Cultural context and self-care impact on medical students' quality of life. A mixed-methods approach.

BACKGROUND: Medical education can make it difficult for students to take actions to improve their health. OBJECTIVE: To evaluate the influence of the university context on self-care behaviors and quality of life. MATERIAL AND METHODS: A mixed-methods approach was used, with surveys being combined to assess self-care and quality of life, with in-depth interviews to explore cultural influences and perceptions. Statistical analysis and qualitative data coding were carried out, with methods being integrated through network analysis. RESULTS: Self-care scores exceeded 50 points, and quality of life scores exceeded 60 points. Medical students' context is shaped by motivations, expectations, skills, and goals that influence identity formation and contribute to the medical profession. CONCLUSIONS: There is a positive connection between self-care practices and quality of life. However, academic stress can potentially disrupt self-care routines. Furthermore, an association between obesity and a decrease in quality of life stands out, which emphasizes the need for health promotion actions.

ANTECEDENTES: La educación médica puede dificultar que los estudiantes realicen acciones para mejorar su salud. OBJETIVO: Evaluar la influencia del contexto universitario en los comportamientos de autocuidado y la calidad de vida. ­. MATERIAL Y MÉTODOS: Se empleó un enfoque de métodos mixtos, combinando encuestas para evaluar el autocuidado y la calidad de vida, con entrevistas en profundidad para explorar influencias culturales y percepciones. Se llevaron a cabo análisis estadísticos y codificación de datos cualitativos; los métodos se integraron a través del análisis de redes. RESULTADOS: Las puntuaciones de autocuidado superaron los 50 puntos y las de calidad de vida, los 60 puntos. El contexto de los estudiantes de medicina está moldeado por motivaciones, expectativas, habilidades y metas que influyen en la formación de la identidad y contribuyen a la profesión médica. CONCLUSIONES: Existe una conexión positiva entre prácticas de autocuidado y la calidad de vida; sin embargo, el estrés académico pueden interrumpir potencialmente las rutinas de autocuidado. Además, se destaca la asociación entre la obesidad y la afectación en la calidad de vida, lo que enfatiza la necesidad de acciones de promoción de la salud.

Contexto cultural e impacto del autocuidado en la calidad de vida de los estudiantes de medicina. Enfoque de métodos mixtos / Cultural context and self-care impact on medical students’ quality of life. A mixed-methods approach

Resumen Antecedentes: La educación médica puede dificultar que los estudiantes realicen acciones para mejorar su salud. Objetivo: Evaluar la influencia del contexto universitario en los comportamientos de autocuidado y la calidad de vida. Material y métodos: Se empleó un enfoque de métodos mixtos, combinando encuestas para evaluar el autocuidado y la calidad de vida, con entrevistas en profundidad para explorar influencias culturales y percepciones. Se llevaron a cabo análisis estadísticos y codificación de datos cualitativos; los métodos se integraron a través del análisis de redes. Resultados: Las puntuaciones de autocuidado superaron los 50 puntos y las de calidad de vida, los 60 puntos. El contexto de los estudiantes de medicina está moldeado por motivaciones, expectativas, habilidades y metas que influyen en la formación de la identidad y contribuyen a la profesión médica. Conclusiones: Existe una conexión positiva entre prácticas de autocuidado y la calidad de vida; sin embargo, el estrés académico pueden interrumpir potencialmente las rutinas de autocuidado. Además, se destaca la asociación entre la obesidad y la afectación en la calidad de vida, lo que enfatiza la necesidad de acciones de promoción de la salud.

Abstract Background: Medical education can make it difficult for students to take actions to improve their health. Objective: To evaluate the influence of the university context on self-care behaviors and quality of life. Material and methods: A mixed-methods approach was used, with surveys being combined to assess self-care and quality of life, with in-depth interviews to explore cultural influences and perceptions. Statistical analysis and qualitative data coding were carried out, with methods being integrated through network analysis. Results: Self-care scores exceeded 50 points, and quality of life scores exceeded 60 points. Medical students’ context is shaped by motivations, expectations, skills, and goals that influence identity formation and contribute to the medical profession. Conclusions: There is a positive connection between self-care practices and quality of life. However, academic stress can potentially disrupt self-care routines. Furthermore, an association between obesity and a decrease in quality of life stands out, which emphasizes the need for health promotion actions.

Double Myelomeningocele Repair by Fetal Surgery with a Single Micro-Hysterotomy.

