A Four Country Study of Strangulation-related Alterations in Consciousness in Women who have Experienced Intimate Partner Violence: Co-occurrence with Traumatic Brain Injuries and Measures of Psychological Distress.

At least one in three women experience intimate partner violence (IPV) in their lifetime. The most commonly sustained IPV-related brain injuries include strangulation-related alterations in consciousness (S-AICs) and traumatic brain injuries (TBIs). Moreover, survivors of IPV-related S-AICs and/or TBIs often demonstrate psychological distress such as depression, anxiety, and post-traumatic stress. However, the co-occurrence of S-AICs and TBIs, and whether such TBIs may be moderate to severe, has not been systematically examined, and most data have been collected from women in North America. The purpose of this study was to examine the co-occurrence of IPV-related S-AICs and TBIs across a range of geographical locations and to determine the extent to which these S-AICs are related to psychological distress. Women who had experienced physical IPV (N=213) were included in this secondary analysis of retrospectively collected data across four countries (Canada, USA, Spain, and Colombia). The Brain Injury Severity Assessment (BISA) was used to assess IPV-related BI across all sites. Because various questionnaires were employed to assess levels of depression, anxiety, and PTSD at each site, we created a standardized composite score by converting raw scores into Z-scores for analysis. Mann Whitney U tests and Chi square tests were conducted to examine differences between women with- versus without-experience of S-AICs and to discover if there was a relationship between the occurrence of S-AICs and TBIs. Analysis of variance, and analysis of covariance (to control for the potential confounding effects of age, education, and non IPV-related TBI) were used to compare levels of psychological distress in women who had or had not experienced S-AICs. Approximately 67% of women sustained at least one IPV-related BI (i.e., TBI and/or S-AIC). In a sub-sample of women who sustained at least one IPV-related BI, approximately 37% sustained both S-AICs and TBIs, 2% sustained only S-AICs (with no TBIs), and 61% sustained TBIs exclusively (with no S-AICs). Furthermore, women who had sustained S-AICs (with or without a TBI) were more likely to have experienced a moderate to severe BI than those who had not sustained an S-AIC (BISA severity subscale: U=3939, p=0.006). Additionally, women who experienced S-AICs (with or without a TBI) reported higher levels of psychological distress compared to women who never experienced S-AICs, irrespective of whether they occurred once or multiple times. These data underscore the importance of assessing for S-AIC in women who have experienced IPV and when present, to also assess for TBIs and the presence of psychological distress. Unfortunately, there were methodological differences across sites precluding cross-site comparisons. Nonetheless, data were collected across four culturally and geographically diverse countries, and therefore highlight IPV-related BIs as a global issue which needs to be aggressively studied with policies established and then implemented to address find.

Diagnosis challenges in CHARGE syndrome: A novel variant and clinical description.

Introduction: In resource-limited settings, patients with uncommon phenotypes often face prolonged diagnostic journeys and potential misdiagnoses. Coloboma, heart defects, atresia choanae, restricted growth and development, genital and ear abnormalities syndrome (CHARGE) syndrome, a congenital condition affecting various body parts such as the heart, ears, eyes, and genitals, exemplifies this challenge. Case presentation: We present the case of a 21-year-old male patient from Ecuador who exhibited hypogonadism, facial deformities, and stunted growth. Due to the scarcity of genetic specialists and limited access to genetic testing in Ecuador, the patient received a misdiagnosis of Noonan syndrome. However, a correct diagnosis of CHARGE syndrome was ultimately reached after eight years, facilitated by genetic sequencing that identified a novel mutation in the Chromodomain helicase DNA binding protein 7 gene. Conclusion: This case highlights the critical role of meticulously assessing patients' symptoms and emphasizes the necessity for enhanced collaboration among physicians and researchers. Such efforts are pivotal in advancing healthcare access and equity for individuals in developing nations.

Parasitosis by Fasciola hepatica and Variations in Gut Microbiota in School-Aged Children from Peru.

(1) Background: Human fascioliasis is considered an endemic and hyper-endemic disease in the Peruvian Andean valleys. Our objective was to determine variations in the composition of the gut microbiota among children with Fasciola hepatica and children who do not have this parasitosis. (2) Method: A secondary analysis was performed using fecal samples stored in our biobank. The samples were collected as part of an epidemiological Fasciola hepatica cross-sectional study in children from 4 through 14 years old from a community in Cajamarca, Peru. (3) Results: In a comparison of the bacterial genera that make up the intestinal microbiota between the F. hepatica positive and negative groups, it was found that there are significant differences in the determination of Lactobacillus (p = 0.010, CI: 8.5-61.4), Bacteroides (p = 0.020, CI: 18.5-61.4), Clostridium (p < 0.001, CI: 3.5-36.0), and Bifidobacterium (p = 0.018, CI: 1.1-28.3), with each of these genera being less frequent in children parasitized with F. hepatica. (4) Conclusions: These results show that F. hepatica may be associated with direct or indirect changes in the bacterial population of the intestinal microbiota, particularly affecting three bacterial genera.

