Falla en la extubación en el paciente con trauma raquimedular: parálisis diafragmática. Una entidad por considerar

La parálisis diafragmática es una entidad con epidemiologia no constatada, sin embargo, debe considerarse en el paciente con antecedente de trauma raquimedular asociado que presente signos tempranos de dificultad respiratoria, para de esta forma investigar y ofrecer manejos oportunos en esta condición clínica. Se presenta caso de varón de 65 años con debilidad diafragmática crónica por antecedente de herida por arma de fuego a nivel de la columna cervical.

Diaphragmatic paralysis is an entity with an unproven epidemiology. However, it should be considered in patients with a history of associated spinal cord trauma who present early signs of respiratory difficulty, to investigate and offer timely management to this clinical condition. We present the case of a 65-year-old man with chronic diaphragmatic weakness due to a history of gunshot wounds at the level of the cervical spine.

Effects of different plyometric training frequencies on physical performance in youth male volleyball players: a randomized trial.

This study aimed to analyze the effect of plyometric training (PT) at different frequencies on jump performance, running sprint speed, and service speed in youth male volleyball players. The participants were randomly assigned to one PT session per week (Experimental Group 1, EG1, n = 15), two PT sessions per week (Experimental Group 2, EG2, n = 14), and a control group (CG, n = 13). The total weekly jumping ranged between 98 and 196 jumps (equalized between, EG1 and, EG2). The assessments performed were squat jump (SJ), countermovement jump (CMJ), CMJ-arms, drop jump (DJ), 5-m sprint, 10-m sprint, and service speed. The intragroup comparisons showed that, EG1 significantly (p < 0.001) improved SJ (Δ = 12.74%; d = 1.30), CMJ (Δ = 11.94%; d = 1.71), CMJ-arms (Δ = 12.02%; d = 1.47), DJ (Δ = 10.93%; d = 1.30), 5-m sprint (Δ = -4.61%; d = 0.29), 10-m sprint (Δ = -3.95%; d = 0.40) and service speed (Δ = 8.17%; d = 1.53). Similarly, EG2 significantly (p˂ 0.001) improved SJ (Δ = 11.52%; d = 1.25), CMJ (Δ = 11.29%; d = 1.38), CMJ-arms (Δ = 11.42%; d = 1.26), DJ (Δ = 13.90%; d = 2.17), 5-m sprint (Δ = -3.85%; d = 0.25), 10-m sprint (Δ = -2.73%; d = 0.25) and service speed (Δ = 6.77%; d = 1.44). The CG significantly (p < 0.05) improved SJ (Δ = 2.68; d = 0.28), CMJ-arms (Δ = 2.30; d = 0.35), 5-m sprint (Δ = -1.27; d = 0.10) and service speed (Δ = 1.42; d = 0.30). Intergroup comparisons revealed significantly greater improvements in all variables (p < 0.001) in, EG1 and, EG2 concerning to CG. However, no significant differences were found between, EG1 and, EG2. A moderate weekly PT volume, distributed in one or two sessions per week, seems equally effective.

Relying on Incomplete Information Can Lead to the Wrong Conclusions. Comment on van Hassel, F.; Bovenkerk, B. How Should We Help Wild Animals Cope with Climate Change? The Case of the Iberian Lynx. Animals 2023, 13, 453.

In their recent paper, Van Hassel and Bovenkerk [...].

Long Term Veno-Pulmonary Arterial Extracorporeal Membrane Oxygenation as Bridge To Lung Transplantation And Its Challenges: A Case Report.

We present a case of a patient with acute respiratory distress syndrome due to severe acute respiratory syndrome coronavirus 2 infection who underwent an extracorporeal membrane oxygenation (ECMO) run of 8 months with various configuration changes, including off-label use of cannulas. The patient eventually underwent successful double lung transplantation after a follow-up of 17 months, demonstrating the successful application of a hybrid approach and careful monitoring in the face of supply shortages during the pandemic. This case highlights the challenges faced by ECMO and transplantation centers during the pandemic and the importance of careful communication and planning to optimize patient outcomes.

