[Etiology of epilepsy in Mexico: results from the national multi-centre register]. / Etiología de la epilepsia en México: resultados del registro multicéntrico nacional.

INTRODUCTION: Epilepsy affects millions of people and its geographical patterns are usually linked to etiological aspects. Our objective was to describe main etiologies of epilepsy in Mexico. PATIENTS AND METHODS: We selected patients from the Multicenter Epilepsy Registry carried out from 2021 to 2022 in 89 Mexican hospitals in 31 states, a sample predominantly of pediatric age. Only patients with electroencephalography and neuroimaging studies were included. RESULTS: We analyzed 6,653 patients with documented etiologies. Etiology frequency with confidence interval (95% CI) was: structural 46.1% (44.9-47.3), genetic 12.9% (12.1-13.7), infectious 2.9%. (2.5-3.3), metabolic 1.4% (1.1-1.7), immune 0.9% (0.8-1.3) and unknown 40.9% (39.8-42.2). The two main structural etiologies were malformations of cortical development and hypoxic-ischemic encephalopathy. Neurocysticercosis represented a minority with only 1%. Structural and genetic etiologies were associated with focal and generalized onset seizures respectively. Status epilepticus was identified, mostly with motor component, associated with immune and infectious etiologies. Comorbidities were found in 61.6%, mainly neurological development disorders. Drug-resistant epilepsy was more common in patients with immune, infectious and structural etiologies. CONCLUSIONS: The main etiology of epilepsy was structural. The frequency of genetic etiology was relatively lower than in other series, possibly due to the limited availability of genetic tests. Despite technological advances, a large fraction of epilepsies still has unknown origin.

TITLE: Etiología de la epilepsia en México: resultados del registro multicéntrico nacional.Introducción. La epilepsia afecta a millones de personas y sus patrones geográficos suelen estar vinculados a aspectos etiológicos. Nuestro objetivo fue describir las principales etiologías de epilepsia en México. Pacientes y métodos. Seleccionamos a pacientes del Registro Multicéntrico de Epilepsia realizado de 2021 a 2022 en 89 hospitales mexicanos de 31 estados, una muestra con predominio en edad pediátrica. Se incluyó a pacientes con estudios de electroencefalografía y neuroimagen. Resultados. Analizamos a 6.653 pacientes con etiologías documentadas. Las frecuencias de etiologías con intervalo de confianza al 95% fueron: estructural, 46,1% (44,9-47,3); genética, 12,9% (12,1-13,7); infecciosa, 2,9% (2,5-3,3); metabólica, 1,4% (1,1-1,7); inmunitaria, 0,9% (0,8-1,3); y desconocida, 40,9% (39,8-42,2). Las dos principales etiologías estructurales fueron las malformaciones del desarrollo cortical y la encefalopatía hipóxico-isquémica. La neurocisticercosis representó una minoría, con sólo el 1%. Las etiologías estructurales y genéticas se relacionaron con crisis de inicio focal y generalizado, respectivamente. Se identificó estado epiléptico, en su mayoría con componente motor, asociado a etiologías inmunitarias e infecciosas. Se encontraron comorbilidades en el 61,6%, principalmente trastornos del desarrollo neurológico. La epilepsia farmacorresistente fue más frecuente en pacientes con etiologías inmunitaria, infecciosa y estructural. Conclusiones. La principal etiología de la epilepsia fue estructural. La frecuencia de etiología genética fue menor que en otras series por la limitada disponibilidad de pruebas genéticas. A pesar de los avances tecnológicos, una gran parte de las epilepsias aún tiene un origen desconocido.

High frequency of multidrug-resistant Escherichia coli from cattle in the Cerrado and Pantanal biomes of Brazil.

