Associations of Menstrual Cycle and Progesterone-to-Estradiol Ratio With Alcohol Consumption in Alcohol Use Disorder: A Sex-Separated Multicenter Longitudinal Study.

OBJECTIVE: Alcohol use disorder (AUD) constitutes a critical public health issue and has sex-specific characteristics. Initial evidence suggests that progesterone and estradiol might reduce or increase alcohol intake, respectively. However, there is a need for a better understanding of how the menstrual cycle in females and the ratio of progesterone to estradiol in females and males influence alcohol use patterns in individuals with AUD. METHODS: In this sex-separated multicenter longitudinal study, the authors analyzed 12-month data on real-life alcohol use (from 21,460 smartphone entries), menstrual cycle, and serum progesterone-to-estradiol ratios (from 667 blood samples at four individual study visits) in 74 naturally cycling females and 278 males with AUD between 2020 and 2022, using generalized and general linear mixed modeling. RESULTS: Menstrual cycle phases were significantly associated with binge drinking and progesterone-to-estradiol ratio. During the late luteal phase, females showed a lower predicted binge drinking probability of 13% and a higher predicted marginal mean of progesterone-to-estradiol ratio of 95 compared with during the menstrual, follicular, and ovulatory phases (binge drinking probability and odds ratios vs. late luteal phase, respectively: 17%, odds ratio=1.340, 95% CI=1.031, 1.742; 19%, odds ratio=1.523, 95% CI=1.190, 1.949; and 20%, odds ratio=1.683, 95% CI=1.285, 2.206; difference in progesterone-to-estradiol ratios, respectively: -61, 95% CI=-105.492, -16.095; -78, 95% CI=-119.322, -37.039; and -71, 95% CI=-114.568, -27.534). In males, a higher progesterone-to-estradiol ratio was related to lower probabilities of binge drinking and of any alcohol use, with a 10-unit increase in the hormone ratio resulting in odds ratios of 0.918 (95% CI=0.843, 0.999) and 0.914 (95% CI=0.845, 0.988), respectively. CONCLUSIONS: These ecologically valid findings suggest that high progesterone-to-estradiol ratios can have a protective effect against problematic alcohol use in females and males with AUD, highlighting the progesterone-to-estradiol ratio as a promising treatment target. Moreover, the results indicate that females with AUD may benefit from menstrual cycle phase-tailored treatments.

Is pronator quadratus muscle repair required after anterior plate fixation for distal radial fractures? A prospective randomized comparative study.

In this prospective, randomized comparative study in patients with distal radial fractures, we aimed to determine whether surgical repair of the superficial head after anterior locking plate fixation of the radius improves clinical or functional outcomes or both, and distal radioulnar joint stability. One hundred patients were randomized to undergo distal radial fixation with or without repair of the superficial head. Twenty-one patients were lost to follow-up, leaving a final sample of 79 patients. No differences were observed between the groups in functional scores or complication after operation. Surgical repair of the superficial head of the pronator quadratus muscle after osteosynthesis with an anterior locking plate for distal radial fractures does not appear to substantially contribute to preserving distal radioulnar joint stability or improving the consolidation process.Level of evidence: II.

Is ultrasound superior to fluoroscopy in distal radius volar fixation?

OBJECTIVES: In volar distal radius fixation, conventional and additional fluoroscopic views could not be sufficient to assess dorsal screw penetration. Ultrasound (US) has been suggested as a technique to improve this assessment. The objective was to determine the agreement between these two explorations in a clinical study. Quantify time-consuming of intraoperative US was the secondary objective. MATERIAL AND METHODS: A prospective descriptive study was performed. Thirty patients with a surgical distal radius fracture were treated with volar fixation by five consultant surgeons in a level I Trauma Centre. Final intraoperative fluoroscopic views: AP, lateral, 20º tilted lateral and Dorsal Tangential views (DTV) were performed assessing for dorsal screw protrusion. Then, ultrasound was performed to reassess dorsal cortex integrity. Those protruding screws were registered and changed. RESULTS: A total of 153 screws were examined. Four protruding screws were observed with no multiple protruding screws in the same fixation. Intraoperative ultrasound detected a dorsal screw protrusion in one fixation, assessed as correct by radiological projections. Almost perfect agreement was found between DTV and US examination k = 0.83 (p < 0.001). The mean surgical time was 63 ± 20.3 min while the addition of the ultrasound, supposed an average of 4 ± 1 min more. CONCLUSION: Ultrasound did not show a clinically significant improvement in the assessment dorsal screw penetration in distal radius fixation. A high agreement was observed between US and the described fluoroscopic views. The addition of intraoperative US was a non-significant time-consuming procedure.

