Molecular and morphometric data provide evidence of intraspecific variation in shape and pigmentation pattern in Otocinclus cocama (Siluriformes: Loricariidae) across major river drainages.

Otocinclus cocama, a uniquely colored species of the loricariid catfish genus Otocinclus described solely from the type locality in the lower Ucayali River in northern Peru, is reported occurring in the Tigre River, a tributary to the Marañón River that drains a different section of the Andean Mountain range in the western Amazon. Both populations differ in the number of dark bars spanning the flanks of the body, and we investigated whether these morphotypes constitute distinct species. The body shapes of populations from the Tigre and Ucayali rivers were compared using geometric morphometrics. Although principal component analysis detected a broad overlap between populations, multivariate analysis of variance and linear driscriminat analysis revealed a subtle differentiation between the populations of the two hydrographic basins. Average body shape of the Ucayali River population tend to be slightly higher than that of the Tigre River, with the caudal peduncle stretched vertically in the Ucayali population. Multivariate regression of shape and centroid size revealed an allometric effect of 10.7% (p < 0.001), suggesting that the variation between Tigre and Ucayali populations was purely shape variation. Molecular data of coI, cytb, nd2, and 16S mitochondrial genes indicated a nucleotide diversity range from 0.001 to 0.003, and haplotypic diversity range from 0.600 ± 0.11 to 0.79 ± 0.07. The median-joining haplotype network for the concatenated matrix exhibited two divergent haplogroups related to the geographic area and separated by <10 mutational steps. The molecular species delimitation methods based on distance (automatic barcode gap discovery and assemble species by automatic partitioning) recovered two molecular lineages evolving independently, being one of the lineages formed by individuals from both populations. Tree-based methods (generalized mixed Yule coalescent and Bayesian implementation of the Poisson tree process) recovered similar topologies and supported single lineage recognition. Methods of molecular delimitation of species disclosed the high similarity between the two populations of Otocinclus cocama, further supported by the presence of old haplotypes common to both groups which could indicate that the populations still maintain gene flow. Although the morphological data reveal a subtle variation between both river basins, the molecular data suggest a weak population structuration based on hydrographic areas, but not different species lineages, therefore Otocinclus cocama is composed of a single lineage with two distinct morphotypes.

[Prognostic scale for in-hospital mortality in patients with COVID-19 viral pneumonia]. / Escala pronóstica para mortalidad intrahospitalaria en pacientes con neumonía viral COVID-19.

Background: The COVID-19 pandemic represented a challenge in medical care. A tool would be very useful to establish the prognosis of in-hospital death that is reliable and can be applied to the Mexican population entitled to the IMSS. Objective: To propose a prognostic scale to stratify patients with viral pneumonia COVID-19 in the emergency services. Material and methods: A nested case-control study was conducted in a cohort of patients who were consecutively admitted to the emergency department with viral pneumonia COVID-19. The cases were those patients who died, and the controls were those who were discharged due to health improvement. An association analysis was performed between the variables with significant differences between groups. Subsequently, the association was adjusted using a multivariate logistic regression model, from which the prognostic scale was developed. Results: A total of 70 subjects with COVID-19 were included, 34 cases and 36 controls. Chronic diseases, smoking, severe pulmonary involvement diagnosed by tomography, leukocytosis, and pulse oximetry less than 80% with were associated with in-hospital mortality; Odds Ratio (OR) of >1.1. Vaccination was a protective factor (OR = 0.04, CI95%: 0.01-0.16). A score greater than 3 points on the prognostic scale predicts in-hospital mortality with a specificity of 0.86 and a sensitivity of 0.73. Conclusions: The proposed prognostic scale can be a useful tool in the classification of patients with COVID-19 viral pneumonia in the emergency room services of secondary care level Hospitals.