The indiscriminate use of antimicrobials has led to the emergence of resistant bacteria, especially pathogenic strains of Escherichia coli, which are associated with diseases in animals and humans. The aim of the present study was to characterize E. coli isolates in calves with regards to the presence of virulence genes and investigate the resistance of the isolates to different antimicrobials. Between 2021 and 2023, 456 fecal samples were collected from calves in the Pantanal and Cerrado biomes of the state of Mato Grosso do Sul, Brazil. All samples were subjected to microbiological analysis and disc diffusion antibiogram testing. The polymerase chain reaction method was used to detect virulence genes. Bacterial growth was found in 451 of the 456 samples and biochemically identified as Escherichia coli. All 451 isolates (100 %) exhibited some phenotypic resistance to antimicrobials and 67.62 % exhibited multidrug resistance. The frequency of multidrug-resistant isolates in the Cerrado biome was significantly higher than that in the Pantanal biome (p = 0.0001). In the Cerrado, the most common pathotype was Shiga toxin-producing Escherichia coli (STEC) (28 %), followed by toxigenic Escherichia coli (ETEC) (11 %), enterohemorrhagic Escherichia coli (EHEC) (8 %) and enteropathogenic Escherichia coli (EPEC) (2 %). In most cases, the concomitant occurrence of pathotypes was more common, the most frequent of which were ETEC + STEC (33 %), ETEC + EHEC (15 %) and ETEC + EPEC (3 %). The STEC pathotype (30 %) was also found more frequently in the Pantanal, followed by EHEC (12 %), ETEC (9 %) and EPEC (6 %). The STEC pathotype had a significantly higher frequency of multidrug resistance (p = 0.0486) compared to the other pathotypes identified. The frequency of resistance was lower in strains from the Pantanal biome compared to those from the Cerrado biome. Although some factors are discussed in this paper, it is necessary to clarify the reasons for this difference and the possible impacts of these findings on both animal and human health in the region.

[Design and application of a device for radiographic projection of the tibio-astragalangeal mortise]. / Diseño y aplicación de dispositivo para proyección radiográfica de la mortaja tibio-astragalina.

INTRODUCTION: ligamentous injuries of the distal tibiofibular syndesmosis resulting in its opening are common occurrences in traumatology; however, their diagnosis poses a challenge for orthopedic surgeons. The tibioastragaloid mortise radiograph view is the most commonly used method for diagnosing this type of injury, but its reliability is compromised due to variations in ankle positioning during the study, which often depend on the operator. OBJECTIVE: to demonstrate that the designed device achieves a correct and consistent radiographic image of the distal tibiofibular syndesmosis in the mortise view. MATERIAL AND METHODS: we present a prospective, longitudinal, observational study. We designed a polypropylene device that maintains the ankle at 90 degrees of dorsiflexion and 15 degrees of internal rotation. The device was used to take mortise view radiographs of healthy ankles, and corresponding measurements were taken to assess the syndesmosis. RESULTS: we evaluated a total of 46 radiographs of healthy ankles, with a predominance of left ankles. The obtained measurements were as follows: anterior tibiofibular distance (ATFD) ranged from 3 to 6 mm, posterior tibiofibular distance (PTFD) ranged from 1 to 3 mm, tibiofibular clear space (TFCS) ranged from 2 to 3 mm, and a Merle D'Aubigne ratio of 2:1 was observed in all ankles. When comparing the measurements obtained with those established by Harper and Keller, no statistically significant difference was found (2 < 5). CONCLUSION: with the use of the designed device, we achieved a correct and consistent radiographic image of the mortise and the distal tibiofibular syndesmosis.

INTRODUCCIÓN: las lesiones ligamentarias de la sindesmosis tibioperonea distal que ocasionan apertura de la misma son muy frecuentes en traumatología; sin embargo, su diagnóstico es un reto para el cirujano ortopedista. La radiografía de la mortaja tibioastragalina es el método más utilizado para el diagnóstico de este tipo de lesiones, pero es poco confiable ya que la posición del tobillo durante el estudio suele variar dependiendo del operador. OBJETIVO: demostrar que con el uso del dispositivo diseñado se logra una imagen radiográfica correcta y constante de la sindesmosis tibioperonea distal en la proyección de la mortaja. MATERIAL Y MÉTODOS: estudio prospectivo, longitudinal y observacional. Diseñamos un dispositivo de polipropileno que mantiene el tobillo a 90 grados de dorsiflexión y rotación interna de 15 grados. Aplicamos el dispositivo para tomar radiografías de la mortaja en tobillos sanos y les realizamos las mediciones correspondientes para valorar la sindesmosis. RESULTADOS: valoramos un total de 46 radiografías de tobillos sanos, con un predominio de tobillos izquierdos. Las mediciones conseguidas fueron las siguientes: espacio tibioperoneo (ETP) de 3 a 6 mm, la superposición tibioperonea (STP) de 1 a 3 mm, espacio astrágalo-tibial medial (EATM) de 2 a 3 mm y una relación de Merle D'Aubigne de 2:1 en todos los tobillos. Al comparar las mediciones obtenidas con las establecidas por Harper y Keller, no se encontró una diferencia estadísticamente significativa (2 < 5). CONCLUSIÓN: con el uso del dispositivo diseñado, obtuvimos una correcta y constante imagen radiográfica de la mortaja y la sindesmosis tibioperonea distal.