Measuring self-regulation in everyday life: Reliability and validity of smartphone-based experiments in alcohol use disorder.

Self-regulation, the ability to guide behavior according to one's goals, plays an integral role in understanding loss of control over unwanted behaviors, for example in alcohol use disorder (AUD). Yet, experimental tasks that measure processes underlying self-regulation are not easy to deploy in contexts where such behaviors usually occur, namely outside the laboratory, and in clinical populations such as people with AUD. Moreover, lab-based tasks have been criticized for poor test-retest reliability and lack of construct validity. Smartphones can be used to deploy tasks in the field, but often require shorter versions of tasks, which may further decrease reliability. Here, we show that combining smartphone-based tasks with joint hierarchical modeling of longitudinal data can overcome at least some of these shortcomings. We test four short smartphone-based tasks outside the laboratory in a large sample (N = 488) of participants with AUD. Although task measures indeed have low reliability when data are analyzed traditionally by modeling each session separately, joint modeling of longitudinal data increases reliability to good and oftentimes excellent levels. We next test the measures' construct validity and show that extracted latent factors are indeed in line with theoretical accounts of cognitive control and decision-making. Finally, we demonstrate that a resulting cognitive control factor relates to a real-life measure of drinking behavior and yields stronger correlations than single measures based on traditional analyses. Our findings demonstrate how short, smartphone-based task measures, when analyzed with joint hierarchical modeling and latent factor analysis, can overcome frequently reported shortcomings of experimental tasks.

Patterns of Alcohol Consumption Among Individuals With Alcohol Use Disorder During the COVID-19 Pandemic and Lockdowns in Germany.

Importance: Alcohol consumption (AC) leads to death and disability worldwide. Ongoing discussions on potential negative effects of the COVID-19 pandemic on AC need to be informed by real-world evidence. Objective: To examine whether lockdown measures are associated with AC and consumption-related temporal and psychological within-person mechanisms. Design, Setting, and Participants: This quantitative, intensive, longitudinal cohort study recruited 1743 participants from 3 sites from February 20, 2020, to February 28, 2021. Data were provided before and within the second lockdown of the COVID-19 pandemic in Germany: before lockdown (October 2 to November 1, 2020); light lockdown (November 2 to December 15, 2020); and hard lockdown (December 16, 2020, to February 28, 2021). Main Outcomes and Measures: Daily ratings of AC (main outcome) captured during 3 lockdown phases (main variable) and temporal (weekends and holidays) and psychological (social isolation and drinking intention) correlates. Results: Of the 1743 screened participants, 189 (119 [63.0%] male; median [IQR] age, 37 [27.5-52.0] years) with at least 2 alcohol use disorder (AUD) criteria according to the Diagnostic and Statistical Manual of Mental Disorders (Fifth Edition) yet without the need for medically supervised alcohol withdrawal were included. These individuals provided 14 694 smartphone ratings from October 2020 through February 2021. Multilevel modeling revealed significantly higher AC (grams of alcohol per day) on weekend days vs weekdays (ß = 11.39; 95% CI, 10.00-12.77; P < .001). Alcohol consumption was above the overall average on Christmas (ß = 26.82; 95% CI, 21.87-31.77; P < .001) and New Year's Eve (ß = 66.88; 95% CI, 59.22-74.54; P < .001). During the hard lockdown, perceived social isolation was significantly higher (ß = 0.12; 95% CI, 0.06-0.15; P < .001), but AC was significantly lower (ß = -5.45; 95% CI, -8.00 to -2.90; P = .001). Independent of lockdown, intention to drink less alcohol was associated with lower AC (ß = -11.10; 95% CI, -13.63 to -8.58; P < .001). Notably, differences in AC between weekend and weekdays decreased both during the hard lockdown (ß = -6.14; 95% CI, -9.96 to -2.31; P = .002) and in participants with severe AUD (ß = -6.26; 95% CI, -10.18 to -2.34; P = .002). Conclusions and Relevance: This 5-month cohort study found no immediate negative associations of lockdown measures with overall AC. Rather, weekend-weekday and holiday AC patterns exceeded lockdown effects. Differences in AC between weekend days and weekdays evinced that weekend drinking cycles decreased as a function of AUD severity and lockdown measures, indicating a potential mechanism of losing and regaining control. This finding suggests that temporal patterns and drinking intention constitute promising targets for prevention and intervention, even in high-risk individuals.

