A Bayesian approach for evaluating equivalence over multiple groups, and comparison with frequentist tost.

Manufacturing and testing of pharmaceutical products frequently occur in multiple facilities within a company's network. It is of interest to demonstrate equivalence among the alternative testing/manufacturing facilities to ensure product consistency and quality regardless of the facility where it was manufactured/tested. In the Frequentist framework, equivalence testing is well established when comparing two labs or manufacturing facilities; however, when considering more than two labs or production sites, the Frequentist approach may not always offer appropriate or interpretable estimates for demonstrating equivalence among all of them simultaneously. This paper demonstrates the utility of Bayesian methods to the equivalence assessment of multiple groups means, with a comparison against traditional Frequentist methods. We conclude that a Bayesian strategy is very useful for addressing the problem of multi-group equivalence. While it is not our intention to argue that Bayesian methods should always replace Frequentist ones, we show that among the advantages of a Bayesian analysis is that it provides a more nuanced understanding of the degree of similarity among sites than the hypothesis testing underpinning the Frequentist approach.

Granulomatosis With Polyangiitis (GPA): Isolated Nasal Bridge Involvement.

Granulomatosis with polyangiitis (GPA) is a rare autoimmune vasculitis primarily affecting small blood vessels and presenting with systemic manifestations, including those in the kidneys and respiratory tracts. Diagnosis involves clinical assessment and specific serological tests. This paper presents the case of a 68-year-old morbidly obese woman with chronic sinusitis, hypertension, and hyperlipidemia who developed a saddle nose deformity. Despite the absence of typical respiratory and renal symptoms, her laboratory results showed positive antineutrophil cytoplasmic antibodies (ANCA) and antinuclear antibodies (ANA), with a nasal septal biopsy confirming GPA. She was treated with methotrexate and folic acid. This case underscores the variability of GPA presentations and the critical importance of early diagnosis and treatment to prevent irreversible damage.

Development and qualification of 3 L scale-down model for large scale vaccine process on vero cell culture using microcarriers.

Scale-down models (SDM) are pivotal tools for process understanding and improvement to accelerate the development of vaccines from laboratory research to global commercialization. In this study, a 3 L SDM representing a 50 L scale Vero cell culture process of a live-attenuated virus vaccine using microcarriers was developed and qualified based on the constant impeller power per volume principle. Both multivariate data analysis (MVDA) and the traditional univariate data analysis showed comparable and equivalent cell growth, metabolic activity, and product quality results across scales. Computational fluid dynamics simulation further confirmed similar hydrodynamic stress between the two scales.

Multiplexed gene editing in citrus by using a multi-intron containing Cas9 gene.

Several expression systems have been developed in clustered regularly interspaced short palindromic repeats (CRISPR)-associated protein 9 (CRISPR/Cas9) framework allowing for gene editing of disease-associated genes across diverse citrus varieties. In this study, we present a new approach employing a multi-intron containing Cas9 gene plus multiple gRNAs separated with tRNA sequences to target the phytoene desaturase gene in both 'Carrizo' citrange and 'Duncan' grapefruit. Notably, using this unified vector significantly boosted editing efficiency in both citrus varieties, showcasing mutations in all three designated targets. The implementation of this multiplex gene editing system with a multi-intron-containing Cas9 plus a gRNA-tRNA array demonstrates a promising avenue for efficient citrus genome editing, equipping us with potent tools in the ongoing battle against several diseases such as canker and huanglongbing.

Effectiveness of an e-Health Quasi-Randomized Controlled Universal Prevention Program for Eating Disorders in Spanish Adolescents.

