BACKGROUND: Rifaximin is a non-reabsorbable antibiotic which acts at gut level, and improves cognition and inflammatory parameters in minimal hepatic encephalopathy (MHE) patients, but not all patients show the same level of response. This study aims to assess brain activity, both within and between brain networks, following rifaximin treatment, considering the differences between response groups as well. METHODS: Twenty-two healthy controls and 53 patients with cirrhosis (22 without and 31 with MHE, diagnosed by Psychometric Hepatic Encephalopathy Score, PHES) performed psychometric, attention and coordination tests, and blood inflammatory parameters were measured. Resting-state functional magnetic resonance imaging (fMRI) acquisitions were performed on controls and MHE patients. Eighteen MHE patients underwent a rifaximin treatment for 6 months, after which all measures were repeated. fMRI images were analysed and changes after treatment were assessed. RESULTS: After rifaximin treatment, 13 patients improved their PHES score (Responder patients) while 5 did not (Non-responder patients). No significant decrease in blood ammonia was observed after rifaximin treatment, but there was a decrease in plasma inflammatory cytokines in responder patients. A global effect of rifaximin was detected on the sensorimotor and fronto-parietal networks. Responder patients showed a relative increase of thalamic network connectivity in comparison to non-responder patients. Before treatment, responder and non-responder patients showed connectivity differences in basal ganglia network. The connection of the sensorimotor and thalamic networks between them and with other networks suffered changes after treatment. These connections between networks mostly decreased after treatment. All changes and differences showed a significant level of correlation with the performance of psychometric tests and the blood levels of inflammatory biomarkers. CONCLUSIONS: There was an improvement of the communication between executive, motor and attention-related brain areas, and their functional independence following rifaximin treatment. Patients who respond also show a less deteriorated connection involved in these functions before treatment. Results suggest that the improved inflammatory state of MHE patients, following rifaximin treatment would favour the observed changes in brain function and enhanced cognitive performance.
Hepatic Encephalopathy , Humans , Rifaximin/therapeutic use , Hepatic Encephalopathy/drug therapy , Cognition , Brain/diagnostic imaging , Brain/pathology , Anti-Bacterial Agents , Liver Cirrhosis/pathology
There are several implications of the surge in the incidence of pandemics and epidemics in the last decades. COVID-19 being the most remarkable one, showed the vulnerability of patients with neurodegenerative diseases like Alzheimer's disease (AD). This review studies the pathological interlinks and triggering factors between the two illnesses and proposes a multifactorial pathway of AD causation due to COVID-19. The article evaluates and describes all the postulated hypotheses which explain the etiology and possible pathogenesis of the disease in four domains: Inflammation & Neurobiochemical interactions, Oxidative Stress, Genetic Factors, and Social Isolation. We believe that a probable hypothesis of an underlying cause of AD after COVID-19 infection could be the interplay of all these factors.
Alzheimer Disease , COVID-19 , Humans , Alzheimer Disease/epidemiology , Alzheimer Disease/etiology , Alzheimer Disease/metabolism , COVID-19/complications , Inflammation/complications , Oxidative Stress
Suspected or confirmed antibiotic allergy is a frequently encountered clinical circumstance that influences antimicrobial prescribing and often leads to the avoidable use of less efficacious and/or more toxic or costly drugs than first-line antimicrobials. Optimizing antimicrobial therapy in patients with antibiotic allergy labels has become one of the priorities of antimicrobial stewardship programs (ASP) in several countries. This guidance document aims to make recommendations for the systematic approach to patients with suspected or confirmed antibiotic allergy based on current evidence. A panel of eleven members of involved Scientific Societies with expertise in the management of patients with suspected or confirmed antibiotic allergy formulated questions about the management of patients with suspected or confirmed antibiotic allergy. A systematic literature review was performed by a medical librarian. The questions were distributed among panel members