High seropositivity against NDO-LID in a group of household contacts of leprosy patients. Are we close to leprosy elimination in Colombia?

INTRODUCTION: Leprosy is a chronic infectious disease caused by two mycobacteria (Mycobacterium leprae and Mycobacterium lepromatosis). The household contacts (HHC) of leprosy index cases are at higher risk of being infected with these mycobacteria. Therefore, serological testing in HHC would be an effective strategy to eliminate leprosy in Colombia. OBJECTIVE: To determine the seroprevalence and factors associated with the infection by M. leprae in HHC. METHODS: An observational study was conducted in 428 HHC located in the Colombian Caribbean, Andean, Pacific, and Amazonian regions. We evaluated the seropositivity and titrations of IgM, IgG, and protein A against NDO-LID. RESULTS: The evaluated HHC showed high seropositivity, precisely 36.9% anti-NDO-LID IgM, 28.3% anti-NDO-LID IgG, and 47.7% protein A. Furthermore, Protein A showed a greater capacity to detect infected individuals than other anti-NDO-LID conjugates (p < 0.0001). This study did not show differences in the seropositivity according to sex or age of the HHC (p > 0.05). Higher seropositivity for IgM was evidenced mainly in HHC located in the Colombian Pacific region (p 0.001). This research did not show differences in the seropositivity for these serological tests between HHC of PB or MB leprosy patients (p > 0.05). CONCLUSION: Leprosy transmission is still active between Colombian HHC. Consequently, controlling leprosy transmission in this population is fundamental to eradicating this disease.

After-school sports programmes and social inclusion processes in culturally diverse contexts: Results of an international multicase study.

This research aimed to understand the role of after-school sports programs in social inclusion processes in culturally diverse contexts through a multicase study within two locations. The first location was in Spain where immigrant and Spanish students were enrolled, and the other was in Chile with Mapuche-Huilliche students, immigrant and Chilean students. The implemented programs at both sites were similar in their educational focus on socio-educational values, and teaching models (hybridization of teaching games for understanding and cooperative learning) that enhance social inclusion. Using individual and group interviews with teachers, sports coordinators, parents, and students, a qualitative approach was used to identify the factors that facilitate or hinder the social inclusion processes. In addition, the researchers used qualitative observations of the programs over six months using "notes logbook" to record their impressions during the observation process. Results indicated that the implemented sports programs successfully facilitated social inclusion processes, enabling the development of interpersonal skills and relationships between students from different cultural backgrounds. The previous training and experiences of teachers in culturally diverse contexts, and incorporation of traditional sporting games from all cultures, seems to be an important facilitator factor for the inclusion potential of the implemented programs.

Tratamiento agudo de la migraña durante el embarazo / Acute treatment of migraine during pregnancy

RESUMEN INTRODUCCIÓN La migraña es una condición médica prevalente y altamente discapacitante. Por lo general, durante el embarazo hay una reducción de los síntomas migrañosos, sin embargo, en ocasiones la sintomatología puede no mostrar mejoría, y en algunos casos empeorar. Por tanto, es necesario que el médico del servicio de urgencias realice un correcto diagnóstico de esta enfermedad, que descarte otros tipos de cefaleas y brinde el mejor y el más seguro tratamiento analgésico de acuerdo con la edad gestacional y perfil clínico de cada paciente. En esta revisión se abordará la relación entre la migraña y el embarazo, el papel de los estrógenos en la génesis de la migraña, así como también los datos más actuales en cuanto al tratamiento del manejo agudo de esta patología durante la gestación. MATERIALES Y METODOS: Se realizó una revisión sistemática de la literatura mundial sobre la relación entre la migraña y el embarazo y el manejo agudo en esta población, obteniéndose un total de 83 referencia bibliográficas. RESULTADOS: Como manejo inicial, se recomienda el uso de Acetaminofén más metoclopramida en cualquier etapa de la gestación. El uso de AINE debe evitarse a partir de la semana 20 de gestación. El Sumatriptán puede ser utilizado como segunda línea en cualquier trimestre. A todas las pacientes se les debe brindar manejo no farmacológico. CONCLUSIONES: Actualmente se cuenta con varios medicamentos y procedimientos seguros para el manejo agudo de la migraña en gestantes, sin embargo, debe tenerse en cuenta la edad gestacional ante su administración.

