[Myocardial deformation evaluated by two-dimensional echocardiography in lupus patients at a national hospital]. / Deformación miocárdica evaluada por ecocardiografía bidimensional en pacientes lúpicos de un hospital nacional.

Background: Patients with systemic lupus erythematosus (SLE) are at high risk of cardiac compromise with high mortality. The subclinical diagnosis may improve their survival. Longitudinal myocardial deformation (strain) has been found to be useful in evaluating cardiac function in these patients. Objectives: Our aims were to evaluate myocardial function by analyzing the two-dimensional (2D) global longitudinal strain, to compare the longitudinal strain in SLE patients with controls, and to determine the correlation with SLE activity index. Material and Methods: 44 patients with SLE (50.0 ± 13 years) and 50 controls (49 ± 12 years) matched by age and sex, underwent transthoracic echocardiogram. Longitudinal strain was assessed using the speckle tracking method and SLE activity was estimated using the Systemic Lupus Erythematous Disease Activity Index (SLEDAI). A score of 4 or more, was defined as active SLE. Results: 2D global longitudinal strain was lower in patients with SLE than controls (- 17.3% ± 1.9% vs. -20%, ± 1.9% p = 0.00). The left ventricular ejection fraction (LVEF) had no specific differences in both groups in 2D (p = 0.650) or three-dimensional (3D) (p = 0.718). In lupus patients, SLEDAI ranged from 0 to 10, and 63.8% were inactive. Negative correlations were found between the SLEDAI score and 2D LVEF (Pearson's r = -0.372, p = 0.017); no correlations were found between the SLEDAI score and the 2D global longitudinal strain (Spearman's rho = - 0.091 p = 0.582). Conclusions: 2D global longitudinal strain was found to be decreased in the SLE group. This technique might can be a useful tool to assess cardiac function in these patiens.

Environmental, Economic, and Social Aspects of Human Urine Valorization through Microbial Fuel Cells from the Circular Economy Perspective.

Population growth increases the challenge of meeting basic human needs, such as water, a limited resource. Consumption habits and water pollution have compromised natural resources to unsustainable levels. Sustainable effluent treatment practices, such as decentralized systems focused on energy, nutrients, and water recovery, have attracted the attention of the scientific community. Human urine (HU) is a physiological liquid waste whose main component is water (~95%). HU has a significant amount of nutrients, such as N, P, K, and organic matter, which are usually lacking in fecal coliforms. Therefore, the possibility exists of recovering nutrients and energy from HU using sustainable and non-sustainable technologies. Treating HU in bioelectrochemical systems (BES) is a novel alternative to obtaining byproducts from this effluent more sustainably than in electrochemical systems. Microbial fuel cells (MFCs) are an interesting example, contributing to HU revalorization from unwanted waste into a valuable resource of nutrients, energy, and water. Even when urine-operated MFCs have not generated attractive potential outputs or produced considerable amounts of bioelectricity, this review emphasizes HU advantages as nutrients or water sources. The aim of this review was to analyze the current development of BES for HU treatment based on the water circular economy, discussing challenges and perspectives researchers might encounter.

Seasonal variation in the response of a monoecious crop to increased temperature and fertilizers.

Climate warming may affect the performance of plants directly through altering vegetative or reproductive traits, and indirectly through modifying interactions with their pollinators. On the other hand, the addition of fertilizers to the soil may increase the quantity and quality of floral rewards, favoring the visitation of pollinators and, consequently, the reproductive success of plants. However, it is still unknown whether fertilizers may counteract the effects of increased temperature on the vegetative, floral, and reproductive traits of plants, as well as on the interaction with their pollinators. The aim of this study is to evaluate the effects of the input of organic and synthetic fertilizers on several vegetative and floral traits, and on the rate of legitimate floral visitors and reproductive success of the squash during two seasons, under a scenario of an increase in ambient temperature. During the dry and the rainy seasons, three vegetative, eleven floral, and two reproductive traits, as well as the duration of visits and visitation rate of legitimate floral visitors were evaluated in squash plants distributed into six treatments in a bifactorial design: temperature (ambient or elevated temperature) and fertilizer (organic, synthetic or without supplementary fertilizers). Contrary to our predictions, we found that an increase of ~1.5°C in ambient temperature, positively influenced several vegetative, floral, and reproductive traits in this crop, and that organic fertilizers, in general, was not better than synthetic fertilizers in improving those traits. Interestingly, the response of the squash and indirectly on their legitimate floral visitors to the increase of temperature and the input of fertilizers vary widely among seasons, suggesting great temporal variation in plant-pollinator responses to temperature and nutrient availability, which makes food security more unpredictable.