Knee osteonecrosis after COVID-19.

BACKGROUND: COVID-19 is an emergent infection, the long-term complications of which are still under study. While hypercoagulability is a common feature in severe cases, the incidence of ischemic complications such as osteonecrosis remains unknown. Previous studies on SARS-CoV1 found an increase in osteonecrosis 3-36 months after infection, and it is still unclear if this was related to the use of corticosteroids or to the virus itself. METHODS: We introduce a 78-year-old woman who complained of right knee pain and swelling a month after COVID-19 infection onset. Her knee radiography showed no significant changes compared to previous ones. MRI, on the other hand, found osteonecrosis in the internal femoral condyle. No coagulation abnormalities were found in blood tests. RESULTS: While knee replacement should be her main treatment, it will be long delayed due to the pandemic. In the meantime, we increased her tapentadol and salicylic acid doses and gave her home exercises to improve functionality. CONCLUSION: In the follow-up after COVID-19, any muscular or joint pain with unusual characteristics should be carefully examined.

Risk factors for infection in fixation of distal tibia fractures.

BACKGROUND: The aim of this study is to evaluate risk factors for infection as well as infection rates after open reduction and internal fixation for distal tibia fractures with a distal tibia locking plate and/or isolated screws. METHODS: This is a retrospective and descriptive study based on 55 patients treated in our Major Trauma Centre from January 2009 to December 2016. All patients were classified by age, sex, open or closed fracture, injury mechanism, comorbidities, fixation and time from injury to surgery. 22 extraarticular fractures AO/OTA 43-A and 33 intraarticular (14 cases 43-B and 19 43-C) were recorded. High energy trauma was related in 27 patients, while open fractures were observed in 10 patients. Splint until surgery was applied routinely while temporary external fixation (EF) was performed in 21 patients (7 extraarticular and 14 intraarticular). Patients were treated by 5 different consultant surgeons performing isolated screws (SC) in 20% of the surgeries, antero-medial locking distal tibia plate (AM) and anterolateral (AL) were used in 47% and 33% of the patients respectively. After assessing normality and homogeneity of the subgroups, statistical contrast tests were performed. RESULTS: Infection rate was 31.5%, mainly caused by S. aureus. We obtained a statistically significant correlation between greater age and infection rate. In the same way, a positive statistical trend between infection and AL plating was found. The use of EF followed by ORIF was not observed as a risk factor for infection compared with splint followed by internal fixation, however, the group of patients in which a splint was used, a positive relationship was found between the infection rate and shorter time until the definitive fixation. No statistically significant associations were found between extra/intraarticular fracture pattern, use of corticosteroids or open fractures and infection rate. CONCLUSION: Greater age was a predisposing factor for infection. The use of external fixation before definitive ORIF seems to be a safe procedure regarding risk infection, and if an external fixation is not used, we recommend longer waiting time until definitive ORIF. Screw fixation or antero-medial plates, if allowed by fracture pattern, can be an option to avoid infection.

