Genetic diversity and cross-species transmissibility of bat-associated picornaviruses from Spain.

BACKGROUND: Emerging zoonotic diseases arise from cross-species transmission events between wild or domesticated animals and humans, with bats being one of the major reservoirs of zoonotic viruses. Viral metagenomics has led to the discovery of many viruses, but efforts have mainly been focused on some areas of the world and on certain viral families. METHODS: We set out to describe full-length genomes of new picorna-like viruses by collecting feces from hundreds of bats captured in different regions of Spain. Viral sequences were obtained by high-throughput Illumina sequencing and analyzed phylogenetically to classify them in the context of known viruses. Linear discriminant analysis (LDA) was performed to infer likely hosts based on genome composition. RESULTS: We found five complete or nearly complete genomes belonging to the family Picornaviridae, including a new species of the subfamily Ensavirinae. LDA suggested that these were true vertebrate viruses, rather than viruses from the bat diet. Some of these viruses were related to picornaviruses previously found in other bat species from distant geographical regions. We also found a calhevirus genome that most likely belongs to a proposed new family within the order Picornavirales, and for which genome composition analysis suggested a plant host. CONCLUSIONS: Our findings describe new picorna-like viral species and variants circulating in the Iberian Peninsula, illustrate the wide geographical distribution and interspecies transmissibility of picornaviruses, and suggest new hosts for calheviruses.

Full-genome sequencing of dozens of new DNA viruses found in Spanish bat feces.

Bats are natural hosts of multiple viruses, many of which have clear zoonotic potential. The search for emerging viruses has been aided by the implementation of metagenomic tools, which have also enabled the detection of unprecedented viral diversity. Currently, this search is mainly focused on RNA viruses, which are largely over-represented in databases. To compensate for this research bias, we analyzed fecal samples from 189 Spanish bats belonging to 22 different species using viral metagenomics. This allowed us to identify 52 complete or near-complete viral genomes belonging to the families Adenoviridae, Circoviridae, Genomoviridae, Papillomaviridae, Parvoviridae, Polyomaviridae and Smacoviridae. Of these, 30 could constitute new species, doubling the number of viruses currently described in Europe. These findings open the door to a more thorough analysis of bat DNA viruses and their zoonotic potential. IMPORTANCE: Metagenomics has become a fundamental tool to characterize the global virosphere, allowing us not only to understand the existing viral diversity and its ecological implications but also to identify new and emerging viruses. RNA viruses have a higher zoonotic potential, but this risk is also present for some DNA virus families. In our study, we analyzed the DNA fraction of fecal samples from 22 Spanish bat species, identifying 52 complete or near-complete genomes of different viral families with zoonotic potential. This doubles the number of genomes currently described in Europe. Metagenomic data often produce partial genomes that can be difficult to analyze. Our work, however, has characterized a large number of complete genomes, thus facilitating their taxonomic classification and enabling different analyses to be carried out to evaluate their zoonotic potential. For example, recombination studies are relevant since this phenomenon could play a major role in cross-species transmission.

SARS-CoV-2 remodels the landscape of small non-coding RNAs with infection time and symptom severity.

The COVID-19 pandemic caused by the coronavirus SARS-CoV-2 has significantly impacted global health, stressing the necessity of basic understanding of the host response to this viral infection. In this study, we investigated how SARS-CoV-2 remodels the landscape of small non-coding RNAs (sncRNA) from a large collection of nasopharyngeal swab samples taken at various time points from patients with distinct symptom severity. High-throughput RNA sequencing analysis revealed a global alteration of the sncRNA landscape, with abundance peaks related to species of 21-23 and 32-33 nucleotides. Host-derived sncRNAs, including microRNAs (miRNAs), transfer RNA-derived small RNAs (tsRNAs), and small nucleolar RNA-derived small RNAs (sdRNAs) exhibited significant differential expression in infected patients compared to controls. Importantly, miRNA expression was predominantly down-regulated in response to SARS-CoV-2 infection, especially in patients with severe symptoms. Furthermore, we identified specific tsRNAs derived from Glu- and Gly-tRNAs as major altered elements upon infection, with 5' tRNA halves being the most abundant species and suggesting their potential as biomarkers for viral presence and disease severity prediction. Additionally, down-regulation of C/D-box sdRNAs and altered expression of tinyRNAs (tyRNAs) were observed in infected patients. These findings provide valuable insights into the host sncRNA response to SARS-CoV-2 infection and may contribute to the development of further diagnostic and therapeutic strategies in the clinic.

A Serious Game for Cognitive Stimulation of Older People With Mild Cognitive Impairment: Design and Pilot Usability Study.