Massive Right Chylothorax Secondary to a Severe Systemic Lupus Erythematosus Flare With Secondary Evans Syndrome: A Case Report and Literature Review.

This case report describes a 23-year-old male patient who presented with right chylothorax as the initial manifestation of a severe flare of systemic lupus erythematosus (SLE) and secondary Evans syndrome. Chylothorax and chylous ascites are rare features of SLE that can occur due to the accumulation of triglyceride-rich fluid in serous cavities. However, they have never been reported as the initial manifestation of a lupus flare. Evans syndrome is a rare disease characterized by autoimmune hemolytic anemia and immune thrombocytopenia, which can be secondary to SLE. The concomitant occurrence of both chylothorax and Evans syndrome in the setting of systemic lupus erythematosus has never been described, and the exact causative mechanisms of both entities are yet to be fully understood. In this report, we discuss our approach to this challenging case to broaden the understanding of the clinical manifestations of systemic lupus erythematosus. Our findings emphasize the importance of considering rare features of systemic lupus erythematosus and secondary diseases when evaluating patients with the disease.

Optimizing Sustainable Energy Generation in Ethanol Fuel Cells: An Exploration of Carrageenan with TiO2 Nanoparticles and Ni/CeO2 Composites.

Based on the search for new biodegradable materials that are low cost and easy to synthesize by environmentally friendly methods, we report the use of carrageenan membranes (mixture of κ and λ carrageenans) with different concentrations of titanium dioxide nanoparticles (TiO2 NPs) and Ni/CeO2 (10 wt % Ni) for the fabrication of a novel fuel cell electrode for the oxidation of ethanol. Each membrane was characterized to determine its physicochemical properties using X-ray diffraction (XRD), differential scanning calorimetry (DSC), and Fourier transform infrared (FTIR) spectroscopy. Using impedance spectroscopy (IS), a maximum value of 2.08 × 10-4 S/cm in ionic conductivity was found for the carrageenan nanocomposite with a concentration of 5 wt % TiO2 NPs (CR5%). Due to its high conductivity values, the CR5% membrane was mixed with Ni/CeO2 to prepare the working electrode for cyclic voltammetry measurements. Using a solution of 1 M ethanol and 1 M KOH, the oxidation of ethanol over CR5% + Ni/CeO2 resulted in peak current density values at forward and reverse scan voltages of 9.52 and 12.22 mA/cm2, respectively. From our results, the CR5% + Ni/CeO2 membrane proves to be more efficient in the oxidation of ethanol compared with commercially available Nafion membranes containing Ni/CeO2.

Aeroallergen immunotherapy associated with reduced risk of severe COVID-19 in 1095 allergic patients.

Introduction: Allergen immunotherapy (AIT) brings along changes in the immune system, restoring dendritic cell function, reducing T2 inflammation and augmenting the regulatory cell activation. Coronavirus disease (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infections, interferes with the immune system causing immune suppression during the first phase and over-activation in more advanced disease. We decided to explore the interaction of both in a real-world observational trial. Methods: We registered COVID-19 outcomes in patients with allergic disorders in Latin America, treated with and without AIT. The registry was conducted during the first 1.3 years of the pandemic, with most of the data collected before COVID-19 vaccination was concluded in most countries. Data collection was anonymous via a web-based instrument. Ten countries participated. Results: 630/1095 (57.6%) of the included patients received AIT. Compared to patients without AIT, those treated with AIT had a reduced risk ratio (RR) for COVID-19 lower respiratory symptoms (RR 0.78, 95% CI: 0.6703-0.9024; p = 0.001662) and need for oxygen therapy (RR 0.65, 95% CI: 0.4217-0.9992; p = 0.048). In adherent patients on maintenance sublingual immunotherapy/subcutaneous immunotherapy (SLIT/SCIT) the RR reduction was larger [RR = 0.6136 (95% CI 0.4623-0.8143; p < 0.001) and RR: 0.3495 (95% CI 0.1822-0.6701; p < 0.005), respectively]. SLIT was slightly more effective (NS). We excluded age, comorbidities, level of health care attendance, and type of allergic disorder as confounders, although asthma was related to a higher frequency of severe disease. When analyzing patients with allergic asthma (n = 503) the RR reduction favoring AIT was more pronounced with 30% for lower respiratory symptoms or worse (RR 0.6914, 95% CI 0.5264 to 0.9081, p = 0.0087) and 51% for need of oxygen therapy or worse (RR 0.4868, 95% CI 0.2829-0.8376, p = 0.0082). Among severe allergic patients treated with biologics (n = 24) only 2/24 needed oxygen therapy. There were no critical cases among them. Conclusion: In our registry AIT was associated with reduced COVID-19 severity.