Comparative study between fixed-angle and polyaxial screws in distal radius fixation with two volar locking plates.

INTRODUCTION: When treating a distal radius fracture with a volar locking plate (VLP), numerous plate-screw designs are available. To date, there is not a screw fastening system with a clear superiority among the others. HYPOTESIS: Fixed-angle screws are superior to polyaxial screws in distal radius VLP fixation with respect to screw protrusion and reduction preservation. MATERIAL AND METHODS: A prospective cohort study based on eighty patients was performed. The first forty patients were treated by polyaxial VLP (PA group) were the next forty by a fixed-angle VLP (FA group). Fixation was performed by the flexor carpi radialis approach. Screws were placed 2mm shorter than actual measurement and intraoperative AP, lateral and tilt wrist views were done routinely. A computed tomography (CT) was conducted searching for screw protrusion. Loss of reduction was calculated from the difference between post-operative x-rays values and those at the 6-month follow-up. The total follow-up was 12 months with no losses. RESULTS: Postoperative CT detected dorsal screw protrusion in 17 patients in PA group and 16 patients in FA group that intraoperative radiographs were assumed as correct (p=0.48). The mean invasion of dorsal cortex was of 2.2mm (1-7mm) for PA group and 2.6mm (1-5mm) for FA group (p=0.70). As from those protruding screws, the mean size was registered founding that fixed-angle screws had protrusions with shorter screws 20 vs. 22mm (p<0.05). Intraarticular screw protrusion was registered in 3 and 2 patients respectively (p>1.0). Experienced loss of reduction in volar tilt (p=0.42), radial inclination (p=0.75) and ulnar variance (p=0.83) were equivalent in both groups while a better preservation of the radial height in the PA group was observed (p<0.05). DISCUSSIONS: In terms of screw protrusion rate, both fastening systems where similar. However, fixed-angle group invaded the dorsal cortex with shorter screws. Polyaxial screws were associated with a better preservation of the radial height. Finally, this study reinforces the idea that dorsal and articular screw protrusion is more frequent than we expected. LEVEL OF EVIDENCE: II; therapeutic, prospective cohort study.

Integrated single-base resolution maps of transcriptome, sRNAome and methylome of Tomato yellow leaf curl virus (TYLCV) in tomato.

Geminiviruses are plant ssDNA viruses that replicate through dsDNA intermediates and form minichromosomes which carry the same epigenetic marks as the host chromatin. During the infection, geminiviruses are targets of the post-transcriptional and transcriptional gene silencing machinery. To obtain insights into the connection between virus-derived small RNAs (vsRNAs), viral genome methylation and gene expression, we obtained the transcriptome, sRNAome and methylome from the geminivirus Tomato yellow leaf curl virus-infected tomato plants. The results showed accumulation of transcripts just at the viral ORFs, while vsRNAs spanned the entire genome, showing a prevalent accumulation at regions where the viral ORFs overlapped. The viral genome was not homogenously methylated showing two highly methylated regions located in the C1 ORF and around the intergenic region (IR). The compilation of those results showed a partial correlation between vsRNA accumulation, gene expression and DNA methylation. We could distinguish different epigenetic scenarios along the viral genome, suggesting that in addition to its function as a plant defence mechanism, DNA methylation could have a role in viral gene regulation. To our knowledge, this is the first report that shows integrative single-nucleotide maps of DNA methylation, vsRNA accumulation and gene expression from a plant virus.

Geminivirus Rep protein interferes with the plant DNA methylation machinery and suppresses transcriptional gene silencing.

