Microbiome in the nasopharynx: Insights into the impact of COVID-19 severity.

Background: The respiratory tract harbors a variety of microbiota, whose composition and abundance depend on specific site factors, interaction with external factors, and disease. The aim of this study was to investigate the relationship between COVID-19 severity and the nasopharyngeal microbiome. Methods: We conducted a prospective cohort study in Mexico City, collecting nasopharyngeal swabs from 30 COVID-19 patients and 14 healthy volunteers. Microbiome profiling was performed using 16S rRNA gene analysis. Taxonomic assignment, classification, diversity analysis, core microbiome analysis, and statistical analysis were conducted using R packages. Results: The microbiome data analysis revealed taxonomic shifts within the nasopharyngeal microbiome in severe COVID-19. Particularly, we observed a significant reduction in the relative abundance of Lawsonella and Cutibacterium genera in critically ill COVID-19 patients (p < 0.001). In contrast, these patients exhibited a marked enrichment of Streptococcus, Actinomyces, Peptostreptococcus, Atopobium, Granulicatella, Mogibacterium, Veillonella, Prevotella_7, Rothia, Gemella, Alloprevotella, and Solobacterium genera (p < 0.01). Analysis of the core microbiome across all samples consistently identified the presence of Staphylococcus, Corynebacterium, and Streptococcus. Conclusions: Our study suggests that the disruption of physicochemical conditions and barriers resulting from inflammatory processes and the intubation procedure in critically ill COVID-19 patients may facilitate the colonization and invasion of the nasopharynx by oral microorganisms.

Is it possible to diagnose therapeutic adherence in mild cognitive impairment and dementia patients in clinical practice?

Background: Non-adherence is common and contributes to adverse health outcomes, reduced quality of life, and increased healthcare expenditure. The objective of this study was to assess the diagnostic validity to estimate the prevalence of non-adherence in patients with mild cognitive impairment (MCI) and dementia using two self-reported methods (SRMs) that are useful and easy in clinical practice, considering the pill count as a reference method (RM). Methods: The cohort study was nested in a multicenter randomized controlled trial NCT03325699. A total of 387 patients from 8 health centers were selected using a non-probabilistic consecutive sampling method. Inclusion criteria were as follows: a score of 20-28 points on the Mini-Mental State Examination (MMSE); older than 55 years; taking prescribed medication; and are in charge of their own medication use. Participants were followed up for 18 months after the baseline visit, i.e., 6, 12, and 18 months. Variables related with treatment adherences were measured in all visits. The variables included age, sex, treatment, comorbidities, and the MMSE test. Adherences included pill counts and Morisky-Green test (MGT) and Batalla test (BT) as SRMs. Statistical analysis included descriptive analysis and 95% confidence intervals (CIs). The diagnostic validity included the following: 1) open comparison statistical association between SRMs and RMs and 2) hierarchy comparison: the RM as the best method to assess non-adherence, kappa value (k), sensitivity (S), specificity (Sp), and likelihood ratio (PPV/PPN). Results: A total of 387 patients were recruited with an average age of 73.29 years (95% CI, 72.54-74.04), of which 59.5% were female. Comorbidities were 54.4% HTA, 35.9% osteoarticular pathology, and 24.5% DM. The MMSE mean score was 25.57 (95% CI, 25.34-25.8). The treatment adherence for the RM oscillates between 22.5% in the baseline and 26.3%, 14.8%, and 17.9% in the follow-up visits. For SRMs, the treatment adherence oscillates between 43.5% in the baseline and 32.4%, 21.9%, and 20.3% in the follow-up visits. The kappa value was statistically significant in all the comparison in all visits with a score between 0.16 and 035. Regarding the diagnostic validity, for the MGT, the sensibility oscillated between 0.4 and 0.58, and the specificity oscillated between 0.68 and 0.87; for the BT, the sensibility oscillated between 0.4 and 0.7, and the specificity oscillated between 0.66 and 0.9; and when both tests were used together, the sensibility oscillated between 0.22 and 0.4, and the specificity oscillated between 0.85 and 0.96. Conclusion: SRMs classify non-adherent subjects correctly. They are very easy to use and yield quick results in clinical practice, so SRMs would be used for the non-adherence diagnosis in patients with MCI and mild dementia.

Problematic smartphone use and academic achievement: A systematic review and meta-analysis.

