Isolation and characterization of a native strain of the entomopathogenic fungus Beauveria bassiana for the control of the palm weevil Dynamis borassi (Coleoptera: Curculionidae) in the neotropics.

This study aimed to isolate and characterize a native strain of Beauveria bassiana, coded as Bv065, showcasing its potential as a biological control agent targeting the palm weevil Dynamis borassi. Originating from a naturally infected D. borassi specimen collected in southwestern Colombia, the fungus underwent molecular identification and was identified as B. bassiana, exhibiting high sequence similarity with known reference strains. The physiological characterization revealed that Bv065 thrived within a temperature range of 25 to 30 °C and a pH range of 6 to 9. Moreover, the key carbon sources that allow optimal growth of the strain were identified through metabolic profiling, including sucrose, D-mannose, and γ-amino-butyric acid. These findings offer strategic insights for scalability and formulation methodologies. Additionally, enzymatic analyses unveiled robust protease activity within Bv065, crucial for catalysing insect cuticle degradation and facilitating host penetration, thus accentuating its entomopathogenic potential. Subsequent evaluations exposed Bv065's pathogenicity against D. borassi, causing significant mortality within nine days of exposure, albeit exhibiting limited effectiveness against Rhynchophorus palmarum. This study underscores the importance of understanding optimal growth conditions and metabolic preferences of B. bassiana strains for developing effective biopesticides. The findings suggest Bv065 as a promising candidate for integrated pest management strategies in neotropical regions, particularly for controlling palm weevil infestations in coconut and peach palm cultivation. Future research avenues include refining mass production methodologies, formulating novel delivery systems, and conducting comprehensive field efficacy trials to unlock the full potential of Bv065 in fostering sustainable pest management practices. Overall, this study contributes to the growing body of knowledge on entomopathogenic fungi and their pivotal role in biological control, offering nuanced perspectives on eco-friendly alternatives to conventional insecticidal interventions.

Anatomy of the Flexor Hallucis Longus and Its Relationship With Hallux Valgus: A Cadaveric Study.

BACKGROUND: Hallux valgus (HV) is a complex deformity, with many associated risk factors. The flexor hallucis longus (FHL) tendon is a dynamic and potentially deforming force as it bowstrings laterally with HV. We hypothesized that FHL is more laterally inserted in the distal phalanx in cadavers with HV; therefore, it might be also a primary destabilizing force. We aim to compare the FHL distal insertion morphology and its relationship with osseous structures in cadavers with and without HV. METHODS: Sixteen cadaver specimens, 8 with HV and 8 without (N-HV) were dissected. We evaluated FHL distal morphology in terms of its insertional footprint location and FHL long-axis position in relation to osseous anatomy. RESULTS: Both the HV and N-HV groups displayed a laterally inserted footprint at the distal phalanx, with the HV group exhibiting median lateral translation of the footprint 6% greater than the N-HV group (P < .01). Both groups also demonstrated a laterally displaced position for the FHL long axis. The median FHL long axis for HV vs N-HV specimens 1 cm proximal to the IP joint was 9% more laterally displaced from the midaxis (P < .01), and at 1 cm proximal to the MTP joint was measured to be 15% more laterally displaced from the midaxis (P < .01). CONCLUSION: FHL demonstrated an eccentric position in terms of insertion and trajectory in both the HV and N-HV groups, with greater lateralization in specimens exhibiting HV deformity. This eccentricity potentially creates a greater deforming force vector contributing to the development of HV. CLINICAL RELEVANCE: The etiology and progression of HV deformity may include a lateralized insertion of the FHL tendon. Treatment implications remain unknown at this time.

Effect of metformin and metformin/linagliptin on gut microbiota in patients with prediabetes.

Lifestyle modifications, metformin, and linagliptin reduce the incidence of type 2 diabetes (T2D) in people with prediabetes. The gut microbiota (GM) may enhance such interventions' efficacy. We determined the effect of linagliptin/metformin (LM) vs metformin (M) on GM composition and its relationship to insulin sensitivity (IS) and pancreatic ß-cell function (Pßf) in patients with prediabetes. A cross-sectional study was conducted at different times: basal, six, and twelve months in 167 Mexican adults with prediabetes. These treatments increased the abundance of GM SCFA-producing bacteria M (Fusicatenibacter and Blautia) and LM (Roseburia, Bifidobacterium, and [Eubacterium] hallii group). We performed a mediation analysis with structural equation models (SEM). In conclusion, M and LM therapies improve insulin sensitivity and Pßf in prediabetics. GM is partially associated with these improvements since the SEM models suggest a weak association between specific bacterial genera and improvements in IS and Pßf.