Eating disorders (EDs) and sub-threshold conditions are prevalent in the adolescent population. Unfortunately, most preventive interventions have been targeted at emerging adults and the effectiveness of online prevention programs has yet to be determined in adolescents. This study sought to examine the short-term effectiveness of a universal e-Health psychoeducational prevention program for EDs compared to a control (non-intervention) group in Spanish adolescents. Using a quasi-randomized trial design, a total of 161 [% girls: 45.96; Mage(SD) = 12.43 (0.43)] adolescents from 5 participating schools were allocated to two intervention arms: (1) psychoeducational intervention (n = 79) and (2) wait-list control (n = 82). The intervention was delivered over 3 months through 3 modules that were accessible 24/7 and 3 school sessions guided by the students´ tutors focusing on nutrition, promoting a healthy lifestyle, mitigating body concerns, and social pressures. Participants completed an online assessment battery including the Eating Attitudes Test (EAT-26) and measures of self-esteem, family disruption, compliance with the Mediterranean diet, and lifestyle. Correlational analysis showed small to moderate relationships between self-esteem and family function (rho = 0.413, p = 0.001), BMI (body mass index) and the EAT-26 dieting subscale (rho = 0.417, p = 0.001), physical activity and the bulimia subscale (rho = - 0.237, p = 0.003), and self-esteem and the dieting subscale (rho = - 0.223, p = 0.004). At the post-intervention assessment, the intervention group showed a statistically significant reduction in ED risk (EAT-26) (d = - 0.323, p = 0.040) and the oral control subscale (d = 0.327, p = 0.038). The e-health intervention including tutor-led digital components was effective for reducing ED risk in children. Results must be interpreted with caution due to the low statistical power and the limited sample size. Large scale randomized controlled trials with longer follow-ups will be needed to bolster the evidence.

O3-Annealing Effect on the Etching Resilience of a TiO2/Al2O3 filter Prepared by Atomic Layer Deposition.

This research investigates the improvements of ozone (O3) annealing on the optical and etching characteristics of TiO2/Al2O3 multilayer band-pass filters designed for potential optoelectronic applications. The band-pass filters were fabricated using atomic layer deposition (ALD), and their performance was systematically analyzed after the addition of O3 annealing at moderate temperatures (up to 300 °C). Results reveal that O3 annealing improves the optical transmittance of the multilayers by approximately 40% without significant spectral changes (∼6 nm). The observed enhancement in the transmittance is attributed to the improved stoichiometry of TiO2. By filling in the oxygen vacancies created during the fabrication process, it reduces its extinction coefficient. Furthermore, the O3 annealing enhances the stability of TiO2 against wet etching, improving the uniformity of etched surfaces. Etching on the ozone-annealed multilayer was up to 8 times more homogeneous, as observed in the roughness. The relatively short duration of the O3 annealing process, approximately 1.6 h, makes it a cost-effective alternative compared to using ozone in the ALD process, which can last several hours for thick optical coatings.

Nonlinear manifolds underlie neural population activity during behaviour.

There is rich variety in the activity of single neurons recorded during behaviour. Yet, these diverse single neuron responses can be well described by relatively few patterns of neural co-modulation. The study of such low-dimensional structure of neural population activity has provided important insights into how the brain generates behaviour. Virtually all of these studies have used linear dimensionality reduction techniques to estimate these population-wide co-modulation patterns, constraining them to a flat "neural manifold". Here, we hypothesised that since neurons have nonlinear responses and make thousands of distributed and recurrent connections that likely amplify such nonlinearities, neural manifolds should be intrinsically nonlinear. Combining neural population recordings from monkey motor cortex, mouse motor cortex, mouse striatum, and human motor cortex, we show that: 1) neural manifolds are intrinsically nonlinear; 2) the degree of their nonlinearity varies across architecturally distinct brain regions; and 3) manifold nonlinearity becomes more evident during complex tasks that require more varied activity patterns. Simulations using recurrent neural network models confirmed the proposed relationship between circuit connectivity and manifold nonlinearity, including the differences across architecturally distinct regions. Thus, neural manifolds underlying the generation of behaviour are inherently nonlinear, and properly accounting for such nonlinearities will be critical as neuroscientists move towards studying numerous brain regions involved in increasingly complex and naturalistic behaviours.

