Assessment of the Interelectrode Distance Effect over the Omnipole with High Multielectrode Arrays.

The development of high-density multielectrode catheters has significantly advanced cardiac electrophysiology mapping. High-density grid catheters have enabled the creation of a novel technique for reconstructing electrogram (EGM) signals known as "omnipole," which is believed to be more reliable than other methods, especially in terms of orientation independence. This study aims to evaluate how distance affects the omnipolar reconstruction of EGMs by comparing different configurations. Using an animal set up of perfused isolated rabbit hearts, recordings were taken using an ad hoc high-density epicardial multielectrode catheter. Inter-electrode distances ranging from 1 to 4 mm were analysed for their effect on the quality of resulting EGMs. Two biomarkers were computed to evaluate the robustness of the reconstructions: the areas contained within the bipolar loops and the amplitudes of the omnipoles. We hypothesised that both bipolar and omnipolar electrograms would be more robust at shorter inter-electrode distances. The results showed that an increase in distance triggers an increase in loop areas and amplitudes, which supports the hypothesis. This finding provides a more reliable estimate of wavefront propagation for the cross-omnipolar reconstruction method. These results emphasise the importance of distance in cardiac electrophysiology mapping and provide valuable insights into the use of high-density multielectrode catheters for EGM reconstruction.Clinical Relevance- The results of this study have direct clinical relevance in the application of the described techniques to recording systems in the cardiac electrophysiology laboratory, enabling clinicians to obtain more precise characterisation of signals in the myocardium.

Anthropogenic eutrophication of Lake Titicaca (Bolivia) revealed by carbon and nitrogen stable isotopes fingerprinting.

Cultural eutrophication is the leading cause of water quality degradation worldwide. The traditional monitoring of eutrophication is time-consuming and not integrative in space and time. Here, we examined the use of carbon (δ13C) and nitrogen (δ15N) isotopic composition to track the degree of eutrophication in a bay of Lake Titicaca impacted by anthropogenic (urban, industrial and agricultural wastewater) discharges. Our results show increasing δ13C and decreasing δ15N signatures in macrophytes and suspended particulate matter with distance to the wastewater source. In contrast to δ15N and δ13C signatures, in-between aquatic plants distributed along the slope were not only affected by anthropogenic discharges but also by the pathway of carbon uptake, i.e., atmospheric (emerged) vs aquatic (submerged). A binary mixing model elaborated from pristine and anthropogenic isotope end-members allowed the assessment of anthropogenically derived C and N incorporation in macrophytes with distance to the source. Higher anthropogenic contribution was observed during the wet season, attributed to enhanced wastewater discharges and leaching of agricultural areas. For both seasons, eutrophication was however found naturally attenuated within 6 to 8 km from the wastewater source. Here, we confirm that carbon and nitrogen stable isotopes are simple, integrative and time-saving tools to evaluate the degree of eutrophication (seasonally or annually) in anthropogenically impacted aquatic ecosystems.

Epidemia COVID. Tras el desconfinamiento ¿qué ocurrió en nuestras consultas de Atención Primaria? / COVID epidemic. After the deconfinement, what happened in our Primary Care consultations?

Introducción: el 11 de marzo de 2020 la Organización Mundial de la Salud (OMS) declaró una pandemia, provocada por un nuevo coronavirus SARS-CoV-2. El rápido aumento de transmisiones obligó a gobiernos y autoridades sanitarias a tomar medidas para frenar el avance de la pandemia. Tras la primera ola epidémica y con un descenso documentado en el número de casos, comenzó la desescalada de las medidas implantadas y el desconfinamiento de la población. En este momento epidemiológico quisimos analizar la actividad asistencial pediátrica llevada a cabo, con objeto de conocer el modelo de consulta realizado (presencial/no presencial), los motivos de consulta atendida y el grado de resolución. Material y métodos: estudio descriptivo, observacional y retrospectivo sobre los pacientes atendidos en las consultas de Pediatría de Atención Primaria en un centro de salud de la ciudad de Madrid, durante el mes de junio de 2020. Resultados: se atendieron un total de 1321 pacientes, 34% menos que el mismo período del año anterior. La modalidad de consulta realizada fue presencial en un 49% y no presencial en el 51%. La consulta telefónica fue la opción mayoritaria como alternativa a la presencial. Un 20,7% del total de motivos de consulta fueron atendidos vía telemática. Conclusiones: tras la crisis sanitaria ocasionada por la COVID-19 la modalidad de atención no presencial ha adquirido protagonismo y mayor grado de resolución en nuestras consultas pediátricas. Pensamos que debe potenciarse mediante la incorporación de herramientas telemáticas, y así coexistir y complementar al modelo habitual de atención presencial (AU)