Background and aims: The present study aimed to synthesize existing quantitative evidence on the relationship between problematic smartphone use (PSU) and academic achievement with a focus on quantifying its magnitude and examining its potential moderators. Methods: Eligible studies were searched for up to February 10, 2023 in six different databases (i.e., MEDLINE, Current Contents Connect, PsycINFO, Web of Science, SciELO, and Dissertations & Theses Global). Studies were considered eligible if they provided information derived from self-report instruments that allowed statistical calculation of the relationship between PSU and academic achievement. Pooled effect sizes (r) were computed using a random-effects model. Meta-regressions were conducted to test the influence of study-level moderators on the relationship of interest. Influence analyses and a three-parameter selection model (3PSM) were conducted to examine the robustness of the results and publication bias, respectively. Results: A total of 33 effect sizes from 29 studies (n = 48,490) were retrieved. Results showed a small effect size (r = -0.110), which tended to be larger in samples consisting of students from elementary and middle schools. Discussion and Conclusions: Findings from the present study contribute to the understanding of a potential determinant of decreased academic achievement by providing evidence that PSU may be one of them.

Optimizing the releasing strategy used for the biological control of the sugarcane borer Diatraea saccharalis by Trichogramma galloi with computer modeling and simulation.

One of the challenges in augmentative biological control programs is the definition of releasing strategy for natural enemies, especially when macro-organisms are involved. Important information about the density of insects to be released and frequency of releases usually requires a great number of experiments, which implies time and space that are not always readily available. In order to provide science-based responses for these questions, computational models offer an in silico option to simulate different biocontrol agent releasing scenarios. This allows decision-makers to focus their efforts to more feasible options. The major insect pest in sugarcane crops is the sugarcane borer Diatraea saccharalis, which can be managed using the egg parasitoid Trichogramma galloi. The current strategy consists in releasing 50,000 insects per hectare for each release, in three weekly releases. Here, we present a simulation model to check whether this releasing strategy is optimal against the sugarcane borer. A sensitive analysis revealed that the population of the pest is more affected by the number of releases rather than by the density of parasitoids released. Only the number of releases demonstrated an ability to drive the population curve of the pest towards a negative growth. For example, releasing a total of 600,000 insects per hectare in three releases led to a lower pest control efficacy that releasing only 250,000 insects per hectare in five releases. A higher number of releases covers a wider range of time, increasing the likelihood of releasing parasitoids at the correct time given that the egg stage is short. Based on these results, it is suggested that, if modifications to the releasing strategy are desired, increasing the number of releases from 3 to 5 at weekly intervals is most likely preferable.

Smoking Cessation Support in the Context of Other Social and Behavioral Needs in Community Health Centers.

BACKGROUND: Cigarette smoking rates remain disproportionately high among low income populations with unmet social and behavioral health needs. To address this problem, we sought to develop and evaluate the feasibility, acceptability, and preliminary effectiveness of a novel smoking cessation program for community health centers that serve these populations. METHODS: We implemented a randomized pilot trial of two smoking cessation programs in three county operated community health center (CHC) sites: (1) a systematic assessment of smoking habits and standard tools to assist with smoking cessation counseling ("Enhanced Standard Program" or ESP), and (2) another that added a structured assessment of social and behavioral barriers to smoking cessation, ("Connection to Health for Smokers" or CTHS). Clinical outcomes were evaluated between 10 to 16 weeks, supplemented with interviews of patient participants and health care team members. RESULTS: 141 adults were randomized and 123 completed the intervention (61 in ESP, 62 in CTHS). At follow-up, over half of participants reported ≥1 quit attempts (59.7% ESP and 56.5% CTHS; adjusted p = .66) while more in ESP (24.6% vs. 12.9%) were documented as not smoking in the last 7 days (adjusted p = 0.03). In addition to being in ESP, predictors of smoking cessation included higher baseline confidence in ability to quit (p = 0.02) and more quit attempts during the study (p = 0.04). Health care teams, however, generally preferred the more comprehensive approach of CTHS. CONCLUSION: Lessons learned from this pilot study may inform the development of effective smoking cessation programs for CHCs that combine elements of both interventions.

Comparison of perioperative outcomes in obese and non-obese patients subjected to open lumbar spine surgery.