Biological activities of 4H-thiochromen-4-one 1,1-dioxide derivatives against tropical disease parasites: A target-based drug design approach.

A promising strategy for developing novel therapies against tropical diseases, including malaria, leishmaniasis, and trypanosomiasis, is to detect biological targets such as trypanothione reductase, a vital parasite enzyme that regulates oxidative stress. This enzyme is highly selective and conserved in the Trypanosotidae family and has an ortholog in the Plasmodium genus. Previous studies have established that an isosteric replacement of naphthoquinone's carbonyl group with a sulfone group leads to compounds with high bioactivity and selectivity (half-maximal inhibitory concentration = 3 µM against intracellular amastigotes of L. panamensis, selectivity index = 153 over monocytes U-937). In this study, we analyzed the reactive oxygen species (ROS) levels of parasites through indirect measurements of the tryparedoxin system after treatment with these isosteric compounds. This strategy proved that a significant increase in the ROS levels and strong mitochondrial perturbation led to the death of parasites due to cell homeostatic imbalance, confirming the compounds' effectiveness in disrupting this important metabolic pathway. To improve understanding of the parasite-molecule interaction, 27 new compounds were synthesized and assessed against parasites of the three principal tropical diseases (malaria, leishmaniasis, and trypanosomiasis), displaying an EC50 below 10 µM and good correlation with in-silico studies, indicating that the 4H-thiochromen-4-one 1,1-dioxide core is a special allosteric modulator. It can interact in the binding pocket through key amino acids like Ser-14, Leu-17, Trp-21, Ser-109, Tyr-110, and Met-113, leading to interhelical disruption.

A network perspective on the ecology of gut microbiota and progression of type 2 diabetes: Linkages to keystone taxa in a Mexican cohort.

Introduction: The human gut microbiota (GM) is a dynamic system which ecological interactions among the community members affect the host metabolism. Understanding the principles that rule the bidirectional communication between GM and its host, is one of the most valuable enterprise for uncovering how bacterial ecology influences the clinical variables in the host. Methods: Here, we used SparCC to infer association networks in 16S rRNA gene amplicon data from the GM of a cohort of Mexican patients with type 2 diabetes (T2D) in different stages: NG (normoglycemic), IFG (impaired fasting glucose), IGT (impaired glucose tolerance), IFG + IGT (impaired fasting glucose plus impaired glucose tolerance), T2D and T2D treated (T2D with a 5-year ongoing treatment). Results: By exploring the network topology from the different stages of T2D, we observed that, as the disease progress, the networks lose the association between bacteria. It suggests that the microbial community becomes highly sensitive to perturbations in individuals with T2D. With the purpose to identify those genera that guide this transition, we computationally found keystone taxa (driver nodes) and core genera for a Mexican T2D cohort. Altogether, we suggest a set of genera driving the progress of the T2D in a Mexican cohort, among them Ruminococcaceae NK4A214 group, Ruminococcaceae UCG-010, Ruminococcaceae UCG-002, Ruminococcaceae UCG-005, Alistipes, Anaerostipes, and Terrisporobacter. Discussion: Based on a network approach, this study suggests a set of genera that can serve as a potential biomarker to distinguish the distinct degree of advances in T2D for a Mexican cohort of patients. Beyond limiting our conclusion to one population, we present a computational pipeline to link ecological networks and clinical stages in T2D, and desirable aim to advance in the field of precision medicine.

Short-term Results of Hemiarthroplasty of the Ankle Joint for Talar-Sided Cartilage Loss.