Survival analysis of the surgical treatment of hepatocellular carcinoma at a tertiary care center.

INTRODUCTION AND AIMS: Hepatocellular carcinoma (HCC) is a primary malignant tumor of liver epithelial cells and is the most frequent primary liver cancer. The broadening of transplantation and resectability criteria has made therapeutic decisions more complex. Our aim was to describe the clinical and survival characteristics of patients with HCC treated through resection or liver transplantation at our hospital and identify the presence of factors that enable outcome prediction and facilitate therapeutic decision-making. MATERIALS AND METHODS: Patients with HCC that underwent surgery with curative intent at the Hospital Universitario Marqués de Valdecilla, within the time frame of 2007 and 2017, were retrospectively identified. Survival, mortality, disease-free interval, and different outcome-related variables were analyzed. RESULTS: Ninety-six patients with a mean follow-up after surgery of 44 months were included. Overall mortality and recurrence were higher in the resection group. Mean survival was 51.4 months in the liver transplantation group and 37.5 months in the resection group, and the disease-free interval was 49.4 ±â€¯37.2 and 27.4 ±â€¯28.7 months, respectively (p = 0.002). The tumor burden score was statistically significant regarding risk for recurrence and specific mortality. CONCLUSIONS: There appears to be no patient subgroup in whom the results of surgical resection were superior or comparable to those of transplantation. Tumor burden determination could be a useful tool for patient subclassification and help guide therapeutic decision-making.

Assessment of dental and periodontal indices and Streptococcus mutans virulence in fragile X syndrome patients.

INTRODUCTION: Fragile X syndrome (FXS) is the most common cause of hereditary genetic disorder in a single gene characterised by intellectual disability. Behavioural features such as autism, hyperactivity and anxiety disorder may be present. Biofilm development and pathogenicity of Streptococcus mutans may be altered because FXS renders the dental approach and oral hygiene more complex. OBJECTIVES: The purpose of this study was to compare the levels of transcripts for VicRK and CovR of S. mutans isolated from FXS patients with the levels of transcripts for VicRK and CovR of standard strain ATCC, using a quantitative polymerase chain reaction (qPCR). METHODS: The caries experience index was assessed by the International Caries Detection and Assessment System (ICDAS), Periodontal Condition Index (PCI) and Invasive Dental Treatment Need Index (INI). RESULTS: The clinical index findings revealed a high rate of caries cavities and bleeding on probing of FXS patients. When VicRK and CovR transcript levels were compared with the reference strain, Fragile X patients were found to have significantly higher values. CONCLUSION: The present study demonstrated that FXS patients have more adverse clinical conditions, with increased biofilm accumulation and virulence. When combined with behavioural abnormalities, these patients become even more vulnerable to dental caries.

Association of tyrosine hydroxylase 01 (TH01) microsatellite and insulin gene (INS) variable number of tandem repeat (VNTR) with type 2 diabetes and fasting insulin secretion in Mexican population.

PURPOSE: A variable number of tandem repeats (VNTR) in the insulin gene (INS) control region may be involved in type 2 diabetes (T2D). The TH01 microsatellite is near INS and may regulate it. We investigated whether the TH01 microsatellite and INS VNTR, assessed via the surrogate marker single nucleotide polymorphism rs689, are associated with T2D and serum insulin levels in a Mexican population. METHODS: We analyzed a main case-control study (n = 1986) that used univariate and multivariate logistic regression models to calculate the risk conferred by TH01 and rs689 loci for T2D development; rs689 results were replicated in other case-control (n = 1188) and cross-sectional (n = 1914) studies. RESULTS: TH01 alleles 6, 8, 9, and 9.3 and allele A of rs689 were independently associated with T2D, with differences between sex and age at diagnosis. TH01 alleles with ≥ 8 repeats conferred an increased risk for T2D in males compared with ≤ 7 repeats (odds ratio, ≥ 1.46; 95% confidence interval, 1.1-1.95). In females, larger alleles conferred a 1.5-fold higher risk for T2D when diagnosed ≥ 46 years but conferred protection when diagnosed ≤ 45 years. Similarly, rs689 allele A was associated with T2D in these groups. In males, larger TH01 alleles and the rs689 A allele were associated with a significant decrease in median fasting plasma insulin concentration with age in T2D cases; the reverse occurred in controls. CONCLUSION: Larger TH01 alleles and rs689 A allele may potentiate insulin synthesis in males without T2D, a process disabled in those with T2D.