who selected the most relevant references, summarized the evidence and formulated graded recommendations when possible. The answers to all questions were finally reviewed by all panel members. A systematic approach to patients with suspected or confirmed antibiotic allergy is recommended to improve antibiotic selection and, consequently clinical outcomes. A clinically oriented, 3-category risk-stratification strategy was recommended for patients with suspected antibiotic allergy. Complementary assessments should consider both clinical risk category and preferred antibiotic agent. Empirical therapy recommendations for the most relevant clinical syndromes in patients with suspected or confirmed β-lactam allergy were formulated. Recommendations on the implementation and monitoring of the impact of the guidelines were formulated. ASP and allergists should design and implement activities that facilitate the most adequate antibiotic use in these patients.(AU)
En la práctica clínica, un antecedente de alergia a los antibióticos, confirmada o sospechada, es frecuente y condiciona la selección de antibióticos, lo que requiere, con frecuencia, el uso de fármacos menos eficaces, más tóxicos o más caros que los antibióticos de primera línea. La optimización del uso de antibióticos en pacientes con este antecedente es una de las prioridades de los programas de optimización de uso de antibióticos (PROA) en varios países. Estas guías pretenden formular recomendaciones para evaluar de una manera sistemática a estos pacientes mediante una aproximación basada en la evidencia. Un panel multidisciplinar constituido por alergólogos, infectólogos, farmacéuticos hospitalarios e intensivistas formularon una serie de preguntas sobre el manejo de estos pacientes. Una documentalista realizó la revisión bibliográfica. Las preguntas se distribuyeron entre los miembros del grupo de trabajo, quienes seleccionaron las referencias más relevantes y formularon las correspondientes recomendaciones, que fueron revisadas y aprobadas por todos los miembros del grupo. Es necesaria una aproximación sistemática a los pacientes con antecedente de alergia a antibióticos para optimizar la selección del tratamiento antibiótico y mejorar los resultados clínicos de estos pacientes cuando precisan antibioterapia. El presente documento recomienda una estrategia de estratificación clínica del riesgo en 3 categorías. La recomendación de realizar evaluaciones complementarias se basa en el riesgo clínico y el antibiótico de primera línea necesario. Además, se formulan recomendaciones de tratamiento antibiótico empírico para los principales síndromes infecciosos en pacientes con alergia confirmada o sospechada. Finalmente se formulan recomendaciones sobre la implementación y monitorización del impacto de las recomendaciones de la guía. Los programas PROA y los alergólogos deben trabajar...(AU)
Humans , Consensus , Hypersensitivity , Anti-Bacterial Agents , Drug Hypersensitivity
Small molecule organic semiconductors (SMOSs) have emerged as a new class of photocatalysts that exhibit visible light absorption, tunable bandgap, good dispersion, and solubility. However, the recovery and reusability of such SMOSs in consecutive photocatalytic reactions is challenging. This work concerns a 3D-printed hierarchical porous structure based on an organic conjugated trimer, named EBE. Upon manufacturing, the photophysical and chemical properties of the organic semiconductor are maintained. The 3D-printed EBE photocatalyst shows a longer lifetime (11.7â ns) compared to the powder-state EBE (1.4â ns). This result indicates a microenvironment effect of the solvent (acetone), a better dispersion of the catalyst in the sample, and reduced intermolecular π-π stacking, which results in improved separation of the photogenerated charge carriers. As a proof-of-concept, the photocatalytic activity of the 3D-printed EBE catalyst is evaluated for water treatment and hydrogen production under sun-like irradiation. The resulting degradation efficiencies and hydrogen generation rates are higher than those reported for the state-of-the-art 3D-printed photocatalytic structures based on inorganic semiconductors. The photocatalytic mechanism is further investigated, and the results suggest that hydroxyl radicals (HOâ ) are the main reactive radicals responsible for the degradation of organic pollutants. Moreover, the recyclability of the EBE-3D photocatalyst is demonstrated in up to 5 uses. Overall, these results indicate the great potential of this 3D-printed organic conjugated trimer for photocatalytic applications.