Background: Ankle hemiarthroplasty is a 1-piece implant system replacing the talar side of the tibiotalar joint. Hemiarthroplasty offers limited bone resection and may provide easier revision options than joint-ablating procedures. Methods: Prospective, multicenter, noncomparative, nonrandomized clinical study with short term follow-up on patients undergoing hemiarthroplasty of the ankle. Radiologic and functional outcomes (Foot and Ankle Outcome Score FAOS, Foot and Ankle Ability Measure [FAAM], Short Form-36 Health Survey [SF-36], Short Musculoskeletal Functional Assessment [SMFA], and visual analog scale [VAS] pain scores) were obtained at 3 and 12 months and the last follow-up (mean 31.9 months). Results: Ten patients met the inclusion criteria. Three were converted to total ankle replacement at 14, 16, and 18 months. Pain VAS scores improved on average from 6.8 to 4.8 (P = .044) of the remaining 7 at a mean of 31.9 months' follow-up. For these 7 in the Survival Group, we found that SF-36 physical health component improved from 25.03 to 42.25 (P = .030), SMFA dysfunction and bother indexes improved from 46.36 to 32.28 (P = .001), and from 55.21 to 30.14 (P = .002) in the Survival Group, and FAAM sports improved from 12.5 to 34.5 (P = .023). Conclusion: Patients undergoing hemiarthroplasty of the ankle joint for talar-sided lesions had a 30% failure rate by 18 months. Those who did not have an early failure exhibited modest pain reduction, functional improvements, and better quality of life in short-term follow-up. This procedure offers a possible alternative for isolated talar ankle cartilage cases. Level of Evidence: Level IV, prospective case series.

Tendones peroneos: una revisión contemporánea / Peroneal tendons. Contemporary update

La patología de peroneos es compleja y frecuentemente subdiagnosticada. El conocimiento detallado de la anatomía, biomecánica y fisiopatología es fundamental para realizar un correcto diagnóstico y tratamiento. El objetivo de este artículo es revisar la información más actualizada sobre la patología de los tendones peroneos (tendinopatía, inestabilidad y rotura).

Pathology of the peroneal tendons is complex and often underdiagnosed. Knowledge of anatomy, biomechanics, and physiopathology is necessary for diagnosing and treating this condition. The objective of this article is to review the most updated information regarding peroneal tendon pathology (tendinopathy, dislocation/subluxation, and tears), which may help managing patients with lateral pain of the foot and ankle.

Neumoperitoneo progresivo preoperatorio para el tratamiento de la hernia inguinoescrotal gigante: reporte de caso / Progressive Preoperative Pneumoperitoneum for Giant Inguinoscrotal Hernia: a Case Report

Resumen Introducción: El procedimiento de neumoperitoneo progresivo preoperatorio para el manejo de hernias gigantes con "Pérdida de dominio" o Pérdida de derecho a domicilio" fue introducido en 1940 por Goñi Moreno en Argentina. Autores como Herszage, Berlemont, Koontz, Gravez y Martínez Munive presentaron variaciones interesantes del método original. Su uso se recomienda para preparación previa de pacientes con hernias gigantes y grandes contenidos de vísceras en el saco herniario, en los cuales no sería posible su re-introducción y efectuar la hernioplástia, o en los que su reducción de manera forzada pudiera llevar al paciente al desarrollo de un síndrome compartimental abdominal en el postoperatorio inmediato. Caso clínico: Paciente de sexo masculino de 65 años de edad, que presenta cuadro clínico de un mes de evolución caracterizado por dolor a nivel de la región inguinal izquierda, en el cual se evidencia presencia de hernia inguino escrotal gigante izquierda, no reductible, con aproximadamente un 40% de contenido abdominal. Resultados: La mayoría de los estudios describen el uso del neumoperitoneo progresivo para la reparación de las eventraciones gigantes, sin embargo, en nuestra experiencia y en la de otros autores, esta técnica también puede utilizarse para resolver las hernias inguinales y umbilicales gigantes, con buenos resultados. En todos los casos se aconseja utilizar material protésico. Conclusión: El uso del neumoperitoneo preoperatorio progresivo, se trata de una técnica segura y fácil de realizar que puede complementar las técnicas de eventroplastía complejas, aportando ventajas en la preparación de los pacientes con grandes defectos de pared abdominal y obteniendo buenos resultados.