[A multicentre epilepsy registry in Mexico]. / Registro multicéntrico de epilepsia en México.

INTRODUCTION: The National Epilepsy Registry in Mexico was carried out, from March 2021 to December 2022, in public hospitals of the Priority Epilepsy Program 'PPE', with the aim of describing the current situation in our pediatric and adult population. PATIENTS AND METHODS: Observational, cross-sectional, multicenter study. We used a database, according to classifications of the International League Against Epilepsy (ILAE) 2017. Patients of all ages were included, with a diagnosis of epilepsy according to the practical clinical definition ILAE 2014. RESULTS: We registered 10,852 patients, 5,495 men (50.6%) and 5,357 women (49.4%). Family history of epilepsy in 1,714 patients (15.8%), febrile seizures in 987 (9.1%). Type of seizure: 5,542 (51.1%) presented focal onset, of which 1,889 (34.1%) evolved to bilateral tonic-clonic seizures; generalized onset 4,861 (44.8%), unknown 33 (3.1%) and unclassified 115 (1.1%). Almost half had unknown etiology and 40% were structural, of which hypoxic ischemic encephalopathy was the most frequent (21.6%) and neurocysticercosis was 1%. Comorbidities appeared in 6,326 patients (58.3%). Anti-seizure medications (ASM) were used in 96.4% patients, mainly valproate. Status epilepticus was found in 1,383 patients (12.7%) and drug-resistant epilepsy in 18.9%. Paraclinical studies: 79.3% with at least one electroencephalogram and 76.9% with a neuroimaging study. Epilepsy surgery occurred in 275 patients (2.5%). CONCLUSIONS: Despite the efforts of the Pan American Health Organization in its Strategy and Action Plan on epilepsy, diagnostic technologies and ASM supply are still lagging behind.

TITLE: Registro multicéntrico de epilepsia en México.Introducción. Se realizó el Registro Nacional de Epilepsia en México, de marzo de 2021 a diciembre de 2022, en hospitales del sector público del Programa Prioritario de Epilepsia, para conocer la situación actual en población pediátrica y adulta. Pacientes y métodos. Es un estudio observacional, transversal y multicéntrico. Se utilizó una base de datos, acorde con las clasificaciones de la Liga Internacional Contra la Epilepsia (ILAE) de 2017. Se incluyó a pacientes de todas las edades, con diagnóstico de epilepsia según la definición clínica práctica de la ILAE de 2014. Resultados. Se registró a 10.852 pacientes, 5.495 hombres (50,6%) y 5.357 mujeres (49,4%). Había antecedente familiar de epilepsia en 1.714 pacientes (15,8%) y crisis febriles en 987 (9,1%). Los tipos de crisis eran: 5.542 (51,1%) de inicio focal, de las que 1.889 (34,1%) evolucionaban a bilateral tonicoclónica; 4.861 (44,8%) de inicio generalizado; 33 (3,1%) de inicio desconocido; y 115 (1,1%) no clasificadas. Casi la mitad tuvo etiología desconocida y el 40% fueron estructurales; de ellas, la encefalopatía hipóxico-isquémica fue la más frecuente (21,6%) y la neurocisticercosis fue el 1%. Las comorbilidades aparecieron en 6.326 pacientes (58,3%). El 96,4% fueron tratados con fármacos anticrisis epilépticas (FACE), principalmente ácido valproico. El estado epiléptico se encontró en 1.383 pacientes (12,7%), y la farmacorresistencia, en 18,9%. Respecto a los estudios paraclínicos, al 79,3% se le realizó al menos un electroencefalograma, y al 76,9%, un estudio de neuroimagen. Se realizó cirugía de epilepsia a 275 pacientes (2,5%). Conclusiones. A pesar del esfuerzo de la Organización Panamericana de la Salud en su Estrategia y Plan de Acción sobre la Epilepsia, las tecnologías diagnósticas y el abasto de los FACE aún se encuentran rezagados.

Massive enlargement of gastric pouch as a complication of gastrojejunal anastomotic stenosis following one anastomosis laparoscopic gastric bypass: A case report.