Suspected or confirmed antibiotic allergy is a frequently encountered clinical circumstance that influences antimicrobial prescribing and often leads to the avoidable use of less efficacious and/or more toxic or costly drugs than first-line antimicrobials. Optimizing antimicrobial therapy in patients with antibiotic allergy labels has become one of the priorities of antimicrobial stewardship programs (ASP) in several countries. This guidance document aims to make recommendations for the systematic approach to patients with suspected or confirmed antibiotic allergy based on current evidence. A panel of eleven members of involved Scientific Societies with expertise in the management of patients with suspected or confirmed antibiotic allergy formulated questions about the management of patients with suspected or confirmed antibiotic allergy. A systematic literature review was performed by a medical librarian. The questions were distributed among panel members who selected the most relevant references, summarized the evidence and formulated graded recommendations when possible. The answers to all questions were finally reviewed by all panel members. A systematic approach to patients with suspected or confirmed antibiotic allergy is recommended to improve antibiotic selection and, consequently clinical outcomes. A clinically oriented, 3-category risk-stratification strategy was recommended for patients with suspected antibiotic allergy. Complementary assessments should consider both clinical risk category and preferred antibiotic agent. Empirical therapy recommendations for the most relevant clinical syndromes in patients with suspected or confirmed ß-lactam allergy were formulated. Recommendations on the implementation and monitoring of the impact of the guidelines were formulated. ASP and allergists should design and implement activities that facilitate the most adequate antibiotic use in these patients.
Communicable Diseases , Drug Hypersensitivity , Hypersensitivity , Pharmacy Service, Hospital , Humans , Coronary Care Units , Anti-Bacterial Agents/therapeutic use , Hypersensitivity/drug therapy
Biomarkers for disease diagnosis and prognosis are crucial in clinical practice. They should be objective and quantifiable and respond to specific therapeutic interventions. Optimal biomarkers should reflect the underlying process (pathological or not), be reproducible, widely available, and allow measurements repeatedly over time. Ideally, biomarkers should also be non-invasive and cost-effective. This review aims to focus on the usefulness and limitations of electroencephalography (EEG) in the search for Alzheimer's disease (AD) biomarkers. The main aim of this article is to review the evolution of the most used biomarkers in AD and the need for new peripheral and, ideally, non-invasive biomarkers. The characteristics of the EEG as a possible source for biomarkers will be revised, highlighting its advantages compared to the molecular markers available so far.
Alzheimer Disease/diagnosis , Biomarkers/analysis , Cerebrospinal Fluid/cytology , Electroencephalography/methods , Alzheimer Disease/diagnostic imaging , Animals , Humans
Oxidative stress is an early occurrence in the development of Alzheimer's disease (AD) and one of its proposed etiologic hypotheses. There is sufficient experimental evidence supporting the theory that impaired antioxidant enzymatic activity and increased formation of reactive oxygen species (ROS) take place in this disease. However, the antioxidant treatments fail to stop its advancement. Its multifactorial condition and the diverse toxicological cascades that can be initiated by ROS could possibly explain this failure. Recently, it has been suggested that cerebral small vessel disease (CSVD) contributes to the onset of AD. Oxidative stress is a central hallmark of CSVD and is depicted as an early causative factor. Moreover, data from various epidemiological and clinicopathological studies have indicated a relationship between CSVD and AD where endothelial cells are a source of oxidative stress. These cells are also closely related to oligodendrocytes, which are, in particular, sensitive to oxidation and lead to myelination being compromised. The sleep/wake cycle is another important control in the proliferation, migration, and differentiation of oligodendrocytes, and sleep loss reduces myelin thickness. Moreover, sleep plays a crucial role in resistance against CSVD, and poor sleep quality increases the silent markers of this vascular disease. Sleep disruption is another early occurrence in AD and is related to an increase in oxidative stress. In this study, the relationship between CSVD, oligodendrocyte dysfunction, and sleep disorders is discussed while focusing on oxidative stress as a common occurrence and its possible role in the onset of AD.
