Casual finding in colonoscopy: Diphyllobothrium latum.

Diphyllobothrium spp., also known as fish tapeworms, is the largest human tapeworm, reaching up to 25 meters of length. Human are considered the definitive host in the Diphyllobothrium lifecycle. Adult tapeworms attach to human intestinal mucosa with to bilateral grooves. There are at least 14 different species of Diphyllobothrium spp. Capable of causing Dyphyllobothriosis, being D. latum and D. nihonkaiense the most frequent etiologic agents in humans. We present the clinical picture and endoscopic images on a patient with incidental finding of Dyphyllobothriosis in a colonoscopy.

Mesalamine induced hepatotoxicity. Is mesalamine safe?

Dear Editor: Mesalamine is a medication used widely in the treatment of patients with inflammatory bowel disease. Although mesalamine is considered safe, hepatotoxicity has been reported with an incidence of 0-4%. We present the clinical picture of a patient with hepatotoxicity due to mesalamine. A 79-year-old woman in the context of chronic diarrhea, a left-sided ulcerative colitis diagnosis was made, and treatment was initiated with oral mesalamine 4 g per day, and mesalamine suppositories. Before starting treatment, she had normal liver test results. After three months, she presented with headache, fatigue, and intermittent low fever. Her laboratory tests showed a liver profile with a cholestatic pattern, and elevation of inflammatory parameters. Mesalamine was suspended, and an extensive study was performed. Cholangioresonance reported intra and extrahepatic bile duct dilation without obstruction, and thickening of the intrahepatic bile duct. She progressed with worsening of the liver profile without signs of liver failure. A liver biopsy was performed, which showed chronic non-suppurative cholangitis with granulomas and focal concentric fibrosis related to medium-caliber bile ducts, and IgG4 stain was negative.

Síndrome de Good, una causa infrecuente de diarrea crónica / Good Syndrome, a rare cause of chronic diarrhea

Chronic diarrhea is a frequent cause of consultation in daily clinical practice. There are multiple diagnostic algorithms that allow a staggered approach to the most frequent pathologies, leaving out some lesser-known ones. This article reports the case of a 66-year-old female patient with a history of arterial hypertension, dyslipidemia and resected AB thymoma and a history of chronic diarrhea of 8 weeks of evolution. The etiological study ruled out infectious causes, celiac disease and negative viral serology. Due to a history of thymoma, immunoglobulin count was performed, showing severe pan-hypogammaglobulinemia. Good's Syndrome is the combination of thymoma and hypogammaglobulinemia, where patients may present with diarrhea secondary to immunodeficiency. Hypogammaglobulinemia associated with the presence of a thymoma is a rare cause but widely described in the literature as Good's Syndrome. Therefore, it seems relevant to describe a case, its approach and subsequent management.

La diarrea crónica constituye una causa frecuente de consulta en la práctica clínica diaria. Existen múltiples algoritmos diagnósticos que permiten realizar un abordaje escalonado de las patologías más frecuentes y permiten descartar algunas menos conocidas. En el presente artículo se reporta el caso de una paciente de género femenino de 66 años, antecedentes de hipertensión arterial, dislipidemia y timoma AB resecado con historia de diarrea crónica de 8 semanas de evolución. Dentro del estudio etiológico se descartan las causas infecciosas, enfermedad celíaca y serologías virales negativas. Por antecedente de timoma, se realizó recuento de inmunoglobulinas, evidenciando una severa pan-hipogammaglobulinemia. El Síndrome de Good es la combinación de timoma e hipogammaglobulinemia, donde los pacientes podrían presentar diarreas secundarias a inmunodeficiencia. La hipogammaglobulinemia asociada a la presencia de un timoma es una causa poco frecuente pero ampliamente descrita en la literatura como Síndrome de Good. Por lo antes señalado, nos parece relevante describir un caso, su abordaje y manejo posterior.

Clinical and epidemiological characteristics of SARS-CoV-2 virus in ambulatory children under 2 years old.