Inmunización con vacunas ARN mensajero contra la COVID-19 en pacientes adolescentes con antecedente de síndrome inflamatorio multisistémico: serie de casos / Immunization with messenger RNA vaccines against COVID-19 in adolescents with a history of multisystem inflammatory

Los niños cursan mayormente la infección por el virus SARS-CoV-2 en forma leve. Sin embargo, de forma muy infrecuente algunos pueden desarrollar una patología con marcada gravedad denominada síndrome inflamatorio multisistémico en niños relacionado temporalmente con COVID-19 (SIM-C). Dado su reciente surgimiento, aún hay aspectos de su fisiopatología que se desconocen. La posibilidad de recidiva en caso de reinfección o ante la vacunación contra SARS-CoV-2 son nuevos interrogantes a los que nos enfrentamos. Reportamos una serie de casos de 4 pacientes adolescentes que cursaron SIM-C y meses después han sido vacunados contra SARS-CoV-2 con plataformas ARN mensajero (ARNm) sin presentar recurrencia de la enfermedad ni efectos adversos cardiológicos

In most cases, children with SARS-CoV-2 have a mild infection. However, very rarely, some children may develop a severe disease called multisystem inflammatory syndrome in children temporally associated with COVID-19 (MIS-C). Given its recent emergence, some aspects of its pathophysiology are still unknown. The possibility of recurrence in case of reinfection or SARS-CoV-2 vaccination are new questions we are facing. Here we report a case series of 4 adolescent patients who developed MIS-C and, months later, received the SARS-CoV-2 vaccine with messenger RNA (mRNA) platforms without disease recurrence or cardiac adverse events.

Growth of Smart Microgels in a Flow Reactor Scrutinized by In-Line SAXS.

In this work, a continuous flow setup for in situ investigation of microgel growth with small-angle X-ray scattering (SAXS) is established. Poly(N-n-propylacrylamide) (PNNPAM) and poly(N-isopropylacrylamide) (PNIPAM) microgels are synthesized in H2O at different residence times inside a continuous flow reactor. The microgels are investigated by in situ SAXS and ex situ photon correlation spectroscopy. The size of the microgels was found to be reproducible in independent experiments with run times of up to 7 h. Already the scattering curves of the microgels with a time of residence of 15 min show a well-defined form factor. Further analysis of the scattering profiles confirms the spherical shape of the microgels. At a residence time of 2 min, the scattering intensity is significantly lower corresponding to a smaller particle size. The experimental conditions remain constant over time, which is crucial for long-time experiments. The PNNPAM system is found to be more suitable for the flow reactor experiment with in-line SAXS as it shows less polymer deposition in the tubing and forms particles with lower polydispersity. The presented reactor is characterized by a compact design and offers a plug-and-play setup close to the sample environment. This work paves the way for investigations of microgel growth at e.g. synchrotron X-ray beamlines.

Immunization with messenger RNA vaccines against COVID-19 in adolescents with a history of multisystem inflammatory syndrome: a case series. / Inmunización con vacunas ARN mensajero contra la COVID-19 en pacientes adolescentes con antecedente de síndrome inflamatorio multisistémico: serie de casos.

In most cases, children with SARS-CoV-2 have a mild infection. However, very rarely, some children may develop a severe disease called multisystem inflammatory syndrome in children temporally associated with COVID-19 (MIS-C). Given its recent emergence, some aspects of its pathophysiology are still unknown. The possibility of recurrence in case of reinfection or SARS-CoV-2 vaccination are new questions we are facing. Here we report a case series of 4 adolescent patients who developed MIS-C and, months later, received the SARS-CoV-2 vaccine with messenger RNA (mRNA) platforms without disease recurrence or cardiac adverse events.

Los niños cursan mayormente la infección por el virus SARS-CoV-2 en forma leve. Sin embargo, de forma muy infrecuente algunos pueden desarrollar una patología con marcada gravedad denominada síndrome inflamatorio multisistémico en niños relacionado temporalmente con COVID-19 (SIM-C). Dado su reciente surgimiento, aún hay aspectos de su fisiopatología que se desconocen. La posibilidad de recidiva en caso de reinfección o ante la vacunación contra SARS-CoV-2 son nuevos interrogantes a los que nos enfrentamos. Reportamos una serie de casos de 4 pacientes adolescentes que cursaron SIM-C y meses después han sido vacunados contra SARS-CoV-2 con plataformas ARN mensajero (ARNm) sin presentar recurrencia de la enfermedad ni efectos adversos cardiológicos.

Fall Risk, Sleep Behavior, and Sleep-Related Movement Disorders in Young Urbanites Exposed to Air Pollution.