INTRODUCTION AND IMPORTANCE: By 2030 it is predicted that 1 in 5 women and 1 in 7 men will be living with obesity. The only long-term effective strategy for achieving significant weight loss over time is surgical treatment. One Anastomosis Gastric Bypass (OAGB) has been proposed as an effective therapeutic option. Stenosis of Gastro-Jejunal Anastomosis (GJA) is one of the most common long-term complications and its cause recognized as multifactorial. CASE PRESENTATION: We present the case of a patient with a history of progressive postoperative oral intolerance after OAGB with 60 kg weight loss (BMI 20.7 kg/m2). Severe stenosis of the GJA and massive dilation of the gastric remnant was documented, treated multiple times with endoscopic balloon dilation. He was referred to our unit due to persistent symptoms. Revision surgery to a Gastric Bypass was programmed, ultimately performed via an open approach with resection of 80 % of the gastric remnant. CLINICAL DISCUSSION: Endoscopic dilatation and surgical revision are the two primary treatment options for GJA stricture. In refractory cases to pneumatic dilation, laparoscopic revision surgery is indicated, however an open approach is frequently required, as surgeries are technically demanding due to distorted anatomy in this population. CONCLUSION: Operations to correct chronic complications are tailored to the patient's anatomy as well as the symptoms or pathologies they are intended to correct. Whilst revision surgeries are associated with an increased risk of conversion, complications and longer hospital stay, they can be performed safely in experienced centers.

Prolonged-release pirfenidone in patients with pulmonary fibrosis as a phenotype of post-acute sequelae of COVID-19 pneumonia. Safety and efficacy.

INTRODUCTION: One of the major concerns with post-acute sequelae of COVID-19 (PASC) is the development of pulmonary fibrosis, for which no approved pharmacological treatment exists. Therefore, the primary aim of this open-label study was to evaluate the safety and the potential clinical efficacy of a prolonged-release pirfenidone formulation (PR-PFD) in patients having PASC-pulmonary fibrosis. METHODS: Patients with PASC-pulmonary fibrosis received PR-PFD 1800 mg/day (1200 mg in the morning after breakfast and 600 mg in the evening after dinner) for three months. Blood samples were taken to confirm the pharmacokinetics of PR-PFD, and adverse events (AEs) were evaluated monthly using a short questionnaire. Symptoms, dyspnea, and pulmonary function tests (spirometry, diffusing capacity for carbon monoxide, plethysmography, and 6-min walk test [6MWT]) were evaluated at baseline, and one and three months after having started the PR-PFD treatment. RESULTS: Seventy subjects with mild to moderate lung restriction were included. The most common AEs were diarrhea (23%), heartburn (23%), and headache (16%), for which no modifications in the drug study were needed. Two patients died within the first 30 days of enrolment, and three opted not to continue the study, events which were not associate with PR-PFD. Pulmonary function testing, 6MWT, dyspnea, symptoms, and CT scan significantly improved after three months of treatment with PR-PFD. CONCLUSION: In patients with PASC pulmonary fibrosis, three months' treatment with PR-PFD was safe and showed therapeutic efficacy. Still, it remains to be seen whether the pulmonary fibrotic process remains stable, becomes progressive or will improve.

Inhibition of Aspergillus carbonarius growth and Ochratoxin A production using lactic acid bacteria cultivated in an optimized medium.

The Gram-positive bacteria lactic acid bacteria (LAB) are used in the food industry but are also known for inhibiting certain food spoilage microorganisms, especially fungi. Sources of nitrogen (N) for culture media are generally organic and expensive. Many attempts have been made to formulate economical culture media with alternative N sources obtained from agricultural and industrial byproducts. This study describes the design and optimization of an inexpensive culture medium for Lactiplantibacillus plantarum (formerly Lactobacillus plantarum) MZ809351 strain B31. The culture medium was optimized using statistical experimental designs to identify the factors with the most significant effects on biomass concentration to reduce the overall cost, aiming to obtain a biomass concentration similar to that obtained with the reference LAB culture medium (de Man, Rogosa and Sharpe; MRS). Sodium acetate and magnesium sulfate were the most significant factors (p < 0.005), and their contents were reduced by 22 % and 40 %, respectively, without affecting biomass concentration. Malt germ extract (MGE) was used as an alternative nitrogen source to replace meat extract (ME) and proteose peptone (PP). Through these experiments, the composition of a culture medium that is less expensive than MRS broth was defined, which produced a biomass concentration (3.8 g/L) similar to that obtained with MRS medium. The inhibitory effects of two LAB strains isolated from the Ivory Coast and Mexico on the growth and production of ochratoxin A (OTA) in an ochratoxigenic fungus was tested. The minimum cellular concentration of the LAB to prevent the development of Aspergillus carbonarius Ac 089 and the production of OTA was determined in a model assay in Petri dishes. The conditions to inhibit the germination of A. carbonarius Ac 089 and the production of OTA were found. Using the optimized medium and a ratio of 2 × 104 LAB/spore (1 × 108 CFU/mL) strain B7 (L. plantarum MZ809351) and 2 × 103 LAB/spore (1 × 107 CFU/mL) strain B31 (L. plantarum MN922335) completely inhibited the growth of the fungus. A ratio of 2 × 105 LAB/spore (1 × 109 CFU/mL) was required to inhibit OTA production with strains B7 and B31. This study indicates the potential of cultivating LAB in an optimized and inexpensive culture medium for use as a biological control agent against ochratoxigenic fungi in food.