Impact of the Salud Mesoamerica Initiative on delivery care choices in Guatemala, Honduras, and Nicaragua.

BACKGROUND: The Salud Mesoamérica Initiative (SMI) is a public-private collaboration aimed to improve maternal and child health conditions in the poorest populations of Mesoamerica through a results-based aid mechanism. We assess the impact of SMI on the staffing and availability of equipment and supplies for delivery care, the proportion of institutional deliveries, and the proportion of women who choose a facility other than the one closest to their locality of residence for delivery. METHODS: We used a quasi-experimental design, including baseline and follow-up measurements between 2013 and 2018 in intervention and comparison areas of Guatemala, Nicaragua, and Honduras. We collected information on 8754 births linked to the health facility closest to the mother's locality of residence and the facility where the delivery took place (if attended in a health facility). We fit difference-in-difference models, adjusting for women's characteristics (age, parity, education), household characteristics, exposure to health promotion interventions, health facility level, and country. RESULTS: Equipment, inputs, and staffing of facilities improved after the Initiative in both intervention and comparison areas. After adjustment for covariates, institutional delivery increased between baseline and follow-up by 3.1 percentage points (ß = 0.031, 95% CI -0.03, 0.09) more in intervention areas than in comparison areas. The proportion of women in intervention areas who chose a facility other than their closest one to attend the delivery decreased between baseline and follow-up by 13 percentage points (ß = - 0.130, 95% CI -0.23, - 0.03) more than in the comparison group. CONCLUSIONS: Results indicate that women in intervention areas of SMI are more likely to go to their closest facility to attend delivery after the Initiative has improved facilities' capacity, suggesting that results-based aid initiatives targeting poor populations, like SMI, can increase the use of facilities closest to the place of residence for delivery care services. This should be considered in the design of interventions after the COVID-19 pandemic may have changed health and social conditions.

The Implications of Membranes Used as Separators in Microbial Fuel Cells.

Microbial fuel cells (MFCs) are electrochemical devices focused on bioenergy generation and organic matter removal carried out by microorganisms under anoxic environments. In these types of systems, the anodic oxidation reaction is catalyzed by anaerobic microorganisms, while the cathodic reduction reaction can be carried out biotically or abiotically. Membranes as separators in MFCs are the primary requirements for optimal electrochemical and microbiological performance. MFC configuration and operation are similar to those of proton-exchange membrane fuel cells (PEMFCs)-both having at least one anode and one cathode split by a membrane or separator. The Nafion® 117 (NF-117) membrane, made from perfluorosulfonic acid, is a membrane used as a separator in PEMFCs. By analogy of the operation between electrochemical systems and MFCs, NF-117 membranes have been widely used as separators in MFCs. The main disadvantage of this type of membrane is its high cost; membranes in MFCs can represent up to 60% of the MFC's total cost. This is one of the challenges in scaling up MFCs: finding alternative membranes or separators with low cost and good electrochemical characteristics. The aim of this work is to critically review state-of-the-art membranes and separators used in MFCs. The scope of this review includes: (i) membrane functions in MFCs, (ii) most-used membranes, (iii) membrane cost and efficiency, and (iv) membrane-less MFCs. Currently, there are at least 20 different membranes or separators proposed and evaluated for MFCs, from basic salt bridges to advanced synthetic polymer-based membranes, including ceramic and unconventional separator materials. Studies focusing on either low cost or the use of natural polymers for proton-exchange membranes (PEM) are still scarce. Alternatively, in some works, MFCs have been operated without membranes; however, significant decrements in Coulombic efficiency were found. As the type of membrane affects the performance and total cost of MFCs, it is recommended that research efforts are increased in order to develop new, more economic membranes that exhibit favorable properties and allow for satisfactory cell performance at the same time. The current state of the art of membranes for MFCs addressed in this review will undoubtedly serve as a key insight for future research related to this topic.