Propiedades psicométricas del cuestionario de actitudes hacia la práctica de actividad físico-deportiva orientada a la salud en adolescentes peruanos / Propriedades psicométricas do Questionário de Atitudes em relação à Prática da Actividade Físico-Sportiva Orientada para a Saúde em adolescentes peruanos / Psychometric properties of the Questionnaire of Attitudes towards the Practice of Health-Oriented Physical-Sports Activity in Peruvian adolescents

Las actitudes predicen el compromiso hacia la práctica de actividad físico-deportiva. Cuanto más se conozcan, mejor será la predicción de los posibles hábitos que las personas adoptarán. Por tanto, es necesario contar con un instrumento que evidencie validez y fiabilidad, especialmente para adolescentes, ya que la adolescencia constituye una etapa fundamental en la adopción de estilos de vida saludables. El objetivo de esteestudio fue analizar las propiedades psicométricas del Cuestionario de Actitudes hacia la Práctica de Actividad Físico-Deportiva Orientada a la Salud (CAAFS) en adolescentes peruanos. Se trata de un estudio descriptivo transversal en el que participaron 1314 adolescentes de edades entre 13 y 19 años (15.59±1.05 años), conformados por 716 hombres y 598 mujeres provenientes de Lima y Callao, Perú. Mediante el software R versión 4.1.0., se efectuó la validez de constructo (Análisis Factorial Exploratorio [AFE] y el Análisis Factorial Confirmatorio [AFC]) y el cálculo de fiabilidad. Los resultados del AFE arrojaron un modelo con tres factores del CAAFS, que explica el 35 % de la varianza total. El AFC reportó un buen ajuste del modelo de tres factores del CAAFSde 19 ítems (Chi-cuadrado sobre los grados de libertad = 2.38; error de aproximacióncuadrático medio = .046; residuo cuadrático medio estandarizado = .060; índice de ajuste comparativo = .940; índice de Tuker-Lewis = .931). El coeficiente de fiabilidad Omega reportó un valor de .77. Finalmente se demostró que el CAAFS de 19 ítems evidencia validez y fiabilidad; por lo tanto, el cuestionario puede ser aplicado en adolescentes del contexto peruano. (AU)

Attitudes predict commitment to the practice of physical-sporting activity. The more they are known, the better the prediction of the possible habits that people will adopt. Therefore, it is necessary to havean instrument that shows validity and reliability, especially for adolescents, since adolescence is a fundamental stage in the adoption of healthy lifestyles. The aim of this study was to analyze the psychometric properties of the Questionnaire of Attitudes towards the Practice of Health-Oriented Physical-Sports Activity (CAAFS) in Peruvian adolescents. This was a descriptive cross-sectional study in which 1314 adolescents aged 13 to 19 years (15.59±1.05 years), made up of 716 males and 598 females from Lima and Callao, Peru, participated. Using R software version 4.1.0, construct validity (Exploratory Factor Analysis [EFA] and Confirmatory Factor Analysis [CFA]) and reliability calculation were performed. The results of the EFA yielded a three-factor modelof the CAAFS, which explains 35% of the total variance. The AFC reported a good fit of the 19-item CAAFS three-factor model (Chi-square over degrees of freedom = 2.38; root mean square error of approximation = .046; standardized root mean square residual = .060; comparative fit index = .940; Tuker-Lewis index = .931). The Omega reliability coefficient reported a value of .77. Finally, it was demonstrated that the 19-item CAAFS shows validity and reliability; therefore, the questionnaire can be applied to adolescents in the Peruvian context. (AU)

As atitudes prevêem o compromisso com a actividade física e o desporto. Quanto mais forem conhecidos, melhor será a previsão dos possíveis hábitos que as pessoas irão adoptar. Por conseguinte, é necessário ter um instrumento que demonstre validade e fiabilidade, especialmente para os adolescentes, uma vez que a adolescência é uma fase chave na adopção de estilos de vida saudáveis. O objectivo deste estudo era analisar as propriedades psicométricas do Questionário de Atitudes para a Prática da Actividade Físico-Sportiva Orientada para a Saúde (CAAFS) em adolescentes peruanos. Este foi um estudo transversal descritivo envolvendo 1314 adolescentes com idades compreendidas entre 13-19 anos (15,59±1,05 anos), compreendendo 716 homens e 598 mulheres de Lima e Callao, Peru. Utilizando o software R versão 4.1.0, foram efectuados cálculos de validade de construção (Análise Exploratória de Factores [EFA] e Análise Confirmativa de Factores [CFA]) e de fiabilidade. Os resultados da AAE produziram um modelo de três factores do CAAFS, o que explica 35% da variação total. O CFA relatou um bom ajuste do modelo de três factores CAAFS de 19 itens (Qui-quadrado sobre graus de liberdade = 2,38; erro quadrático médio de aproximação = 0,046; raiz média quadrada residual padronizada = 0,060; índice de ajuste comparativo = 0,940; índice Tuker-Lewis = 0,931). O coeficiente de fiabilidade ómega comunicou um valor de 0,77. Finalmente, foi demonstrado que o CAAFS de 19 itens mostra validade e fiabilidade; por conseguinte, o questionário pode ser aplicado aos adolescentes no contexto peruano. (AU)

The accuracy of the Stroke Risk Analysis (SRA) system for predicting atrial fibrillation in patients in the postoperative period of myocardial revascularization.