INTRODUCTION: Open spina bifida (OSB) is the most common congenital anomaly of the central nervous system. It is associated with severe neurodevelopmental delay, motor impairment, hydrocephalus, and bowel and bladder dysfunction. In selected cases, intrauterine spina bifida repair has been shown to improve neonatal outcomes. Rarely, the spine can have a double defect compromising two different segments and there is a lack of evidence on the feasibility and benefits of intrauterine repair in these cases. CASE PRESENTATION: We present a case with both cervicothoracic and lumbosacral myelomeningocele, Arnold-Chiari malformation type II and bilateral ventriculomegaly, that was treated successfully at 25 weeks with open micro-neurosurgery. Double myelomeningocele was successfully treated through a single 2-cm micro-hysterotomy, by performing external versions to sequentially expose and repair both defects. Weekly postoperative follow-up showed no progression of ventriculomegaly or complications attributable to the procedure. Preterm rupture of membranes prompted a conventional cesarean delivery at 32 weeks of gestation. Neurodevelopmental outcome at 20 months was within normal ranges, having achieved ambulation without orthopedic support and with no need for ventriculoperitoneal shunting. CONCLUSION: This report demonstrates for the first time the feasibility of double OSB repair through a single 2-cm micro-hysterotomy, suggesting that selected isolated cases of double myelomeningocele could be candidates for fetal intervention. Further prospective studies should be carried out to assess the potential benefit of double OSB intrauterine open repair.

Antarctic snow algae: unraveling the processes underlying microbial community assembly during blooms formation.

BACKGROUND AND AIMS: At the West Antarctic Peninsula, snow algae blooms are composed of complex microbial communities dominated by green microalgae and bacteria. During their progression, the assembly of these microbial communities occurs under harsh environmental conditions and variable nutrient content due to fast snow melting. To date, it is still unclear what are the ecological mechanisms governing the composition and abundance of microorganisms during the formation of snow algae blooms. In this study, we aim to examine the main ecological mechanisms governing the assembly of snow algae blooms from early stages to colorful stages blooms. METHODS: The composition of the microbial communities within snow algae blooms was recorded in the West Antarctic Peninsula (Isabel Riquelme Islet) during a 35-day period using 16S rRNA and 18S rRNA metabarcoding. In addition, the contribution of different ecological processes to the assembly of the microbial community was quantified using phylogenetic bin-based null model analysis. RESULTS: Our results showed that alpha diversity indices of the eukaryotic communities displayed a higher variation during the formation of the algae bloom compared with the bacterial community. Additionally, in a macronutrients rich environment, the content of nitrate, ammonium, phosphate, and organic carbon did not play a major role in structuring the community. The quantification of ecological processes showed that the bacterial community assembly was governed by selective processes such as homogenous selection. In contrast, stochastic processes such as dispersal limitation and drift, and to a lesser extent, homogenous selection, regulate the eukaryotic community. CONCLUSIONS: Overall, our study highlights the differences in the microbial assembly between bacteria and eukaryotes in snow algae blooms and proposes a model to integrate both assembly processes. Video Abstract.

Management of Late Twin-to-Twin Transfusion Syndrome beyond 26 Weeks: Comparison between Fetoscopic Laser Therapy versus Traditional Management.

INTRODUCTION: A proportion of monochorionic diamniotic (MCDA) twin pregnancies complicated by twin-to-twin transfusion syndrome (TTTS) can present after 26 weeks of gestation. The aim of this study was to compare perinatal outcomes of late TTTS treated by fetoscopic laser coagulation versus traditional management with amniodrainage and/or emergency preterm cesarean delivery (CD). METHODS: Retrospective cohort from January 2012 to January 2023 of consecutive MCDA twin pregnancies complicated by TTTS after 26 weeks and evaluated in our referring centers. We analyzed perinatal outcomes of cases treated with fetoscopic laser surgery at our national referral fetal surgery center in Queretaro, Mexico, and compared them with those managed with traditional management (amniodrainage and/or emergency preterm CD). The primary outcome was survival at discharge and the secondary outcome was gestational age (GA) at birth. RESULTS: Among the study population, 46 TTTS cases were treated by fetoscopy at 27+6 (26+0-31+0) weeks+days and were compared with a group of 39 cases who underwent emergency preterm CD. In comparison to the group who underwent traditional management, the group treated by laser fetoscopy showed a significantly higher GA at birth (32+3 vs. 29+1 weeks+days, p < 0.001), lower frequency of preterm delivery below 37 weeks (91.3% vs. 100%, p = 0.06), 34 weeks (63.0% vs. 100%, p < 0.001), 32 weeks (50% vs. 74.4%, p = 0.02), or 30 weeks (28.3% vs. 53.8%, p = 0.01), and significantly higher perinatal survival (89.1% vs. 71.8%, p < 0.05 of at least one twin; and 65.2% vs. 38.5%, p = 0.01 of both twins, respectively). CONCLUSION: MCDA twins complicated with TTTS can be treated with fetoscopic laser surgery between 26 and 31 weeks of gestation, which is a feasible and safe option, and such cases are associated with a higher GA at birth and better perinatal survival than those managed with amniodrainage and/or emergency preterm CD.