Introducción: la pandemia por COVID-19 representó un reto en la atención médica. Sería de gran utilidad una herramienta para establecer el pronóstico de muerte intrahospitalaria que sea confiable y pueda aplicarse a la población mexicana derechohabiente del Instituto Mexicano del Seguro Social. Objetivo: proponer una escala pronóstica para estratificar a los pacientes con neumonía viral por COVID-19 en los servicios de urgencias de los hospitales de segundo nivel. Material y métodos: se realizó un estudio de casos y controles anidado en una cohorte de pacientes adultos que fueron admitidos consecutivamente en el servicio de Urgencias con diagnóstico de neumonía viral por COVID-19. Los casos fueron aquellos pacientes que fallecieron y los controles aquellos que fueron egresados de la unidad por mejoría. Se realizó un análisis de asociación ente las variables con diferencias significativas entre ambos grupos, se ajustó la asociación mediante un modelo de regresión logística multivariada a partir del cual se elaboró la escala pronóstica. Resultados: se incluyeron en total 70 personas con COVID-19, 34 casos y 36 controles. Se asociaron a la mortalidad intrahospitalaria: las enfermedades crónicas, el tabaquismo, la afectación pulmonar severa diagnosticada por tomografía, la leucocitosis y la oximetría de pulso menor a 80% con una razón de Momios (RM) de > 1.1. La vacunación fue un factor protector (RM: 0.29, IC95%: 0.11-0.80). Un puntaje mayor a 3 puntos en la escala pronóstica predice la mortalidad intrahospitalaria (sensibilidad: 0.73, especificidad: 0.86). Conclusiones: la escala pronóstica propuesta puede ser una herramienta útil en la clasificación de los pacientes con neumonía viral por COVID-19 en los servicios de urgencias de los hospitales de segundo nivel de atención.

Challenges of remotely witnessed emergencies - A case of international out-of-hospital cardiac arrest recognition via video call.

We present the first report, to our knowledge, of an Out-of-hospital cardiac arrest (OHCA) witnessed during a remote international video meeting. We report an emergency system activation and OHCA resuscitation initiated after an OHCA in a 41-year-old otherwise healthy female in Houston, Texas witnessed by a co-worker in Australia during a 1-on-1 Zoom video call. Remotely witnessed emergencies such as OHCA present unique challenges to successful cardiac resuscitation and will likely become significantly more common in the future as remote video calls increase.

Species-level ichthyoplankton dynamics for 97 fishes in two major river basins of the Amazon using quantitative metabarcoding.

The Amazon basin holds the world's largest freshwater fish diversity. Information on the intensity and timing of reproductive ecology of Amazonian fish is scant. We use a metabarcoding method by capture using a single probe to quantify species-level ichthyoplankton dynamics. We sampled the Marañón and the Ucayali rivers in Peru monthly for 2 years. We identified 97 species that spawned mainly during the flood start, the flood end or the receding periods, although some species had spawning activity in more than one period. This information was new for 40 of the species in the Amazon basin and 80 species in Peru. Most species ceased spawning for a month during a strong hydrological anomaly in January 2016, demonstrating the rapidity with which they react to environmental modifications during the breeding season. We also document another unreported event in the Amazon basin, the inverse phenology of species belonging to one genus (Triportheus). Overall larval flow in the Marañón was more than twice that of the Ucayali, including for most commercial species (between two and 20 times higher), whereas the Ucayali accounts for ~80% of the fisheries landings in the region. Our results are discussed in the light of the main anthropogenic threats to fishes, hydropower dam construction and the Hidrovía Amazónica, and should serve as a pre-impact baseline.

Clinical manifestations and risk factors for oral immune reconstitution inflammatory syndrome in Mexico.

The immune reconstitution inflammatory syndrome (IRIS) is a rare acute complication presenting in people living with HIV (PLWH) within the first 6 months of starting combined antiretroviral therapy (cART). While there is relevant information about its pathogenesis and clinical spectrum, IRIS-oral lesions (IRIS-OLs) have been scarcely described. Thus, to establish the incidence and clinical characteristics of IRIS-OLs, data from a cohort of 158 HIV individuals starting cART, followed for 6 months, were obtained retrospectively. IRIS-OLs developed in 11.4% of the individuals, in a median time of 87.5 days, with oral candidiasis being the most frequent manifestation detected in eight individuals (5.1%). The study emphasizes the importance of the correct diagnosis and management of these lesions.

Características epidemiológicas y costos de la atención de las heridas en unidades médicas de la Secretaría de Salud / Epidemiological characteristics and wound care costs in medical units of the Secretaria de Salud

Resumen

Introducción: la atención de las heridas implica una importante inversión económica, relacionada con la formación y contratación de recursos humanos especializados en el cuidado de heridas, la adquisición de insumos de alta tecnología y el incremento en los días de estancia hospitalaria de los pacientes o del número de reingresos.

Objetivo: describir las características epidemiológicas y los costos directos de la atención de las heridas en las unidades médicas de la Secretaría de Salud.

