Evaluation of microplastic pollution using bee colonies: An exploration of various sampling methodologies.

Recent research has highlighted the potential of honeybees and bee products as biological samplers for monitoring xenobiotic pollutants. However, the effectiveness of these biological samplers in tracking microplastics (MPs) has not yet been explored. This study evaluates several methods of sampling MPs, using honeybees, pollen, and a novel in-hive passive sampler named the APITrap. The collected samples were characterized using a stereomicroscopy to count and categorise MPs by morphology, colour, and type. To chemical identification, a micro-Fourier transform-infrared (FTIR) spectroscopy was employed to determine the polymer types. The study was conducted across four consecutive surveillance programmes, in five different apiaries in Denmark. Our findings indicated that APITrap demonstrated better reproducibility, with a lower variation in results of 39%, compared to 111% for honeybee samples and 97% for pollen samples. Furthermore, the use of APITrap has no negative impact on bees and can be easily applied in successive samplings. The average number of MPs detected in the four monitoring studies ranged from 39 to 67 in the APITrap, 6 to 9 in honeybee samples, and 6 to 11 in pollen samples. Fibres were the most frequently found, accounting for an average of 91% of the total MPs detected in the APITrap, and similar values for fragments (5%) and films (4%). The MPs were predominantly coloured black, blue, green and red. Spectroscopy analysis confirmed the presence of up to five different synthetic polymers. Polyethylene terephthalate (PET) was the most common in case of fibres and similarly to polypropylene (PP), polyethylene (PE), polyacrylonitrile (PAN) and polyamide (PA) in non fibrous MPs. This study, based on citizen science and supported by beekeepers, highlights the potential of MPs to accumulate in beehives. It also shows that the APITrap provides a highly reliable and comprehensive approach for sampling in large-scale monitoring studies.

Cross-Sectional Analysis of Colombian University Students' Perceptions of Mental Health during the COVID-19 Pandemic: Repercussions on Academic Achievement.

BACKGROUND: During the COVID-19 pandemic, the increase in academic activities at home negatively impacted mental health, due to significant levels of stress, anxiety, and depression. We investigated the association of depression and anxiety with university students' academic performance during the COVID-19 lockdown in Bucaramanga, Colombia. MATERIALS AND METHODS: A cross-sectional study was conducted through an online survey during the lockdown, through the use of the Hospital Anxiety and Depression Scale (HADS) and the grade-point average. RESULTS: 1090 females, out of 1957 students, with mean age 22.2 ± 5.3 years, participated in the study. The prevalence of low academic performance was higher in men (4.7% p = 0.014). As for mental health, 2.5% of the students were classified as "definite cases" of anxiety and 8.2% were diagnosed with depression. Women with a low academic performance had a greater percentage of being "definite cases" (3.8%) of anxiety as compared to men (1.1%). Regarding depression, in men, 12.2% of those with low academic performance were "definite cases" (6.9% p < 0.05); in females with low academic performance, 10.1% were "definite cases" of depression, according to the Poisson regression analysis. The probability of low performance was 100% higher for women identified as "doubtful cases" of depression (PR = 2.0; 95% CI: 1.10-5.18, p = 0.03). CONCLUSIONS: A positive association between the severity of anxiety/depression and lower grades, especially in women, was found. Mental health should be a special concern when considering university students, in order to improve their academic performance.

Low Muscle Mass Is Associated with Poorer Glycemic Control and Higher Oxidative Stress in Older Patients with Type 2 Diabetes.

Body composition changes that occur during aging, such as loss of lean mass, are unfavorable at metabolic level and they can explain, in part, the appearance of certain age-associated diseases such as type 2 diabetes (T2D). Separately, T2D is associated with an increase in oxidative stress (OS) which negatively affects skeletal muscle. Our aim was to study the differences in clinical and nutritional parameters, disease control, and OS in a cohort of older patients with T2D classified according to the amount of lean mass they had. We included 100 adults older than 65 years with T2D. We found that women with low fat-free mass and muscle mass have worse T2D metabolic control. Moreover, the patients with a low percentile of muscle mass present a high value of OS. The study shows that the presence of low lean mass (LM) in the geriatric population diagnosed with T2D is associated with poorer glycemic control and greater OS.

Bioactives Overproduction through Operational Strategies in the Ichthyotoxic Microalga Heterosigma akashiwo Culture.