BACKGROUND: Quadruple aberrant hyperphosphorylated tau, amyloid-ß, α-synuclein, and TDP-43 pathology had been documented in 202/203 forensic autopsies in Metropolitan Mexico City ≤40-year-olds with high exposures to ultrafine particulate matter and engineered nanoparticles. Cognition deficits, gait, equilibrium abnormalities, and MRI frontal, temporal, caudate, and cerebellar atrophy are documented in young adults. OBJECTIVE: This study aimed to identify an association between falls, probable Rapid Eye Movement Sleep Behavior Disorder (pRBD), restless leg syndrome (RLS), and insomnia in 2,466 Mexican, college-educated volunteers (32.5±12.4 years). METHODS: The anonymous, online study applied the pRBD and RLS Single-Questions and self-reported night-time sleep duration, excessive daytime sleepiness, insomnia, and falls. RESULTS: Fall risk was strongly associated with pRBD and RLS. Subjects who fell at least once in the last year have an OR = 1.8137 [1.5352, 2.1426] of answering yes to pRBD and/or RLS questions, documented in 29% and 24% of volunteers, respectively. Subjects fell mostly outdoors (12:01 pm to 6:00 pm), 43% complained of early wake up hours, and 35% complained of sleep onset insomnia (EOI). EOI individuals have an OR of 2.5971 [2.1408, 3.1506] of answering yes to the RLS question. CONCLUSION: There is a robust association between falls, pRBD, and RLS, strongly suggesting misfolded proteinopathies involving critical brainstem arousal and motor hubs might play a crucial role. Nanoparticles are likely a significant risk for falls, sleep disorders, insomnia, and neurodegenerative lethal diseases, thus characterizing air particulate pollutants' chemical composition, emission sources, and cumulative exposure concentrations are strongly recommended.

Caracterización epidemiológica de lesiones no intencionales en edad pediátrica. 2004-2019

Introducción: el término lesión no intencional en la literatura científica es relativamente nuevo; la acepción más utilizada ha sido "accidente". Objetivo: describir las características epidemiológicas de las lesiones no intencionales en menores de 15 años y el pronóstico para el año 2020. Métodos: se realizó un estudio observacional, descriptivo, ambispectivo, en menores de 15 años atendidos en el Hospital Provincial Pediátrico Docente "General Milanés", de Bayamo, Granma, en el período 2004-2019. La muestra estuvo constituida por 17 595 pacientes. Se utilizó la estadística descriptiva para el procesamiento de la información obtenida (tasa, media, desviación estándar). Resultados: la tasa media de mortalidad en el período 2004-2019 fue de 0,7446 por 1000 habitantes, predominó el sexo masculino, superando en cada año el 50 % de la casuística, existió predominio de los pacientes del área de salud que atiende el policlínico ″René Vallejo Ortiz″ (n=5314, para 30,20 %), seguido de los atendidos por el policlínico ″Bayamo Oeste″ (n=4484, para 25,48 %), La contusión fue la lesión no intencional más frecuente (12 644 pacientes; 71,86 %); seguido de las heridas (2550 pacientes; 14,49 %). En los dos primeros trimestres del año se produjo el mayor número de lesiones no intencionales. Conclusiones: hubo predominio del sexo masculino, el grupo de 1 a 4 años y el área de salud que atiende el policlínico ″René Vallejo″. Las contusiones, seguidas de las heridas, fueron las lesiones no intencionales más frecuentes; la mayoría de los pacientes no requirió de ingreso hospitalario. El patrón estacional fue casi homogéneo, con una tendencia estable de ese evento de salud.