Background: SARS-CoV-2 is an emerging virus that has mainly affected adults; hence, most clinical information has been derived from that population. Most pediatric cases are mild and with nonspecific symptoms requiring outpatient management. Children are a major source of spread for most traditional respiratory viruses. Their role in SARS-CoV-2 transmission was thought to be relevant. Children under the age of two comprise a group that is more susceptible to infection since vaccines have not been approved for them until recently. The knowledge of clinical manifestation of COVID-19 in young children is scarce. Objectives: To describe the clinical, epidemiological, and demographic characteristics of children under 2 years old with confirmed COVID-19, who did not require hospitalization. Methods: This descriptive study was performed from May, 2020 to June, 2021. Children ages 0-2 years with COVID-19, confirmed by transcriptase-polymerase chain reaction assay that were performed in laboratories of the Red de Salud UC CHRISTUS Health Network, were selected to be contacted. If the parents accepted participating and their children were not hospitalized, a survey was sent to the patients' caregivers. Results: Of the 242 cases, 159 caregivers answered the survey (65.7%). The median age of the subjects was 14 months, and 53.5% were males. Fifty percent had comorbidities, of which one third corresponded to atopy. Ninety eight percent were secondary cases. Most of them were infected within their households (81%). The most frequent sources were their parents, followed by their grandparents. The most common symptom was fever (78%) followed by irritability (67.3%), rhinorrhea (66%), and fatigue (64.8%). Infants less than 6 months old more often presented with conjunctival congestion and less loss of appetite compared to older children (p < 0.05). Conclusions: This study provides valuable insights regarding COVID-19 in ambulatory young children. Most cases of SARS-CoV-2 infection in children under 2 years old do not require hospitalization. There was a slight male predominance, and the majority had been infected within their households. SARS-CoV-2 infection should be suspected in children under 2 years old presenting with fever, irritability, fatigue, and rhinorrhea. Children with positive household contacts and fever should also be tested for COVID-19.

Equity and Prevention of Cardiovascular Diseases in Latin America and the Caribbean.

Non-communicable diseases, particularly cardiovascular diseases, are the leading cause of decreased life expectancy and death in Latin America and the Caribbean. Although a lifestyle, which includes no tobacco use, good nutrition, and regular physical activity is touted as key to health, the environmental, racial, social and economic conditions, which underpin lifestyle are often ignored or considered only secondarily. Placing the main responsibility on a patient to change their lifestyle or to simply comply with pharmacological treatment ignores the specific conditions in which the individual lives. Furthermore, there are major disparities in access to both healthy living conditions as well as access to medical care. There is sufficient evidence to support advocating for policies that support healthy living, particularly healthy food choices. Progress is being made to improve the food environment with enactment of front of package nutritional labels. However, policies were enacted only after intense regional research and advocacy supporting their implementation. Government officials must rise above the pressures of commercial interests and support health-promoting policies or be exposed as self-interest groups themselves. Strong advocacy is required to persuade officials that all policies should take health into consideration both to improve lives and economies.

Adding and subtracting by hand: Metaphorical representations of arithmetic in spontaneous co-speech gestures.

This study investigated the spontaneous co-speech gestures produced by speakers who were talking about the concepts of addition and subtraction in a television news setting. We performed a linguistic and co-speech gesture analysis of expressions related to the concepts of addition (N plus N, addition, add) and subtraction (N minus N, subtraction, subtract). First, we compared the linguistic frequency of these structures across several corpora. Second, we performed a multimodal gesture analysis, drawing data from a television news repository. We analyzed 423 co-speech gestures (169 for subtraction and 254 for addition) in terms of their axis (e.g., lateral, sagittal) and their direction (e.g., leftwards, away from their body). Third, we examined the semantic properties of the direct object that was added or subtracted. There were two main findings. First, low-frequency linguistic expressions were more likely to be accompanied by co-speech gestures. Second, most gestures about addition and subtraction were produced along the lateral or sagittal axes. When people spoke about addition, they tended to produce lateral, rightwards movements or movements away from the body. When people spoke about subtraction, they tended to produce lateral, leftwards movements or movements towards the body. This co-speech gesture data provides evidence that people activate two different metaphors for arithmetic in spontaneous behavior: arithmetic is motion along a path and arithmetic is collecting objects.