The red tide-forming microalga Heterosigma akashiwo has been associated with massive events of fish deaths, both wild and cultured. Culture conditions are responsible for the synthesis or accumulation of some metabolites with different interesting bioactivities. H. akashiwo LC269919 strain was grown in a 10 L bubble column photobioreactor artificially illuminated with multi-coloured LED lights. Growth and production of exopolysaccharides, polyunsaturated fatty acids (PUFAs), and carotenoids were evaluated under different culture modes (batch, fed-batch, semicontinuous, and continuous) at two irradiance levels (300 and 700 µE·s-1·m-2). Continuous mode at the dilution rate of 0.2·day-1 and 700 µE·s-1·m-2 provided the highest production of biomass, PUFAs (132.6 and 2.3 mg·L-1·day-1), and maximum fucoxanthin productivity (0.16 mg·L-1·day-1). The fed-batch mode accumulated exopolysaccharides in a concentration (1.02 g·L-1) 10-fold over the batch mode. An extraction process based on a sequential gradient partition with water and four water-immiscible organic solvents allowed the isolation of bioactive fucoxanthin from methanolic extracts of H. akashiwo. Metabolites present in H. akashiwo, fucoxanthin and polar lipids (i.e., eicosapentaenoic acid (EPA)), or probably such as phytosterol (ß-Sitosterol) from other microalgae, were responsible for the antitumor activity obtained.

Glucose 6-P Dehydrogenase Overexpression Improves Aging-Induced Endothelial Dysfunction in Aorta from Mice: Role of Arginase II.

The increase of vascular arginase activity during aging causes endothelial dysfunction. This enzyme competes with the endothelial nitric oxide synthase (eNOS) for L-arginine substrate. Our hypothesis is that glucose 6-P dehydrogenase (G6PD) overexpression could improve the endothelial function modulating the arginase pathway in aorta from mice. For this study, three groups of male mice were used: young wild type (WT) (6-9 months), old WT (21-22 months) and old G6PD-Tg (21-22 months) mice. Vascular reactivity results showed a reduced acetylcholine-dependent relaxation in the old WT but not old G6PD-Tg group. Endothelial dysfunction was reverted by nor-NOHA, an arginase inhibitor. Mice overexpressing G6PD underexpressed arginase II and also displayed a lower activity of this enzyme. Moreover, histological analyses demonstrated that age causes a thickness of aortic walls, but this did not occur in G6PD-Tg mice. We conclude that the overexpressing G6PD mouse is a model to improve vascular health via the arginase pathway.

Physical Activity Levels and Psychological Well-Being during COVID-19 Lockdown among University Students and Employees.

During the lockdown for the coronavirus disease 2019 (COVID-19), entire populations were instructed to live in home confinement. We investigated the effects of the COVID-19 lockdown on the physical activity (PA) and mental health of students and employees in a Colombian University. A cross-sectional study was conducted through an online survey during the first isolation. A total of 431 respondents (192 males) aged 18-60 years old (28.1 ± 11.1 years) participated. The international Physical Activity Questionnaire (IPAQ) and the short version of the Psychological General Well-Being Index (PGWBI-S) were used. The lockdown had a negative effect on PA levels, with students exhibiting the greatest decrease (~34%; p ˂ 0.001) compared to employees (~24%; p ˂ 0.01). The analysis showed a greater change in PA behavior before and during the lockdown in highly active student participants (5750 vs. 5141 MET min/week; p < 0.05). Additionally, the psychological assessment revealed a lower score in students compared to employees in the male (70.1 vs. 82.6) and female groups (60.2 vs. 79.6). Moreover, the results revealed an influence of sex, with only the female students exhibiting a state of distress. Self-reported PA and psychological well-being were compromised during the COVID-19 lockdown in the academic community, with students and females being more affected.

Glucosamine Supplementation Improves Physical Performance in Trained Mice.