OBJECTIVE: Obesity is a global epidemic affecting developing countries. The relationship between obesity and perioperative outcomes during elective lumbar spine surgery remains controversial, especially in those without morbid disease. MATERIALS AND METHODS: We retrospectively revised the medical records of patients with lumbar spine degeneration subjected to elective surgery. The data retrieved included demographic and clinical characteristics, body mass index (BMI), obesity status (BMI ≥ 30), surgical interventions, estimated blood loss (EBL), operative time, length of stay (LOS), and post-operative complications. Perioperative outcomes were compared between Grade I-II obese and non-obese individuals. RESULTS: We enrolled 53 patients, 18 with Grade I-II obesity. Their median age was 51, with no differences in gender, comorbidities, laboratory parameters, and surgical procedures received between groups. No clinically relevant differences were found between grade I-II obese and non-obese participants in EBL (300 mL vs. 250 mL, p = 0.069), operative time (3.2 h vs. 3.0 h, p = 0.037), and LOS (6 days vs. 5 days, p = 0.3). Furthermore, BMI was not associated with the incidence of significant bleeding and long stay but showed a modest correlation with operative time. CONCLUSION: Grade I-II obesity does not increase surgical complexity nor perioperative complications during open lumbar spine surgery.

OBJETIVO: La obesidad es una epidemia mundial que afecta a países subdesarrollados. Su relación con los resultados de la cirugía de columna lumbar electiva sigue siendo controvertida, especialmente en obesos sin enfermedad mórbida. MÉTODOS: Se revisaron los expedientes de pacientes con degeneración de la columna lumbar sometidos a cirugía. Los datos recuperados incluyeron características demográficas y clínicas, índice de masa corporal (IMC), estado de obesidad (IMC > 30), intervenciones quirúrgicas, sangrado estimado, tiempo operatorio, tiempo de estancia y complicaciones. Los resultados se compararon entre individuos obesos grado I-II y controles. RESULTADOS: Se incluyeron 53 pacientes, 18 con obesidad de grado I-II. La edad media fue de 51 años, sin diferencias en el sexo, las comorbilidades, los parámetros de laboratorio y los procedimientos quirúrgicos recibidos entre grupos. No se encontraron diferencias relevantes entre los participantes obesos y los no obesos en sangrado (300 vs. 250 mL, p = 0.069), tiempo operatorio (3.2 vs. 3.0 horas, p = 0.037) y estancia (6 vs. 5 días, p = 0.3). El IMC no se asoció con hemorragia y larga estancia, pero mostró una correlación modesta con el tiempo operatorio. CONCLUSIONES: La obesidad grado I-II no predispone a complicaciones durante la cirugía de columna lumbar.

Fine-mapping genomic loci refines bipolar disorder risk genes.

Bipolar disorder (BD) is a heritable mental illness with complex etiology. While the largest published genome-wide association study identified 64 BD risk loci, the causal SNPs and genes within these loci remain unknown. We applied a suite of statistical and functional fine-mapping methods to these loci, and prioritized 22 likely causal SNPs for BD. We mapped these SNPs to genes, and investigated their likely functional consequences by integrating variant annotations, brain cell-type epigenomic annotations, brain quantitative trait loci, and results from rare variant exome sequencing in BD. Convergent lines of evidence supported the roles of SCN2A, TRANK1, DCLK3, INSYN2B, SYNE1, THSD7A, CACNA1B, TUBBP5, PLCB3, PRDX5, KCNK4, AP001453.3, TRPT1, FKBP2, DNAJC4, RASGRP1, FURIN, FES, YWHAE, DPH1, GSDMB, MED24, THRA, EEF1A2, and KCNQ2 in BD. These represent promising candidates for functional experiments to understand biological mechanisms and therapeutic potential. Additionally, we demonstrated that fine-mapping effect sizes can improve performance and transferability of BD polygenic risk scores across ancestrally diverse populations, and present a high-throughput fine-mapping pipeline (https://github.com/mkoromina/SAFFARI).

Analysis of Mercury in Aquifers in Gold Mining Areas in the Ecuadorian Amazon and Its Associated Risk for Human Health.