Introduction: the term unintentional injury in the scientific literature is relatively new; the most used meaning has been "accident". Objective: to Describe the epidemiological characteristics of unintentional injuries in children under 15 years of age and the prognosis for the year 2020. Methods: an observational, descriptive, ambispective study was carried out in children under 15 years of age treated at the "General Milanés" Provincial Pediatric Teaching Hospital in Bayamo, Granma, in the period 2004-2019. The sample consisted of 17,595 patients. Descriptive statistics were used: for the processing of the information obtained (mean, standard deviation). Results: the average rate in the period 2004-2019 was 0.7446 per 1000 inhabitants, the male sex predominated, exceeding 50% of the casuistry in each year, there was a predominance of patients in the health area that attends the polyclinic ″René Vallejo Ortiz″ (n=5,314, for 30.20%), followed by those attended by the ″Bayamo Oeste″ polyclinic (n=4,484, for 25.48%), contusion was the most frequent unintentional injury (12,644 patients 71.86%); followed by wounds (2550 patients; 14.49%). The highest number of unintentional injuries occurred in the first two quarters of the year. Conclusions: there was a predominance of the male sex, the group from 1 to 4 years old and the health area served by the ″René Vallejo″ polyclinic. Contusions, followed by wounds, were the most frequent unintentional injuries; most of the patients did not require hospital admission. The seasonal patteern was almost homogeneous, with a stable trend of that salt event.

Introdução: o termo lesão não intencional na literatura científica é relativamente novo; O significado mais comumente usado tem sido "acidente". Objetivo: descrever as características epidemiológicas das lesões não intencionais em menores de 15 anos e o prognóstico para o ano de 2020. Métodos: foi realizado um estudo observacional, descritivo e ambispectivo em crianças menores de 15 anos atendidas no Hospital Pediátrico Provincial de Ensino "General Milanés" em Bayamo, Granma, no período de 2004 a 2019. A amostra foi composta por 17.595 pacientes. A estatística descritiva foi utilizada para processar as informações obtidas (taxa, média, desvio padrão). Resultados: a taxa média de mortalidade no período 2004-2019 foi de 0,7446 por 1000 habitantes, predominou o sexo masculino, ultrapassando 50% da casuística em cada ano, houve predomínio de pacientes na área da saúde atendidos pela policlínica "René Vallejo Ortiz" (n=5314, para 30,20%), seguidos pelos atendidos pela policlínica "Bayamo Oeste" (n=4484, para 25,48%), a contusão foi a lesão não intencional mais frequente (12.644 pacientes; 71,86%); seguido de feridas (2550 pacientes; 14,49%). Os doisprimeiros trimestres do ano viram o maior número de lesões não intencionais. Conclusões: houve predomínio do sexo masculino, do grupo de 1 a 4 anos e da área da saúde atendida pela policlínica René Vallejo. As contusões, seguidas das feridas, foram as lesões não intencionais mais frequentes; A maioria dos pacientes não necessitou de internação. O padrão sazonal foi quase homogêneo, com tendência estável desse evento de saúde.

Validation of "the patient evaluation of emotional care during hospitalisation" questionnaire in intensive care unit patients.

OBJECTIVE: To validate the "Patient Evaluation of Emotional Care During Hospitalization" (PEECH) questionnaire, which assesses hospitalised patients' emotional experiences, in patients admitted to the intensive care unit (ICU). INTERVENTIONS: Prospective study. The PEECH consists of three sections and four sub-scales: "level of security", "level of knowing", "level of personal value", and "level of connection". The questionnaire was completed by 253 hospitalised patients. Expert judgement was used to analyse the content validity and factor analysis was performed to confirm construct validity. Cronbach's alpha was used to measure the internal consistency of the four sub-scales. RESULTS: In the confirmatory factor analysis of the four sub-scales, the weights of all questions were found to be significant (>1). The internal consistency of the PEECH questionnaire was 0.86 (Cronbach's alpha) and the homogeneity index was high (>0.50). CONCLUSION: The PEECH questionnaire is a valid and reliable tool to evaluate the perception of emotional care in ICU patients. The information gathered can help provide more comprehensive care for patients in the ICU and in other hospitalised patients.

ppGpp, the General Stress Response Alarmone, Is Required for the Expression of the α-Hemolysin Toxin in the Uropathogenic Escherichia coli Isolate, J96.