Percepción de brechas y oportunidades en eSalud de estudiantes de último año de Medicina en Colombia

Introducción: En los últimos años la explosión de dispositivos con acceso a internet en el mundo ha presentado una oportunidad para el desarrollo de intervenciones en salud. Métodos: Se realizó un estudio observacional transversal de tipo descriptivo; se clasificaron las propuestas de innovación presentadas por estudiantes de último año de medicina como trabajo final de un curso de eSalud. Los proyectos se clasificaron en tres dimensiones: grupo poblacional, problema de salud a resolver y tipo de intervención de salud digital. Resultados: Se analizaron 86 proyectos entre los años 2017 y 2020. El 80,2 % se orienta a la población general, seguidos por la gestante (10,4 %), la infantil (8,14 %) y la geriátrica (1,2 %). El 36 % de los proyectos no mencionaban una condición particular de salud; el 12,8 % se dedicó a la salud sexual y reproductiva; el 10,4 % a las enfermedades cardiovasculares; el 9,3 % a la salud mental y el 4,65 % a aspectos de crecimiento y desarrollo. El 59,3 % de los proyectos se dirigía a apoyar las actividades del prestador de servicios de salud; el 34,9 % estaba orientado hacia las necesidades de los usuarios de los sistemas de salud y el 5,9 % se enfocó en los servicios de datos. Conclusiones: La percepción colectiva de los estudiantes refleja la oportunidad de fortalecer la atención primaria en salud mediante el uso de las tecnologías de la información y las comunicaciones, con énfasis en las poblaciones vulnerables. Los estudiantes empiezan a identificar los servicios de datos como oportunidad de intervención.

Introduction: In recent years, the explosion of devices with Internet access in the world has presented an opportunity for the development of health interventions. Methods: A descriptive cross-sectional observational study was carried out. Innovation proposals submitted by last-year medical students were classified as the final project of an eHealth course. The projects were classified into three dimensions: population group, health problem to be solved, and type of digital health intervention. Results: Eighty-six projects were analyzed from 2017 to 2020. 80.2% were aimed at the general population, followed by pregnant women (10.4%), children (8.14%) and geriatrics (1, 2 %). 36% of the projects did not mention a particular health condition; 12.8% was dedicated to sexual and reproductive health; 10.4% to cardiovascular diseases; 9.3% to mental health and 4.65% to aspects of growth and development. 59.3% of the projects were aimed at supporting the activities of the health service provider; 34.9% were oriented towards the needs of users of health systems and 5.9% focused on data services. Conclusions: The collective perception of the students reflects the opportunity to strengthen primary health care through the use of information and communication technologies, with emphasis on vulnerable populations. Students begin to identify data services as an opportunity for intervention.

Giant Partially Thrombosed Coronary Aneurysm in Multisystem Inflammatory Syndrome Associated with SARS-CoV-2 in Children.

Multisystem inflammatory syndrome in children (MIS-C) is a postinfectious condition which usually develops 4 to 6 weeks after SARS-CoV-2 infection in a genetically predisposed individual. Clinical features are heterogeneous and include fever, respiratory compromise, mucocutaneous involvement with conjunctival abnormalities and erythematous exanthem, abdominal pain, and diarrhea. Neurologic and cardiovascular symptoms can also develop, including coronary artery dilatation. Some cases involve 2 or more organs and require critical admission. Echocardiography is the mainstay of cardiac evaluation in the acute setting as well as on outpatient follow-up. We present the case of a 4-month-old female with no past medical or surgical history who presented with a prolonged febrile syndrome associated with severe respiratory illness, gastrointestinal symptoms, and mucocutaneous abnormalities. Diagnosis of MIS-C was established based on clinical findings, persistently elevated markers of systemic inflammation and positive SARS-CoV-2 molecular test and evidence of prior SARS-CoV-2 infection with SARS-CoV-2 IgG positive. Echocardiogram evidenced myopericarditis and coronary aneurysms and patient was deemed candidate for immunomodulatory therapy with intravenous immunoglobulin (IVIg), resulting in favorable clinical and paraclinical outcomes. Few cases of giant coronary aneurysms have been reported in children. There are no existing literature reports about coronary thrombosis or thrombus formation resulting from vascular aneurysmal dilations in this population. As such, the prognosis and natural history of coronary artery aneurysms in the setting of MIS-C remain largely unknown.

Bycatch and discards in the artisanal shrimp trawl fishery in Northern Peru.