INTRODUCTION: d-Glucosamine (GlcN) is one of the most widely consumed dietary supplements and complementary medicines in the world and has been traditionally used to attenuate osteoarthritis in humans. GlcN extends life span in different animal models. In humans, its supplementation has been strongly associated with decreased total mortality and improved vascular endothelial function. GlcN acts as a suppressor of inflammation, and by inhibiting glycolysis, it can activate the metabolism of stored fat and mitochondrial respiration. METHODS: The conventional human GlcN dose is 1500 mg·d-1, but extensive evidence indicates that much higher doses are well tolerated. GlcN is one of the supplements that has experienced a greater use in the last years in elite athletes mainly because of its potential chondroprotective effects that may promote cartilage health. However, the possibility of it being an ergogenic aid has not been explored. We aimed to study the potential beneficial effects of GlcN on mitochondrial content, physical performance, and oxidative stress in mice that were aerobically trained and supplemented with three different doses of glucosamine (250, 500, and 1000 mg·kg-1) for 6 wk. We measured exercise performance (grip strength, motor coordination, and running capacity) before and after the training period. Proteins involved in mitochondrial biogenesis (AMPK, PGC-1, NRF-1, SIRT-1, cytochrome c, citrate synthase), markers of oxidative stress (GSSG/GSH) or damage (malondialdehyde, carbonylated proteins), antioxidant enzymes (NRF-2, SOD1, SOD2, catalase, and PRDX6), and MAPKs (p38 and ERK1/2 were also determined in skeletal muscle. RESULTS AND CONCLUSIONS: Our results show that GlcN supplementation in aerobically trained mice, at doses equivalent to those conventionally used in humans, increases the protein levels of mitochondrial biogenesis markers, improves motor coordination, and may have a synergistic effect with exercise training on running distance.

Frailty Is Associated with Oxidative Stress in Older Patients with Type 2 Diabetes.

Aging has increased the prevalence of frailty, and type 2 diabetes (T2D) has also increased in prevalence. Diabetes and oxidative stress (OS) have been shown to be related to frailty. However, the exact mechanism by which it occurs is not fully known. Our aim was to analyze body composition in community-dwelling older diabetic people treated in our center and to evaluate the possible relation between OS, frailty, and body composition. We included 100 adults older than 65 years with T2D. We found that 15% were frail and 57% were prefrail. The patients included in the nonrobust group showed increased levels of OS. Our study shows that the presence of T2D in the geriatric population is associated with a high prevalence of frailty and high OS levels, conditions that cause greater morbidity and mortality and that highlight the importance of the diagnosis of frailty in this population.

Intervención grupal con adolescentes con epilepsia refractaria: programa terapéutico educativo / Intervenció grupal amb adolescents amb epilèpsia refractària: programa terapèutic educatiu / Group intervention with adolescents with refractory epilepsy: a therapeutic educational programme

Se presentauna intervención grupal terapéutico-educativa con adolescentes con diagnóstico de epilepsia refractaria en elque se trabajaron diferentes áreas psicológicas: personal, cognitiva, social y tiempo libre. La valoración se realizóa partir de la descripción clínica, el cuestionario SENA y la plataforma NEURONUP, valorando que una interven-ción específica ayuda a los pacientes a crear una mayor conciencia y capacidad de implicarse en los objetivos,permitiendo mejoras en su autoconcepto y autocuidado.(AU)

We presenta therapeutic-educational group intervention with adolescents diagnosed with refractory epilepsy in which diffe-rent psychological areas were worked on: personal, cognitive, social, and free time. The assessment was basedon the clinical description, the SENA questionnaire, and the NEURONUP platform, evaluating that a specific inter-vention helps patients to create greater awareness and capacity to become involved in the objectives, allowingimprovements in their self-concept and self-care.(AU)

Es presenta unaintervenció grupal terapèutica i educativa amb adolescents amb diagnòstic d'epilèpsia refractària en què es vantreballar diferents àrees psicològiques: personal, cognitiva, social i temps lliure. La valoració es va realitzar a partirde la descripció clínica, el qüestionari SENA i la plataforma NEURONUP i es va veure que una intervenció espe-cífica ajuda els pacients a crear una major consciència i capacitat d'implicar-se en els objectius, cosa que permetmillores en el seu autoconcepte i en la pròpia cura.(AU)

Overexpression of glucose 6 phosphate dehydrogenase preserves mouse pancreatic beta cells function until late in life.