ppGpp is an intracellular sensor that, in response to different types of stress, coordinates the rearrangement of the gene expression pattern of bacteria to promote adaptation and survival to new environmental conditions. First described to modulate metabolic adaptive responses, ppGpp modulates the expression of genes belonging to very diverse functional categories. In Escherichia coli, ppGpp regulates the expression of cellular factors that are important during urinary tract infections. Here, we characterize the role of this alarmone in the regulation of the hlyCABDII operon of the UPEC isolate J96, encoding the toxin α-hemolysin that induces cytotoxicity during infection of bladder epithelial cells. ppGpp is required for the expression of the α-hemolysin encoded in hlyCABDII by stimulating its transcriptional expression. Prototrophy suppressor mutations in a ppGpp-deficient strain restore the α-hemolysin expression from this operon to wild-type levels, confirming the requirement of ppGpp for its expression. ppGpp stimulates hlyCABDII expression independently of RpoS, RfaH, Zur, and H-NS. The expression of hlyCABDII is promoted at 37 °C and at low osmolarity. ppGpp is required for the thermoregulation but not for the osmoregulation of the hlyCABDII operon. Studies in both commensal and UPEC isolates demonstrate that no UPEC specific factor is strictly required for the ppGpp-mediated regulation described. Our data further support the role of ppGpp participating in the coordinated regulation of the expression of bacterial factors required during infection.

Tuning Xanthan Viscosity by Directed Random Coil-to-Helix Transition.

Xanthan gum is a polysaccharide that is widely used as a thickening agent in numerous food, cosmetic, and technical applications. Therefore, the knowledge of the molecular interplay that builds up and stabilizes water-binding networks is crucial for the optimization of xanthan thickening performance. Using atomic force microscopy, rheometry, and inductively coupled plasma optical emission spectroscopy, we show a clear correlation between xanthan thickening properties and the ability to form characteristic secondary structures as well as the valence and amount of cations coordinated at the polysaccharide side chain. Based on these findings and the Debye-Hückel theory, we derive an ion-interaction model in which divalent cations mediate bridging of adjacent single polymer strands due to chelate-like coordination building stable secondary structures. We furthermore demonstrate in a cation exchange assay that xanthan secondary structures can be modified in a directed and reversible manner, which, in turn, alters its thickening properties.

Reinfección por SARS-CoV-2 en un niño con antecedente de síndrome inflamatorio multisistémico: a propósito de un caso / Reinfection by SARS-CoV-2 in a child with history of multisystem inflammatory syndrome: a case report

El síndrome inflamatorio multisistémico en niños y adolescentes relacionado temporalmente con la COVID-19 (SIM-C) es una entidad poco frecuente en pediatría, que emerge en relación con la pandemia por el coronavirus de tipo 2 causante del síndrome respiratorio agudo grave (SARS-CoV-2) y fue descripto por primera vez en mayo de 2020. Debido al escaso tiempo de evolución de esta enfermedad, hay aspectos sobre su fisiopatología, pronóstico y posibilidad de recurrencia, que aún se desconocen. Se presenta el caso clínico de un paciente de 12 años que cursó un cuadro compatible con SIM-C en enero de 2021, con buena evolución clínica posterior. Luego presentó una reinfección por SARS-CoV-2 a los 5 meses de la infección inicial (junio de 2021), con síntomas leves y sin recurrencia del SIM-C.

The multisystem inflammatory syndrome in children temporally related to COVID-19 (MIS-C) is a rare disease in pediatrics, which emerges related to the SARS-CoV-2 pandemic and was initially described in May 2020. Given the short time of evolution of this disease, little is known about the pathophysiology, prognosis, and the possibility of recurrence. We present a clinical case of a 12-year-old patient who presented symptoms compatible with MIS-C in January 2021, with good subsequent clinical evolution. He developed reinfection by SARS-CoV-2 at five months later (June 2021), with mild symptoms and without recurrence of MIS-C

[Reinfection by SARS-CoV-2 in a child with history of multisystem inflammatory syndrome: a case report]. / Reinfección por SARS-CoV-2 en un niño con antecedente de síndrome inflamatorio multisistémico: a propósito de un caso.

The multisystem inflammatory syndrome in children temporally related to COVID-19 (MIS-C) is a rare disease in pediatrics, which emerges related to the SARS-CoV-2 pandemic and was initially described in May 2020. Given the short time of evolution of this disease, little is known about the pathophysiology, prognosis, and the possibility of recurrence. We present a clinical case of a 12-year-old patient who presented symptoms compatible with MIS-C in January 2021, with good subsequent clinical evolution. He developed reinfection by SARS-CoV-2 at five months later (June 2021), with mild symptoms and without recurrence of MIS-C.

