokaryotic storage compounds of carbon and energy, acting as sinks for reducing power during periods of surplus of carbon source relative to other nutrients. With close to 150 different hydroxyalkanoate monomers identified, the structure and properties of these polyesters can be adjusted to serve applications ranging from food packaging to biomedical uses. Despite its versatility and the intensive research in the area over the last three decades, the market share of PHAs is still low. While considerable rich literature has accumulated concerning biochemical, physiological, and genetic aspects of PHAs intracellular accumulation, the costs of substrates and processing costs, including the extraction of the polymer accumulated in intracellular granules, still hampers a more widespread use of this family of polymers. This review presents a comprehensive survey and critical analysis of the process engineering and metabolic engineering strategies reported in literature aimed at the production of chiral (R)-hydroxycarboxylic acids (RHAs), either from the accumulated polymer or by bypassing the accumulation of PHAs using metabolically engineered bacteria, and the strategies developed to recover the accumulated polymer without using conventional downstream separations processes. Each of these topics, that have received less attention compared to PHAs accumulation, could potentially improve the economy of PHAs production and use. (R)-hydroxycarboxylic acids can be used as chiral precursors, thanks to its easily modifiable functional groups, and can be either produced de-novo or be obtained from recycled PHA products. On the other hand, efficient mechanisms of PHAs release from bacterial cells, including controlled cell lysis and PHA excretion, could reduce downstream costs and simplify the polymer recovery process.