Bioimmobilization of toxic metals by precipitation of carbonates using Sporosarcina luteola: An in vitro study and application to sulfide-bearing tailings.

Metal release from mining wastes is a major environmental problem affecting ecosystems that requires effective, low-cost strategies for prevention and reclamation. The capacity of two strains (UB3 and UB5) of Sporosarcina luteola was investigated to induce the sequestration of metals by precipitation of carbonates in vitro and under microcosm conditions. These strains carry the ureC gene and have high urease activity. Also, they are highly resistant to metals and have the capacity for producing metallophores and arsenophores. SEM, EDX and XRD reveal that the two strains induced precipitation of calcite, vaterite and magnesian calcite as well as several (M2+)CO3 such as hydromagnesite (Mg2+), rhodochrosite (Mn2+), cerussite (Pb2+), otavite (Cd2+), strontianite (Sr2+), witherite (Ba2+) and hydrozincite (Zn2+) in vitro. Inoculation of the mixed culture of UB3+UB5 in tailings increased the pH and induced the precipitation of vaterite, calcite and smithsonite enhancing biocementation and reducing pore size and permeability slowing down the oxidation of residual sulfides. Results further demonstrated that the strains of S. luteola immobilize bioavailable toxic elements through the precipitation and coprecipitation of thermodynamically stable (M2+)CO3, Fe-Mn oxyhydroxides and organic chelates.

Conocimientos, actitudes y prácticas sobre competencia cultural en estudiantes de medicina de séptimo año: San Fernando, UNMSM, Lima, Perú: 2009 / Knowledge, attitudes and practices about cultural competency in medicine students of seventh year: San Fernando, UNMSM, Lima, Peru: 2009

Introducción: la multiculturalidad es una realidad ineludible en nuestro país, por lo que se requiere conocer en qué medida los estudiantes de medicina de séptimo año, próximos a ser médicos, están capacitados para interactuar en situaciones interculturales. Objetivo: determinar la competencia cultural en estudiantes de Medicina de séptimo año, mediante un estudio de conocimientos, actitudes y prácticas (CAP). Metodología: estudio descriptivo, cuantitativo y transversal de la población total de estudiantes de Medicina, de séptimo año, de San Fernando matriculados en 2009. Se aplicó una encuesta a la totalidad de estudiantes de medicina de séptimo año (internos), para determinar los conocimientos, actitudes y prácticas en competencia cultural. El instrumento fue validado mediante juicio de expertos y análisis factorial, se obtuvo pruebas de esfericidad de Bartletl significativas y Pruebas de Kaiser-Meyer-Olkin en valor de 0,631. La confiabilidad (Alfa de Cronbach) fue de 0,843 para la prueba total. Resultados: Dentro de los resultados descriptivos, se obtuvo 117 encuestas; en ellas se observa una clara predominancia del género masculino (58,3 por ciento) y del rango de 22 a 28 años (88,9 por ciento). Los resultados de nuestro trabajo arrojan que no se aprecia mayor nivel de conocimientos, actitudes ni prácticas en competencia cultural, ubicándose los porcentajes mayoritarios en rango medio. Adicionalmente, los conocimientos guardan relación con las actitudes (r=0,665; p=0,01) pero no con las prácticas (r=-0,123; p=0,185) ni tener actitudes muy positivas sobre competencia cultural garantiza prácticas congruentes (r=0,001; p=0,988). Conclusión: en los internos de Medicina de San Fernando existe correlación entre conocimientos y actitudes sobre competencia cultural, pero no entre conocimientos y prácticas ni entre actitudes y prácticas. Postulamos que se requieren más estudios para poder explorar en qué medida es posible integrar mejor estas tres áreas mediante la incorporación de la interculturalidad como un eje transversal de la enseñanza médica.