INTRODUCTION: Postoperative myocardial revascularization atrial fibrillation (POAF) is a clinical complication that affects about 30% of patients and its mechanisms of origin are still poorly understood. This fact makes it difficult to identify the patient at greatest risk for this arrhythmia. This mission seems evident due to the complications it entails, including longer hospital stays, risk of stroke, heart failure, and death. There are reports of preoperative clinical aspects inherent to the patient's condition, such as gender and age, and discontinuation of beta-blockers as risk factors. In addition, additional information obtained by electrocardiogram, echocardiogram, and blood count data, for example, present only modest predictive results. The analysis of heart rate and heart rate variability obtained by the Stroke Risk Analysis System (SRA) is a technique used to predict ambulatory atrial fibrillation (AF), using recordings of only one hour showing good accuracy. This system, however, has not yet been used to predict the emergence of POAF. The rationale for its use is based on the suspicion that the emergence of POAF is strongly related to sympatho-vagal imbalance and the increase in atrial ectopia, that is, changes in heart rhythm, the main variables analyzed by the SRA algorithm. OBJECTIVE: To assess the accuracy of the SRA to identify patients at risk of having POAF after coronary artery bypass graft surgery (CABG). METHOD: 114 consecutive patients with coronary artery disease underwent coronary artery bypass grafting between the years 2015 and 2018. Between the first and fifth postoperative days, they underwent continuous electrocardiographic monitoring using the Holter system for cardiac rhythm analysis. Patients were divided into two groups: Group I was formed of those with POAF and Group II included patients without POAF. The tracings obtained by Holter were reanalyzed using the CardioManager®/Cardios program, converted and divided into one-hour sections using the SRA®/Cardios and Geratherm Converter program and submitted to the SRA-Apoplex medical/Geratherm® analysis algorithm. The SRA identifies three possibilities for classifying patient risk: a) Risk 0: patient in sinus rhythm; b) Risk 1: patient at increased risk for paroxysmal AF; c) Risk 2: patient with AF already present. For Group I, SRA were considered positive when Risks 1 and 2 were identified. For Group II, those identified as Risk 0 were considered negative SRA. RESULTS: POAF occurred in 33/114 patients (28%). The sensitivity, specificity, positive predictive value, and negative predictive value of the SRA to identify patients with POAF were 69%, 84%, 69%, and 82%, respectively; the positive and negative likelihood ratios, in addition to the accuracy of the SRA were, respectively, 4.3%, 0.36%, and 79%. A subanalysis of the results of the day on which AF occurred was performed on the records obtained in the first three hours of recording and up to three hours before the appearance of POAF. In the first period, the SRA was able to predict POAF in 57% of cases, while in the second period, the system identified the arrhythmia in 83% of cases. CONCLUSIONS: a) The SRA presents good accuracy to predict POAF; b) its accuracy is moderate in the first three hours of recording; c) the accuracy increases significantly near the beginning of POAF; d) these findings indicate that electrophysiological changes that precede POAF are acute, occurring a few hours before the event and are identified by the SRA algorithm.

Semi-conductive micellar networks of all-conjugated diblock and triblock copolymer blends.

The crystallization-driven self-assembly of the blends of the all-conjugated block copolymers of poly(3-hexylthiophene) (P3HT) and poly(3-ethylhexylthiophene) (P3EHT) results in the cross-linking of the one-dimensional nanowires of P3HT-b-P3EHT, which is achieved by intercalating P3HT-b-P3EHT-b-P3HT into the nanowire cores. The micellar networks constitute flexible and porous materials that conduct electricity upon doping.

The accuracy of the stroke risk analysis (SRA) system for predicting atrial fibrillation in patients in the postoperative period of myocardial revascularization