ABSTRACT INTRODUCTION: Migraine is a prevalent and highly disabling condition. Usually during pregnancy there is relief of symptoms, however, sometimes headache cannot improve, and some cases may get worse. Therefore, it is necessary for physicians who work at the emergency department perform a correct diagnosis of this pathology, rule-out other types of headaches and give the best and safest treatment according to gestational age and clinical profile of each patient. This review will address the relationship between migraine and pregnancy, the role of estrogens in the genesis of migraine. Updated information with respect to acute treatment of migraine during this period will be discussed. METHODS: A systematic review of the world literature on the relationship between migraine and pregnancy and acute management in this population was carried out, obtaining a total of 83 bibliographic references. RESULTS: As an initial management, the use of acetaminophen plus metoclopramide is recommended at any stage of pregnancy. The use of NSAIDs should be avoided from week 20 of gestation. Sumatriptan can be used as a second line in any trimester. Non-pharmacological management should be provided to all patients. CONCLUSIONS: There are currently safe drugs and procedures for the acute management of migraine in pregnant women, however, gestational age should be taken into account before administering them.

Effect of natural abiotic soil vibrations, rainfall and wind on anuran calling behavior: a test with captive-bred midwife toads (Alytes obstetricans).

Anurans are known to detect vibrations, but few studies explore relationships between vibrations and resultant behaviors. We studied the reaction of calling captive-bred male midwife toads (Alytes obstetricans) to the randomized playback of a vibrational crescendo stimulus train. We considered two sources of natural abiotic vibrational stimuli: rainfall and wind. Rainfall was expected to induce calling and wind was expected to inhibit it. Playback experiments with two synthetic tones (200 Hz and 300 Hz) tested the sensitivity to pure tones and could possibly reveal a hearing sensitivity trend between these frequencies. The toads did not increase call rate in response to rainfall vibrations and only one of the five wind stimulus levels caused a significant decrease in call rate. This limited response could be explained, because the tested toads came from a captive population, where emergence may not be mediated by rainfall vibrations. We found that A. obstetricans is highly sensitive to very low frequencies, which could explain the sensitivity observed to vibrational stimuli. Playback of a random crescendo stimulus train proves to be a valid approach for addressing behavioral questions. However, the use of a captive population may have been a limitation in the clarity of the results.

Prophylaxis and hemophilia care in LATAM: Baring it all-Highlights from the CLAHT 2021 symposium.

A large group of countries constitute Latin American (LATAM) countries, where hemophilia care is as varied as the landscape of this region. To better understand the care provided to persons with bleeding disorders, especially hemophilia, a symposium was organized as part of the CLAHT Congress 2021 in Colombia to highlight the issues of hemophilia care and challenges faced by persons with hemophilia in four LATAM countries, Colombia, Peru, Argentina, and Mexico. A summary of the symposium is provided. Four clinicians highlighted the issues in their own country, the status, and the path forward to bring the standard of care to the international level in each of these countries. The geography of the country, the health infrastructure, and the resources available are obstacles in these countries to provide state-of-the-art care to the bleeding disorder community. However, depending on the country, its infrastructure and the resources available, progress is being made to upend the care provided. Indeed, the care of persons with hemophilia has been greatly improved, including personalized prophylaxis. The information summarized here first emphasizes how the geography of a country and the different healthcare infrastructures play a major role in how care is offered. It also provides a path for other countries to evaluate these issues in their own realities. In parallel, these data provide hope to many developing countries; despite obstacles, strides can be made in the care of the bleeding disorder community.