Cytosine methylation is an epigenetic mark that promotes gene silencing and plays an important role in genome defence against transposons and invading DNA viruses. Previous data showed that the largest family of single-stranded DNA viruses, Geminiviridae, prevents methylation-mediated transcriptional gene silencing (TGS) by interfering with the proper functioning of the plant methylation cycle. Here, we describe a novel counter-defence strategy used by geminiviruses, which reduces the expression of the plant maintenance DNA methyltransferases, METHYLTRANSFERASE 1 (MET1) and CHROMOMETHYLASE 3 (CMT3), in both locally and systemically infected tissues. We demonstrated that the virus-mediated repression of these two maintenance DNA methyltransferases is widespread among geminivirus species. Additionally, we identified Rep (Replication associated protein) as the geminiviral protein responsible for the repression of MET1 and CMT3, and another viral protein, C4, as an ancillary player in MET1 down-regulation. The presence of Rep suppressed TGS of an Arabidopsis thaliana transgene and of host loci whose expression was strongly controlled by CG methylation. Bisulfite sequencing analyses showed that the expression of Rep caused a substantial reduction in the levels of DNA methylation at CG sites. Our findings suggest that Rep, the only viral protein essential for replication, displays TGS suppressor activity through a mechanism distinct from that thus far described for geminiviruses.

Estudio comparativo entre la accion de un nuevo amino-glucosido (Netilmicina) y la de nueve antibioticos de uso comun sobre cepas bacterianas colombianas / Comparative study between a new amino-glicoside (nethylmicina) and 9 common use antibiotics in local bacterial strains in Colombia

Se hace un estudio descriptivo sobre el comportamiento de cepas bacterianas de diez y siete microorganismos frente a diez antibioticos de amplio espectro, de uso mas comun en nuestro medio, dentro de los cuales se encuentra un aminoglucosido, la netilmicina, de reciente introduccion. Se presentan los porcentajes de inhibicion logrados por los antibioticos probados, para cada microorganismo, ordenados en magnitudes decrecientes. Se recomienda este tipo de estudios para tener un conocimiento basico relativo al comportamiento de las cepas bacterianas de una comunidad frente a los antibioticos

Hepatitis Fulminante Epidemica de la Sierra Nevada de Santa Marta: 1. Estudio de un brote en la localidad de Julio Zawady, Cienaga, Magdalena, Colombia / Fulminant epidemic hepatitis at the Sierra Nevada de Santa Marta: 1. Study of an outbreak at the location of Julio Zawady, Cienaga, Magdalena, Colombia

En la localidad de Julio Zawady, municipio de Cienaga, Magdalena, con censo de 435 habitantes, mueren entre marzo y mayo de 1981, tres personas, victimas de una enfermedad febril aguda, terminal. El diagnostico histopatologico para el unico caso con necropsia fue de Hepatitis Fulminante tipo Sierra Nevada de Santa Marta. El estado portador del alguno de los antigenos de la Hepatitis B, (AgHBs y AgHBe), encontrado en el 39% de los sueros probados al azar, (53% para el grupo de 5 a 9 anos de edad) y de anticuerpos anti-HBe en el 78% de 14 sueros estudiados, en familiares y no familiares de los casos, residentes ambos en la zona, permite pensar que el agente causal fue el virus B. Los datos sobre el macro y el microambiente no arroja luz acerca de la historia natural de la enfermedad. Se desconoce la razon del comportamiento tan agresivo de esta hepatitis

Histoplasmosis epidemica: II. Hallazgos en la Cueva del eden (Cunday, Tolima) / Epidemic hystoplasmosis: II. Findings at the Eden Cave (Cunday, Tolima, Col.)

Se informa el estudio realizado en la Cueva del Eden (Cunday, Tolima) para aislar, de las tierras de la cueva y de murcielagos alli capturados, al Histoplasma Capsulatum, como agente causal de una anterior epidemia de histoplasmosis ocurrida entre visitantes de la cueva. El agente se aislo en 8 de las 27 muestras de tierra y guano de murcielago. Se capturaron 233 ejemplares pertenecientes a 4 generos de murcielagos y en los cultivos practicados en higado, pulmon y bazo de cien de ellos, no fue posible aislar el H. Capsulatum

Las pruebas VDRL falsas reactivas en el manejo de la sifilis: 1. reacciones falsas positivas en el embarazo / The false reactive VDRL tests in syphilis management: 1. false positive reactions in pregnancy