Metodología: estudio descriptivo, prospectivo y transversal, en una muestra de 159 unidades médicas de la Secretaría de Salud con un total de 36 022 casos de heridas.

Resultados: la atención de las heridas principalmente fue en unidades de segundo nivel (79.4%) y ambulatorias (75.1%). Las heridas más recurrentes fueron las heridas traumáticas (26.6%) y las úlceras de pie diabético (23.4%). Los costos directos mensuales fueron estimados en $46 563 070.76 (ambulatorio) y $1 864 124 436.89 (hospitalización).

Conclusión: las heridas continúan siendo un problema de salud pública que representa un elevado gasto económico para las unidades médicas de la Secretaría de Salud.

Abstract

Introduction: Wound care involves an important economic investment, related to the training and hiring of specialized human resources in the care of wounds, the acquisition of high technology inputs and the increase in days of hospital stay of patients and/or the number of réadmissions. Objective: To describe the epidemiological characteristics and the direct costs of wound care in the medical units of the Mexican Secretaria de Salud (Ministry of Health).

Methods: Descriptive, prospective and cross-sectional study, in a sample of 159 medical units of the Secretaria de Salud with a total of 36 022 cases of injuries.

Results: The attention of the wounds was mainly in units of second level (79.4%) and ambulatory (75.1%); the most recurrent were traumatic injuries (26.6%) and diabetic foot ulcers (23.4%). The direct monthly costs were estimated at 46 563 070.76 MXN (outpatient) and $ 1 864 124 436.89 MXN (hospitalization).

Conclusion: Wounds continue to be a public health problem that represents a high economic cost for the medical units of the Secretaria de Salud.

Synthesis of substituted ß-diketiminate gallium hydrides via oxidative addition of H-O bonds.

Oxidative addition of LGa into the OH bonds from HCCCH2OH, Ph2Si(OH)2, (nBuO)2P(O)(OH) and 4-MeC6H4S(O)2(OH) results in the formation of four compounds of the general formula LGa(H)(O-X). The correlation of the Ga-O bond length and the strength of the Ga-H bond depending on the acidity of the OH group in the starting materials has been demonstrated. The molecular structures of all four compounds have been determined using single crystal X-ray diffraction experiments. DFT calculations were performed on the reacting complex of LGa with propargyl alcohol and show an OHGa hydrogen bond as the first interaction between the reagents. This reacting complex changes into a D-A complex where the oxygen atom of the propargyl alcohol coordinates to the gallium atom and in a concerted reaction the oxidative addition product is formed.

Continuous flow micro-bioreactors for the production of biopharmaceuticals: the effect of geometry, surface texture, and flow rate.

We used continuous flow micro-devices as bioreactors for the production of a glycosylated pharmaceutical product (a monoclonal antibody). We cultured CHO cells on the surface of PMMA/PDMS micro-channels that had been textured by micromachining and coated with fibronectin. Three different micro-channel geometries (a wavy channel, a zigzag channel, and a series of donut-shape reservoirs) were tested in a continuous flow regime in the range of 3 to 6 µL min(-1). Both the geometry of the micro-device and the flow rate had a significant effect on cell adhesion, cell proliferation, and monoclonal antibody production. The most efficient configuration was a series of donut-shaped reservoirs, which yielded mAb concentrations of 7.2 mg L(-1) at residence times lower than one minute and steady-state productivities above 9 mg mL(-1) min(-1). These rates are at about 3 orders of magnitude higher than those observed in suspended-cell stirred tank fed-batch bioreactors.

A biopharmaceutical plant on a chip: continuous micro-devices for the production of monoclonal antibodies.

We report a proof-of-principle for the use of micro-devices as continuous bioreactors for the production of monoclonal antibodies. We culture CHO cells on the surface of PMMA "zigzag" channels textured with semi-spherical cavities coated with fibronectin, observing steady-state productivities 100 times higher than those observed in full scale systems.