Trends in the Use of Sedative-Hypnotics, Opioids, and Neuromuscular Blockers in Hospitalized Patients During the COVID-19 Pandemic: Observational Retrospective Study.

BACKGROUND: The coronavirus disease 2019 (COVID-19) pandemic has increased the use of drugs administered for mechanical ventilation, leading to shortages in some countries. OBJECTIVE: The aim was to identify trends in the consumption of sedatives, hypnotics, neuromuscular blockers, and opioids used for anesthetic induction and deep sedation in hospitals in Colombia. METHOD: This was a descriptive, longitudinal, and retrospective study with monthly follow-up of sedative, hypnotic, opioid, and neuromuscular blocker dispensing in 20 clinics and hospitals from January to November 2020. The frequencies of use of each drug and variations in the institutions and intensive care units (ICUs) were identified. RESULTS: A total of 1,252,576 units of the analyzed drugs were delivered to 79,094 treated patients, 55.0% of whom were women (n = 43,521). The drugs with the greatest increase in consumption were rocuronium (1058% variation in March-November) and propofol (511%). The consumption of midazolam and vecuronium initially increased, but by the end of the study period, it decreased. Among drugs dispensed only in ICUs, 920,170 units were delivered (73.5% of the drugs dispensed during the study), and the most often dispensed drugs were fentanyl (n = 251,519; 27.3% of the drugs used in the ICU) and midazolam (5 mg/5 mL) solution (n = 188,568; 20.5%). Specifically in the ICU, the drugs with the greatest increase in use were rocuronium (19,709%), propofol (2622%), and ketamine (2591%). CONCLUSION: Rapid changes in the use of drugs were evident, which demonstrates the need for closer cooperation among treating physicians, service providers, pharmaceutical managers, and state institutions to maintain a sufficient and timely supply of critical drugs in this type of contingency.

Real-time dynamic single-molecule protein sequencing on an integrated semiconductor device.

Studies of the proteome would benefit greatly from methods to directly sequence and digitally quantify proteins and detect posttranslational modifications with single-molecule sensitivity. Here, we demonstrate single-molecule protein sequencing using a dynamic approach in which single peptides are probed in real time by a mixture of dye-labeled N-terminal amino acid recognizers and simultaneously cleaved by aminopeptidases. We annotate amino acids and identify the peptide sequence by measuring fluorescence intensity, lifetime, and binding kinetics on an integrated semiconductor chip. Our results demonstrate the kinetic principles that allow recognizers to identify multiple amino acids in an information-rich manner that enables discrimination of single amino acid substitutions and posttranslational modifications. With further development, we anticipate that this approach will offer a sensitive, scalable, and accessible platform for single-molecule proteomic studies and applications.

Opponent or allied? An European analysis of the union presence and human resource practices.

Human Resources Practices (HRPs) and unions coexist in some organisations to manage the employment relationships of the workers. In this study, we analyse how the presence/absence of unions and HRPs are combined in private European organisations, and which of these combinations are related to higher levels of wellbeing and the quality of labor relations. Data come from 24,503 workers of private organisations, obtained from the Sixth European Working Conditions Survey. Latent profiles analysis and different analyses of the variance suggested four different profiles. The profile with the greatest presence of HRPs and union presence is related to the highest levels of employees' wellbeing and quality of labor relations in organisations, whereas those organisations with a low level of union presence or HRPs reached the worst levels in employees' wellbeing and quality of labor relations indicators. The results and their practical implications are discussed.

Host-microbiome protein-protein interactions capture disease-relevant pathways.