A robust nonlinear PI-type controller for the DC-DC buck-boost power converter.

In this study, a novel Lyapunov function-based robust nonlinear proportional-integral (PI)-type controller for regulating the output voltage of the direct current to direct current (DC-DC) inverting buck-boost power converter operating in continuous conduction mode (CCM) is presented. The control scheme guarantees global asymptotic stability of the closed-loop system even in case of parameter uncertainty. The analysis of the closed-loop trajectories is carried out using Lyapunov method and LaSalle's invariance principle. Robustness to additive disturbances is shown and simple gain tuning guidelines are given. Real-time experiments support the theoretical results. Experimental tests are presented where the proposed PI-type control design is compared with other PI-type schemes found in the literature. The proposed scheme presents very good consistent performance under line and load disturbance.

Adverse effects, pharmacological interactions, and cardiovascular drugs in COVID-19 treatment.

In severe coronavirus disease (COVID)-19 patients, an extraordinary systemic inflammatory response is seen. It could impact in multiple organ disorders, specially a severe myocardial injury, an acute myocarditis results in focal or global myocardial inflammation and necrosis. Those events can be present in healthy subjects or cardiovascular (CV) patients. It is clinically associated with ventricular dysfunction exacerbation or worsening and tachyarrhythmias. It is also related to a poor outcome for CV patients with ischemic heart disease, hypertensión, and heart failure. COVID-19 patients require multiple and complex treatment that alleviates symptoms, the vast variety of agents interacts with diseases and CV drugs. Our purpose is to correlate in guidance synopsis: Adverse effects, pharmacological interactions, and CV drugs in COVID-19 treatment.

En pacientes con COVID-19 grave se ha observado una extraordinaria respuesta inflamatoria sistémica. Este impacto se traduce en múltiples trastornos de órganos, especialmente cardíacos, por lesión miocárdica grave, miocarditis aguda que resulta en inflamación focal o miocárdica global, necrosis cardiaca. Estos tremendos eventos son observados en sujetos sanos como pacientes cardiovasculares. Clínicamente asociados con nueva presentación o empeoramiento de la disfunción ventricular y taquiarritmias. Relacionado a un predictor principal de malos resultado en pacientes cardiovasculares (CV), especialmente en aquellos con cardiopatía isquémica, hipertensión e insuficiencia cardíaca. Los enfermos con COVID-19 requieren múltiples y complejos tratamientos que alivien los síntomas, esta gran variedad de agentes interactúa con enfermedades y medicamentos CV. Nuestro propósito es correlacionar, en una guía sinóptica: efectos adversos, interacciones farmacológicas y fármacos cardiovasculares en el tratamiento del COVID-19.

Temporal Expressions in English and Spanish: Influence of Typology and Metaphorical Construal.

This study investigates how typological and metaphorical construal differences may affect the use and frequency of temporal expressions in English and Spanish. More precisely, we explore whether there are any differences between English, a satellite-framed language, and Spanish, a verb-framed language, in the use of certain temporal linguistic expressions that include a spatial, deictic component (Deictic Time), a purely temporal relation between two events (Sequential Time) or the expression of the duration of an event (Duration). To achieve this, we perform two different types of studies. First, we conduct an informational gain or loss analysis of 1,650 of English-to-Spanish translations extracted from parallel corpora. Secondly, we compare the frequency of 33 English and 27 Spanish temporal expressions in two similar written online corpora (EnTenTen and EsTenTen, respectively) and a television news spoken corpus (NewsScape). Our results suggest that English uses "deictic expressions with directional language" (explicitly stating the spatial location of the temporal event, e.g., back in those days/in the future ahead) much more frequently than Spanish, to the extent that such directional information is often excluded in English-to-Spanish translations. Also, sequential expressions (such as before that/later than) and duration expressions (during the whole day) are much more frequent in Spanish. These usage differences, explained by the variability in motion typology and metaphoric construal, open up the interesting question of how these differences in linguistic usage could affect the conceptualization of time of English and Spanish speakers.