This study analyses the bycatch composition of an artisanal shrimp trawl fleet operating between Cabo Blanco and Máncora in Northern Peru between April 2019 and March 2020. A total of 300 hauls were analysed with respect to target catch and bycatch (consisting of other commercial species, discards, and macroalgae). A total of 277 species were recorded including 111 species of fish, 65 species of molluscs, 51 species of crustaceans, 22 species of algae, 12 species of cnidarian, 9 species of echinoderms, 4 species of Bryozoa and 3 species of polychaeta. Capture per unit effort (CPUE, kg.h-1) was highest for fish, followed by crustaceans, algae and molluscs. The target species Penaeus californiensis coffee shrimp constituted 17.8% of the overall catch,82.2% represented bycatch, and 50.6% represented discards. Coffee shrimps were more abundant in June and November 2019 and in January and February 2020. Highest bycatch CPUE occurred in May, June and December 2019. The most abundant species in the bycatch throughout the study period were sand perch (Diplectrum conceptione, 16% weight of the total catch), the macroalgae caulerpa (Caulerpa filiformis, 13%), sole flounder (Etropus ectenes, 6.4%), Pacific drum (Larimus pacificus, 5.7%), and lumptail searobin (Prionotus stephanophrys, 5.1%). Overall, the contribution of sand perch and flounder, exceeded the weight of coffee shrimp, therefore the interpretation that shrimp is the sole target species needs to be revised. The number of discarded species per month increased towards the spring months with the highest value in November. This study represents the first characterisation of bycatch in the artisanal trawling fishery in the Piura region in northern Peru and reveals a high proportion of bycatch in the fishery but also hints at potential temporal management measures that could be imposed to reduce the levels of bycatch. For example, the months of May and December had the greatest bycatch to shrimp ratios and the fishery could potentially be closed to avoid high bycatch risk, however, longer term information is needed to assess if the trends observed in bycatch are similar over longer periods of time. The species characterisation of bycatch also provides information for the design of modified nets which would target the reduction of small fish present in the catch.

Multisystemic Inflammatory Syndrome in Children From the South of Colombia: One Year of Experience.

Background: Multisystemic inflammatory syndrome in children (MIS-C) is one of the most severe presentations of COVID-19 infection in pediatrics. Currently, we have few studies that describe the characteristics of this condition in Colombian children. Objective: To describe the clinical and epidemiological characteristics of children hospitalized with MIS-C in Neiva, Colombia. Methods: Observational follow-up study of a cohort of children with MIS-C for 12 months (May 15, 2020, to May 30, 2021) in two hospitals in the city of Neiva. Epidemiological data, clinical characteristics, laboratory characteristics, cardiological evaluation, treatment, and clinical outcomes were analyzed. Results: We included 34 patients who met the diagnosis of MIS-C. The median age was 68 months. Some type of nutritional issue was observed by 43.75% of those under 5 years of age and by 27.78% of those over 5 years of age. Gastrointestinal symptoms were the most frequent, with vomiting, diarrhea, and abdominal pain being the most frequent by 79, 70, and 67%, respectively. By 77% of the patients, a history of SARS-COV-2 infection was documented through IgG. In the echocardiogram, 35.4% of the patients had systolic dysfunction, followed by coronary involvement by 35%. Conclusion: This study describes a series of cases of children with MIS-C in Colombia. Gastrointestinal manifestations were predominant. Mortality was high in comparison to other countries but similar to that reported in Colombia. This fact was associated with relevant pathological background. More training is required for physicians in order to have a better understanding of the disease so as to have an early diagnosis and timely treatment.

Mortality and clinical characteristics of multisystem inflammatory syndrome in children (MIS-C) associated with covid-19 in critically ill patients: an observational multicenter study (MISCO study).

BACKGROUND: The clinical presentation and severity of Multisystem Inflammatory Syndrome in Children associated with COVID-19 (MIS-C) is widespread and presents a very low mortality rate in high-income countries. This research describes the clinical characteristics of MIS-C in critically ill children in middle-income countries and the factors associated with the rate of mortality and patients with critical outcomes. METHODS: An observational cohort study was conducted in 14 pediatric intensive care units (PICUs) in Colombia between April 01, 2020, and January 31, 2021. Patient age ranged between one month and 18 years, and each patient met the requirements set forth by the World Health Organization (WHO) for MIS-C. RESULTS: There were seventy-eight children in this study. The median age was seven years (IQR 1-11), 18 % (14/78) were under one year old, and 56 % were male. 35 % of patients (29/78) were obese or overweight. The PICU stay per individual was six days (IQR 4-7), and 100 % had a fever upon arrival to the clinic lasting at least five days (IQR 3.7-6). 70 % (55/78) of patients had diarrhea, and 87 % (68/78) had shock or systolic myocardial dysfunction (78 %). Coronary aneurysms were found in 35 % (27/78) of cases, and pericardial effusion was found in 36 %. When compared to existing data in high-income countries, there was a higher mortality rate observed (9 % vs. 1.8 %; p=0.001). When assessing the group of patients that did not survive, a higher frequency of ferritin levels was found, above 500 ngr/mL (100 % vs. 45 %; p=0.012), as well as more cardiovascular complications (100 % vs. 54 %; p = 0.019) when compared to the group that survived. The main treatments received were immunoglobulin (91 %), vasoactive support (76 %), steroids (70.5 %) and antiplatelets (44 %). CONCLUSIONS: Multisystem Inflammatory Syndrome in Children due to SARS-CoV-2 in critically ill children living in a middle-income country has some clinical, laboratory, and echocardiographic characteristics similar to those described in high-income countries. The observed inflammatory response and cardiovascular involvement were conditions that, added to the later presentation, may explain the higher mortality seen in these children.

Abdominal manifestation of multisystemic inflammatory syndrome in children.