Background: Cognitive stimulation of older people helps prevent, and even treat, age-related diseases, such as mild cognitive impairment. Playing games reduces the probability of experiencing this pathology, which is related to the loss of the ability to carry out some instrumental activities of daily living. Objective: This work describes the design and development of a serious game for the cognitive stimulation of older people, with exercises related to the daily life task of shopping. A pilot study for its preliminary usability validation is also presented. Methods: The designed serious game includes 4 exercises consisting of shopping in a hypermarket, ordering products, making payments, and organizing the purchase, thus dealing with the most frequent cognitive problems of older people associated with episodic declarative memory, naming, calculation, and organization, respectively. Results: A total of 19 older people participated in the pilot study for the usability validation of the serious game. They indicated that they like the aesthetic and interesting topic of the game. They reported that it provides a high level of entertainment and could be useful in daily life for mental stimulation. The participants found the serious game to be intuitive, but the ease of use and readability of the instructions could be improved. Conclusions: This study suggests that the innovative serious game developed could be accepted by older people for their cognitive stimulation to prevent or treat mild cognitive impairment, although a long-term intervention study should be performed as future work. Its ecological validity design, with everyday tasks, adaptable levels of difficulty, and motivational mechanisms, is a differentiating factor compared to similar serious games.

Optimized Recovery of Viral DNA and RNA from Blood Plasma for Viral Metagenomics.

Metagenomics is vastly improving our ability to discover new viruses, as well as their possible associations with disease. However, metagenomics has also changed our understanding of viruses in general. This is because we can find viruses in healthy hosts in the absence of disease, which changes the perspective of viruses as mere pathogens and offers a new perspective in which viruses function as important components of ecosystems. In concrete, human blood metagenomics has revealed the presence of different types of viruses in apparently healthy subjects. These viruses are human anelloviruses and, to a lower extent, human pegiviruses. Viral metagenomics' major challenge is the correct isolation of the viral nucleic acids from a specific sample. For the protocol to be successful, all steps must be carefully chosen, in particular those that optimize the recovery of viral nucleic acids. Here, we present a procedure that allows the recovery of both DNA and RNA viruses from plasma samples.

Bio-Monitoring of Metal(loid)s Pollution in Dry Riverbeds Affected by Mining Activity.

The aim of this study was to evaluate the most abundant native plants that could be used as a bio-monitor of metal(loid) concentration in dry riverbeds affected by mining activities. Three plants species and their respective rhizospheric soils were sampled from the El Beal (Piptatherum miliaceum, 15 samples), La Carrasquilla (Foeniculum vulgare, 10 samples), and Ponce (Dittrichia viscosa, 12 samples) dry riverbeds from the mining district of Cartegena-La Unión (SE Spain). There is scanty bibliography of the capacity of these species to be used as bio-monitors in the dry riverbeds. Plants categorized as a bio-monitor were established according to the bioaccumulation factor (BF), mobility ratio (MR), and linear correlations between metal(loid) concentrations in plants tissues (root or stem)-rhizospheric soils. The rhizospheric soils were highly contaminated for As, Cd, Pb, and Zn (Cf ≥ 6), and moderately contaminated for Mn (1 ≤ Cf < 3). Piptatherum miliaceum presented on Cd similar mean concentrations on rhizospheric soil and root, BF = 1.07, with a strong correlation soil-root (r = 0.61, p = 0.02). Therefore, of the three species with the capacity to grow in the area, Piptatherum miliaceum showed characteristics to be considered as a bio-monitor for Cd, with a BF > 1, and a positive-significant correlation between the rhizospheric soil and roots.

Generation of Photopolymerized Microparticles Based on PEGDA Hydrogel Using T-Junction Microfluidic Devices: Effect of the Flow Rates.

The formation of microparticles (MPs) of biocompatible and biodegradable hydrogels such as polyethylene glycol diacrylate (PEGDA) utilizing microfluidic devices is an attractive option for entrapment and encapsulation of active principles and microorganisms. Our research group has presented in previous studies a formulation to produce these hydrogels with adequate physical and mechanical characteristics for their use in the formation of MPs. In this work, hydrogel MPs are formed based on PEGDA using a microfluidic device with a T-junction design, and the MPs become hydrogel through a system of photopolymerization. The diameters of the MPs are evaluated as a function of the hydrodynamic condition flow rates of the continuous (Qc) and disperse (Qd) phases, measured by optical microscopy, and characterized through scanning electron microscopy. As a result, the following behavior is found: the diameter is inversely proportional to the increase in flow in the continuous phase (Qc), and it has a significant statistical effect that is greater than that in the flow of the disperse phase (Qd). While the diameter of the MPs is proportional to Qd, it does not have a significant statistical effect on the intervals of flow studied. Additionally, the MPs' polydispersity index (PDI) was measured for each experimental hydrodynamic condition, and all values were smaller than 0.05, indicating high homogeneity in the MPs. The microparticles have the potential to entrap pharmaceuticals and microorganisms, with possible pharmacological and bioremediation applications.

Neurophysiological monitoring during endovascular treatment of brain arteriovenous malformations: A meta-analysis.