Presentación sistémica de Aspergillus spp con semiología neurológica en un Pastor Alemán: informe de un caso clínico / Systemic presentation of Aspergillus spp with neurological involvement in a German Shepherd: clinical case report

Infections of the central nervous system are uncommon in dogs. Pathogenic fungi such as Aspergillus, Cryptococcus spp, Blastomyces dermatitidis and Coccidioides immitis have been reported. An Aspergillus infection is mainly a respiratory event and very seldom it may become disseminated, the German shepherd seems to be the more prone to this type of aspergillosis specially if an immunological deficiency is present. A 1.5 year old female German Shepherd from Cancun, Quintana Roo, State, in the southeast of Mexico was presented to the small animal hospital, she showed tetraparesis, hiporeflex and deep retarded sensitivity in all four members, loss of sensitivity in the left side of the face, absence of pupil reflex and menace reflex as well as absence of muscular tone of the vulva and anal sphincter. The third day after presentation, she died. At necropsy polyencephalomalace, mielitis and diffuse leucomielitis piogranomalotosus were found. In the cytology of lymph node and other tissues aspergilli like hiphae were observed, this was confirmed by using the highly specific double diffusion test. Then, a PCR test was carried out with tissue fixed in 10% formaldehyde, but it failed probably due to destruction of the DNA.

La infección del sistema nervioso en el perro es poco común; posibles causas son Aspergillus spp, Cryptococcus neoformans, Blastomyces dermatidis y Coccidioides immitis. La infección por Aspergillus spp afecta al aparato respiratorio y en pocas ocasiones se presenta de manera diseminada. Sin embargo, en el Pastor Alemán hay mayor incidencia de éste, pues dicha infección se asocia con una deficiencia inmunológica. Se describe el caso de una perra de raza Pastor Alemán, de 1.5 años de edad, referida de Cancún, Quintana Roo, México, con tetraparesis, hiporreflexia y sensibilidad profunda retardada en los cuatro miembros, disminución de sensibilidad en el lado derecho de la cara y ausencia de reflejo pupilar y de amenaza en ojo derecho; además de ausencia de tono vulvar y de esfínter anal. A los tres días después del ingreso la perra falleció. A la necropsia se encontró polioencefalomalacia, mielitis y leucomielitis piogranulomatosa difusa. En la citología de linfonodo y en la histopatología de diferentes tejidos se identificaron hifas compatibles con Aspergillus spp. Con el fin de dar certeza al diagnóstico, se realizó prueba de doble inmunodifusión, que es altamente específica, la cual confirmó el diagnóstico de Aspergillus spp. Posteriormente se corrió PCR a partir de una muestra de tejido en formalina al 10%, para identificar la especie, en donde no se lograron resultados, probablemente debido a la destrucción del ADN por el formaldehído.

[Cost analysis: metronidazole-amikacin vs. preoperative monodose of ceftriaxone in appendicitis. Preliminary report]. / Análisis de costos: metronidazol-amikacina versus monodosis preoperatoria de ceftriaxona en apendicitis. Reporte preliminar.

INTRODUCTION: Postoperative management of acute appendicitis in our country has been supported by results from studies overseas. Ampicillin, clindamycin and gentamicin is the classic association of antimicrobial drugs. However, it is expensive, unnecessary and risky. We believe that a single dose can be useful. MATERIAL AND METHODS: We studied two groups comprised of 82 patients each in whom an appendectomy was performed. In group A an intravenous (i.v.) dose of ceftriaxone was given 30-240 minutes before skin incision. Group B or control group was comprised by the same number of patients previously operated and managed under traditional method (amikacin-metronidazole). RESULTS: In group A, three wound infections and an intraperitoneal abscess were identified, while in group B only one wound infection was seen. Average cost for patients in group A was 2,108.91 pesos (approx. 200 US dollars). In group B, the average cost was 9,407.48 pesos (approx. 900 US dollars). CONCLUSIONS: One dose of preoperative ceftriaxone proved to be most financially economical.

[Battered child syndrome. Surgical implications]. / Síndrome del niño maltratado. Implicaciones quirúrgicas.

INTRODUCTION: Major trauma, specially abdominal and thoracic trauma due to child abuse is a serious, but fortunately infrequent problem which carries unacceptably high mortality. MATERIAL AND METHODS: We reviewed our experience with childhood trauma due to battered child syndrome in our hospital to learn the extent, circumstances, presentations, and consequences of this kind of events. Our hospital is the most important center for traumatized child care in Mexico. RESULTS: After our study, mild trauma due to child abuse accounted for 35 and major trauma accounted for 50 cases. In the former group, 10 patients with fractures were observed; 21 were male patients. Children were abused by father or stepfather in the 21 cases, and by the mother in six. There was delay in seeking immediate medical attention treatment in all patients. In the second group, there were ruptures of small bowel in 27, of the colon in four patients, pancreas in three, and esophagus in two. Lung, pleura, bladder, spleen and other anatomic structures also were affected. Five patients died. Similarity between the two patient groups studied indicates both the widespread nature of child abuse and the need to suspect this diagnosis whenever a child is present with unexplained shock or peritonitis, specially if there is anemia or bilious emesis. Delay in diagnosis contributed to mortality.