NAD(P)H donates electrons for reductive biosynthesis and antioxidant defense across all forms of life. Glucose-6-phosphate dehydrogenase (G6PD) is a critical enzyme to provide NADPH. G6PD deficiency is present in more than 400 million people worldwide. This enzymopathy provides protection against malaria but sensitizes cells to oxidative stressors. Oxidative stress has been involved in the pathogenesis of the diabetic complications and several studies have provided evidences of a link between G6PD deficiency and type 2 diabetes (T2D). We hypothesized that a moderate overexpression of G6PD (G6PD-Tg) could protect ß-cells from age-associated oxidative stress thus reducing the risk of developing T2D. Here we report, that G6PD-Tg mice show an improved glucose tolerance and insulin sensitivity when compared to old age-matched Wild Type (WT) ones. This is accompanied by a decrease in oxidative damage and stress markers in the pancreas of the old Tg animals (20-24month-old). Pancreatic ß-cells progress physiologically towards a state of reduced responsiveness to glucose. In pancreatic islets isolated from G6PD-Tg and WT animals at different ages, and using electrophysiological techniques, we demonstrate a wider range of response to glucose in the G6PD-Tg cells that may explain the improvements in glucose tolerance and insulin sensitivity. Together, our results show that overexpression of G6PD maintains pancreatic ß-cells from old mice in a "juvenile-like" state and points to the G6PD dependent generation of NADPH as an important factor to improve the natural history of diabetes.

Erythema Multiforme-Like Presentation in an Asymptomatic COVID-19 Patient.

In clinical practice, there are a lot of variations in disease manifestations. Diseases are constantly evolving, and one negative test cannot completely rule out a disease. Erythema multiforme (EM) is a common mucocutaneous disease that can be linked to a lot of etiologies, with the most common being herpes simplex virus (HSV) types 1 and 2, Mycoplasma pneumoniae, and the use of various drugs. Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is a new virus, and traditionally it is not the first differential for EM eruptions. We report the case of a 52-year-old female patient with a history of multiple drug use, pneumonia-like symptoms, an initial negative viral panel for SARS-CoV-2, followed by a positive polymerase chain reaction (PCR) test, asymptomatic coronavirus disease 2019 (COVID-19) clinical course, and break-out of typical targetoid lesions of EM. Throughout her hospital stay, the patient maintained her oxygenation levels and improved clinically with steroids and symptomatic treatment. She regained her health and was counseled to quit smoking, alcohol, and opioid usage at the time of discharge from the hospital, and a regular follow-up with her primary care practitioner (PCP) was advised.

Physical exercise in the prevention and treatment of Alzheimer's disease.

Dementia is one of the greatest global challenges for health and social care in the 21st century. Alzheimer's disease (AD), the most common type of dementia, is by no means an inevitable consequence of growing old. Several lifestyle factors may increase, or reduce, an individual's risk of developing AD. Much has been written over the ages about the benefits of exercise and physical activity. Among the risk factors associated with AD is a low level of physical activity. The relationship between physical and mental health was established several years ago. In this review, we discuss the role of exercise (aerobic and resistance) training as a therapeutic strategy for the treatment and prevention of AD. Older adults who exercise are more likely to maintain cognition. We address the main protective mechanism on brain function modulated by physical exercise by examining both human and animal studies. We will pay especial attention to the potential role of exercise in the modulation of amyloid ß turnover, inflammation, synthesis and release of neurotrophins, and improvements in cerebral blood flow. Promoting changes in lifestyle in presymptomatic and predementia disease stages may have the potential for delaying one-third of dementias worldwide. Multimodal interventions that include the adoption of an active lifestyle should be recommended for older populations.

Modulating Oxidant Levels to Promote Healthy Aging.

Significance: Free radicals although originally thought of as damaging molecules, inevitable side effects of the utilization of oxygen by cells, are now considered as signals that by modifying, among others, the thiol-disulfide balance regulate many cell processes from metabolism to cell cycle. Recent Advances: This review discusses the importance of the modulation of the oxidant levels through physiological strategies such as physical exercise or genetic manipulations such as the overexpression of antioxidant enzymes, in the promotion of healthy aging. Critical Issues: We have divided the review into five different sections. In the first two sections of the article "Oxidants are signals" and "Exercise training is an antioxidant," we discuss the main sources of free radicals during muscle contraction and their role, as hormetic substances, in the regulation of two main muscle adaptations to exercise in skeletal muscle; that is, mitochondrial biogenesis and the endogenous antioxidant defense. In the third section of the review, we deal with "the energy collapse in aging." The increased rate of reactive oxygen species (ROS) production and the low rate of mitochondria biosynthesis in the old cells are examined. Finally, in the fourth and fifth sections entitled "Overexpression of antioxidants enzymes in healthy aging" and "Exercise, longevity, and frailty," we consider the importance of the potentiation of the cellular defenses in health span and in life span. Future Directions: A correct manipulation of the ROS generation, directing these species to their physiological signaling role and preventing their deleterious effects, would allow the promotion of healthy aging. Antioxid. Redox Signal. 33, 570-579.