SUMMARY: Multisystemic inflammatory syndrome (MIS-C) can develop as a complication of SARS CoV-2 infection, involving the gastrointestinal system mainly by vasoconstriction, edema, glandular hyperplasia, and a procoagulant state leading to direct tissue injury. METHOD: ology: a series of cases including 8 patients with MIS-C treated in two highly complex institutions is presented. These patients, had abdominal symptoms of surgical management. RESULTS: The average age was 9.5 years and the most frequent symptoms were fever, abdominal pain, diarrhea (100%); in addition, 87.5% presented shock. The diagnosis of SARS CoV-2 was confirmed by RT-PCR test in 37.5%, antigen 12.5% and the rest of the patients showed IgM and IgG antibodies. In laboratories, the increase in acute phase reactants, Erythrocyte Sedimentation Rate (ESR), C-reactive protein, procalcitonin, as well as troponin, D dimer and proBNP, is highlighted. The surgical outcome documented 2 patients with a normal appendix, 3 patients with edematous appendicitis, and 3 patients with complicated appendicitis. CONCLUSIONS: patients with MIS-C display abdominal symptoms similar to those present in surgical emergencies and a non-negligible number of cases require surgical exploration. This condition poses a new differential diagnosis to the surgical abdomen in pediatric patients.

Dengue Infection and Its Relationship with Evans Syndrome: A Pediatric Case.

Dengue is a single-stranded RNA virus belonging to the Flaviviridae family. It is an endemic virus in tropical countries. In Colombia, 4 serotypes are present, and the disease is a burden for public health, social programs, and the economic sectors. The main vector is Aedes aegypti, and most infections are asymptomatic or minimally symptomatic. The hemorrhagic appearances of severe dengue are due to plasma leakage as a result of increased vascular permeability, severe thrombopenia, and hemoconcentration. In 2020, 78,979 cases of dengue were reported in Colombia. 38,836 (49.2%) of them were warning-free signs, 39,246 (49.7%) with warning signs, and 897 (1.1%) of severe dengue. As it is well-known, viral diseases are immune system activators, triggering off a loss of tolerance in it. Dengue is not an exception, and it is able to explain different autoimmune phenomena including macrophage activation. Mechanisms have been described by which an exacerbated response of the disease is triggered through the increase of infected cells, formation of immune complexes, and complement pathway activation, which lead to a cross-reaction of viral antigens with epithelial cells with platelets with subsequent endothelial dysfunction and bleeds. The first description of Evans syndrome was made in 1951 by Robert Evans. This syndrome is characterized by the combination of autoimmune hemolytic anemia, immune thrombocytopenia, and, less common/usual, immune neutropenia. This disease's etiology is unknown, and the dysregulation of the immune system is among its possibilities. Here, we present the case of an unusual hematological and immunological complication of a patient who developed Evans syndrome during severe dengue, taking into account the concomitantly limited literature available for these two diseases, the need for a broader diagnostic approach, multidisciplinary intervention, and a more complex therapeutic approach.

Revealing the Characteristics of the Antarctic Snow Alga Chlorominima collina gen. et sp. nov. Through Taxonomy, Physiology, and Transcriptomics.

Snow algae play crucial roles in cold ecosystems, however, many aspects related to their biology, adaptations and especially their diversity are not well known. To improve the identification of snow algae from colored snow, in the present study we used a polyphasic approach to describe a new Antarctic genus, Chlorominima with the species type Chlorominima collina. This new taxon was isolated of colored snow collected from the Collins Glacier (King George Island) in the Maritime Antarctic region. Microscopy revealed biflagellated ellipsoidal cells with a rounded posterior end, a C-shaped parietal chloroplast without a pyrenoid, eyespot, and discrete papillae. Several of these characteristics are typical of the genus Chloromonas, but the new isolate differs from the described species of this genus by the unusual small size of the cells, the presence of several vacuoles, the position of the nucleus and the shape of the chloroplast. Molecular analyzes confirm that the isolated alga does not belong to Chloromonas and therefore forms an independent lineage, which is closely related to other unidentified Antarctic and Arctic strains, forming a polar subclade in the Stephanosphaerinia phylogroup within the Chlamydomonadales. Secondary structure comparisons of the ITS2 rDNA marker support the idea that new strain is a distinct taxon within of Caudivolvoxa. Physiological experiments revealed psychrophilic characteristics, which are typical of true snow algae. This status was confirmed by the partial transcriptome obtained at 2°C, in which various cold-responsive and cryoprotective genes were identified. This study explores the systematics, cold acclimatization strategies and their implications for the Antarctic snow flora.

Photobiology of the giant kelp Macrocystis pyrifera in the land-terminating glacier fjord Yendegaia (Tierra del Fuego): A look into the future?