Abstract Introduction: The procedure of progressive preoperative pneumoperitoneum for the management of giant hernias with "Loss of domain" or "Loss of the right of domain" was introduced in 1940 by Goñi Moreno in Argentina, followed in later years by authors such as Herszage, Berlemont, Koontz, Gravez and Martínez Munive, all with some interesting variations of the original method. Its use is recommended for previous preparation of patients with giant hernias and large contents of viscera in the hernial sac, in which it would not be possible to re-introduce and perform hernioplasty, or in which its forced reduction could lead to the patient to the development of an abdominal compartment syndrome in the immediate postoperative period. Clinical case: A 65-year-old male patient with a clinical picture of one month of evolution characterized by pain in the left inguinal region. There was evidence of a giant left inguinal scrotum, not reducible, with approximately 40% abdominal contents. Results: Most studies describe the use of progressive pneumoperitoneum for the repair of giant hernias, however, in our experience and in that of other authors, this technique can also be used to resolve hernias giant inguinal and umbilical, with good results. In all cases it is recommended use prosthetic material. Conclusion: The use of progressive preoperative pneumoperitoneum is a safe and easy-to-perform technique that can complement complex eventroplasty's techniques, providing advantages in the preparation of patients with large abdominal wall defects and obtaining good results.

Is nutrition labeling associated with decreased obesity? A quantitative approach to nutritional health policy in Ecuador.

Few studies assess consumer response to nutrition labeling, especially in less-developed countries. We analyzed the link between nutrition labeling and obesity in Ecuador using a representative cross-sectional sample of 29,770 individuals from the National Health and Nutrition Survey (ENSANUT) in 2018. Nutrition labeling reduced the probability of obesity in adolescent (12-18 years old) and adult (18-59 years old) people by 4% (CI: - 5.7, - 2.2) and 8.4% (CI: - 12.7, - 4.0), respectively. The magnitude of average treatment effect of using nutrition label on obesity ranged from 0.90 (CI: - 1.299, - 0.500) to 1 (CI: - 1.355, - 0.645) BMI points for adolescent, and from 1.16 (CI: - 1.554, - 0.766) to 1.80 (CI: - 2.791, - 0.811) BMI points for adult. The effect of nutrition labeling is greater among the less obese. We recommend that health policy makers and clinicians continue to promote nutrition labeling especially where obesity is not chronic, where nutrition labeling is most successful.

Estimating the non-pecuniary benefit of engaging in pro-environmental behaviors: Incorporating both heterogeneous preferences and income endogeneity.

This article estimates the individuals' non-pecuniary benefit of engaging in pro- environmental behaviors (PEB) using a large sample from Ecuador. As a novelty, we estimate a model that allows incorporating both unobserved heterogeneity in preferences and controlling for the potential endogeneity of income through instrumental variables. Although both problems have been addressed separately in the literature, we show that considering both sources of bias allows finding more accurate and credible monetary values. Our results show that subjective monetary evaluations regarding PEBs are generally overestimated (the income coefficient is underestimated), but not including unobserved heterogeneity hides important patterns for an important group of the sample with completely different preferences.

One-Stage Lengthening and Minimally Invasive Distal Metatarsal Metaphyseal Osteotomy (DMMO) for Brachymetatarsia.

Level of Evidence: Level V.

Diseño y validación de una escala de actitudes hacia la Policía Nacional, para muestras colombianas / Desenho e validação de uma escala de atitudes em relação à Polícia Nacional, para amostras colombianas / Designing and Validating a Scale of Attitudes towards the National Police, for Colombian Samples

El diseño de esta investigación es de corte empírico y cuantitativo, además, es de tipo psicométrico, bajo el criterio de estudio instrumental. Su objetivo principal fue diseñar y validar una escala de actitudes hacia la Policía Nacional para una muestra colombiana. Para ello, se realizó una revisión teórica y se diseñó una tabla de especificaciones que permitió identificar la cantidad de ítems que se requerían para abarcar las seis funciones principales de dicha entidad. Posteriormente, los ítems fueron sometidos a la validación por parte de jueces, se realizaron algunos ajustes sugeridos a la escala y se aplicó la encuesta a 566 ciudadanos colombianos con edades entre los 18 y 82 años, cuya media fue de 26 años. Se tuvo acceso a la población a través de un muestreo no probabilístico por bola de nieve. Así mismo, se llevó a cabo un análisis factorial exploratorio, que agrupó los reactivos en cuatro factores: pensamientos y creencias hacia la Policía Nacional, emociones y sentimientos hacia la Policía Nacional, accionar propio de la Policía y accionar de la Policía ante riñas y peleas. Además, se realizó un análisis factorial confirmatorio que refiere adecuados índices de bondad de ajuste. Los resultados de los análisis estadísticos demostraron que este instrumento tiene una alta consistencia interna y confiabilidad, lo cual se ve reflejado en el alfa de Cronbach general de 0,875 y una adecuada validez, ya que los ítems tienen apropiados índices de extracción y los cuatro factores en los que se agruparon explican el 47,140% de la varianza total.