Long-term exercise training improves memory in middle-aged men and modulates peripheral levels of BDNF and Cathepsin B.

Aging is accompanied by a decline in memory and other brain functions. Physical exercise may mitigate this decline through the modulation of factors participating in the crosstalk between skeletal muscle and the brain, such as neurotrophins and oxidative stress parameters. We aimed to determine whether long term exercise training (35 ± 15 years) promotes memory maintenance in middle-aged men, and to characterize the changes in neurotrophic factors and lipid oxidation markers in peripheral blood samples in both middle-aged and young men. The neuropsychological analysis showed significant improvements in memory through the Free and Cued Immediate Recall tests, in the middle-aged trained individuals when compared to the sedentary ones. We found a significant decrease in the resting serum BDNF and plasma Cathepsin B (CTSB) levels in the trained groups at both middle and young ages. BDNF and CTSB levels were inversely correlated with weekly hours of exercise. We also found a significant decrease in plasma malondialdehyde, an index of lipid peroxidation, in middle-aged and young trained subjects. The positive impact of long-term exercise training by delaying the onset of physiological memory loss and the associated neurotrophic and redox peripheral modulation, suggests the effectiveness of exercise as preventive strategy against age-related memory loss and neurodegeneration.

Peripheral Maintenance of the Axis SIRT1-SIRT3 at Youth Level May Contribute to Brain Resilience in Middle-Aged Amateur Rugby Players.

Physical exercise performed regularly is known to improve health and to reduce the risk of age-related diseases. Furthermore, there is some evidence of cognitive improvement in physically active middle-aged and older adults. We hypothesized that long-term physically active middle-aged men may have developed brain resilience that can be detected with the analysis of peripheral blood markers. We aimed to analyze the activation of pathways potentially modulated by physical activity in a cohort of healthy amateur rugby players (n = 24) and control subjects with low physical activity (n = 25) aged 45-65 years. We had previously reported neuropsychological improvement in immediate memory responses in the player group compared to the controls. Here, we tested the expression of selected genes of longevity, inflammation, redox homeostasis, and trophic signaling in whole blood mRNA. Analyses were also performed on blood samples of young (aged 15-25 years) control subjects with low physical activity (n = 21). Physical activity and other lifestyle factors were thoroughly recorded with standardized questionnaires. Interestingly, middle-aged control subjects showed lower levels of expression of SIRT1, SIRT3, CAT, and SOD1 than the young controls, although rugby players maintained the expression levels of these genes at a young-like level. Middle-aged players showed lower levels of IL1B than the non-physically active groups. However, there was a tendency towards a decrease in trophic and transduction factors in middle-aged groups as compared to the young controls. A statistical study of Spearman's correlations supported a positive effect of sporting activity on memory and executive functions, and on peripheral gene expression of SIRT1, SIRT3 and downstream genes, in the middle-aged rugby players. Our results indicate that the SIRT1-SIRT3 axis, and associated neuroprotective signaling, may contribute to the anti-aging resilience of the brain mediated by physical exercise.

Incidencia, mortalidad y prevalencia de enfermedad renal crónica terminal en la región del Bajo Lempa, El Salvador: 10 años de registro comunitario / Incidence, mortality, and prevalence of end-stage chronic renal disease in the Bajo Lempa region of El Salvador: A ten-year community registry