The channel and fjord region of southern Chilean Patagonia hosts giant kelp forests (Macrocystis pyrifera) that have little known site-specific responses to diverse physical gradients. In this study, the functionality of the bio-optical, morphological and biochemical features of the kelps, that determine their light trapping and acclimation, were studied along a gradient of varying turbidity and light conditions at the land-terminating glacier of fjord Yendegaia in the Beagle Channel. These habitats are marked by glacial retreat, and M. pyrifera has successfully colonized new areas due to the effects of warming. Results indicated that under a sharp gradient of turbidity and light availability, the kelps have adapted shading characteristics. The photobiological traits (e.g. light absorption, pigment concentration, photochemistry and blade optics) of algae from depths between 6 and 13 m varied in relation to the degree of turbidity along the fjord. However, these populations did not show obvious intra-thallus variation along the longitudinal profile e.g. blades located at different depths showed relatively similar acclimation potential to the prevailing light field. Only basal sporophylls showed general differences in comparison with the vegetative fronds. Otherwise, the high phenolic (phlorotannin) content, which was reflected in the massive presence of intracellular physodes, suggests that these organisms could be biochemically well-equipped to cope with changes in physical conditions or the presence of herbivore invertebrates (e.g. sea urchins).

Uptake of microalgae as sublethal biomarker reveals phototoxicity of oxytetracycline to the crustacean Daphnia magna.

Antibiotics are considered emerging pollutants as their presence in the environment is increasingly common. Although their environmental concentrations are generally low, they can pose risk to organisms through bioaccumulation, causing sublethal effects. Furthermore, solar radiation can trigger reactions in certain compounds after their accumulation within organisms or in the environment. Toxicity and photoinduced toxicity of oxytetracycline (OTC, widely used antibiotic in salmon aquaculture) on Daphnia magna (Crustacea, Cladocera) and microalgae Raphidocelis subcapitata (Chlorophyceae) as its food source was assessed via aqueous exposure. Also, the impact via diet (microalga) to the crustacean was examined. In addition to lethal (immobility) effect, in vivo chlorophyll fluorescence techniques were used to determine food ingestion (gut content as a biomarker of physiological health) in D. magna and physiological status of microalgae. OTC (≤10 mg L - 1) was not acutely (24 h) toxic to R. subcapitata when measured as maximum quantum yield (Fv/Fm) in darkness. However, under short (1 h) UV exposure OTC caused irreversible decrease of Fv/Fm (50%) at ≥0.5 mg L - 1. OTC was not acutely lethal to D. magna (≤10 mg L - 1), however, sublethal effects (43% decrease in food ingestion) at 10 mg L - 1 were demonstrated. UV exposure (4.5 h) strongly exacerbated toxicity of OTC, leading to lethal (87% immobility) and sublethal (81% decrease of feeding in survived individuals) effects. Uptake of OTC (aqueous exposure) and its photosensitization in tissues of D. magna under UV exposure was confirmed. On the other hand, rapid bioadsorption of OTC on cell surface was evident in R. subcapitata. Uptake of OTC in D. magna through diet could not be confirmed at short-term. Photomodification of OTC under UV exposure was observed through changes in its absorption spectrum. The results show that short exposure to summer UV levels of southern Chile can rapidly induce phototoxicity of OTC, suggesting a potential risk to aquatic organisms.

XML Data and Knowledge-Encoding Structure for a Web-Based and Mobile Antenatal Clinical Decision Support System: Development Study.

BACKGROUND: Displeasure with the functionality of clinical decision support systems (CDSSs) is considered the primary challenge in CDSS development. A major difficulty in CDSS design is matching the functionality to the desired and actual clinical workflow. Computer-interpretable guidelines (CIGs) are used to formalize medical knowledge in clinical practice guidelines (CPGs) in a computable language. However, existing CIG frameworks require a specific interpreter for each CIG language, hindering the ease of implementation and interoperability. OBJECTIVE: This paper aims to describe a different approach to the representation of clinical knowledge and data. We intended to change the clinician's perception of a CDSS with sufficient expressivity of the representation while maintaining a small communication and software footprint for both a web application and a mobile app. This approach was originally intended to create a readable and minimal syntax for a web CDSS and future mobile app for antenatal care guidelines with improved human-computer interaction and enhanced usability by aligning the system behavior with clinical workflow. METHODS: We designed and implemented an architecture design for our CDSS, which uses the model-view-controller (MVC) architecture and a knowledge engine in the MVC architecture based on XML. The knowledge engine design also integrated the requirement of matching clinical care workflow that was desired in the CDSS. For this component of the design task, we used a work ontology analysis of the CPGs for antenatal care in our particular target clinical settings. RESULTS: In comparison to other common CIGs used for CDSSs, our XML approach can be used to take advantage of the flexible format of XML to facilitate the electronic sharing of structured data. More importantly, we can take advantage of its flexibility to standardize CIG structure design in a low-level specification language that is ubiquitous, universal, computationally efficient, integrable with web technologies, and human readable. CONCLUSIONS: Our knowledge representation framework incorporates fundamental elements of other CIGs used in CDSSs in medicine and proved adequate to encode a number of antenatal health care CPGs and their associated clinical workflows. The framework appears general enough to be used with other CPGs in medicine. XML proved to be a language expressive enough to describe planning problems in a computable form and restrictive and expressive enough to implement in a clinical system. It can also be effective for mobile apps, where intermittent communication requires a small footprint and an autonomous app. This approach can be used to incorporate overlapping capabilities of more specialized CIGs in medicine.