This study's design was empirical and quantitative. In addition, it was psychometric, under instrumental study criteria. Its main objective was to design and validate a scale of attitudes towards the National Police for a Colombian sample. To do so, a theoretical review was performed and a table of specifications was created, which allowed identifying the amount of items required to cover the six main functions of said entity. Subsequently, the ítems were submitted to validation by judges. Some suggested adjustment were made to the scale, and the survey was given to 566 Colombian citizens between the ages of 18 to 82. The average age was 26. The population was accessed by means of non-probability, snowball sampling. Moreover, an exploratory factor analysis was performed, which regrouped the reactive items into four factors: thoughts and beliefs regarding the National Police, feelings and emotions towards the National Police, the Police's own actions, and the Police's actions in light of brawls and fights. In addition, a confirmatory factor analysis that refers to proper goodness of fit indices was performed. The results of the statistical analyses demonstrated that this instrument has high internal consistency and reliability, which is reflected in the general Cronbach's alpha of 0,875 and proper validity, since the items have appropriate extraction indices and the four factors in which they were grouped explain 47,140% of total variance.

O desenho desta pesquisa é empírico e quantitativo, além disso, é psicométrico, sob o critério de estudo instrumental. Seu principal objetivo foi desenhar e validar uma escala de atitudes em relação à Polícia Nacional para uma amostra colombiana. Para isso, foi realizada uma revisão teórica e foi elaborado um quadro de especificações para identificar o número de itens necessários para cobrir as seis funções principais da referida entidade. Posteriormente, os itens foram submetidos à validação de juízes, alguns ajustes sugeridos foram feitos na escala e a pesquisa foi aplicada a 566 cidadãos colombianos com idade entre 18 e 82 anos, cuja média foi de 26 anos. A população foi acessada por amostragem não probabilística em bola de neve. Da mesma forma, foi realizada uma análise fatorial exploratória, que agrupou os itens em quatro fatores: pensamentos e crenças em relação à Polícia Nacional, emoções e sentimentos em relação à Polícia Nacional, atuação característica da Polícia e atuação da Polícia frente a rixas e brigas. Além disso, foi realizada uma análise fatorial confirmatória que se refere a índices adequados de bondade de ajuste. Os resultados das análises estatísticas demonstraram que este instrumento possui alta consistência interna e confiabilidade, o que se reflete no alfa de Cronbach geral de 0,875 e validade adequada, uma vez que os itens apresentam taxas de extração adequadas e os quatro fatores nos quais foram agrupados explicam 47,140% da variância total.

CLINICAL AND EPIDEMIOLOGICAL CHARACTERISTICS OF PATIENTS DIAGNOSED WITH COVID-19 IN A TERTIARY CARE CENTER IN MEXICO CITY: A PROSPECTIVE COHORT STUDY.