INTRODUCTION: Postoperative myocardial revascularization atrial fibrillation (POAF) is a clinical complication that affects about 30% of patients and its mechanisms of origin are still poorly understood. This fact makes it difficult to identify the patient at greatest risk for this arrhythmia. This mission seems evident due to the complications it entails, including longer hospital stays, risk of stroke, heart failure, and death. There are reports of preoperative clinical aspects inherent to the patient's condition, such as gender and age, and discontinuation of beta-blockers as risk factors. In addition, additional information obtained by electrocardiogram, echocardiogram, and blood count data, for example, present only modest predictive results. The analysis of heart rate and heart rate variability obtained by the Stroke Risk Analysis System (SRA) is a technique used to predict ambulatory atrial fibrillation (AF), using recordings of only one hour showing good accuracy. This system, however, has not yet been used to predict the emergence of POAF. The rationale for its use is based on the suspicion that the emergence of POAF is strongly related to sympatho-vagal imbalance and the increase in atrial ectopia, that is, changes in heart rhythm, the main variables analyzed by the SRA algorithm. OBJECTIVE: To assess the accuracy of the SRA to identify patients at risk of having POAF after coronary artery bypass graft surgery (CABG). METHOD: 114 consecutive patients with coronary artery disease underwent coronary artery bypass grafting between the years 2015 and 2018. Between the first and fifth postoperative days, they underwent continuous electrocardiographic monitoring using the Holter system for cardiac rhythm analysis. Patients were divided into two groups: Group I was formed with POAF and Group II included patients without POAF. The tracings obtained by Holter were reanalyzed using the Cardio Manager/Cardios program, converted and divided into one-hour sections using the SRA/Cardios and Geratherm Converter program and submit ted to the SRA-Apoplex medical/Geratherm analysis algorithm. The SRA identifies three possibilities for classifying patient risk: a) Risk 0: patient in sinus rhythm; b) Risk 1: patient at increased risk for paroxysmal AF; c) Risk 2: patient with AF already present. For Group I, SRA were considered positive when Risks 1 and 2 were identified. For Group II, those identified as Risk 0 were considered negative SRA. RESULTS: POAF occurred in 33/114 patients (28%). The sensitivity, specificity, positive predictive value, and negative predictive value of the SRA to identify patients with POAF were 69%, 84%, 69%, and 82%, respectively; the positive and negative likelihood ratios, in addition to the accuracy of the SRA were, respectively, 4.3%, 0.36%, and 79%. A sub analysis of the RESULTS: of the day on which AF occurred was performed on the records obtained in the first three hours of recording and up to three hours before the appearance of POAF. In the first period, the SRA was able to predict POAF in 57% of cases, while in the second period, the system identified the arrhythmia in 83% of cases. CONCLUSIONS: a) The SRA presents good accuracy to predict POAF; b) its accuracy is moderate in the first three hours of recording; c) the accuracy increases significantly near the beginning of POAF; d) these findings indicate that electrophysiological changes that precede POAF are acute, occurring a few hours before the event and are identified by the SRA algorithm.

[Guidelines on atopic dermatitis for Mexico (GUIDAMEX): using the ADAPTE methodology]. / Guía de dermatitis atópica para México (GUIDAMEX): lineamientos usando metodología ADAPTE.

With the advancement of knowledge in relation to the physiopathogenesis of atopic dermatitis (AD), several new therapeutic forms have been developed. There are also new guidelines for self-care. On the other hand, there is still an underdiagnosis of AD in Mexico. Thus, the need was seen to develop a national guide, with a broad base among the different medical groups that care for patients with AD. The Atopic Dermatitis Guidelines for Mexico (GUIDAMEX) was developed with the ADAPTE methodology, with the endorsement and participation of ten national medical societies, from physicians in Primary Healthcare to allergists and dermatologists. Throughout the manuscript, key clinical questions are answered that lead to recommendations and suggestions for the diagnosis of AD (including differential diagnosis with immunodeficiency syndromes), the recognition of comorbidities and complications, non-pharmacological treatment including therapeutic education, treatment of flares and maintenance therapy. The latter encompasses general measures to avoid triggering factors, first-line treatment focussed on repair of the skin barrier, second-line treatment (topical proactive therapy), and third-line phototherapy or systemic treatment, including dupilumab and JAK inhibitors.

Con el avance de los conocimientos en relación con la fisiopatogenia de la dermatitis atópica (DA) se han desarrollado varias formas terapéuticas nuevas. Asimismo, existen nuevos lineamientos para el autocuidado. Por otro lado, aún existe un subdiagnóstico de la DA en México. Así, se vio la necesidad de desarrollar una guía nacional, con base amplia entre las diferentes agrupaciones médicos que atienden pacientes con DA. Se desarrolló la Guía de DA para México (GUIDAMEX) con la metodología ADAPTE, con el aval y la participación de diez sociedades médicas nacionales, desde médicos del primer contacto hasta alergólogos y dermatólogos. A lo largo del escrito se contestan preguntas clínicas clave que llevan a recomendaciones y sugerencias para el diagnóstico de la DA (incluyendo diagnóstico diferencial con síndromes de inmunodeficiencia), el reconocer de las comorbilidades y complicaciones, las medidas generales (tratamiento no farmacológico) incluyendo la educación terapéutica, el tratamiento de los brotes y el tratamiento de mantenimiento. Este último abarca las medidas generales de evitar agravantes, el tratamiento de primera línea reparador de la barrera cutánea, de segunda línea (manejo proactivo tópico), hasta la fototerapia y el tratamiento sistémico de la tercera línea, incluyendo dupilumab y los inhibidores de la cinasa de Jano.

Bacteriophage Genetic Edition Using LSTM.