Se presenta un estudio sobre reacciones VDRL falsas reactivas en el embarazo. Se analizan los resultados de las pruebas practicadas a los sueros sanguineos obtenidos de 4.344 gestantes tomadas al azar sobre un universo restringido de 13.477; 64 muestras fueron VDRL reactivas y FTA-ABS no reactivas, lo cual da 1.5% de falsas reactivas; 25 reacciones fueron VDRL reactivas y FTA-ABS reactivas, para 0,6% de sifilis. Las reacciones falsas reactivas estan mas asociadas con el primer embarazo. Las reacciones falsas reactivas estan mas asociadas con el primer embarazo. Las reacciones falsas reactivas lo son a titulos muy bajos de 0 a 2 diluciones. Se encontro una marcada relacion entre la ocurrencia de falsas reactivas y el grupo sanguineo A, Rh(-). No existe relacion entre la falsa reactividad y los antecedentes patologicos generales u obstetricos. Igualmente se encontro que no existe una distribucion especifica por grupos de edad. La falsa reactividad no esta asociada con un periodo especial del embarazo y aparece desde los primeros meses. El seguimiento durante el post-parto se demostro que las pruebas falsas reactivas se negativizan hasta seis meses despues

Lepra: algunos aspectos inmunologicos / Leprae: some immunological aspects

Se estudiaron 252 pacientes con Lepra:156 hombres y 96 mujeres. 108 hombres y 48 mujeres con Lepra Lepromatosa; 48 hombres y 52 mujeres con Lepra Tuberculoide. En esta muestra se estudiaron su patron electroforetico, la concentracion de C3 y los niveles circulantes de IgG, IgA e IgM. Se encontro que no existe un patron definido electroforetico que pueda asociarse con la Lepra, solo la fraccion gamma muestra niveles altos en Lepra Lepromatosa y esta alteracion comparada con la poblacion general tiene significancia estadistica. Unicamente la IgG e IgM muestran aumentos considerables con significacion estadistica para Lepra Lepromatosa. IgA se encuentra aumentada en los dos tipos de Lepra. No se encontro ninguna alteracion en los niveles circulantes de C3

Estudio del estado sanitario del Municipio de Funza, Colombia / The health situation in the Municipality of Funza, Colombia

A survey of environmental santiation in Funza, a semi-rural community near Bogota, capital of Colombia, was made by a group of 6th year medical students as part of their preventive medicine course. The methods used were a questionnaire on each household and subjective observation of sanitary services in common use. For the purpose of this survey the community was divided into three areas: urban, suburban, and rural. The results of the survey show: 1) very deficient public services; 2) almost complete lack of knowledge about environmental sanitation; 3) poor quality construction and lighting, etc. of houses; 4) almost 50 percent of the population living on overcrowded conditions. The common services are usually of very poor quality and are deficient both in installation, equipment, etc., as well as in maintenance. The paper ends with certain conclusions about the poor environmental sanitation conditions and outlines possible ways of improving them. Completion of the study on the municipality as the basis for the planning of its development is recommended, as is the participation of university students in this type of study

Estudio del estado sanitario del Municipio de Funza, Colombia / The health situation in the Municipality of Funza, Colombia

A survey of environmental santiation in Funza, a semi-rural community near Bogota, capital of Colombia, was made by a group of 6th year medical students as part of their preventive medicine course. The methods used were a questionnaire on each household and subjective observation of sanitary services in common use. For the purpose of this survey the community was divided into three areas: urban, suburban, and rural. The results of the survey show: 1) very deficient public services; 2) almost complete lack of knowledge about environmental sanitation; 3) poor quality construction and lighting, etc. of houses; 4) almost 50 percent of the population living on overcrowded conditions. The common services are usually of very poor quality and are deficient both in installation, equipment, etc., as well as in maintenance. The paper ends with certain conclusions about the poor environmental sanitation conditions and outlines possible ways of improving them. Completion of the study on the municipality as the basis for the planning of its development is recommended, as is the participation of university students in this type of study