BACKGROUND: Regional information regarding the characteristics of patients with coronavirus disease (COVID)-19 is needed for a better understanding of the pandemic. OBJECTIVE: The objective of the study to describe the clinical features of COVID-19 patients diagnosed in a tertiary-care center in Mexico City and to assess differences according to the treatment setting (ambulatory vs. hospital) and to the need of intensive care (IC). METHODS: We conducted a prospective cohort, including consecutive patients with COVID-19 from February 26, 2020 to April 11, 2020. RESULTS: We identified 309 patients (140 inpatients and 169 outpatients). The median age was 43 years (interquartile range, 33-54), 59.2% men, and 18.6% healthcare workers (12.3% from our center). The median body mass index (BMI) was 29.00 kg/m2 and 39.6% had obesity. Compared to outpatients, inpatients were older, had comorbidities, cough, and dyspnea more frequently. Twenty-nine (20.7%) inpatients required treatment in the IC unit (ICU). History of diabetes (type 1 or 2) and abdominal pain were more common in ICU patients compared to non-ICU patients. ICU patients had higher BMIs, higher respiratory rates, and lower room-air capillary oxygen saturations. ICU patients showed a more severe inflammatory response as assessed by white blood cell count, neutrophil and platelet count, C-reactive protein, ferritin, procalcitonin, and albumin levels. By the end of the study period, 65 inpatients had been discharged because of improvement, 70 continued hospitalized, and five had died. CONCLUSIONS: Patients with comorbidities, either middle-age obese or elderly complaining of fever, cough, or dyspnea, were more likely to be admitted. At admission, patients with diabetes, high BMI, and clinical or laboratory findings consistent with a severe inflammatory state were more likely to require IC.

Clinical and epidemiological characteristics of patients diagnosed with covid-19 in a tertiary care center in Mexico City: a prospective cohort study

ABSTRACT Background: Regional information regarding the characteristics of patients with coronavirus disease (COVID)-19 is needed for a better understanding of the pandemic. Objective: The objective of the study to describe the clinical features of COVID-19 patients diagnosed in a tertiary-care center in Mexico City and to assess differences according to the treatment setting (ambulatory vs. hospital) and to the need of intensive care (IC). Methods: We conducted a prospective cohort, including consecutive patients with COVID-19 from February 26, 2020 to April 11, 2020. Results: We identified 309 patients (140 inpatients and 169 outpatients). The median age was 43 years (interquartile range, 33-54), 59.2% men, and 18.6% healthcare workers (12.3% from our center). The median body mass index (BMI) was 29.00 kg/m2 and 39.6% had obesity. Compared to outpatients, inpatients were older, had comorbidities, cough, and dyspnea more frequently. Twenty-nine (20.7%) inpatients required treatment in the IC unit (ICU). History of diabetes (type 1 or 2) and abdominal pain were more common in ICU patients compared to non-ICU patients. ICU patients had higher BMIs, higher respiratory rates, and lower room-air capillary oxygen saturations. ICU patients showed a more severe inflammatory response as assessed by white blood cell count, neutrophil and platelet count, C-reactive protein, ferritin, procalcitonin, and albumin levels. By the end of the study period, 65 inpatients had been discharged because of improvement, 70 continued hospitalized, and five had died. Conclusions: Patients with comorbidities, either middle-age obese or elderly complaining of fever, cough, or dyspnea, were more likely to be admitted. At admission, patients with diabetes, high BMI, and clinical or laboratory findings consistent with a severe inflammatory state were more likely to require IC.

Synthesis and Evaluation of Antileishmanial and Cytotoxic Activity of Benzothiopyrane Derivatives.

In continuation of our efforts to identify promising antileishmanial agents based on the chroman scaffold, we synthesized several substituted 2H-thiochroman derivatives, including thiochromenes, thichromanones and hydrazones substituted in C-2 or C-3 with carbonyl or carboxyl groups. Thirty-two compounds were thus obtained, characterized, and evaluated against intracellular amastigotes of Leishmania (V) panamensis. Twelve compounds were active, with EC50 values lower than 40 µM, but only four compounds displayed the highest antileishmanial activity, with EC50 values below 10 µM; these all compounds possess a good Selectivity Index > 2.6. Although two active compounds were thiochromenes, a clear structure-activity relationship was not detected since each active compound has a different substitution pattern.

Urban concentration, non-renewable energy consumption, and output: do levels of economic development matter?

The accelerated urbanization process generates a significant increase in energy, whose sources are mainly polluting. The harmful effects of both processes are reflected in climate change. This article examines the equilibrium and causality relationship among urban concentration, non-renewable energy consumption, and the real per capita output in 110 countries during 1971-2017. Using data from the World Bank's World Development Indicators (2018), we classify countries into four groups according to their level of development. Our evidence suggests that urban concentration has a negative effect on real per capita output in high-income countries, while non-renewable energy consumption has a positive effect on all groups of countries. The cointegration tests show that there is short- and long-term equilibrium in all groups of countries. The results of the DOLS and PDOLS models indicate that the strength of the cointegration vector is weak in most of the countries and groups analyzed. The Granger-type causality tests show that there is bidirectional causality from the real per capita output to the urban concentration in high and middle-low-income countries. There is unidirectional causality from the population concentration towards the real per capita output in the low-income countries; from the non-renewable energy consumption to the real per capita output in high-income countries; from the real per capita output to the non-renewable energy consumption in the countries of medium-high and medium-low income; and from urban concentration to non-renewable energy consumption in high- and medium-high-income countries. Our results highlight the importance of promoting policies of urban planning and generation and consumption of renewable energy without limiting the expansion of the output.