El síndrome inflamatorio multisistémico en niños y adolescentes relacionado temporalmente con la COVID-19 (SIM-C) es una entidad poco frecuente en pediatría, que emerge en relación con la pandemia por el coronavirus de tipo 2 causante del síndrome respiratorio agudo grave (SARS-CoV-2) y fue descripto por primera vez en mayo de 2020. Debido al escaso tiempo de evolución de esta enfermedad, hay aspectos sobre su fisiopatología, pronóstico y posibilidad de recurrencia, que aún se desconocen. Se presenta el caso clínico de un paciente de 12 años que cursó un cuadro compatible con SIM-C en enero de 2021, con buena evolución clínica posterior. Luego presentó una reinfección por SARS-CoV-2 a los 5 meses de la infección inicial (junio de 2021), con síntomas leves y sin recurrencia del SIM-C.

Nephro-urological outcomes of a proactive management of children with spina bifida in their first 5 Years of life.

INTRODUCTION: The proactive management of spina bifida (SB), especially of its severe form, myelomeningocele (MMC), has contributed to decreasing chronic kidney disease (CKD). The objective of this study is to present the evolution of 5-year-old patient with MMC followed from birth with a proactive approach. MATERIAL AND METHODS: This retrospective study included 55 cases with MMC of up to 5 years of age. All of them were admitted at birth and followed by a multidisciplinary group, with a proactive approach: CIC and anticholinergics. In the same group, the variables were compared within the first year and the within the fifth year of life. Chronic kidney disease (CKD) was defined by: alterations on renal DMSA scintigraphy; alterations in microalbuminuria/creatininuria ratio, proteinuria 24 hs and decrease in glomerular filtration rate (GFR) calculated with Schwartz bedside equation. RESULTS: Although overactivity, UTI and VUR decreased throughout the first 5 years (49, 9 and 12%), reduced cystometric capacity, DLPP >40 cm of water and end-filling pressure (Pdet) >20 cm of water increased (41, 27 and 61%). All patients at 5 years of age required CIC. Reduced cystometric capacity and VUR were more significant with abnormal DMSA (36%) at 5 years old ( p: 0.03). Proteinuria and CKD increased to 25% and 49%. Similarly, the need for enalapril increased from 10% to 27%. The microalbuminuria/creatininuria ratio was pathological in 27.3%. 48 patients (87%) remained unchanged on DMSA scan and the other 7 underwent modifications (4 new cases with altered DMSA) over time. Of the 32 normal DMSA cases without changes, 81% did not present proteinuria and 88% continued to respond favorably to oxybutynin. GFR <90 ml/min/1.72m 2 was found in only 3 cases with abnormal DMSA. There was a RR 1.91 (IC95% 1.15-3.16) greater of renal compromise in cases that were anticholinergic-resistant compared to non-refractory cases. DISCUSSION: Over time, some patients suffered loss of bladder wall compliance, despite the proactive approach. There is an association between abnormal renal DMSA, reduced bladder capacity, and VUR at 5 years of age. Although proteinuria, CKD and enalapril requirement increased over 5 years, almost 90% did not show changes in renal DMSA status. CONCLUSIONS: Over time, some patients suffered loss of bladder wall compliance. Hence, even if a proactive approach is followed since birth, it is essential to continue with the ongoing monitoring of the renal status and thus avoid greater renal deterioration.

Efecto de programa de ejercicios físicos para la fuerza de extremidades inferiores en adultos mayores