Identifying pollution dynamics using discrete Fourier transform: From an urban-rural river, Central Mexico.

The quality of life and human survival is dependent on sustainable development and sanitation of water bodies in an environment. The present research focuses on cyclicity data of more than 750,000 records of parameters associated with the water quality from a rural-urban river monitoring stations in real-time from River Atoyac in Central Mexico. The events detected in the instrumental records correlated with 2528 laboratory and instrumental determinations. The 64 polluting compounds were grouped into inorganic compounds (metals and metalloids) and organic compounds (pesticides, herbicides, hydrocarbons). Metal associated compounds were grouped along mechanical, pharmaceutical and textile industries which associates itself with the entry of polluting components. The cyclicity of the events was detected through Discrete Fourier Transformation time series analysis identifying the predominant events in each station. These highlight the events at 23-26 h corresponding to a circadian pattern of the metabolism of the city. Likewise, pollution signals were detected at 3.3, 5.5, and 12-14 h, associated with discharges from economic activities. Multivariate statistical techniques were used to identify the circadian extremes of a regionalized cycle of polluting compounds in each of the stations. The results of this research allow pollution prevention using a mathematical analysis of time series of different quality parameters collected at monitoring stations in real-time as a tool for predicting polluting events. The DFT analysis makes it possible to prevent polluting events in different bodies of water, allowing to support the development of public policies based on the supervision and control of pollution.

Benefits and harms of fibrate therapy in patients with type 2 diabetes: a systematic review and meta-analysis.

PURPOSE: This systematic review aimed to evaluate the benefits and harms of fibrate therapy, alone or in combination with statins, in adult patients with type 2 diabetes (T2D). METHODS: A comprehensive search was conducted in six databases, from inception to January 27, 2022. Clinical trials that compared fibrate therapy with other lipid-lowering interventions or placebo were included. Outcomes of interest comprised cardiovascular (CV) events, complications of T2D, metabolic profile, and adverse events. Random-effects meta-analyses were performed to estimate mean differences (MD) and risk ratios (RR), alongside 95% confidence intervals (CI). RESULTS: A total of 25 studies were included, six comparing fibrates against statins, 11 against placebo, and eight evaluating the combination of fibrates with statins. Overall risk of bias was rated as moderate, and most outcomes rendered low confidence per GRADE approach. Fibrates showed reduction of serum triglycerides (TGs) (MD -17.81, CI -33.92 to -1.69) and a marginal increase of high-density lipoprotein cholesterol (HDL-c) (MD: 1.60, CI 0.29 to 2.90) in adults with T2D, but no differences were found in CV events when compared to statin therapy (RR 0.99, CI 0.76 to 1.09). When used in combination with statins, no major differences were exhibited regarding lipid profile and CV outcomes. Adverse events were comparable between fibrate and statin monotherapies (e.g., RR of 1.03 for rhabdomyolysis, and 0.90 for gastrointestinal events). CONCLUSIONS: Fibrate therapy in patients with T2D results in a marginal improvement of TGs and HDL-c but without reducing the risk of CV events and mortality. Their use should be reserved for very specific scenarios after a deliberative dialogue between patients and clinicians regarding their benefits and harms.

5-Fluorouracil drug delivery system based on bacterial nanocellulose for colorectal cancer treatment: Mathematical and in vitro evaluation.