BACKGROUND: There is a paucity of global data on cardiovascular disease (CVD) prevalence in people with type 2 diabetes (T2D). The primary objective of the CAPTURE study was to estimate the prevalence of established CVD and its management in adults with T2D across 13 countries from five continents. Additional objectives were to further characterize the study sample regarding demographics, clinical parameters and medication usage, with particular reference to blood glucose-lowering agents (GLAs: glucagon-like peptide-1 receptor agonists and sodium-glucose co-transporter-2 inhibitors) with demonstrated cardiovascular benefit in randomized intervention trials. METHODS: Data were collected from adults with T2D managed in primary or specialist care in Australia, China, Japan, Czech Republic, France, Hungary, Italy, Argentina, Brazil, Mexico, Israel, Kingdom of Saudi Arabia, and Turkey in 2019, using standardized methodology. CVD prevalence, weighted by diabetes prevalence in each country, was estimated for the overall CAPTURE sample and participating countries. Country-specific odds ratios for CVD prevalence were further adjusted for relevant demographic and clinical parameters. RESULTS: The overall CAPTURE sample included 9823 adults with T2D (n = 4502 from primary care; n = 5321 from specialist care). The overall CAPTURE sample had median (interquartile range) diabetes duration 10.7 years (5.6-17.9 years) and glycated hemoglobin 7.3% (6.6-8.4%) [56 mmol/mol (49-68 mmol/mol)]. Overall weighted CVD and atherosclerotic CVD prevalence estimates were 34.8% (95% confidence interval [CI] 32.7-36.8) and 31.8% (95% CI 29.7-33.8%), respectively. Age, gender, and clinical parameters accounted for some of the between-country variation in CVD prevalence. GLAs with demonstrated cardiovascular benefit were used by 21.9% of participants, which was similar in participants with and without CVD: 21.5% and 22.2%, respectively. CONCLUSIONS: In 2019, approximately one in three adults with T2D in CAPTURE had diagnosed CVD. The low use of GLAs with demonstrated cardiovascular benefit even in participants with established CVD suggested that most were not managed according to contemporary diabetes and cardiology guidelines. Study registration NCT03786406 (registered on December 20, 2018), NCT03811288 (registered on January 18, 2019).
Cardiovascular Diseases/epidemiology , Diabetes Mellitus, Type 2/epidemiology , Aged , Cardiovascular Diseases/diagnosis , Cardiovascular Diseases/prevention & control , Cross-Sectional Studies , Diabetes Mellitus, Type 2/diagnosis , Diabetes Mellitus, Type 2/drug therapy , Female , Humans , Hypoglycemic Agents/therapeutic use , Male , Middle Aged , Prevalence , Prognosis , Protective Factors , Risk Assessment , Risk Factors , Time Factors
We used histological techniques to describe the morphology of the yolk and pericardial sacs in developing embryos of the lecithotrophic species Girardinus creolus, Gambusia puncticulata, Limia vittata, and Quintana atrizona, in comparison with the extreme matrotrophic Heterandria formosa. In lecithotrophic species, the yolk sac was enlarged and lasted until the final stages of development, while in H. formosa it was completely absorbed soon after fertilization. Lecithotrophic poeciliids showed a pericardial sac with a single layer of blood vessels covering the dorsal surface of the cephalic region only, while H. formosa showed a more complex largely vascularized pericardial sac covering the entire dorsal surface, except the caudal region. In advanced gestation of G. creolus, a vascular plexus of the yolk sac reaches the pharyngeal region, behind the gills, suggesting that the pharynx may play a role in embryonic nutrition in lecithotrophic species. These morphological evidences suggest that matrotrophy derives from lecithotrophy.
Cyprinodontiformes , Animals , Cytoplasm , Yolk Sac
Letter to the editor.
Carta al editor.
Statistics as Topic , Humans , Psychometrics , Reproducibility of Results
RESUMEN La postura corporal correcta es un aspecto importante para la salud y la calidad de vida de los niños desde las primeras edades y se incluye como parte del eje temático de Higiene en el Programa Director de Salud que se desarrolla en las escuelas cubanas. Teniendo en cuenta la existencia de esta problemática en la Educación Primaria, se partió de un diagnóstico sobre la situación actual referente a la postura corporal en una muestra de 184 niños de ambos sexos pertenecientes al semi-internado «Isidro de Armas¼ de Pinar del Río. Durante el estudio se empleó la observación científica y el examen somatoscópico, además se aplicó una encuesta a 27 maestros trabajadores en ese centro. A partir de las deficiencias y debilidades encontradas se elaboró un conjunto de acciones encaminadas a la capacitación de los maestros del referido centro, para un desarrollo eficiente de la educación corporal en los niños comprendidos entre 6 a 12 años. La implementación de dichas acciones en la práctica pedagógica permitió a los maestros profundizar en los aspectos teóricos, prácticos y metodológicos indispensables para el logro de un desarrollo adecuado de la postura corporal en los infantes.