Bacteriophages are gaining increasing interest as antimicrobial tools, largely due to the emergence of multi-antibiotic-resistant bacteria. Although their huge diversity and virulence make them particularly attractive for targeting a wide range of bacterial pathogens, it is difficult to select suitable phages due to their high specificity which limits their host range. In addition, other challenges remain such as structural fragility under certain environmental conditions, immunogenicity of phage therapy, or development of bacterial resistance. The use of genetically engineered phages may reduce characteristics that hinder prophylactic and therapeutic applications of phages. Nowadays, there is no systematic method to modify a given phage genome conferring its sought characteristics. We explore the use of artificial intelligence for this purpose as it has the potential to both guide and accelerate genome modification to generate phage variants with unique properties that overcome the limitations of natural phages. We propose an original architecture composed of two deep learning-driven components: a phage-bacterium interaction predictor and a phage genome-sequence generator. The former is a multi-branch 1-D convolutional neural network (1D-CNN) that analyses phage and bacterial genomes to predict interactions. The latter is a recurrent neural network, more particularly a long short-term memory (LSTM), that performs genomic modifications to a phage to offer substantial host range improvement. For this component, we developed two different architectures composed of one or two stacked LSTM layers with 256 neurons each. These generators are used to modify, more precisely to rewrite, the genome sequence of 42 selected phages, while the predictor is used to estimate the host range of the modified bacteriophages across 46 strains of Pseudomonas aeruginosa. The proposed generators, trained with an average accuracy of 96.1%, are able to improve the host range for an average of 18 phages among the 42 under study, increasing both their average host range, by 73.0 and 103.7%, and the maximum host ranges from 21 to 24 and 29, respectively. These promising results showed that the use of deep learning methodologies allows genetic modification of phages to extend, for instance, their host range, confirming the potential of these approaches to guide bacteriophage engineering.

Effect of Process Parameters on the Graphite Expansion Produced by a Green Modification of the Hummers Method.

Adsorption stand out among other standard techniques used for water treatment because of its remarkable simplicity, easy operation, and high removal capability. Expanded graphite has been selected as a promising agent for oil spill adsorption, but its production involves the generation of corrosive remnants and massive amounts of contaminated washing waters. Although the advantageous use of the H2O2-H2SO4 mixture was described in 1978, reported works using this method are scarce. This work deals with the urgent necessity for the development of alternative chemical routes decreasing their environmental impact (based on green chemistry concepts), presenting a process for expanded graphite production using only two intercalation chemicals, reducing the consumption of sulfuric acid to only 10% and avoiding the use of strong oxidant salts (both environmentally detrimental). Three process parameters were evaluated: milling effect, peroxide concentration, and microwave expansion. Some remarkable results were obtained following this route: high specific volumes elevated oil adsorption rate exhibiting a high oil-water selectivity and rapid adsorption. Furthermore, the recycling capability was checked using up to six adsorption cycles. Results showed that milling time reduces the specimen's expansion rate and oil adsorption capacity due to poor intercalant insertion and generation of small particle sizes.

Surface Inactivation of Highly Mutated SARS-CoV-2 Variants of Concern: Alpha, Delta, and Omicron.

Continued SARS-CoV-2 transmission among the human population has meant the evolution of the virus to produce variants of increased infectiousness and virulence, coined variants of concern (VOCs). The last wave of pandemic infections was driven predominantly by the delta VOC, but because of continued transmission and adaptive mutations, the more highly transmissible omicron variant emerged and is now dominant. However, due to waning immunity and emergence of new variants, vaccines alone cannot control the pandemic. The application of an antiviral coating to high-touch surfaces and physical barriers such as masks are an effective means to inactivate the virus and their spread. Here, we demonstrate an environmentally friendly water-borne polymer coating that can completely inactivate SARS-CoV-2 independent of the infectious variant. The polymer was designed to target the highly glycosylated spike protein on the virion surface and inactivate the virion by disruption of the viral membrane through a nano-mechanical process. Our findings show that, even with low amounts of coating on the surface (1 g/m2), inactivation of alpha, delta, and omicron VOCs and degradation of their viral genome were complete. Furthermore, our data shows that the polymer induces little to no skin sensitization in mice and is non-toxic upon oral ingestion in rats. We anticipate that our transparent polymer coating can be applied to face masks and many other surfaces to capture and inactivate the virus, aiding in the reduction of SARS-CoV-2 transmission and evolution of new variants of concern.

Clinical Proof of Concept for Stabilization of Tracheostomy Tubes Using Novel DYNAtraq Device.

Introduction: Tracheostomy is one of the most common surgical strategies in intensive care units (ICU) and provides relevant clinical benefit for multiple indications. However, the complications associated with its use range from 5 to 40% according to different series. The risk of these complications could be reduced if fixation strategies and alignment of the tracheostomy tube with respect to the tracheal axis are improved. Aim: To build a functional device of technological innovation in respiratory medicine for the fixation and alignment of tracheostomy cannula (acronym DYNAtraq) and to evaluate its feasibility and safety in a pilot study in mechanically ventilated patients. Methods: Study carried out in four phases: (1) design engineering and functional prototyping of the device; (2) study of cytotoxicity and tolerance to the force of traction and push; (3) pilot study of feasibility and safety of its use in tracheostomized and mechanically ventilated patients; and (4) health workers satisfaction study. Results: The design of the innovative DYNAtraq device included, on the one hand, a connector with very little additional dead space to be inserted between the cannula and the ventilation tubes, and, on the other hand, a shaft with two supports for adhesion to the skin of the thorax with very high tolerance (several kilograms) to pull and push. In patients, the device corrected the malpositioned tracheostomy tubes for the latero-lateral (p < 0.001) and cephalo-caudal angles (p < 0.001). Its effect was maintained throughout the follow-up time (p < 0.001). The use of DYNAtraq did not induce serious adverse events and showed a 70% protective effect for complications (RR = 0.3, p < 0.001) in patients. Conclusion: DYNAtraq is a new device for respiratory medicine that allows the stabilization, alignment and fixation of tracheostomy tubes in mechanically ventilated patients. Its use provides additional benefits to traditional forms of support as it corrects misalignment and increases tolerance to habitual or forced movements. DYNAtraq is a safe element and can reduce the complications of tracheostomy tubes.