Colorectal cancer (CRC) is the third most common worldwide. Its treatment includes adjuvant chemotherapy with 5-fluorouracil (5FU) administered intravenously. 5FU is an antineoplastic drug of the fluoropyrimidines group, widely used in the treatment of solid tumors, mainly CRC. Nevertheless, it causes several adverse effects and poor effectiveness due to its short half-life. This work aimed to employ bacterial nanocellulose (BNC) as an encapsulation material for the oral administration of 5FU. First, the adsorption phenomena were analyzed by isotherms, thermodynamic parameters, and kinetic models. Then, encapsulation was carried out using spray-drying, and encapsulated 5FU desorption profiles were assessed in simulated fluids. The biological behavior was evaluated on colon cancer SW480 and SW620 cell lines. As result, it was found that at 25 °C a monolayer of 5FU was formed and the process showed to be the most spontaneous one. In the characterization of the nanocapsules, important changes were detected by the presence of 5FU. The delivery in the colon corresponded to a controlled release behavior. The in vitro assay indicated an improvement in the toxicity effect of the drug and its mechanism of action. Accordingly, BNC is a promising biomaterial for the development of a colon drug delivery platform of 5FU.

Continuous to intermittent flows in growing granular heaps.

If a granular material is poured from above on a horizontal surface between two parallel, vertical plates, a sand heap grows in time. For small piles, the grains flow smoothly downhill, but after a critical pile size X_{c}, the flow becomes intermittent: sudden avalanches slide downhill from the apex to the base, followed by an "uphill front" that slowly climbs up, until a new downhill avalanche interrupts the process. By means of experiments, controlling the distance between the apex of the sandpile and the container feeding it from above, we show that X_{c} grows linearly with the input flux, but scales as the square root of the feeding height. We explain these facts from a phenomenological model based on the experimental observation that the flowing granular phase forms a "wedge" on top of the static one, differently from the case of stationary heaps. Moreover, we demonstrate that our controlled experiments allow to predict the value of X_{c} for the common situation in which the feeding height decreases as the pile increases in size.

Modified quasispecies model: the analysis of a periodic therapy.

We propose a modified mathematical model of the quasispecies type to analyze an unstable tumor progression evolution. In our study, we consider a heterogeneous population with different individuals, generated by the accumulation of successive mutations. Our model's main feature is that it allows for variable growth rates for each subpopulation and takes into account mutations from nonconsecutive types of mutants. Bifurcations and linear stability of the steady states are analyzed. We focus on two equilibria; one of them implies the coexistence of anomalous growth and genetically unstable cells. The other one yields the dominance of the anomalous growth population and the extinction of the malignant cells. However, linear stability analysis of the second equilibrium is inconclusive and suggests a suitable environment for the study of periodic therapy. This is carried out by introducing a small perturbation modeling the effect of a periodic medical treatment. As a result, a Zero-Hopf periodic orbit is identified, showing a cyclic behavior among the populations, with a strong dominance of the parental anomalous growth cell population.

Ozone pollution, oxidative stress, synaptic plasticity, and neurodegeneration.

INTRODUCTION: Overpopulation and industrial growth result in an increase in air pollution, mainly due to suspended particulate matter and the formation of ozone. Repeated exposure to low doses of ozone, such as on a day with high air pollution levels, results in a state of chronic oxidative stress, causing the loss of dendritic spines, alterations in cerebral plasticity and in learning and memory mechanisms, and neuronal death and a loss of brain repair capacity. This has a direct impact on human health, increasing the incidence of chronic and degenerative diseases. DEVELOPMENT: We performed a search of the PubMed, Scopus, and Google Scholar databases for original articles and reviews published between 2000 and 2018 and addressing the main consequences of ozone exposure on synaptic plasticity, information processing in cognitive processes, and the alterations that may lead to the development of neurodegenerative diseases. CONCLUSIONS: This review describes one of the pathophysiological mechanisms of the effect of repeated exposure to low doses of ozone, which causes loss of synaptic plasticity by producing a state of chronic oxidative stress. This brain function is key to both information processing and the generation of structural changes in neuronal populations. We also address the effect of chronic ozone exposure on brain tissue and the close relationship between ozone pollution and the appearance and progression of neurodegenerative diseases.