BACKGROUND: Host-microbe interactions are crucial for normal physiological and immune system development and are implicated in a variety of diseases, including inflammatory bowel disease (IBD), colorectal cancer (CRC), obesity, and type 2 diabetes (T2D). Despite large-scale case-control studies aimed at identifying microbial taxa or genes involved in pathogeneses, the mechanisms linking them to disease have thus far remained elusive. RESULTS: To identify potential pathways through which human-associated bacteria impact host health, we leverage publicly-available interspecies protein-protein interaction (PPI) data to find clusters of microbiome-derived proteins with high sequence identity to known human-protein interactors. We observe differential targeting of putative human-interacting bacterial genes in nine independent metagenomic studies, finding evidence that the microbiome broadly targets human proteins involved in immune, oncogenic, apoptotic, and endocrine signaling pathways in relation to IBD, CRC, obesity, and T2D diagnoses. CONCLUSIONS: This host-centric analysis provides a mechanistic hypothesis-generating platform and extensively adds human functional annotation to commensal bacterial proteins.

Functions predict horizontal gene transfer and the emergence of antibiotic resistance.

Phylogenetic distance, shared ecology, and genomic constraints are often cited as key drivers governing horizontal gene transfer (HGT), although their relative contributions are unclear. Here, we apply machine learning algorithms to a curated set of diverse bacterial genomes to tease apart the importance of specific functional traits on recent HGT events. We find that functional content accurately predicts the HGT network [area under the receiver operating characteristic curve (AUROC) = 0.983], and performance improves further (AUROC = 0.990) for transfers involving antibiotic resistance genes (ARGs), highlighting the importance of HGT machinery, niche-specific, and metabolic functions. We find that high-probability not-yet detected ARG transfer events are almost exclusive to human-associated bacteria. Our approach is robust at predicting the HGT networks of pathogens, including Acinetobacter baumannii and Escherichia coli, as well as within localized environments, such as an individual's gut microbiome.

Cyber-Physical System for Environmental Monitoring Based on Deep Learning.

Cyber-physical systems (CPS) constitute a promising paradigm that could fit various applications. Monitoring based on the Internet of Things (IoT) has become a research area with new challenges in which to extract valuable information. This paper proposes a deep learning classification sound system for execution over CPS. This system is based on convolutional neural networks (CNNs) and is focused on the different types of vocalization of two species of anurans. CNNs, in conjunction with the use of mel-spectrograms for sounds, are shown to be an adequate tool for the classification of environmental sounds. The classification results obtained are excellent (97.53% overall accuracy) and can be considered a very promising use of the system for classifying other biological acoustic targets as well as analyzing biodiversity indices in the natural environment. The paper concludes by observing that the execution of this type of CNN, involving low-cost and reduced computing resources, are feasible for monitoring extensive natural areas. The use of CPS enables flexible and dynamic configuration and deployment of new CNN updates over remote IoT nodes.

Variation in upper thermal tolerance among 19 species from temperate wetlands.

Communities usually possess a multitude of interconnected trophic interactions within food webs. Their regulation generally depends on a balance between bottom-up and top-down effects. However, if sensitivity to temperature varies among species, rising temperatures may change trophic interactions via direct and indirect effects. We examined the critical thermal maximum (CTmax) of 19 species from temperate wetlands (insect predators, amphibian larvae, zooplankton and amphipods) and determined if they vary in their sensitivity to warming temperatures. CTmax differed between the groups, with predatory insects having higher CTmax than amphibians (both herbivorous larval anurans and predatory larval salamanders), amphipods and zooplankton. In a scenario of global warming, these differences in thermal tolerance may affect top-down and bottom-up processes, particularly considering that insect predators are more likely to maintain or improve their performance at higher temperatures, which could lead to increased predation rates on the herbivores in the food web. Further studies are needed to understand how the energy flows through communities, how species' energy budgets may change and whether other physiological and behavioral responses (such as phenotypic plasticity and thermoregulation) can buffer or increase these changes in the top-down regulation of wetland food webs.

Identification and Characterization of the Heat-Induced Plastidial Stress Granules Reveal New Insight Into Arabidopsis Stress Response.