Introduction: on March 11, 2020, the World Health Organization (WHO) declared the outbreak caused by the novel coronavirus SARS-CoV-2 a pandemic. The rapid increase in cases forced governments and health authorities to take measures to contain the pandemic. After the first wave, when there was evidence of a decline in the number of cases, reopening started with progressive lifting of containment measures and ending the confinement of the population. Our objective was to analyse paediatric care delivery in our primary care centre at this point in the pandemic to determine the modalities of care delivery used (in-person/remote), the reasons for consultation in the total provided services and the degree of successful resolution of the reason for consultation.Material and methods: prospective, observational and descriptive study of the patients managed by the paediatrics clinic of a primary care centre in the city of Madrid, Spain, in June 2020. We collected data from the paediatric primary care electronic health records system of Madrid.Results: a total of 1321 patients were treated, 34% fewer compared to the same period the previous year. Forty-nine percent of consultations were managed in-person at the site and 51% remotely. Telephone consultations were the most frequent alternative to in-person visits. Of all the reasons for consultation, 20.7% were managed remotely.Conclusion: in the wake of the public health emergency brought on by COVID-19, the remote care modality has become prevalent and grown as a means to resolve patient needs and presenting complaints in our paediatric primary care clinic. We believe that this care modality should be reinforced with digital tools so that it can supplement and coexist with the conventional model of in-person care delivery. (AU)

The integrin beta1 modulator Tirofiban prevents adipogenesis and obesity by the overexpression of integrin-linked kinase: a pre-clinical approach in vitro and in vivo.

BACKGROUND: Obesity is caused by the enlargement of the white adipose tissue (WAT) depots, characterized by the hypertrophic enlargement of malfunctioning adipocytes within WAT which increases the storage of triglycerides (TG) in the lipid droplets (LD). Adipogenesis pathways as well as the expression and activity of some extracellular matrix receptors integrins are upregulated. Integrinß1 (INTB1) is the main isoform involved in WAT remodeling during obesity and insulin resistance-related diseases. We recently described Integrin Linked Kinase (ILK), a scaffold protein recruited by INTB1, as an important mediator of WAT remodeling and insulin resistance. As the few approved drugs to fight obesity have brought long-term cardiovascular side effects and given that the consideration of INTB1 and/or ILK modulation as anti-obesogenic strategies remains unexplored, we aimed to evaluate the anti-obesogenic capacity of the clinically approved anticoagulant Tirofiban (TF), stated in preclinical studies as a cardiovascular protector. METHODS: Fully differentiated adipocytes originating from C3H10T1/2 were exposed to TF and were co-treated with specific INTB1 blockers or with siRNA-based knockdown ILK expression. Lipid-specific dyes were used to determine the TG content in LD. The genetic expression pattern of ILK, pro-inflammatory cytokines (MCP1, IL6), adipogenesis (PPARγ, Leptin), thermogenesis (UCP1), proliferation (PCNA), lipid metabolism (FASN, HSL, ATGL), and metabolite transporters (FABP4, FAT, AQP7) were detected using quantitative PCR. Cytoskeletal actin polymerization was detected by confocal microscopy. Immunoblotting was performed to detect INTB1 phosphorylation at Thr788/9 and ILK activity as phosphorylation levels of protein kinase B (AKT) in Ser473 and glycogen synthase kinase 3ß (GSK3ß) at Ser9. TF was intraperitoneally administered once per day to wildtype and ILK knockdown mice (cKDILK) challenged with a high-fat diet (HFD) or control diet (STD) for 2 weeks. Body and WAT weight gains were compared. The expression of ILK and other markers was determined in the visceral epididymal (epi) and inguinal subcutaneous (sc) WAT. RESULTS: TF reduced TG content and the expression of adipogenesis markers and transporters in adipocytes, while UCP-1 expression was increased and the expression of lipases, cytokines or PCNA was not affected. Mechanistically, TF rapidly increased and faded the intracellular phosphorylation of INTB1 but not AKT or GSK3ß. F-actin levels were rapidly decreased, and INTB1 blockade avoided the TF effect. After 24 h, ILK expression and phosphorylation rates of AKT and GSK3ß were upregulated, while ILK silencing increased TG content. INTB1 blockade and ILK silencing avoided TF effects on the TG content and the transcriptional expression of PPARγ and UCP1. In HFD-challenged mice, the systemic administration of TF for several days reduced the weight gain on WAT depots. TF reduced adipogenesis and pro-inflammatory biomarkers and increased lipolysis markers HSL and FAT in epiWAT from HFD, while increased UCP1 in scWAT. In both WATs, TF upregulated ILK expression and activity, while no changes were observed in other tissues. In HFD-fed cKDILK, the blunted ILK in epiWAT worsened weight gain and avoided the anti-obesogenic effect of in vivo TF administration. CONCLUSIONS: ILK downregulation in WAT can be considered a biomarker of obesity establishment. Via an INTB1-ILK axis, TF restores malfunctioning hypertrophied WAT by changing the expression of adipocyte-related genes, increasing ILK expression and activity, and reducing TG storage. TF prevents obesity, a property to be added to its anticoagulant and cardiovascular protective advantages.