Quantifying the speech-gesture relation with massive multimodal datasets: Informativity in time expressions.

The development of large-scale corpora has led to a quantum leap in our understanding of speech in recent years. By contrast, the analysis of massive datasets has so far had a limited impact on the study of gesture and other visual communicative behaviors. We utilized the UCLA-Red Hen Lab multi-billion-word repository of video recordings, all of them showing communicative behavior that was not elicited in a lab, to quantify speech-gesture co-occurrence frequency for a subset of linguistic expressions in American English. First, we objectively establish a systematic relationship in the high degree of co-occurrence between gesture and speech in our subset of expressions, which consists of temporal phrases. Second, we show that there is a systematic alignment between the informativity of co-speech gestures and that of the verbal expressions with which they co-occur. By exposing deep, systematic relations between the modalities of gesture and speech, our results pave the way for the data-driven integration of multimodal behavior into our understanding of human communication.

A family of saturated controllers for UWMRs.

Input saturation appears in a physical system when a large power dissipation is requested. In this situation, and specifically for unicycle-type wheeled mobile robots, actuators only can deliver a finite amount of power. Thus, in practice the linear and angular velocity input of this class of mobile robots is limited and this should be considered in the control design. In this paper, a family of controllers that produce saturated velocity input for unicycle-type wheeled mobile robots is presented. The proposed family of controllers is designed to satisfy the trajectory tracking control goal. Sufficient conditions to prove the closed-loop system global asymptotic stability are established by using Lyapunov's theory. Already reported schemes and original designs are shown to satisfy the properties of the given family of controllers. By using two different motion tasks, experimental tests in real-time with five saturated control schemes are presented in order to validate the proposed theory. In order to show the ability of the family of controllers to produce limited control action, experiments have also been carried out with an unsaturated algorithm. Better tracking accuracy is obtained with the original design derived from the proposed class of algorithms.

Do Patients Older Than 60 Years With Inflammatory Bowel Disease Have More Vertebral Fractures Than Age-matched Controls? A Study Using Abdominal and Pelvic CT Scans With Sagittal Reformatting as Screening Tool.

INTRODUCTION: It is undetermined whether patients with inflammatory bowel diseases (IBDs) have increased prevalence of vertebral compression fractures (VCFs) since many VCFs are asymptomatic and radiographs may overlook them. We compared the prevalence of VCFs in patients older than 60 years with and without IBDs. METHODS: We studied 55 patients with IBDs and 165 controls who underwent CT scans for nonspinal conditions. We evaluated the presence of VCFs, fracture severity using the Genant score, and we determined whether age, sex, diagnosis of IBD, treatment, and time since diagnosis were associated with VCFs. Using logistic regression analysis, we assessed the independent effect of each variable. RESULTS: Mean age was 72.7 years; 165 patients (75%) were women. Thirty-five patients (16%) had at least one VCF (16.4% IBD; 15.8% controls, P = 0.92); both groups exhibited similar fracture severity. Patients with VCFs were older than patients without VCFs (79.8 versus 70.2, P < 0.01 IBD; 76.4 versus 72.4, P = 0.02 controls). No other clinical variables were different in patients with and without VCFs in either cohort. Only age was independently associated with VCFs in both cohorts. DISCUSSION: VCFs were not more frequent or severe in patients older than 60 years with IBD presented than in age-matched controls.