Gold mining activity is a source of supply in many areas of the world, and especially in developing countries, it is practiced illegally and by applying unsafe techniques. Particularly in Ecuador, artisanal and small-scale gold mining (ASGM) is widespread, and it is based on the use of toxic substances, such as mercury (Hg), in gold recovery. Hg is a heavy metal that is water-insoluble, which, once mobilized, poses a threat to both the environment and human health. This study analyzes Hg concentrations in the six provinces of Napo, Sucumbíos, Orellana, Pastaza, Morona Santiago, and Zamora Chinchipe of the Ecuadorian Amazon region to conduct a human health risk assessment. Significant differences in Hg levels were found between provinces, but concentrations were below MPL imposed by Ecuadorian regulations everywhere. Nevertheless, a worrisome picture emerges, especially with regard to the most vulnerable receptors represented by the child population. There are multiple factors of incidence that may affect the possible future development of the phenomenon, and with reference to the social, economic, and environmental context of the region, it can be concluded that it may be appropriate to plan further investigation to arrive at a more comprehensive assessment. The results of this study can be used by decision makers to plan further investigation and to implement monitoring networks, risk mitigation strategies, and groundwater protection measures.

Gender differences and risk of readmission in hospitalizations with a diagnosis of psychotic spectrum disorders.

BACKGROUND: Gender differences in psychosis are a topic that has been studied considering different aspects. Although some available evidence would point to a possible better prognosis in women, this claim is far from conclusively established. METHODS: We propose an analysis of gender differences in the risk of readmission to an acute hospitalization unit, an indicator related to prognosis. RESULTS AND CONCLUSIONS: We found that although the risk of readmission at 1 year is lower in women, this seems to be explained by other confounding factors.

Elucidation of temperature-induced water structuring on cellulose surfaces for environmental and energy sustainability.

Optimizing drying energy in the forest products industry is critical for integrating lignocellulosic feedstocks across all manufacturing sectors. Despite substantial efforts to reduce thermal energy consumption during drying, further enhancements are possible. Cellulose, the main component of forest products, is Earth's most abundant biopolymer and a promising renewable feedstock. This study employs all-atom molecular dynamics (MD) simulations to explore the structural dynamics of a small Iß-cellulose microcrystallite and surrounding water layers during drying. Molecular and atomistic profiles revealed localized water near the cellulose surface, with water structuring extending beyond 8 Å into the water bulk, influencing solvent-accessible surface area and solvation energy. With increasing temperature, there was a ∼20 % reduction in the cellulose surface available for interaction with water molecules, and a ∼22 % reduction in solvation energy. The number of hydrogen bonds increased with thicker water layers, facilitated by a "bridging" effect. Electrostatic interactions dominated the intermolecular interactions at all temperatures, creating an energetic barrier that hinders water removal, slowing the drying processes. Understanding temperature-dependent cellulose-water interactions at the molecular level will help in designing novel strategies to address drying energy consumption, advancing the adoption of lignocellulosics as viable manufacturing feedstocks.

Community-based art groups in mental health recovery: A systematic review and narrative synthesis.

INTRODUCTION: Though the evidence of the role of the arts in mental health is growing, no systematic review has focused on the impact of art groups in non-clinical settings in the process of recovery following the CHIME framework. AIM: The aim of this study was to examine the effects of engaging in community-based art groups in mental health recovery. METHOD: A search in five electronic databases for relevant research using quantitative, qualitative or mixed methods published between 2000 and 2019 identified nine eligible studies. RESULTS: While there was great methodological heterogeneity, most studies were qualitative, used visual arts, facilitated by artists and assessed by mental health nurses, and took place in community locations or artistic venues. Quantitative outcomes, though few, provided evidence of increased well-being, and qualitative outcomes corresponded mostly with the recovery process of Connectedness. Additional outcomes related to the settings were a sense of safety and to the intervention: self-expression, development of skills and achievements, and the impact of final exhibitions and peer leadership. DISCUSSION: Studies should aim at prospective designs following mixed methods approaches, with larger and gender-sensitive samples, control groups and follow-up assessments, and evaluate cost-effectiveness. IMPLICATIONS FOR PRACTICE: Community-based art groups which increase well-being and promote connectedness should be key in recovery-action planning.

Community engagement in the development of health-related data visualizations: a scoping review.