Novel Variation in Acyl-CoA Synthetase Long Chain Family Member 6 (ACSL6) Results in Protein Structural Modification and Multiple Non-Related Neoplasia in a 46-Year-Old: Case Report.

Multiple non-related neoplasia does not have an established approach or benefits for performing whole-exome sequencing (WES) analysis. We report on a 46-year-old woman who developed astrocytoma, thyroid, and breast cancer within 10 years. The WES analysis found a novel missense variant in the ACSL6 gene, and the protein modeling showed altered secondary and tertiary structures, which modify the binding to cofactors and substrates. ACSL6 is involved in lipid metabolism, expressed in the brain, thyroid, and breast tissues, and is associated with diverse types of cancer. Our study demonstrates the benefit of WES analysis compared with commercial panels in patients with non-related neoplasia.

Multicentric and Observational Study of Omalizumab for Chronic Spontaneous Urticaria in Real-Life in Colombia.

Background: Although chronic urticaria (CU) is a common, cause of medical consulting both in general practitioners and allergist specialists worldwide, there is little information about its behavior and management in Latin America. Currently, national and international guidelines recommend using Omalizumab for cases refractory to management with antihistamines. Despite advances in the knowledge of Omalizumab for the management of CU, although there are few studies in underdeveloped countries, there are many studies evaluating the impact of Omalizumab treatment. There is not clinical information related with CSU-Omalizumab in patient settled in the Caribbean area. This research aims to evaluate the management of CU with Omalizumab in a real-life scenario in Colombia. Methodology: We conducted an observational, descriptive, and retrospective study with patient recruitment between 2014 and 2017 of individuals diagnosed with Chronic Urticaria (CU) treating allergology specialists in five Colombian cities. We included patients with CU who failed to achieve disease control after treatment for 4 weeks with fourfold doses of second-generation H1-antihistamines, as recommended by the EAACI/GA2LEN/EDF/WAO guidelines and who received treatment with Omalizumab. Results: We included 123 patients, 73.1% (n = 90) were women. The mean age was 47.1 years (Standard Deviation, SD: 16.2). The median of the total months of disease evolution was 30 (IQR = 13-58). 81.3 % (n = 100) of patients were diagnosed with chronic spontaneous urticarial (CSU). 4.8% (n = 6) had inducible CU (CIndU), and 13.8% (n = 17) reported mixed urticaria (spontaneous CU with at least one inducible component). Regarding emotional factors, 34.9% (n = 43) of subjects indicated anxiety symptoms, 34.1% (n = 42) had exacerbations associated with stress, and 14.6% (n = 18) manifested episodes of sadness. The percentage of patients with CSU controlled according to medical criteria at 3 months with Omalizumab were 80% (n = 80/100) and at 6 months 87% (n = 87/100). The frequency of adverse events was 29.2% (n = 36), with headache being the most frequent adverse event. Conclusions: This real-life study with Omalizumab at CU describes percentages of effectiveness and safety similar to those observed in pivotal and real-life studies conducted in other regions around the world.

Acurácia do SRA para identificação e fibrilação atrial de pós operatório de cirurgia cardíaca: implicação sobre o mecanismo de deflagração dessa arritmia / Accuracy of the RAS for identification and atrial fibrillation after cardiac surgery: implications for the triggering mechanism of this arrhythmia