Diseño de un simulador de ficha clínica electrónica para estudiantes de Nutrición y Dietética / Design of an electronic clinical record simulator for Nutrition and Dietary students

INTRODUCCIÓN: La motivación a los estudiantes hacia un rol diligente en su aprendizaje es una constante en su formación profesional. Es por esto que surge la necesidad de ofrecer herramientas que faciliten este proceso, como son las aplicaciones disponibles en la web, como parte de las tecnologías de la información y la comunicación. OBJETIVO: Fortalecer el aprendizaje activo en estudiantes de la carrera de Nutrición y Dietética de la Universidad Católica de la Santísima Concepción, a través del uso de un simulador de ficha clínica electrónica disponible en la web. MATERIAL Y MÉTODO: Para su diseño, realizado durante el año 2016, participaron expertos en el área de informática, los que dieron respuesta a las necesidades establecidas por el equipo ejecutor, con base en las actividades clásicas del nutricionista en el área clínica, como es la prescripción dietoterapéutica, el diagnóstico nutricional y la determinación de los requerimientos nutricionales, entre otras acciones. RESULTADOS: Se diseñó una aplicación web que apoya las labores del nutricionista clínico. Como prueba de conceptos, se evalúa el uso de la ficha en estudiantes de la carrera, a quienes se les aplicó una encuesta de opinión. Los aspectos con mejor evaluación fueron el acceso a la aplicación, el no requerir de conocimientos en profundidad de informática para su utilización y la utilidad de la aplicación. No se presentaron respuestas negativas para la aplicación web. CONCLUSIONES: Se presenta una estrategia didáctica que responde al uso de tecnologías de la información y la comunicación como apoyo al desarrollo de competencias disciplinales del nutricionista clínico, incentivando el aprendizaje activo de los estudiantes

INTRODUCTION: To motivate students towards a committed role in their own learning process is a constant in their professional formation. This is the reason why it is necessary to offer them tools that make this process easier, such as the applications available in the web, as part of the information and communication technologies. OBJECTIVE: To empower the active learning in students of the Nutrition and Dietary career in the Universidad Católica de la Santísima Concepción, using an electronic clinical record simulator available in the web. MATERIAL AND METHOD: In its design, done during the 2016, participated a group of experts in the computing area, who gave an answer to the needs set by the implementation team, based on the typical activities done by nutritionist in the clinical area, such as the diet-therapeutic prescription, nutritional diagnosis, and to determine nutritional requirements, among others. RESULTS: It was designed a web application, that supports the work of the clinical nutritionist. As a concept proof, it is evaluated the use of the record in students of the career, to whom has been applied an opinion poll. The best evaluated aspects were the access to the application, the fact that there is no specific knowledge required to use it and the usefulness of the application. There were not negative answers for the web application. CONCLUSIONS: It is presented as a didactic strategy that responds to the use of information and communication technologies, as support for the development of clinical nutritionist's disciplinary skills, promoting the student's active learning

A robust approach for trajectory tracking control of a quadrotor with experimental validation.

In this paper, a new control scheme for motion control of quadrotors is presented. The proposed model based controller makes use of simple estimations of vehicle parameters. Besides, the controller is developed under properties of the vehicle model. A rigorous analysis is developed to prove that the closed-loop system trajectories are uniformly ultimately bounded. The validity of the proposed control scheme is tested by numerical simulations and experimental results. This validation shows that the proposed controller guarantees that the quadrotor performs tracking of a desired pose (position and orientation) trajectory with good accuracy. The new scheme has been compared with respect to other robust controllers. The results indicate better tracking accuracy for the new scheme.

Adaptive Neural Network Control for the Trajectory Tracking of the Furuta Pendulum.

The purpose of this paper is to introduce a novel adaptive neural network-based control scheme for the Furuta pendulum, which is a two degree-of-freedom underactuated system. Adaptation laws for the input and output weights are also provided. The proposed controller is able to guarantee tracking of a reference signal for the arm while the pendulum remains in the upright position. The key aspect of the derivation of the controller is the definition of an output function that depends on the position and velocity errors. The internal and external dynamics are rigorously analyzed, thereby proving the uniform ultimate boundedness of the error trajectories. By using real-time experiments, the new scheme is compared with other control methodologies, therein demonstrating the improved performance of the proposed adaptive algorithm.