Respuesta terapéutica de la hipoplasia de timo conbiomodulina T

RESUMEN:Introducción: las inmunodeficiencias congénitas son defectos génicos que con frecuencia se manifiestan precozmente, durante la la ctancia o la infancia, aunque aveces se detectan clínicamente en fases posteriores de la vida. Dentro de sus trastornos se encuentran los relacionados con uno de los órganos primarios de la respuesta inmune, el timo.Objetivo: describir el resultado del tratamiento con biomodulina T y los factores asociados que afectan a la población en estudio.Métodos: se realizó una investigación de desarrollo, descriptiva, longitudinal y prospectiva en niños de seis meses a siete años con infecciones recurrentes e hipoplasia del timo diagnosticado en las Consultas de Inmunología de la Provincia de Sancti Spíritus en el período comprendido desde noviembre de 2017 hasta octubre de2020. La muestra quedó conformada por un total de 49 pacientes. Se utilizó como técnica el ultrasonido de timo, un cuestionario elaborado al efecto y la aplicación de labiomodulina T como tratamiento inmunomodulador.Resultados: predominaron los pacientes con hipoplasia de timo moderada, del sexo masculino, en el grupo etario pre-escolar, con infecciones respiratorias recurrentes no complicadas y antecedentes prenatales de sepsis urinaria. La mayoría de los pacientes mostraron una respuesta satisfactoria, tanto clínica como imagenológica, altratamiento con biomodulina T.Conclusiones: la utilización de biomodulina T como terapia inmunomoduladora mostró resultados satisfactorios, tanto clínicos como imagenológicos, en la mayoría delos pacientes.[AU]

Collagen based electrospun materials for skin wounds treatment.

Materials used for wound care have evolved from simple covers to functional wound dressings with bioactive properties. Electrospun nanofibers show great similarity to the natural fibrillar structure of skin extracellular matrix (ECM); therefore, by mimic, the morphology of ECM, nanofibers show high potential for facilitating the healing of skin injuries. Besides morphology, scaffold composition is another important parameter in the production of bioactive wound dressings. Collagen type I is the main structural protein of skin ECM is biocompatible, biodegradable, and its extraction from animal sources is relatively simple. The fabrication of electrospun wound dressings based on collagen and its blends have been studied for skin tissue engineering applications. This review focus on the new advances of collagen electrospun materials for skin wound treatment. It summarizes the recent research on pristine collagen, collagen blends, and collagen surface modifications on nanofibers mats. Finally, the strategies for three-dimensional nanofibers production will also be discussed.

[Hip fracture in the elderly: epidemiology and costs of care]. / Fractura de cadera en el adulto mayor: epidemiología y costos de la atención.

INTRODUCTION: The aim of this study was to describe the epidemiology and to estimate the direct medical costs of hip fracture among elderly patients in Mexico. MATERIAL AND METHODS: An observational, cross sectional and retrospective study was undertaken. Hospital discharge and surgical procedures for the period 2013-2018 were the databases used for the analysis, and obtained from General Directorate of Health Information. Variables included were sex, federal entity, age, year of discharge, and fracture type according to the CIE-10; and also, the supplies needed for the surgical procedures. RESULTS: A total of 16,829 patients with hip fracture were discharge, 69% were women, and the mean for age was 79 years old and for the hospital stay length was nine days. The most frequent fracture type was the femur neck with 77% and the average medical costs was USD$45,122,228.00. CONCLUSION: Falling risks increase with age, especially in patients among 80-89 years of age, hence, is expected that this type of pathology increases in the following years. The medical costs for treatment of hip fracture represents an economic impact on health services. For that reason, the implementation of prevention strategies, risk of falling for example, is the one of most efficient approach.

INTRODUCCIÓN: El objetivo general de la investigación fue describir la epidemiología y estimar los costos médicos directos de la fractura de cadera en el adulto mayor en México. MATERIAL Y MÉTODOS: Se realizó un estudio observacional y transversal retrospectivo. Se utilizaron dos bases de datos obtenidas de la Dirección General de Información en Salud del período 2013-2018: egresos hospitalarios y procedimientos quirúrgicos. Las variables incluidas fueron: sexo, entidad federativa, edad, año de registro y tipo de fractura de acorde a la CIE-10; de igual forma, todos los insumos necesarios para la realización del procedimiento quirúrgico. RESULTADOS: Se registraron 16,829 ingresos de pacientes con fractura de cadera. Las mujeres representaron 69% del total de pacientes, la edad en promedio fue de 79 años y la estancia hospitalaria fue de nueve días, 77% de las fracturas fueron de cuello de fémur y el promedio de los costos médicos directos de los procedimientos ascendieron a USD $45,122,228.00 para el período estudiado. CONCLUSIÓN: El riesgo de caídas aumenta con la edad, especialmente en el grupo etario de 80-89 años, por lo que se espera que este tipo de patologías se incremente en los próximos años. De igual forma, los costos para la atención de estas fracturas representan un impacto económico para los sistemas de salud. De manera que la implementación de estrategias de prevención, por ejemplo, en caídas es el método más eficiente para contribuir al envejecimiento saludable.