INTRODUÇÃO: A fibrilação atrial de pós-operatório de cirurgia cardíaca (FAPO) é uma entidade clínica que acomete cerca de 30% dos pacientes submetidos a revascularização miocárdica. Seus mecanismos de origem ainda são poucos compreendidos. Estudos clínicos indicam que instabilidades na atividade elétrica atrial (incremento de ectopias e taquicardias atriais) precedem gradualmente o surgimento dessa arritmia. O SRA (Stroke Risk Analysis) é uma ferramenta utilizada para identificar pacientes com risco de fibrilação atrial (FA) ambulatorial. No seu algoritmo são consideradas a presença de ectopias atriais, assim como a variabilidade de RR pelo sistema Poincaré. O uso dessa ferramenta para identificação de FAPO ainda não foi testada em nosso meio. OBJETIVO: Avaliar a utilização do SRA para caracterização do risco de FAPO bem como o mecanismo de origem dessa arritmia. MÉTODOS: 114 pacientes foram submetidos ao Holter de sete dias a partir do dia um de pós operatório, cujas gravações foram desmembradas em trechos de uma hora e submetidos ao algoritmo do SRA. Foram considerados positivos aqueles com risco maior de FA segundo o software do equipamento. RESULTADOS: A incidência de FA foi de 28%, com pico de detecção no segundo dia (56%). A sensibilidade, especificidade, valor preditivo positivo e negativo e razão de verossimilhança positiva do SRA em identificar FAPO foram respectivamente 69%, 84%, 69%, 82%, 4,3. A acurácia do sistema foi de 79%. Os resultados positivos do SRA referente as primeiras 3 horas iniciais da gravação do dia que aconteceu o evento foi de 57%. Quando se analisaram às três horas que antecederam a FAPO, o número de resultados positivos SRA foi de 82% (p< 0,000). Houve um incremento da probabilidade pós teste para detecção de FA de 26%. Esse incremento na detecção da FAPO 3 horas antes de sua ocorrência indica que o circuito arritmogênico se instabiliza agudamente, ao contrário da FA ambulatorial. CONCLUSÃO: De maneira diferente da FA ambulatorial, o SRA tem capacidade modesta para identificar FAPO quando analisado mais de 3 horas antes do evento. B) Os achados do SRA 3h antes da FAPO apresenta elevada acurácia para detecção dessa arritmia, confirmando que FA é resultado de uma instabilidade aguda da atividade elétrica atrial. C) O mecanismo da FAPO difere daqueles FA paroxística não relacionada a cirurgia.

Factores asociados a la aparición de aterosclerosis subclínica en lupus eritematoso sistémico / Factors associated with the appearance of subclinical atherosclerosis in systemic lupus erythematosus

RESUMEN Introducción: El lupus eritematoso sistémico es una enfermedad inflamatoria, crónica, multisistémica, que se define por sus múltiples rasgos clínicos y por la casi invariable presencia de autoanticuerpos dirigidos contra uno o más componentes del núcleo celular. Objetivo: Caracterizar a los pacientes con lupus eritematoso sistémico e identificar su posible relación con la aterosclerosis subclínica. Métodos: Se realizó un estudio transversal, descriptivo, de pacientes con diagnóstico de lupus eritematoso sistémico, atendidos en el Centro de Reumatología en La Habana, durante el periodo comprendido entre octubre del 2015 a octubre del 2017. La muestra fue no probabilística y estuvo formada por 50 pacientes. Se empleó estadística descriptiva e inferencial. Resultados: Del total de pacientes el 54,0 % (n = 27) presentaba aterosclerosis subclínica. Los factores de riesgo tradicionales que mostraron asociación con la presencia de placa en pacientes con LES fueron la hipercolesterolemia, 70,4 % (n = 19) e hipertrigliceridemia 55,6 % (n = 15). Se observó relación entre el tiempo de evolución, presencia de daño acumulado, compromiso renal, cifras de PCR y dosis acumulada de esteroides, con la presencia de aterosclerosis subclínica. Conclusiones: Se constató en pacientes con LES y presencia de placa un promedio de edad mayor. Los factores de riesgo tradicionales que mostraron asociación con la presencia de placa aterosclerótica fueron hipercolesterolemia e hipertrigliceridemia. Se comprobó asociación entre el tiempo de evolución, daño acumulado, compromiso renal, cifras de PCR y dosis acumulada de esteroides, con la presencia de placa. En los pacientes del estudio el uso de cloroquina estuvo asociado a la no aparición de aterosclerosis subclínica.

ABSTRACT Introduction: Systemic lupus erythematosus is an inflammatory, chronic, multisystemic disease, which is defined by its multiple clinical features and by the almost invariable presence of autoantibodies directed against one or more components of the cell nucleus. Objective: To characterize patients with Systemic Lupus Erythematosus and to identify its possible relationship with subclinical atherosclerosis. Methods: A descriptive cross-sectional study of patients diagnosed with Systemic Lupus Erythematosus, treated at the Rheumatology Center in Havana, was carried out during the period from October 2015 to October 2017. The sample was non-probabilistic and consisted of 50 patients. Descriptive and inferential statistics were used. Results: Of the total number of patients, 54.0% (n=27) had subclinical atherosclerosis. The traditional risk factors that showed association with the presence of plaque in patients with SLE were hypercholesterolemia, 70.4% (n=19) and hypertriglyceridemia 55.6% (n=15). A relationship was observed between the time of evolution, the presence of accumulated damage, renal compromise, CRP figures and accumulated dose of steroids, with the presence of subclinical atherosclerosis. Conclusions: A higher average age was found in patients with SLE and presence of plaque. The traditional risk factors that showed association with the presence of atherosclerotic plaque were hypercholesterolemia and hypertriglyceridemia. An association was found between the time of evolution, the presence of accumulated damage, renal compromise, CRP figures and the accumulated dose of steroids, with the presence of plaque. In the study patients, the use of chloroquine was associated with the absence of subclinical atherosclerosis.