BACKGROUND: Treatment of brain arteriovenous malformations (b-AVM) carries a risk of iatrogenic injury to eloquent brain regions. Intraoperative neuro-monitoring (IONM) has increasingly been used to monitor spontaneous or evoked neural activity during neurosurgery, but its use is not as well characterized in the endovascular treatment (EVT) of b-AVMs. We aimed to provide a systematic review and meta-analysis of studies reporting any neurological deficit after b-AVM embolization with IONM, with or without provocative test (PT), and no-IONM. METHODS: This systematic review followed the PRISMA guidelines. Medline, EMBASE, and Scopus were searched from conception until March 1, 2022 for studies evaluating EVT with IONM and PT. Primary outcome was the rate of postoperative neurological deficits in EVT with IONM versus no-IONM, while secondary outcome was the subanalysis of IONM with or without PT. Meta-analysis was performed using the Mantel-Haenszel method and random effects modeling. RESULTS: Six studies reached synthesis. Out of a total of 192 EVT, 14 events occurred. Results demonstrated a nonsignificant trend favoring IONM compared to no-IONM to prevent neurological deficits (OR 0.09, 95% CI 0-4.68). Among the EVT with IONM, PT was done in 411 branches with 10 events (0.2%) despite a negative PT. There was a nonsignificant trend favoring IONM plus PT compared to IONM without PT (OR 0.16, 95% CI 0.02-1.07). CONCLUSIONS: Our study suggests that b-AVM EVT with IONM plus PT might reduce rates of postprocedural neurological deficits compared with EVT without IONM. Further studies are needed to confirm these results.

Human Anelloviruses: Influence of Demographic Factors, Recombination, and Worldwide Diversity.

Anelloviruses represent the major and most diverse component of the healthy human virome, referred to as the anellome. In this study, we determined the anellome of 50 blood donors, forming two sex- and age-matched groups. Anelloviruses were detected in 86% of the donors. The number of detected anelloviruses increased with age and was approximately twice as high in men as in women. A total of 349 complete or nearly complete genomes were classified as belonging to torque teno virus (TTV), torque teno mini virus (TTMV), and torque teno midi virus (TTMDV) anellovirus genera (197, 88, and 64 sequences, respectively). Most donors had intergenus (69.8%) or intragenus (72.1%) coinfections. Despite the limited number of sequences, intradonor recombination analysis showed 6 intragenus recombination events in ORF1. As thousands of anellovirus sequences have been described recently, we finally analyzed the global diversity of human anelloviruses. Species richness and diversity were close to saturation in each anellovirus genus. Recombination was found to be the main factor promoting diversity, although its effect was significantly lower in TTV than in TTMV and TTMDV. Overall, our results suggest that differences in diversity between genera may be caused by variations in the relative contribution of recombination. IMPORTANCE Anelloviruses are the most common human infectious viruses and are considered essentially harmless. Compared to other human viruses, they are characterized by enormous diversity, and recombination is suggested to play an important role in their diversification and evolution. Here, by analyzing the composition of the plasma anellome of 50 blood donors, we find that recombination is also a determinant of viral evolution at the intradonor level. On a larger scale, analysis of anellovirus sequences currently available in databases shows that their diversity is close to saturation and differs among the three human anellovirus genera and that recombination is the main factor explaining this intergenus variability. Global characterization of anellovirus diversity could provide clues about possible associations between certain virus variants and pathologies, as well as facilitate the implementation of unbiased PCR-based detection protocols, which may be relevant for using anelloviruses as endogenous markers of immune status.

Comparison of Sedation and Analgesia Requirements in Patients With SARS-CoV-2 Versus Non-SARS-CoV-2 Acute Respiratory Distress Syndrome on Veno-Venous ECMO.

BACKGROUND: Increased analgosedation requirements have been described in patients with acute respiratory distress syndrome (ARDS) on extracorporeal membrane oxygenation (ECMO) support due to unique pharmacokinetic challenges. There is a paucity of data comparing sedation requirements in patients on ECMO for ARDS secondary to SARS-CoV-2 versus other etiologies of respiratory failure. OBJECTIVE: To compare sedation and analgesia requirements in adult patients with SARS-CoV-2 versus non-SARS-CoV-2 ARDS requiring veno-venous (VV) ECMO support. METHODS: We performed a retrospective cohort study of adult patients receiving sedation and analgesia on VV-ECMO support. Patients were excluded if cannulated at an outside hospital for greater than 24 hours, expired within 48 hours of ECMO cannulation, or received neuromuscular blocking agents for greater than 7 consecutive days following ECMO cannulation. RESULTS: We evaluated 108 patients on VV-ECMO support, including 44 with non-SARS-CoV-2 ARDS and 64 with SARS-CoV-2 ARDS. The median daily dexmedetomidine requirements were significantly higher in the SARS-CoV-2 cohort (16.7 vs 13.4 mcg/kg/day, P = 0.03), while the median propofol daily requirements were significantly higher in the non-SARS-CoV-2 cohort (40.3 vs 53.5 mg/kg/day, P < 0.01). There was no difference in daily requirements of opioids, benzodiazepines, and ketamine between groups. Use of adjunct agents to facilitate weaning was significantly higher in the SARS-CoV-2 cohort (78.1% vs 43.2%, P < 0.01). CONCLUSION AND RELEVANCE: Patients with ARDS on VV-ECMO support require multiple analgosedative agents with concomitant use of nonparenteral adjunct agents. Further studies are needed to evaluate optimal analgosedation strategies in patients on ECMO support.