RESUMEN Fundamento: el envejecimiento es un proceso caracterizado por la pérdida progresiva de capacidades físicas, cognitivas, biológicas y psicosociales. Los programas de ejercicios físicos específicos, en personas mayores estimulan el equilibrio, la fuerza, la marcha y protegen de las caídas y sus efectos. La actividad física favorece el mantenimiento de la independencia funcional de los adultos mayores. Objetivo: determinar el efecto de un programa de ejercicios físicos para aumentar la fuerza de extremidades inferiores en adultos mayores. Métodos: se realizó un estudio que se correspondió con un diseño pre-experimental, con pre y pos-test y un grupo de control. La muestra n=30, la edad =72,3 y desviación estándar S=7,0. Se aplicaron los test: Levántate y anda, Pasos sobre y por encima de un escalón de 15,2 cm. Estadísticamente, se realizó un análisis descriptivo de datos y comparación, según la distribución de frecuencias y porcentajes de indicadores de fuerza; se determinó correlación e independencia entre variables: fuerza, sexo, edad y padecimientos, mediante los estadísticos de correlación Chi-cuadrado de Pearson, R de Pearson y Correlación de Spearman. Se aplicó Chi-cuadrado de Pearson, Gamma y Tau-b de Kendall, con normalidad en la distribución de los datos y confianza p=0,05, por medio del programa estadístico IBM SPSS para Windows versión 21.0. Resultados: se demostraron cambios significativos en la fuerza de miembros inferiores de adultos mayores y ninguna dependencia entre las variables sociodemográficas relacionadas, p>0,05, excepto en la relación padecimientos y test: Levántate y anda p<0,05, que evidenció dependencia entre fuerza de extremidades inferiores y padecimientos cardiovasculares. Conclusiones: el programa aumenta la fuerza en miembros inferiores de adultos mayores, con relación de dependencia entre fuerza de extremidades inferiores y padecimientos cardiovasculares.

ABSTRACT Background: aging is a process characterized by the progressive loss of physical, cognitive, biological and psychosocial capacities. Specific physical exercise programs for older people stimulate balance, strength, and gait and protect against falls and their effects. Physical activity favors the maintenance of functional independence in older adults. Objective: to determine the effect of a physical exercise program to increase lower extremity strength in older adults. Methods: a study was carried out that corresponded to a pre-experimental design, with pre and post-test and a control group. The sample n=30, age=72.3 and standard deviation S=7.0. The tests were applied: Get up and walk, Steps on and over a 15.2 cm step. Statistically, a descriptive analysis of data and comparison was carried out, according to the distribution of frequencies and percentages of strength indicators; correlation and independence between variables were determined: strength, sex, age and illnesses, using Pearson's Chi-square correlation statistics, Pearson's R and Spearman's Correlation. Chi-square of Pearson, Gamma and Tau-b of Kendall were applied, with normality in the data distribution and confidence p=0.05, through the statistical program IBM SPSS for Windows version 21.0. Results: significant changes were shown in the strength of the lower limbs of older adults and no dependence between the related sociodemographic variables, p>0.05, except in the relationship between conditions and the Get up and walk test p<0.05, which showed dependence between lower extremity strength and cardiovascular disease. Conclusions: the program increases the strength in the lower limbs of older adults, with a dependency relationship between the strength of the lower limbs and cardiovascular diseases.

Brainstem Quadruple Aberrant Hyperphosphorylated Tau, Beta-Amyloid, Alpha-Synuclein and TDP-43 Pathology, Stress and Sleep Behavior Disorders.

Quadruple aberrant hyperphosphorylated tau (p-τ), amyloid-ß peptide, alpha-synuclein and TDP-43 brainstem and supratentorial pathology are documented in forensic ≤40y autopsies in Metropolitan Mexico City (MMC), and p-τ is the major aberrant protein. Post-traumatic stress disorder (PTSD) is associated with an elevated risk of subsequent dementia, and rapid eye movement sleep behavior disorder (RBD) is documented in PD, AD, Lewy body dementia and ALS. This study aimed to identify an association between PTSD and potential pRBD in Mexico. An anonymous online survey of 4502 urban college-educated adults, 29.3 ± 10.3 years; MMC, n = 1865; non-MMC, n = 2637, measured PTSD symptoms using the Impact of Event Scale-Revised (IES-R) and pRBD symptoms using the RBD Single-Question. Over 50% of the participants had IES-R scores ≥33 indicating probable PTSD. pRBD was identified in 22.6% of the participants across Mexico and 32.7% in MMC residents with PTSD. MMC subjects with PTSD had an OR 2.6218 [2.5348, 2.7117] of answering yes to the pRBD. PTSD and pRBD were more common in women. This study showed an association between PTSD and pRBD, strengthening the possibility of a connection with misfolded proteinopathies in young urbanites. We need to confirm the RBD diagnosis using an overnight polysomnogram. Mexican women are at high risk for stress and sleep disorders.