OBJECTIVE: This scoping review aims to address a gap in the literature on community engagement in developing data visualizations intended to improve population health. The review objectives are to: (1) synthesize literature on the types of community engagement activities conducted by researchers working with community partners and (2) characterize instances of "creative data literacy" within data visualizations developed in community-researcher partnerships. METHODS: Using the 2018 PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews) guidelines, the review focuses on peer-reviewed journal articles from 2010 to 2022 in PubMed, Web of Science, and Google Scholar. A community engagement tool was applied to the studies by independent reviewers to classify levels of community engagement, social determinants, and vulnerable populations. RESULTS: Twenty-seven articles were included in the scoping review. Twelve articles worked with vulnerable populations. Four articles attempted to alleviate barriers to representation in their respective studies, with addressing language barriers being the most prevalent approach. Thirteen articles considered social determinants of health. Sixteen studies engaged in iterative approaches with intended users when developing the visualization or tool. DISCUSSION: Only a few significant examples of creative data literacy are incorporated in the studies. We recommend a specific focus on engaging intended users at every step of the development process, addressing language and cultural differences, and empowering intended users as data storytellers. CONCLUSIONS: There is room for deeper and more meaningful community involvement in the development of health-related data visualizations geared towards them.

Domestication signatures in the non-conventional yeast Lachancea cidri.

Evaluating domestication signatures beyond model organisms is essential for a thorough understanding of the genotype-phenotype relationship in wild and human-related environments. Structural variations (SVs) can significantly impact phenotypes playing an important role in the physiological adaptation of species to different niches, including during domestication. A detailed characterization of the fitness consequences of these genomic rearrangements, however, is still limited in non-model systems, largely due to the paucity of direct comparisons between domesticated and wild isolates. Here, we used a combination of sequencing strategies to explore major genomic rearrangements in a Lachancea cidri yeast strain isolated from cider (CBS2950) and compared them to those in eight wild isolates from primary forests. Genomic analysis revealed dozens of SVs, including a large reciprocal translocation (~16 kb and 500 kb) present in the cider strain, but absent from all wild strains. Interestingly, the number of SVs was higher relative to single-nucleotide polymorphisms in the cider strain, suggesting a significant role in the strain's phenotypic variation. The set of SVs identified directly impacts dozens of genes and likely underpins the greater fermentation performance in the L. cidri CBS2950. In addition, the large reciprocal translocation affects a proline permease (PUT4) regulatory region, resulting in higher PUT4 transcript levels, which agrees with higher ethanol tolerance, improved cell growth when using proline, and higher amino acid consumption during fermentation. These results suggest that SVs are responsible for the rapid physiological adaptation of yeast to a human-related environment and demonstrate the key contribution of SVs in adaptive fermentative traits in non-model species.IMPORTANCEThe exploration of domestication signatures associated with human-related environments has predominantly focused on studies conducted on model organisms, such as Saccharomyces cerevisiae, overlooking the potential for comparisons across other non-Saccharomyces species. In our research, employing a combination of long- and short-read data, we found domestication signatures in Lachancea cidri, a non-model species recently isolated from fermentative environments in cider in France. The significance of our study lies in the identification of large array of major genomic rearrangements in a cider strain compared to wild isolates, which underly several fermentative traits. These domestication signatures result from structural variants, which are likely responsible for the phenotypic differences between strains, providing a rapid path of adaptation to human-related environments.

SARS-CoV-2 seroprevalence and respiratory disease disability claims in Mexico City Metropolitan Area.

OBJECTIVE: To characterize the impact of SARS-CoV-2 infection in workers from an essential large-scale company in the Greater Mexico City Metropolitan Area using point prevalence of acute infection, point prevalence of past infection through serum antibodies and respiratory disease short-term disability claims (RD-STDC). MATERIALS AND METHODS: Four randomized surveys, three during 2020 before and one after (December 2021) vaccines' availability. OUTCOMES: point prevalence of acute infection through saliva PCR (polymerase chain reaction) testing, point prevalence of past infection through serum antibodies against Covid-19, RD-STDC and prevalence of symptoms during the previous six months. RESULTS: Prevalence of SARS-CoV-2 cases was 1.29-4.88%, on average, a quarter of participants pre-vaccination were seropositive; over half of participants with a RD-STDC had antibodies. The odds of having antibodies were 6-7 times more among workers with an RD-STDC. CONCLUSIONS: High antibody levels against Covid-19 in this study population reflects that coverage is high among workers in this industry. STDCs are a useful tool to track workplace epidemics.