Adherence to evidence-based recommendations for chronic noncommunicable diseases: a multicenter cross-sectional study of Bogotá physicians / Adherencia a recomendaciones basadas en evidencia para enfermedades crónicas no transmisibles: estudio de corte transversal multicéntrico en médicos de Bogotá / Adesão às recomendações baseadas em evidências para doenças crônicas não transmissíveis: estudo transversal multicêntrico em médicos de Bogotá

Introduction. The management of patients with chronic noncommunicable diseases, when it follows evidence-based recommendations, improves clinical outcomes and health costs. Despite its importance, little is known about adherence to guidelines and the processes for its monitoring in our environment. The objective of this study was to report the applicability and adherence to a selection of recommendations from clinical practice guidelines for noncommunicable chronic diseases by doctors in Bogotá. Methods. This was a cross-sectional study, the baseline of a cluster experiment that assessed the impact of disseminating recommendations on seven chronic diseases to patients, caregivers, and physicians. A total of 177 physicians from public and private health institutions were invited. Consecutive samples of their medical records were manually reviewed in predefined time ranges (up to 20 patients per physician, with up to two diseases of interest). The proportions of applicability and adherence were calculated according to 40 recommendations. Results. The 177 physicians who participated (out of 266 eligible) were from seven institutions, and 3,747 medical records (21,093 patients/recommendation) were analyzed. The general applicability was 31.9% (95% CI 31.3-32.6%), and it varied considerably by recommendation (range 0.3-100%) and disease (range 10.7-65%). Overall adherence was 42.0% (95% CI 40.8-43.2%), with higher adherence in acute coronary syndrome patients (58.4%) and lower adherence in diabetes mellitus patients (23.7%). Discussion. This is the most up-to-date, exhaustive, and representative measurement of adherence to guideline recommendations by doctors in Bogotá. Conclusions. Adherence to evidence-based recommendations for patients with chronic noncommunicable diseases in Bogotá is poor and highly variable. Keywords: Practice Guideline; Evidence-Based Medicine; Noncommunicable Diseases; Quality of Health Care; Implementation Science; Internal Medicine; Primary Health Care

Introducción. El manejo de pacientes con enfermedades crónicas no transmisibles, cuando se realiza a partir de recomendaciones basadas en la evidencia, mejora los desenlaces clínicos y los costos en salud. Pese a su importancia, poco se conocen la adherencia a las recomendaciones de guías y los procesos para su monitoreo en nuestro medio. El objetivo de este estudio es reportar la aplicabilidad y la adherencia a una selección de recomendaciones de guías de práctica clínica, en enfermedades crónicas no transmisibles, por médicos de Bogotá. Metodología. Estudio de corte MSc.Participaron 177 médicos de instituciones de salud públicas y privadas. Se revisaron manualmente muestras consecutivas de sus historias clínicas en rangos de tiempo predefinidos (meta hasta 20 pacientes por médico, en hasta dos enfermedades de interés). Se calcularon las proporciones de aplicabilidad y adherencia en 40 recomendaciones. Resultados. Participaron 177 médicos (de 266 elegibles), de 7 instituciones, con 3,747 historias clínicas (21,093 pacientes/recomendación) analizadas. La aplicabilidad general fue 31.9% (IC95% 31.3%-32.6%), y varió considerablemente por recomendación (rango 0.3%-100%) y enfermedad (rango 10.7%-65%). La adherencia general fue 42.0% (IC95% 40.8% -43.2%), siendo mayor en síndrome coronario agudo (58.4%) y menor en diabetes mellitus (23.7%). Discusión. Esta es la medición más actualizada, exhaustiva y representativa de la adherencia a las recomendaciones de guías por parte de médicos de Bogotá. Conclusiones. La adherencia a recomendaciones basadas en evidencia, para pacientes con enfermedades crónicas no transmisibles de Bogotá, es deficiente y altamente variable. Palabras clave: Guía de Práctica Clínica; Medicina Basada en la Evidencia; Enfermedades no Transmisibles; Calidad de la Atención de Salud; Ciencia de la Implementación; Medicina Interna; Atención Primaria de Salud