Knotless Modified Arthroscopic-Broström Technique for Ankle Instability.

Instability is a common sequela after repeated ankle sprains. When nonoperative treatment fails, open lateral ligament complex repair and reinforcement with the inferior extensor retinaculum has been the gold standard procedure. The recent advancements in arthroscopic techniques have created comparable biomechanical and functional results to open procedures. The authors' modification to the standard arthroscopic technique permits ligament approximation to the distal fibula over a larger surface area, using knotless anchors to avoid the need of an accessory portal and limit potential suture knot-related complications. Level of Evidence: Level V, expert opinion.

Unexpected Intraoperative Findings, Situations, and Complications in Bariatric Surgery.

BACKGROUND: Bariatric surgery is considered a safe therapy to treat obesity. Postoperative complications are well known; however, there is a lack of data describing intraoperative complications and/or unexpected findings, and if there is further impact on outcomes. METHODS: Retrospective study with patients operated between 2013 and 2016 at a single institution. All operative information was collected prospectively and aimed to analyze the incidence and causes of unexpected intraoperative findings, complications, change in surgical plan, extra surgeries, and procedure interruption in patients submitted to bariatric surgery. Secondarily, a morbidity analysis was performed, correlating intraoperative complications with postoperative complications and length of stay. RESULTS: Four-hundred and five patients were included. Female sex comprised 82% of cases, and a median age of 38 years old was observed; almost 90% were gastric bypass. In 29.3% of cases, there were intraoperative findings, mainly adhesions, abdominal wall hernias, positive methylene blue test, hiatal hernias, and gastrointestinal stromal tumors. Associated surgeries were performed in 8.6% cases, and intraoperative adverse events reported in 7.1%, where organ injury and anastomosis problems were the most frequent. A change in the operative plan was done in 0.9% and surgery interruption in 1.2% of the cases. Early complications were observed in 6.6%. There was no correlation between intraoperative complications and length of stay or early complications. CONCLUSION: Unexpected intraoperative findings/complications are common in bariatric surgery, but without increasing morbidity or length of stay. Surgery suspension, change in the planned technique, or adding extra (non-bariatric) procedures may occur.

Metabolic syndrome 2 years after laparoscopic gastric bypass.

BACKGROUND: The latest diabetes consensus identified obesity as key component of the metabolic syndrome. The role of bariatric surgery over such syndrome has been less explored with a lack of long term studies, and especially among Mexicans. METHODS: Retrospective study including patients with metabolic syndrome submitted to laparoscopic gastric bypass at a single institution with complete data after 24 months. The objective was to analyze the improvement of the syndrome and each component. Demographic, anthropometric, biochemical and clinical parameters were analyzed at 12 and 24 months. Secondarily weight loss and other parameters were also analyzed. Finally, an analysis of syndrome improvement related to weight loss was performed. RESULTS: Sixty-three patients were included. The 2 most common components associated with obesity were reduced HDL and raised glucose or Type 2 diabetes. There was a significant improvement of metabolic syndrome and its components, as well as for the rest of the analyzed data, from the first check point and throughout follow-up. Prevalence of such syndrome was 6.3% at 12 and 24 months. Hypertension and raised glucose or Type 2 diabetes were the components with the greatest and fastest improvement; HDL levels and obesity were the least improved. There was a direct relationship between percentage of excess weight loss or percentage of excess BMI loss, and syndrome's improvement. CONCLUSION: Patients with metabolic syndrome improved after gastric bypass, with results lasting after 2 years; other metabolic parameters important for cardiovascular risk were also positively affected. There was a relationship between the amount of weight loss and improvement of metabolic syndrome.