ABSTRACT The correct corporal posture is an important aspect for the health and the quality of children's life since the early years and it is included as part of the hygiene thematic axis in the Health Principal Program which is developed in our schools. Taking into account the existence of the problematic situation in the Elementary Education, the authors of this investigation elaborated and validated an up-grading strategic for the primary teachers of the school «Isidoro Garcia¼ from Las Minas de Matahambres municipality, gaining outstanding results after applying the corresponding methods such as the observation, the survey and a Somatoscopical test. Besides, other samples of groups were included in the investigation, like the family, supervisors and principals.
La confiabilidad es entendida como una propiedad métrica de las puntuaciones de un instrumento de medida. Recientemente se viene utilizando el coeficiente omega (ω) para la estimación de la confiabilidad. No obstante, la medición nunca es exacta por la influencia del error aleatorio, por esa razón es necesario calcular y reportar el intervalo de confianza (IC) que permite encontrar en valor verdadero en un rango de medida. En ese contexto, el artículo plantea una forma de estimar el IC mediante el método de bootstrap para facilitar este procedimiento se brindan códigos de R (un software de acceso libre) para que puedan realizarse los cálculos de una forma amigable. Se espera que el artículo sirva de ayuda a los investigadores de ámbito de salud.
La confiabilidad es entendida como una propiedad métrica de las puntuaciones de un instrumento de medida. Recientemente se viene utilizando el coeficiente omega (ω) para la estimación de la confiabilidad. No obstante, la medición nunca es exacta por la influencia del error aleatorio, por esa razón es necesario calcular y reportar el intervalo de confianza (IC) que permite encontrar en valor verdadero en un rango de medida. En ese contexto, el artículo plantea una forma de estimar el IC mediante el método de bootstrap para facilitar este procedimiento se brindan códigos de R (un software de acceso libre) para que puedan realizarse los cálculos de una forma amigable. Se espera que el artículo sirva de ayuda a los investigadores de ámbito de salud.
Confidence Intervals , Mathematical Concepts , Reproducibility of Results
No disponible
16136 , Reproducibility of Results , Factor Analysis, Statistical , Confidence Intervals , Research
Recientemente se publicó en la revista un artículo,1que proporciona información relevante acerca del consumo de drogas y su relación con el estilo de vida en estudiantes de una facultad de comunicación. No obstante, es necesario establecer una diferencia en la descripción de los participantes del estudio. En el artículo objeto de análisis en esta carta, se refiere en la parte de resultado, que se ha hecho uso de una muestra. Sin embargo, una muestra es entendida como un subconjunto de la población conformado por unidades de análisis.2 Pese a ello, en ningún momento en el artículo se describe a la población. La población es un conjunto de elementos que contienen ciertas características que se pretenden estudiar.3 Por esa razón, entre la población y la muestra existe un carácter inductivo (de lo particular a lo general), esperando que la parte observada (en este caso la muestra) sea representativa de la realidad (entiéndase aquí a la población); para de esa forma garantizar las conclusiones extraídas en el estudio.4 Existen dos niveles de población, el primero,la población diana, que generalmente es muy grande y el investigador no logra tener acceso a ella y el segundo, la población accesible, en donde el número de elementos es menor y está delimitado por criterios de inclusión y exclusión.3Es en la última población en la que se realiza el muestreo y tamaño muestral. No obstante, en el artículo que se analiza, no indica la población accesible, pese a referir que se usó una muestra. De ser realmente una muestra, los autores debieron indicar, el tipo de muestreo, si este fue probabilístico o no probabilístico.5 En caso de usar el primero, debió referir si fue: simple, sistemático, estratificado y conglomerado; en caso del segundo, si fue por cuota, conveniencia o intencional. Por lo antes mencionado, se recomienda que la utilización correcta del término muestra; y que, en caso de referirla en un artículo, esta deba ir acompañada de la descripción de la población y el tipo de muestreo(AU)
Humans , Young Adult , Substance-Related Disorders/diagnosis , Substance-Related Disorders/etiology , Life Style/ethnology , Peru/ethnology , Students , Stratified Sampling