Impulsivity, decision-making, and risk behavior in bipolar disorder and major depression from bipolar multiplex families.

OBJECTIVES: Bipolar disorder (BD) and major depressive disorder (MDD) are characterized by specific alterations of mood. In both disorders, alterations in cognitive domains such as impulsivity, decision-making, and risk-taking have been reported. Identification of similarities and differences of these domains in BD and MDD could give further insight into their etiology. The present study assessed impulsivity, decision-making, and risk-taking behavior in BD and MDD patients from bipolar multiplex families. METHODS: Eighty-two participants (BD type I, n = 25; MDD, n = 26; healthy relatives (HR), n = 17; and healthy controls (HC), n = 14) underwent diagnostic interviews and selected tests of a cognitive battery assessing neurocognitive performance across multiple subdomains including impulsivity (response inhibition and delay aversion), decision-making, and risk behavior. Generalized estimating equations (GEEs) were used to analyze whether the groups differed in the respective cognitive domains. RESULTS: Participants with BD and MDD showed higher impulsivity levels compared to HC; this difference was more pronounced in BD participants. BD participants also showed lower inhibitory control than MDD participants. Overall, suboptimal decision-making was associated with both mood disorders (BD and MDD). In risk-taking behavior, no significant impairment was found in any group. LIMITATIONS: As sample size was limited, it is possible that differences between BD and MDD may have escaped detection due to lack of statistical power. CONCLUSIONS: Our findings show that alterations of cognitive domains-while present in both disorders-are differently associated with BD and MDD. This underscores the importance of assessing such domains in addition to mere diagnosis of mood disorders.

A systematic review of the effects of nutrition programmes in high schools

Introduction/Objectives: Obesity rates are reaching alarming levels. Adolescence is a critical period for the prevention of nutritional problems, as it is a time of development of one's own eating habits. These habits will persist into adulthood, so showing adolescents healthy lifestyle patterns is important. The ideal option would be through school-based nutrition intervention programmes. The main objective of this article is to investigate the effectiveness of intervention programmes based on nutritional knowledge and the behaviour of adolescents aged 11-19 years. Method: To carry out this systematic review we employed Scopus, PubMed, and Web of Science as databases and a search period that spanned the last 10 years, following the PRISMA statement. Subsequent to the search, 110 articles were found. Finally, 19 articles were selected for in-depth analysis after a thorough screening. Results: The results show that, in general, intervention programmers have improved the nutritional knowledge of high school students, which means an improvement in their eating behaviours. In addition, these programmes increase their levels of physical activity. However, gender differences are observed, with girls being more concerned about maintaining a balanced diet. Conclusion: In conclusion, schools are an ideal environment for developing programmes that interfere in adolescent eating behaviour.

Introducción/Objetivos: Las tasas de obesidad están alcanzando niveles alarmantes. La adolescencia es un periodo crítico para la prevención de problemas nutricionales, ya que es un momento de desarrollo de los propios hábitos alimentarios. Estos hábitos permanecerán en la edad adulta, por lo que es importante mostrarles a los adolescentes patrones de estilo de vida saludable. La opción ideal sería a través de programas de intervención nutricional en las escuelas. El objetivo principal de este artículo es investigar la efectividad de los programas de intervención basados en el conocimiento y comportamiento nutricional en adolescentes de 11 a 19 años. Métodos: Para llevar a cabo esta revisión sistemática utilizamos como bases de datos Scopus, PubMed y Web of Science y un periodo de búsqueda que abarcó los últimos diez años, siguiendo la declaración Prisma. Después de la búsqueda, se encontraron 110 artículos. Finalmente, 19 artículos fueron seleccionados para un análisis en profundidad después de una revisión exhaustiva. Resultados: Los resultados muestran que, en general, los programas de intervención han mejorado los conocimientos nutricionales de los estudiantes de secundaria, lo que significa una mejora en sus conductas alimentarias. Además, estos programas aumentan sus niveles de actividad física. Sin embargo, se observan diferencias de género, estando las chicas más preocupadas por mantener una dieta equilibrada. Conclusiones: En conclusión, las escuelas son un ambiente ideal para el desarrollo de programas que interfieren en la conducta alimentaria de los adolescentes.

The role of TNF receptors as mediators of chronic vasculitis in possible milder forms of the CNS tuberculosis.