El buen trato / Humane relations

El autor presenta las innumerables formas que existen en Colombia de maltrato a los niños y como se hace necesaria una sostenida campaña nacional a lo largo y ancho de la geografia colombiana en inspecciones, veredas, municipios y en donde hay un hogar para evitar que esto siga sucediendo.

Síndrome de Tolosa Hunt / Tolosa Hunt Syndrome

El síndrome de Tolosa Hunt es una entidad clínica caracterizada por una lesión granulomatosa a nível del seno cavernoso que da origen a una oftalmoplejía dolorosa con respeto de la pupila. La respuesta favorable a los esteroides en estos pacientes generalmente hace el diagnóstico. La venografía orbitaria es un procedimiento útil en el diagnóstico; puede mostrar obstrucción de la vena orbitaria superior flujo venoso colateral u opacificación del seno cavernoso que sugiere un flujo disminuido a través del seno carvenoso. Se estudiaron dos pacientes de 17 y 30 años de edad cuyo motivo de consulta fue el de diplopia y dolor retrocular. Los dos casos mostraron al examen neurológico únicamente compromiso de un III par incompleto con respecto de la pupila. A los dos pacientes se les hizo una venografía orbitaria, la cual fue compatible con el diagnóstico de Tolosa Hunt

Estudio clínico de potenciales evocados y bandas oligoclonales en esclerosis múltiple / Clinical study of evoked potentials and oligoclonal bands in multiple sclerosis

Se estudiaron 30 pacientes con diagnóstico definitivo de esclerosis múltiple de acuerdo con los criterios clínicos de Schumacher. La edad de presentación de la enfermedad asciló entre los 13 y 53 años, con un predominio del 63.3% para el sexo femenino. Se utilizaron como métodos diagnósticos el cuadro clínico, en el cual predominaron como síntomas de iniciación los trastornos de equilibrio y de sensibilidad; el estudio de LCR con electroforesis de proteínas, bandas oligoclonales, índice de gammaglobulinas/proteínas totales y gammaglobulinas/albúmina. También se practicó a la totalidad de los pacientes potenciales evocados somatosensoriales, visuales y de tallo. Las cifras de positividad fueron del 89% para los potenciales somatosensoriales, del 80% para los visuales y del 44.4% para los potenciales de tallo

Sindrome de Guillain-Barre / Guillain-Barre syndrome

Teniendo en cuenta que el Sindrome de Guillain-Barre no es infrecuente en nuestro medio, analizamos el cuadro clinico haciendo un analisis del LCR, la presencia de antecedentes o no y su tratamiento. Estudiamos 50 pacientes con diagnostico de Sindrome de Guillain-Barre en un total de 5601 hospitalizaciones en el FINC entre el 1o de Noviembre de 1973 y 31 de Diciembre de 1979. La frecuencia en pacientes hospitalizados fue de 0.89%. Hubo predominio en el sexo masculino 3,1:1 con una mayor incidencia en la tercera decada. 48 pacientes presentaron el cuadro clinico caracteristico y 2 un sindrome de Miller Fisher. En una tercera parte de los pacientes se encontro el antecedente infeccioso previo. El electromiograma es concluyente a partir de la segunda semana de iniciada la enfermedad. Despues de 15 dias el LCR mostro siempre un aumento significativo de las proteinas sin el correspondiente aumento de las celulas. Sin embargo, no existe relacion entre el nivel de las proteinas y la severidad, forma de iniciacion o de progresion de la enfermedad y el descenlace del sindrome.

Hiperlipidemia y accidentes cerebrovasculares oclusivos / Hyperlipidemia and occlusive cerebrovascular accidents

Se estudian cien pacientes con afecciones vasculares cerebrales, del tipo accidente cerebral trombotico y accidente transitorio. Se analizan sus perfiles lipidicos en suero segun la clasificacion internacional de Fredrickson. La verificacion diagnostica se realizo en base a los hallazgos clinicos, angiograficos y escanograficos. Predominaron los perfiles tipo II y tipo IV, siendo el IV mas frecuente en el sexo masculino. Se recalca la importancia de la escasa patologia de grandes vasos en comparacion con otros estudios. El 98% de los pacientes con problema arterial cerebral mostro algun tipo de dislipidemia.