Introdução. O manejo de pacientes com doenças crônicas não transmissíveis, quando realizado com base em recomendações baseadas em evidências, melhora os resultados clínicos e os custos de saúde. Apesar da sua importância, pouco se sabe sobre a adesão às recomendações das diretrizes e os processos para monitorá-la em nosso meio. O objetivo deste estudo é relatar a aplicabilidade e adesão a uma seleção de recomendações das diretrizes de prática clínica, em doenças crônicas não transmissíveis, por médicos em Bogotá. Metodologia. Estudo transversal (linha de base de um experimento cluster que avalia o impacto da divulgação de recomendações sobre sete doenças crônicas a pacientes, cuidadores e médicos). Participaram 177 médicos de instituições de saúde públicas e privadas. Foram revisadas manualmente amostras consecutivas de seus prontuários em intervalos de tempo pré-definidos (alvo de até 20 pacientes por médico, em até duas doenças de interesse). Foram calculadas proporções de aplicabilidade e adesão para 40 recomendações. Resultados. Participaram 177 médicos (de 266 elegíveis), de 7 instituições, com 3,747 prontuários (21,093 pacientes/recomendação) analisados. A aplicabilidade geral foi de 31.9% (IC 95% 31.3%-32.6%) e variou consideravelmente por recomendação (intervalo 0.3%-100%) e doença (intervalo 10.7%-65%). A adesão geral foi de 42.0% (IC 95% 40.8%-43.2%), sendo maior na síndrome coronariana aguda (58.4%) e menor na diabetes mellitus (23.7%). Discussão. Esta é a medição mais atualizada, exaustiva e representativa da adesão às recomendações das diretrizes por médicos em Bogotá. Conclusões. A adesão às recomendações baseadas em evidências para pacientes com doenças crônicas não transmissíveis em Bogotá é fraca e altamente variável. Palavras-chave: Guia de Prática Clínica; Medicina Baseada em Evidências; Doenças não Transmissíveis; Qualidade da Assistência à Saúde; Ciência da Implementação; Medicina Interna; Atenção Primária à Saúde

Combined technique as first approach in mechanical thrombectomy: Efficacy and safety of REACT catheter combined with stent retriever.

INTRODUCTION: Mechanical thrombectomy (MT) with combined treatment including both a stent retriever and distal aspiration catheter may improve recanalization rates in patients with acute ischemic stroke (AIS) due to large vessel occlusion (LVO). Here, we evaluated the effectiveness and safety of the REACT aspiration catheter used with a stent retriever. METHODS: This prospective study included consecutive adult patients who underwent MT with a combined technique using REACT 68 and/or 71 between June 2020 and July 2021. The primary endpoints were final and first pass mTICI 2b-3 and mTICI 2c-3 recanalization. Analysis was performed after first pass and after each attempt. Secondary safety outcomes included procedural complications, symptomatic intracranial hemorrhage (sICH) at 24 h, in-hospital mortality, and 90-day functional independence (modified Rankin Scale [mRS] 0-2). RESULTS: A total of 102 patients were included (median age 78; IQR: 73-87; 50.0% female). At baseline, median NIHSS score was 19 (IQR: 11-21), and ASPECTS was 9 (IQR: 8-10). Final mTICI 2b-3 recanalization was achieved in 91 (89.2%) patients and mTICI 2c-3 was achieved in 66 (64.7%). At first pass, mTICI 2b-3 was achieved in 55 (53.9%) patients, and mTICI 2c-3 in 37 (36.3%). The rate of procedural complications was 3.9% (4/102), sICH was 6.8% (7/102), in-hospital mortality was 12.7% (13/102), and 90-day functional independence was 35.6% (36/102). CONCLUSION: A combined MT technique using a stent retriever and REACT catheter resulted in a high rate of successful recanalization and first pass recanalization in a sample of consecutive patients with AIS due to LVO in clinical use.

Increased Number of Passes and Double Stent Retriever Technique Induces Cumulative Injury on Arterial Wall After Mechanical Thrombectomy in a Swine Model.

The number of stentriever passes during endovascular thrombectomy impacts clinical outcomes in acute ischemic stroke. Previous studies suggest that the simultaneous double stent retriever technique (DSRT) could improve the efficacy and reduce the number of passes. We aim to analyze the degree of vessel wall injury according to the number of passes and technique (single vs. simultaneous devices). Histological changes were evaluated in renal arteries (RAs) of swine models after thrombectomy (1, 2, or 3 passes) with single stent (SSRT) and DSRT. Thrombectomy passes were performed in 12 RA: 3 samples from each artery were studied by optical microscopy to assess a vascular damage score. All thirty-six samples showed endothelial denudation and different degrees of damage in the deepest layers of the arterial wall; however, all arteries remained patent by the time of assessment. In all cases, the degree of vascular injury increased with the number of passes. Compared with a SSRT, DSRT showed a higher severity of histological damage corresponding to the damage caused by 1.4 SSRT passes. However, in distal arteries, vascular damage was relatively similar when comparing SSRT with multiple passes and DSRT with one pass. The degree of vessel injury increases with the number of passes. Even though histological damage per pass was 1.4 higher with DSRT than SSRT, short-term vessel patency was not compromised after up to 3 DSRT passes. Further studies are needed to characterize the risk-benefit ratio of the DSRT in routine clinical practice.