INTRODUCTION: Central nervous system (CNS) tuberculosis (TB) is the most severe form of TB due to its high mortality and functional sequelae. There are several differential diagnoses for TB; and, it can also cause secondary conditions, such as vasculitis. METHODOLOGY: 155 biopsies, corresponding to 155 different patients out of 5,386 registered biopsies from 2008-2013, met the criteria of unknown etiology vasculitis and evidence of cerebral vascular disease. These were analyzed to assess the presence of central nervous system TB. The selected cases were assessed with Suzaan Marais (SM) criteria for clinical tuberculosis. After that, Ziehl-Neelsen (ZN) staining and polymerase chain reaction (PCR) were performed to amplify a fragment of the insertion sequence IS6110 of M. tuberculosis. 21 patients met the criteria for definitive tuberculosis by ZN staining and PCR, and 2 met the criteria for possible tuberculosis. Tumor necrosis factor (TNF)-α, TNF-R1, and TNF-R2 were determined by immunohistochemistry in histological sections from formalin-fixed paraffin-embedded (FF-PE) tissues in the 23 selected patients. RESULTS: Granulomatous TB was present in almost half of the cases. TNF-R1 and TNF-R2 were expressed mainly in blood vessels, histiocytes, and macrophages. TNF-R2 expression was higher than the other markers, which suggests an anti-inflammatory response against M. tuberculosis. CONCLUSIONS: The histopathological presentation of TB is not always limited to granulomas, abscesses, or meningitis; there are also clinical presentations characterized only with chronic inflammation of nervous and vascular tissue.

Perception of the Level of Competency of Candidates for Graduation: A Multidisciplinary Approach to Complex Thinking.

Complex thinking is a cognitive skill that focuses on the integrated analysis and synthesis of information with a systemic and critical perspective that enables creative decision-making in the face of complex realities or challenges. At the educational level, it is valued as a transdisciplinary competency, meaning it is relevant for individuals regardless of their profession or field of study. This article presents the results of measuring the perceived achievement of complex thinking among 830 graduating students from a technological university in Mexico, aiming to identify possible significant differences based on their discipline or major. Methodologically, a multivariate descriptive statistical analysis was performed using R and RStudio software, including calculation of means and standard deviations, violin plots, boxplot and ANOVA significance analysis, and t-test. The results show that the differences were not statistically significant in all the disciplines, although it is possible to note significant differences, which reveals a differentiated behavior in the process of formation and development of complex thinking according to the discipline of study. In conclusion, the present study shows that the students' areas of training are associated with differences in perception of complex thinking and its associated sub-competencies, thus differentiating this ability in their graduation profile. This article contributes to the existing literature on the formation and development of complex thinking and its sub-competencies as relevant professional skills for lifelong learning.

Suicidal behavior in persons attended in out-of-hospital emergency services in Spain.

Background: The aims of this study were to describe the use of health services by patients attended for suicidal behavior by out-of-hospital emergency services and to identify the variables associated with the repetition of this behavior in Spain. Methods: An analytical, observational, retrospective study was carried out. A total of 554 patients attended by the mobile teams of the Primary Care Emergency (mt-PCES) of the Malaga Health District (Spain), after being coordinated by the 061 Emergency Coordination Center (ECC) were analyzed. Results: Of the total, 61.9% of the patients were women and the mean age was 43.5 years. Ninety-six percent (N = 532) of the patients attended by mt-PCES were transferred to hospital emergency services. Regarding clinical decision, of those transferred 436 persons (82%) were discharged home. Of the total sample 25.5% (N = 141) were referred to primary care, while 69% (N = 382) were referred to outpatient mental health care. Regarding follow up in the 6 months after being seen by emergency services, among those referred to a mental health facility, 64.4% (N = 246) attended the follow-up appointment while out of the total sample only 50.5% (N = 280) attended a follow-up appointment with an outpatient mental health service. Finally, it should be noted that 23.3% presented a relapse of suicidal behavior in the 6 months following index episode. The variables associated with repetition of suicidal behavior were older age, greater number of previous suicide attempts and having any contact with mental health services in the following 6 months. Conclusion: We believe that selective suicide prevention initiatives should be designed to target the population at risk of suicide, especially those receiving both out-of-hospital and in-hospital emergency services.