El Bajo Lempa es una región rural costera pobre de El Salvador afectada por la epidemia de enfermedad renal crónica (ERC) denominada nefropatía mesoamericana. La organización local comunitaria Fondo Social de Emergencia para la salud (FSES) colabora contra la epidemia en 42 comunidades de la región (19.223 habitantes; edad promedio 26,7 años; 48,5% masculino; 40,2% < 18 años). Objetivos: Reportar tasas anuales de incidencia de ERC terminal (ERCT) y de mortalidad de pacientes en estas comunidades durante 10 años (2004-2013), más la prevalencia de pacientes en tratamiento sustitutivo renal (TSR) al 31 de diciembre del 2013. Métodos: El FSES registró casos nuevos de ERCT, sus antecedentes básicos, la modalidad de TSR recibida y sus fallecimientos. Resultados: Registramos 271 nuevos casos de ERCT (promedio anual 27,1; 89% masculino; edad promedio 55,6 años; 4 < 18 años). Tasa de incidencia de ERCT anual promedio: 1.409,8 por millón de población (pmp). Un 66% no reportaba diabetes ni hipertensión. Recibieron TSR 94 (34,7%) pacientes: 58 en el Ministerio de Salud, 26 en servicios privados, 9 en la seguridad social y uno en la sanidad militar. Fallecieron 246 (promedio anual 24,6; 89,4% masculino; edad promedio 56,1 años; 92,3% en su domicilio). Tasa de mortalidad anual promedio: 128/100.000 habitantes. Prevalencia de pacientes en TSR al 2013: 1.300,5 pmp (N=25; 84% masculino; edad promedio 51 años). Conclusiones: En esta región la incidencia de ERCT es elevada. Pocos reciben TSR. La mortalidad es alta, aun con TSR. Son mayormente varones adultos (9:1). Los determinantes sociales inciden en la alta mortalidad (AU)

The Bajo Lempa is an impoverished rural coastal region of El Salvador affected by the chronic kidney disease (CKD) epidemic known as Mesoamerican nephropathy. The local community organisation Fondo Social de Emergencia para la Salud (FSES) (Emergency social fund for health) is helping to fight the epidemic in 42 communities of the region (19,223 inhabitants; average age 26.7 years; 48.5% male; 40.2% <18 years). Objectives: To report annual rates of end-stage renal disease (ESRD) incidence and patient mortality in these communities during a 10-year period (2004-2013), and the prevalence of patients receiving renal replacement therapy (RRT) as of 31 December 2013. Methods: The FSES recorded new ESRD cases, basic patient history, form of RRT if received and patient deaths. Results: We registered 271 new ESRD cases (annual average 27.1; 89% male; average age 55.6 years, four <18 years). Average annual ESRD incidence rate: 1409.8 per million population (pmp). Two-thirds did not report diabetes or hypertension. 94 patients (34.7%) received RRT: 58 in the Ministry of health, 26 in private services, 9 in social security and 1 in the military health system. 246 patients died (annual average 24.6 deaths; 89.4% male; average age 56.1 years; 92.3% at home). Average annual mortality rate: 128/100,000 population. Prevalence of patients receiving RRT in 2013: 1300.5 pmp (N=25; 84% male; average age 51 years). Conclusions: This region has a high incidence of ESRD. Few receive RRT. Patient mortality is high even with RRT. Most patients are male (9:1). Social determinants influence the high mortality (AU)

Incidence, mortality, and prevalence of end-stage chronic renal disease in the Bajo Lempa region of El Salvador: A ten-year community registry. / Incidencia, mortalidad y prevalencia de enfermedad renal crónica terminal en la región del Bajo Lempa, El Salvador: 10 años de registro comunitario.

The Bajo Lempa is an impoverished rural coastal region of El Salvador affected by the chronic kidney disease (CKD) epidemic known as Mesoamerican nephropathy. The local community organisation Fondo Social de Emergencia para la Salud (FSES) (Emergency social fund for health) is helping to fight the epidemic in 42 communities of the region (19,223 inhabitants; average age 26.7 years; 48.5% male; 40.2% <18 years). OBJECTIVES: To report annual rates of end-stage renal disease (ESRD) incidence and patient mortality in these communities during a 10-year period (2004-2013), and the prevalence of patients receiving renal replacement therapy (RRT) as of 31 December 2013. METHODS: The FSES recorded new ESRD cases, basic patient history, form of RRT if received and patient deaths. RESULTS: We registered 271 new ESRD cases (annual average 27.1; 89% male; average age 55.6 years, four <18 years). Average annual ESRD incidence rate: 1409.8 per million population (pmp). Two-thirds did not report diabetes or hypertension. 94 patients (34.7%) received RRT: 58 in the Ministry of health, 26 in private services, 9 in social security and 1 in the military health system. 246 patients died (annual average 24.6 deaths; 89.4% male; average age 56.1 years; 92.3% at home). Average annual mortality rate: 128/100,000 population. Prevalence of patients receiving RRT in 2013: 1300.5 pmp (N=25; 84% male; average age 51 years). CONCLUSIONS: This region has a high incidence of ESRD. Few receive RRT. Patient mortality is high even with RRT. Most patients are male (9:1). Social determinants influence the high mortality.

Apraxia bucofacial cruzada / Crossed bucofaical apraxia

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