Antarctic intertidal macroalgae under predicted increased temperatures mediated by global climate change: Would they cope?

The Antarctic Peninsula is one of the regions to be most affected by increase in sea surface temperatures (SSTs) mediated by Global Climate Change; indeed, most negative predictions imply an up to 6 °C increment by the end of the XXI century. Temperature is one of the most important factors mediating diversity and distribution of macroalgae, although there is still no consensus as to the likely effects of higher SSTs, especially for polar seaweeds. Some available information suggests that potential strategies to withstand future increases in SSTs will be founded upon the glutathione-ascorbate cycle and the induction of chaperone-functioning heat shock proteins (HSPs); however, their eventual role, even for general stress responses, is unclear. The intertidal green, brown and red macroalgae species Monostroma hariotii, Adenocystis utricularis and Pyropia endiviifolia, respectively, from King George Island, Antarctic Peninsula, were exposed to 2 °C (control) and 8 °C (climate change scenario) for up to 5 days (d). Photosynthetic activity (αETR and ETRmax, and EkETR), photoinhibition (Fv/Fm) and photoprotection processes (αNPQ, NPQmax, and EkNPQ) provided no evidence of negative ecophysiological effects. There were moderate increases in H2O2 production and levels of lipid peroxidation with temperature, results supported by stable levels of total glutathione and ascorbate pools, with mostly higher levels of reduced ascorbate and glutathione than oxidized forms in all species. Transcripts of P. endiviifolia indicated a general upregulation of all antioxidant enzymes and HSPs genes studied under warmer temperature, although with different levels of activation with time. This pioneering investigation exploring different levels of biological organization, suggested that Antarctic intertidal macroalgae may be able to withstand future rise in SSTs, probably slightly altering their latitudinal distribution and/or range of thermal tolerance, by exhibiting robust glutathione-ascorbate production and recycling, as well as the induction of associated antioxidant enzymatic machinery and the syntheses of HSPs.

Registro multicéntrico prospectivo de pacientes hospitalizados por síndrome coronario agudo sin elevación del segmento ST en centros de alta complejidad. Resultados intrahospitalarios y evolución a 6 meses (Buenos Aires I) / Prospective multicenter registry of patients hospitalized for acute coronary syndrome without ST segment elevation in highly complex centers

RESUMEN Introducción: El manejo de los síndromes coronarios agudos (SCA) sin elevación del segmento ST (SCASEST) ha presentado cambios en los últimos años, basados en nuevos agentes farmacológicos y en el avance de las técnicas de revascularización coronaria. El objetivo de este estudio fue determinar cómo es el manejo de los SCASEST en la actualidad, en centros de alta complejidad de la ciudad de Buenos Aires y la provincia de Buenos Aires. Métodos: Se registraron en forma prospectiva pacientes hospitalizados en 21 centros con servicio de unidad coronaria, hemodinamia disponible las 24 horas y cirugía cardíaca. Se realizó seguimiento a 6 meses del alta hospitalaria. Resultados: Se incluyeron 1 100 pacientes consecutivos; el 62,6% fue catalogado como infarto sin elevación del ST y, 37,4% como angina inestable. La edad media fue de 65,4 ± 11,5 años, con el 77,2% de sexo masculino. El 27,6% presentaba diabetes mellitus y el 31,5% infarto previo. El manejo inicial fue invasivo en el 86,7%, con una mediana de tiempo a la cinecoronariografía de 18 horas (RIC 7-27,7). En la evolución intrahospitalaria, la incidencia de nuevo infarto fue del 5,2%, el accidente cerebrovascular de 0,3% y la mortalidad total, 2,7%. La tasa de sangrado BARC ≥2 fue del 10,1%. En el seguimiento extrahospitalario a los 6 meses del alta hospitalaria, la tasa de infarto fue de 8,4%, SCA 10,9% y la mortalidad total de 5,7%. Conclusiones: El registro evidenció un abordaje terapéutico predominantemente invasivo de los pacientes con SCASEST en los centros con alta complejidad, con baja prevalencia de complicaciones intrahospitalarias y en la evolución.