Catalytic autoantibodies against myelin basic protein (MBP) isolated from serum of autistic children impair in vitro models of synaptic plasticity in rat hippocampus.

Autoantibodies from autistic spectrum disorder (ASD) patients react with multiple proteins expressed in the brain. One such autoantibody targets myelin basic protein (MBP). ASD patients have autoantibodies to MBP of both the IgG and IgA classes in high titers, but no autoantibodies of the IgM class. IgA autoantibodies act as serine proteinases and degrade MBP in vitro. They also induce a decrease in long-term potentiation in the hippocampi of rats either perfused with or previously inoculated with this IgA. Because this class of autoantibody causes myelin sheath destruction in multiple sclerosis (MS), we hypothesized a similar pathological role for them in ASD.

Effect of pH and dilution rate on specific production rate of extra cellular metabolites by Lactobacillus salivarius UCO_979C in continuous culture.

The effect of pH and dilution rate on the production of extracellular metabolites of Lactobacillus salivarius UCO_979 was studied. The experiments were carried out in continuous mode, with chemically defined culture medium at a temperature of 37 °C, 200 rpm agitation and synthetic air flow of 100 ml/min. Ethanol, acetic acid, formic acid, lactic acid and glucose were quantified through HPLC, while exopolysaccharide (EPS) was extracted with ethanol and quantified through the Dubois method. The results showed no linear trends for the specific production of lactic acid, EPS, acetic acid and ethanol, while the specific glucose consumption and ATP production rates showed linear trends. There was a metabolic change of the strain for dilution rates below 0.3 h(-1). The pH had a significant effect on the metabolism of the strain, which was evidenced by a higher specific glucose consumption and increased production of ATP at pH 6 compared with that obtained at pH 7. This work shows not only the metabolic capabilities of L. salivarius UCO_979C, but also shows that it is possible to quantify some molecules associated with its current use as gastrointestinal probiotic, especially regarding the production of organic acids and EPS.

A composite controller for trajectory tracking applied to the Furuta pendulum.

In this paper, a new composite scheme is proposed, where the total control action is composed of the sum of a feedback-linearization-based controller and an energy-based compensation. This new proposition is applied to the rotary inverted pendulum or Furuta pendulum. The Furuta pendulum is a well-known underactuated mechanical system with two degrees of freedom. The control objective in this case is the tracking of a desired periodic trajectory in the actuated joint, while the unactuated link is regulated at the upward position. The closed-loop system is analyzed showing uniformly ultimately boundedness of the error trajectories. The design procedure is shown in a constructive form, such that it may be applied to other underactuated mechanical systems, with the proper definitions of the output function and the energy function. Numerical simulations and real-time experiments show the practical viability of the controller. Finally, the proposed algorithm is compared with a tracking controller previously reported in the literature. The new algorithm shows better performance in both arm trajectory tracking and pendulum regulation.

Consistency between indexers in the LILACS database (Latin American and Caribbean Health Science Literature)

Introduction. Consistency in indexing of Literatura Latinoamericana y del Caribe en Ciencias de la Salud is analysed and some features are compared with those of MEDLINE, ISA and PsycInfo. Method. The study was carried out with 194 duplicate entries chosen from 8,547 entries, which is analogous to the process followed in MEDLINE, ISA and PsycInfo. Analysis. Consistency was calculated using the Hooper and Rolling formulas. Analysis. Consistency was calculated using the Hooper and Rolling formulas. The Mann-Whitney U Test and the Student T were used to study the relationships between different variables. Results. Consistency increased on separating out the quailifiers for secondary terms. The quailifiers are used more consistently than secondary terms. Secondary terms are used with very low frequency in the description of documents. In general, the more terms used to describe the documents, the lower the level of consistency. Conclusions. Indexing consistency in LILAC is shown to be substantially less than that offered by MEDLINE, ISA and PsycINFO.