Plants exhibit different physiological and molecular responses to adverse changes in their environment. One such molecular response is the sequestration of proteins, RNAs, and metabolites into cytoplasmic bodies called stress granules (cSGs). Here we report that, in addition to cSGs, heat stress also induces the formation of SG-like foci (cGs) in the chloroplasts of the model plant Arabidopsis thaliana. Similarly to the cSGs, (i) cpSG assemble rapidly in response to stress and disappear when the stress ceases, (ii) cpSG formation is inhibited by treatment with a translation inhibitor (lincomycin), and (iii) cpSG are composed of a stable core and a fluid outer shell. A previously published protocol for cSG extraction was successfully adapted to isolate cpSG, followed by protein, metabolite, and RNA analysis. Analogously to the cSGs, cpSG sequester proteins essential for SG formation, dynamics, and function, also including RNA-binding proteins with prion-like domain, ATPases and chaperones, and the amino acids proline and glutamic acid. However, the most intriguing observation relates to the cpSG localization of proteins, such as a complete magnesium chelatase complex, which is involved in photosynthetic acclimation to stress. These data suggest that cpSG have a role in plant stress tolerance.

Niche models at inter- and intraspecific levels reveal hierarchical niche differentiation in midwife toads.

Variation and population structure play key roles in the speciation process, but adaptive intraspecific genetic variation is commonly ignored when forecasting species niches. Amphibians serve as excellent models for testing how climate and local adaptations shape species distributions due to physiological and dispersal constraints and long generational times. In this study, we analysed the climatic factors driving the evolution of the genus Alytes at inter- and intraspecific levels that may limit realized niches. We tested for both differences among the five recognized species and among intraspecific clades for three of the species (Alytes obstetricans, A. cisternasii, and A. dickhilleni). We employed ecological niche models with an ordination approach to perform niche overlap analyses and test hypotheses of niche conservatism or divergence. Our results showed strong differences in the environmental variables affecting species climatic requirements. At the interspecific level, tests of equivalence and similarity revealed that sister species were non-identical in their environmental niches, although they neither were entirely dissimilar. This pattern was also consistent at the intraspecific level, with the exception of A. cisternasii, whose clades appeared to have experienced a lower degree of niche divergence than clades of the other species. In conclusion, our results support that Alytes toads, examined at both the intra- and interspecific levels, tend to occupy similar, if not identical, climatic environments.

Inexpensive, non-invasive biomarkers predict Alzheimer transition using machine learning analysis of the Alzheimer's Disease Neuroimaging (ADNI) database.

The Alzheimer's Disease Neuroimaging (ADNI) database is an expansive undertaking by government, academia, and industry to pool resources and data on subjects at various stage of symptomatic severity due to Alzheimer's disease. As expected, magnetic resonance imaging is a major component of the project. Full brain images are obtained at every 6-month visit. A range of cognitive tests studying executive function and memory are employed less frequently. Two blood draws (baseline, 6 months) provide samples to measure concentrations of approximately 145 plasma biomarkers. In addition, other diagnostic measurements are performed including PET imaging, cerebral spinal fluid measurements of amyloid-beta and tau peptides, as well as genetic tests, demographics, and vital signs. ADNI data is available upon review of an application. There have been numerous reports of how various processes evolve during AD progression, including alterations in metabolic and neuroendocrine activity, cell survival, and cognitive behavior. Lacking an analytic model at the onset, we leveraged recent advances in machine learning, which allow us to deal with large, non-linear systems with many variables. Of particular note was examining how well binary predictions of future disease states could be learned from simple, non-invasive measurements like those dependent on blood samples. Such measurements make relatively little demands on the time and effort of medical staff or patient. We report findings with recall/precision/area under the receiver operator curve after application of CART, Random Forest, Gradient Boosting, and Support Vector Machines, Our results show (i) Random Forests and Gradient Boosting work very well with such data, (ii) Prediction quality when applied to relatively easily obtained measurements (Cognitive scores, Genetic Risk and plasma biomarkers) achieve results that are competitive with magnetic resonance techniques. This is by no means an exhaustive study, but instead an exploration of the plausibility of defining a series of relatively inexpensive, broad population based tests.