Diagenetic production, accumulation and sediment-water exchanges of methylmercury in contrasted sediment facies of Lake Titicaca (Bolivia).

Monomethylmercury (MMHg) concentrations in aquatic biota from Lake Titicaca are elevated although the mercury (Hg) contamination level of the lake is low. The contribution of sediments to the lake MMHg pool remained however unclear. In this work, seven cores representative of the contrasted sediments and aquatic ecotopes of Lake Titicaca were sliced and analyzed for Hg and redox-sensitive elements (Mn, Fe, N and S) speciation in pore-water (PW) and sediment to document early diagenetic processes responsible for MMHg production and accumulation in PW during organic matter (OM) oxidation. The highest MMHg concentrations (up to 12.2 ng L-1 and 90% of THg) were found in subsurface PWs of the carbonate-rich sediments which cover 75% of the small basin and 20% of the large one. In other sediment facies, the larger content of OM restricted MMHg production and accumulation in PW by sequestering Hg in the solid phase and potentially also by decreasing its bioavailability in the PW. Diagenetically reduced S and Fe played a dual role either favoring or restricting the availability of Hg for biomethylation. The calculation of theoretical diffusive fluxes suggests that Lake Titicaca bottom sediments are a net source of MMHg, accounting for more than one third of the daily MMHg accumulated in the water column of the Lago Menor. We suggest that in the context of rising anthropogenic pressure, the enhancement of eutrophication in high altitude Altiplano lakes may increase these MMHg effluxes into the water column and favor its accumulation in water and biota.

Selection on life-history traits and genetic population divergence in rotifers.

A combination of founder effects and local adaptation - the Monopolization hypothesis - has been proposed to reconcile the strong population differentiation of zooplankton dwelling in ponds and lakes and their high dispersal abilities. The role genetic drift plays in genetic differentiation of zooplankton is well documented, but the impact of natural selection has received less attention. Here, we compare differentiation in neutral genetic markers (F(ST)) and in quantitative traits (Q(ST)) in six natural populations of the rotifer Brachionus plicatilis to assess the importance of natural selection in explaining genetic differentiation of life-history traits. Five life-history traits were measured in four temperature x salinity combinations in common-garden experiments. Population differentiation for neutral genetic markers - 11 microsatellite loci - was very high (F(ST) = 0.482). Differentiation in life-history traits was higher in traits related to sexual reproduction than in those related to asexual reproduction. Q(ST) values for diapausing egg production (a trait related to sexual reproduction) were higher than their corresponding F(ST) in some pairs of populations. Our results indicate the importance of divergent natural selection in these populations and suggest local adaptation to the unpredictability of B. plicatilis habitats.

Carriage of Staphylococcus aureus and of gram-negative bacilli resistant to third-generation cephalosporins in cirrhotic patients: a prospective assessment of hospital-acquired infections.

OBJECTIVE: To study the relation between Staphylococcus aureus nasal and stool colonization, stool carriage of gram-negative bacilli resistant to third-generation cephalosporins (CephR), and subsequent infections during hospitalization. DESIGN: Prospective study. PATIENTS: 551 cirrhotic patients with 589 consecutive hospital stays. All patients were screened within 48 hours of admission; 589 nasal swabs, 417 stool specimens, and 589 urine samples were analyzed. RESULTS: Carriage rates were 18.8% for methicillin-sensitive S aureus (MSSA), 16.3% for methicillin-resistant S aureus (MRSA), and 13.7% for CephR. We observed 87 episodes of spontaneous bacterial peritonitis, 63 cases of bacteremia, and 167 urinary tract infections occurred. Only 1 case of bacteremia and 4 urinary tract infections due to CephR occurred in patients carrying the same organism in their stools. The risk of MRSA ascitic fluid infections, bacteremia, and urinary tract infections was 3.1% versus 1% (not significant), 8.3% versus 0.8% (P<.001), and 11.4% versus 0.6% (P<.001) in carriers and noncarriers, respectively. Pulsed-field gel electrophoresis (PFGE) of isolates from 16 patients infected by MSSA (3 cases) and MRSA (13 cases) demonstrated that the colonizing strains matched the invasive strains in the 3 MSSA cases and in 8 of 13 MRSA cases. CONCLUSION: Carriage of CephR strains is not associated with subsequent infection by these organisms in hospitalized cirrhotic patients. In contrast, MRSA carriage was an important risk factor for MRSA bacteremia and urinary tract infection.