Emotional States, Adherence and Prevention Behaviors in Trans Women during the COVID-19 Lockdown / Estados Emocionais e Comportamentos de Aderência e Prevenção em Mulheres Trans Durante o Confinamento por COVID-19 / Estados Emocionales y Conductas de Adherencia y Prevención en Mujeres Trans Durante el Confinamiento por COVID-19

Abstract The pandemic generated multiple biopsychosocial challenges that significantly impacted the health of trans women. The aim of this study is to characterize emotional states and resilience in trans women in Colombia and their relationship to COVID-19 adherence behaviors and prevention behaviors during lockdown. The study employed a cross-sectional descriptive correlational design, with an anonymous online questionnaire that was given to 100 trans women in five cities in Colombia. During the pandemic, more than half of trans women experienced negative emotional states such as depression, anxiety and somatization, and some positive ones such as resilience and personal growth. The latter two contribute to reinforcing adherence and prevention behaviors. This study demonstrates a clear need to give priority and recognition to trans women and their health needs, in order to protect their rights, their well-being, and their health.

Resumo A pandemia gerou múltiplos desafios biopsicossociais que impactaram significativamente a saúde das mulheres trans. O objetivo deste estudo é caracterizar estados emocionais e resiliência em mulheres trans da Colômbia e sua relação com os comportamentos de aderência à COVID-19 e os comportamentos de prevenção durante o confinamento. Foi realizado um desenho descritivo, transversal e correlacional, foi administrado um questionário online anônimo a 100 mulheres trans em cinco cidades da Colômbia. Durante a pandemia, mais da metade das mulheres trans experimentaram estados emocionais negativos como depressão, ansiedade e somatização, e alguns positivos como a resiliência e o crescimento pessoal. Estes dois últimos contribuem para reforçar os comportamentos de adesão e de prevenção. Em situações como a pandemia, é prioritário dar reconhecimento às mulheres trans e às suas necessidades de saúde, a fim de proteger os seus direitos e a sua saúde integral.

Resumen La pandemia generó múltiples desafíos biopsicosociales que impactaron significativamente en la salud de las mujeres trans. El objetivo del presente estudio fue caracterizar los estados emocionales y resiliencia en mujeres trans de Colombia y su relación con las conductas de adherencia y prevención a la COVID-19 durante el confinamiento. Se realizó un diseño trasversal correlacional descriptivo, administrando un cuestionario online anónimo a 100 mujeres trans en cinco ciudades de Colombia. Se encontró que más de la mitad de las mujeres trans han experimentado estados emocionales negativos como depresión, ansiedad y somatización y algunos positivos como resiliencia y crecimiento personal. Los dos últimos contribuyen a fortalecer las conductas de adherencia y prevención de la COVID-19. Es prioritario dar reconocimiento a las mujeres trans y a sus necesidades de salud, desde diversos frentes de acción con el fin de proteger sus derechos y su salud integral.

Impact of Automated Blood Culture Systems on the Management of Bloodstream Infections: Results from a Crossover Diagnostic Clinical Trial.

Bloodstream infections are associated with high rates of morbidity and mortality. Blood culture remains the gold standard for the diagnosis of BSIs. We report a prospective crossover diagnostic clinical trial comparing the performances of two blood culture incubation systems: Virtuo and Bactec FX. The primary outcome was the time to detection (TTD) (from the loading of the sample into the incubator to the positivity signal). Patients over 16 years old suspected of having bacteremia/fungemia were included. They were divided into two strata with a total of 9,957 blood extractions. Initially, each stratum was randomly assigned to one of the incubators and then alternated every 2 weeks for 6 months. Each sample was inoculated into an aerobic bottle and an anaerobic bottle. All bottles were processed equally according to the laboratory's standard procedures after they were flagged positive. We analyzed 4,797 samples in the Virtuo system and 5,160 in the Bactec FX system. The median TTD was significantly lower for the Virtuo group (Virtuo, 15.2 h; Bactec FX, 16.3 h [P < 0.0001]). The turnaround time (TAT) (from sample loading to the Gram stain report) was also reduced with Virtuo (Virtuo, 26.2 h; Bactec FX, 28.3 h [P < 0.004]). When considering only samples from patients with antimicrobial treatment prior to blood culture extraction, the TTD was shorter for Virtuo (median differences in the TTD of 4.5 h for all bottles and 8.7 h for aerobic bottles only [P = 0.0001]). In conclusion, virtuo provided shorter TTD and TAT than Bactec FX. The difference in the median TTD was increased when considering samples incubated in aerobic bottles from patients with antimicrobial treatment. This could have an important effect on the faster diagnosis of BSIs. IMPORTANCE Bloodstream infections are associated with high rates of morbidity and mortality. Blood culture remains the gold standard for its diagnosis. While the identification of the pathogen and its antibiotic susceptibility is required to confirm the optimal antimicrobial regimen, reductions in the times to the detection of positivity and reporting of Gram stain results may be important and time-saving to reduce inappropriate antimicrobial use, improve patient outcomes, and decrease health care costs. We report the first clinical diagnostic study of this scale in a "real-world" setting with a crossover design, comparing two automatic blood culture incubators using samples from patients with a suspected diagnosis of bacteremia/sepsis, as opposed to spiked vials. Our study design mimics that of clinical trials performed for drug marketing authorization, but patient randomization was replaced with the crossover design. A shorter time to detection could have an important effect on the faster identification of causative microorganisms of BSIs and antimicrobial stewardship.