ABSTRACT Introduction: The medical management of acute coronary syndromes (ACS) has changed significantly over the past few decades, primarily due to novel pharmacotherapies and improvement in coronary revascularization strategies. This registry was compiled from data from management of patient populations in high complexity centers from Buenos Aires, Argentina. Methods: Patients hospitalized in 21 centers in the city of Buenos Aires and peripheries, with a coronary unit service, hemodynamics available 24 hours and cardiac surgery are prospectively registered. Follow-up was performed at 6 months. Results: A total of 1100 patients were included; the final diagnosis was myocardial infarction in 62.% and unstable angina in 37.4%. The mean age of the population was 65.4 ± 11.5 and 77.2% were male. 27.6% of patients having diabetes mellitus, with 31.5% having a medical history of myocardial infarction. The initial management was invasive in 86.7%, with a median time for PCI of 18 hours (IQR 7-27,7). Over the course of the in-hospital stay, the rate of myocardial infarction was 5.2%, stroke 0.3% and total all-cause mortality 2.7%. The rate of in-hospital total bleeding events was 20.1%, with BARC ≥2 in 10.1% of patients. In the 6-month follow-up, the infarction rate was 8.4%, ACS 10.9%, and total mortality 5.7%. Conclusions: This registry shows the predominant usage of invasive approaches in management of patients with acute coronary syndrome without ST elevation, in high complexity medical centers. In this subset of patients, a low rate of in-hospital and follow up complications were also observed.

Análisis de usuarios para el diseño de un sistema de información para cuidados paliativos

Objetivo. Explorar el acceso a las tecnologías de la información y la comunicación (TIC) de los usuarios de cuidados paliativos. Métodos. Se trabajó sobre el marco de análisis de tareas, usuarios, representaciones y funciones (TURF) usado para caracterizar los usuarios de cuidados paliativos de dos instituciones de salud de Medellín, Colombia. Las instituciones se visitaron entre mayo y septiembre de 2017 de acuerdo con el reporte de nuevas hospitalizaciones o cuando los investigadores detectaban la hospitalización de nuevos pacientes. En total, se realizaron 64 encuestas: 35 pacientes y a 39 cuidadores, el instrumento incluía preguntas acerca de factores demográficos, clínicos, el uso de TIC en la vida cotidiana, variables clínicas y síntomas de los pacientes y cuidadores. Las variables categóricas fueron mostradas de estadísticas descriptivas como porcentajes y frecuencias. Resultados. La mayoría de pacientes fueron mujeres, residentes de áreas urbanas quienes tenían acceso a las tecnologías de información y comunicación, con poca frecuencia en su uso. Los cuidadores fueron usuarios habituales de las tecnologías de información y comunicación, especialmente de redes sociales. Conclusión. Las instituciones que presten cuidados paliativos que busquen implementar las TIC en el cuidado a sus pacientes deberán hacer énfasis en los cuidadores y en el acceso de estos a las redes sociales.

Objective: To explore access to Information and Communication Technologies (ICT) for palliative care users. Method: The framework for the analysis of tasks, users, representation, and function (TURF) was used to characterize the users of palliative care of two health institutions in Medellín, Colombia. The institutions were visited between May and September 2017 according to the report of new hospitalizations or when the researchers detected the hospitalization of new patients. A total of 64 surveys were conducted: 35 patients and 39 caregivers, the instrument included questions about demographic and clinical factors, the use of ICT in daily life, clinical variables, and symptoms of the patients and caregivers. The categorical variables were shown from descriptive statistics as percentages and frequencies. Results: most patients were women, residents of urban areas who had access to information and communication technologies, with little frequency in their use. The caregivers were regular users of Information and Communication Technologies, especially social networks. Conclusion: Institutions that provide palliative care and seek to implement ICT in the care of their patients should center their efforts in caregivers and their access to social networks.

Satellite-derived mapping of kelp distribution and water optics in the glacier impacted Yendegaia Fjord (Beagle Channel, Southern Chilean Patagonia).

Giant kelp Macrocystis pyrifera is a brown alga with extensive global distribution, however, recent evidence suggests that its dynamics presents high degree of regional variability. In southern Chilean fjord region, largely unexplored kelp forests are currently being threatened by global change and human impacts. High-resolution satellite (Sentinel-2) imagery was used to describe temporal and spatial distribution patterns of kelp beds in Yendegaia Fjord (Beagle Channel) using Spectral Mixture Analysis (SMA), and to characterize water optical gradients of this habitat strongly influenced by river runoff from a melting glacier. The suitability of SMA for kelp classification was contrasted with other vegetation indices (NDVI, EVI, FAI). Validation was made using drone aerial photographs of kelp canopies. Different analysis tools resulted in up to 35% difference in kelp coverage estimation. The overall accuracy (66-82%) of kelp classification followed an order FAI < EVI < NDVI < SMA. Omission error of SMA and lower coincidence with vegetation indices occurred in pixels with low kelp pixel abundance (<0.50). Based on SMA, the lowest kelp abundance was observed in the river mouth with high turbidity, increasing towards the Beagle Channel. The highest kelp abundance was observed in late summer, but otherwise no clear seasonal patterns could be observed. Water turbidity presented both spatial and seasonal variation. Strong particle sedimentation (leading to light attenuation, interference with remote detection of kelps, and even to their detachment due to substrate quality) and tidal fluctuations in glacier-impacted fjord-type environments can be identified as key features affecting both the kelp population dynamics as well as their remote sensing. Also, low sun elevation at high latitudes in mid winter produces uncertainties in image analyses. In all, the remote sensing approach used in the present study can be regarded as a useful tool to map and monitor kelps forests from a remote region.