Modelización del tiempo que tarda un paciente con cáncer diferenciado de tiroides en presentar la primera recaída / Modeling of the Time it Takes for a Patient with Differentiated Thyroid Cancer to Present the First Relapse / Modelagem do tempo que um paciente com câncer diferenciado de tireoide leva para apresentar a primeira recidiva

Introducción: de todos los carcinomas de tiroides, los diferenciados son los predominantes. Según la Asociación Colombiana de Endocrinología, la tasa de recaída puede ser de hasta del 30 %, especialmente en pacientes mayores de 45 años y con características tumorales agresivas. En esta investigación se estimó el tiempo libre de enfermedad que transcurre entre la finalización del tratamiento y la ocurren-cia de la primera recaída. Materiales y métodos: se tomó un archivo de datos con los registros de 469 pacientes con cáncer diferenciado de tiroides (cdt) tratados en una clínica especializada de cuarto nivel de complejidad en Bogotá (Colombia). Los datos se recolectaron entre enero de 1997 y diciembre de 2012 y se analizaron estadísticamente usando modelos paramétricos y no paramétricos para obtener las curvas de supervivencia y riesgo. Resultados: con el método no paramétrico se evidenció que en 8.5 años el 75 % de los pacientes no habrán presentado la primera recaída en cdt; mientras que en el método paramétrico el 50 % de los pacientes que no presentaron una tiroglobulina postratamiento menor o igual a 1 ng/mL y un tamaño del tumor menor o igual a 2 cm, su tiempo estimado de la primera recaída fue 29.2 años. Conclusiones: el tiempo libre de enfermedad y el riesgo de hacer recaída para pacientes con cdt está afectado por la presencia de un tamaño de tumor mayor a 2 cm en el momento de la consulta y una cantidad de tiroglobulina mayor a 1 ng/mL, registrada al terminar el tratamiento.

Introduction: Between all thyroid carcinomas, the differentiated are predominant. According to the Colombian Association of Endocrinology, the relapse rate can be up to 30%, especially in patients older than 45 years old and with aggressive tumor characteristics. In this investigation, the time that elapses between the initial surgical treatment and the first relapse of the disease was estimated. Materials and methods: A data file was taken with the records of 469 patients with differentiated thyroid cancer (cdt) treated in a specialized clinic of fourth level of complexity iv in the city of Bogotá (Colombia). Data were collected between January 1997 and December 2012 and were statistically analyzed using para-metric and non-parametric models to obtain survival curves and risk. Results: With the non-parametric method, it is evident that in 8.5 years 75% of the patients will not have presented the first relapse in cdt. While applying the parametric method 50% of patients who do not have a postreatment thyroglobulin or one less than or equal to 1 ng/mL and a tumour size less than or equal to 2 cm, their estimated time of First relapse was 29.2 years. Conclusions: Disease-free time and the risk of relapse for patients with cdt is affected by the presence of a tumor size greater than 2 cm at the time of consultation and levels of thyroglobulin greater than 1 ng/mL, recorded at the end of the treatment.

Introdução: de todos os carcinomas da tireoide, os diferenciados são os predominantes. Segundo a Associação Colombiana de Endocrinologia, a taxa de recaída pode ser até 30%, principalmente em pacien-tes com mais de 45 anos e com características de agressividade tumoral. Nesta investigação, estimou-se o tempo decorrido entre o tratamento cirúrgico inicial e a primeira recaída. Materiais e métodos: tomou-se um arquivo de dados com os prontuários de 469 pacientes com câncer diferenciado de tireoide (cdt) atendidos em uma clínica especializada de quarto nível de complexidade na cidade de Bogotá (Colombia). Coletaram-se os dados entre janeiro de 1997 e dezembro de 2012, que depois foram analisados estatisti-camente usando modelos paramétricos e não paramétricos para encontrar curvas de sobrevida e risco. Resultados: com o método não paramétrico, evidenciou-se que, em 8,5 anos, 75% dos pacientes não terão apresentado a primeira recaída na cdt. Enquanto na aplicação do método paramétrico, 50% dos pacientes que não apresentaram tireoglobulina pós-tratamento ou valores menores ou iguais a 1 ng/mL e tamanho do tumor menor ou igual a 2 cm, seu tempo estimado de primeira recaída foi de 29,2 anos. Conclusões: o tempo livre de doença e o risco de recaída, para pacientes com cdt são afetados pela presença de tama-nho de tumor maior a 2 cm no momento da consulta e uma quantidade de tireoglobulina maior a 1 ng/mL, registrada ao terminar o tratamento.

Effectiveness of a group intervention using pain neuroscience education and exercise in women with fibromyalgia: a pragmatic controlled study in primary care.

BACKGROUND: Very positive effects have been described in the application of pain neuroscience education (PNE) to chronic pain and migraine. However, there are few data on the applicability of this therapeutic approach in actual clinical practice in a primary care (PC) setting. The aim of this study was to explore the efficacy in fibromyalgia (FM) of an intervention based on PNE and exercise compared to treatment as usual (TAU). METHODS: Pragmatic nonrandomised controlled trial set in 5 healthcare centres and one physiotherapy centre in PC. Fifty-three women with FM (2010 American College of Rheumatology Diagnostic Criteria for Fibromyalgia) were studied, 35 in the intervention group (IG) and 18 in the control group (CG). The women in the IG were interviewed individually and then received 6 weekly sessions plus one review session (1 month later): those in the CG received their TAU. The subject assignation to the CG or the IG was determined according to their availability to attend the sessions. They all filled in several questionnaires (prior to and 1 year after the intervention) to evaluate the impact of FM in their daily lives, catastrophism, anxiety and depression, severity and impact of pain in daily personal performance and functional capacity. RESULTS: The reductions (improvements) in the scores of all tests (baseline-final) were greater in the IG (p < 0.05) when adjusted for age and baseline values, with moderate or high effect size. After 1 year, 20% (CI - 1 to 42%) more women in the IG, compared to the CG, had a FIQ score < 39 (mild functional impairment). 17/38 (49%) women in the IG no longer met FM criteria at the end of follow-up. CONCLUSIONS: An intervention based on PNE and exercise in patients with FM is feasible and seems effective in PC. TRIAL REGISTRATION: The study was retrospectively registered at ClinicalTrials.gov (Trial Registration NCT04539171 ), on 04/09/2020.

Ruptura hepática espontánea en paciente con síndrome HELLP.

Hemorrhagic liver rupture is a rare and deadly complication. The pathogenesis is unknown. This situation forces the multidisciplinary team, the immediate termination of pregnancy, the treatment and management of the patient in an intensive care unit (ICU). We report the results of two patients with spontaneous rupture of the liver during pregnancy and HELLP (hemolysis, elevated liver enzymes, low platelet count) syndrome, asymptomatic, during cesarean section, with management in ICU, poor evolution without adequate response; one died and the other leaves hospital. Liver rupture requires high suspicion and timely, aggressive multidisciplinary management in all cases and surgical intervention in those who develop liver ruptura, to improve survival.

La hemorragia por ruptura hepática es una rara y letal complicación, de etiología desconocida. Obliga al equipo multidisciplinario a la interrupción del embarazo, al tratamiento agresivo y al manejo de la paciente en una unidad de cuidado intensivo (UCI). Se presentan dos pacientes con embarazo de término con ruptura de hematoma hepático subcapsular asociado a síndrome HELLP (hemolysis, elevated liver enzymes, low platelet count), asintomáticas, durante operación cesárea, con manejo en UCI, ambas con evolución tórpida; una fallece y la otra se egresa. La ruptura hepática requiere una alta sospecha y un manejo multidisciplinario oportuno, agresivo en todos los casos y de intervención quirúrgica en quienes desarrollen ruptura hepática, para mejorar la supervivencia.

Depressive symptomatology in adults during the COVID-19 pandemic.

Depression entails changes in the mental health of individuals worldwide. Episodes of depression lead to mood swings and changes in the motivational dimension. Our research focused on the prevalence of depression in the adult population and on how it affected the social and affective dimensions. Owing to the current pandemic, we deemed it necessary to explore how protective measures against COVID-19 infection, such as quarantines, could be related to mental health. Moreover, we found it important to determine the prevalence of depressive and anxious symptomatology in adults from the Valle del Cauca region in Colombia during the social isolation connected to COVID-19. Our study was descriptive, analytical and cross-sectional, and involved 1248 subjects. As tools, we used the Hamilton Depression Rating Scale and the Hamilton Anxiety Rating Scale. The data demonstrated that women were more likely to display symptoms of depression and that individuals aged between 24 and 29 were less likely to reveal symptoms of anxiety than those aged between 18 and 23. Moreover, childless or economically dependent individuals proved to be more likely to display symptoms of depression during the pandemic.