El médico general frente al bebdor problema / The general practitioner and the problem drinker

En este artículo se presentan las cifras de prevalencia de los problemas de alcoholismo a los que se enfrenta el médico general en México. Estas cifras se basan en las investigaciones que se han llevado a cabo en el Instituto Mexicano de Psiquiatría (IMP). Posteriormente se comenta el papel que se el médico general puede desempeñar en la prevención secundaria de los problemas relacionados con el consumo de alcohol. Por último, se informa brevemente sobre un proyecto de investigación que la Organización Mundial de la Salud (OMS) estás coordinando en once países y en el cual participa México, por intermedio del IMP. Desde hace varios años, el IMP realiza estudios epidemiológicos para conocer la prevalencia de los trastornos psiquiátricos en la práctica médica general. Los ha efectuado en diversos medios que abarcan diferentes contextos socioculturales, como son los centros de salud de la Secretaría del mismo nombre (SSA), las unidades familiares del Instituto Mexicano del Seguro Social (IMSS) y un hospital general privado, el Hospital Español; los primeros atienden a la población económicamente más desamparada; los del IMSS, a obreros y trabajadores asalariados, y el último, a personas de las clases sociales media, media alta y alta. Los estudios han seguido el clásico diseño epidemiológico inglés, que se devide en dos etapas. Las primera emplea como procedimiento de tamizaje (screening) o de identificación de los casos psiquiátricos, un cuestionario autoaplicable. La segunda consiste en confirmar la existencia de los casos psiquiátricos y en establecer un diagnóstico de acuerdo con la clasificación de enfermedades de la OMS. En la primera etapa se utilizó el Cuestionário General de Salud de Goldberg y en la segunda, una entrevista psiquiátrica estructurada del mismo autor...

[Prevalence of mental disorders and risk factors in a population of a general medical practice]. / Prevalencia de trastornos mentales y factores de riesgo en una población de práctica médica general.

The present paper reports the most relevant results from an epidemiologic survey that was carried out in a hospital's general practice service in Mexico. The survey comprises several issues such-as: the validity and standardization of the General Health Questionnaire (GHQ), a screening instrument, designed for the early detection of mental disorders, which is validated against the clinical criteria expressed through the Standardized Psychiatric Interview (SPI), the prevalence of psychiatric disorders which includes type of syndromes and affected subgroups, the relation between the ratings of the SPI and the scales of the GHQ (somatic symptoms, sleep disturbances, social disfunction and severe depression) with demographic variables. From the population attending the service during a period of 5 weeks, a total of 619 patients, to whom the GHQ was administered, were randomly selected. From this sample 364 patients were separately interviewed by means of the SPI. No significant differences were found between the sample and the population regarding age, sex, and educational level. The prevalence of mental disorders obtained for the mixed population was of 34%, being of 26% for men and of 36% for women. The only risk factor found for both populations was the low educational level of the head of the family. In the multiple regression analysis, significant differences were found among some groups in spite of the low predictive power of the studied variables.

Prevalencia de trastornos mentales y factores de riesgo en una población de practica medica general / Prevalence of mental disorders and risk factors in a population of general medical

En la presente investigación llevada a cabo en México, en la consulta externa de un hospital general en un período de 5 semanas, se reportanlos resultados más relevantes sobre: la validez y estandarización de un instrumento de detección temprana de casos, el Cuestionario General de Salud (CGS), utilizando como criterio de validez externa la Entreviosta Psiquiátrica Estandarizada (EPE); la prevalencia de transtornos psiquiátricos, grupo diagnóstico y subgrupos afectados; la relación entre las puntuaciones obtenidas entre la EPE y las subescalas de CGS

Prevalencia de trastornos mentales y factores de riesgo en una población de practica medica general / Prevalence of mental disorders and risk factors in a population of general medical

En la presente investigación llevada a cabo en México, en la consulta externa de un hospital general en un período de 5 semanas, se reportanlos resultados más relevantes sobre: la validez y estandarización de un instrumento de detección temprana de casos, el Cuestionario General de Salud (CGS), utilizando como criterio de validez externa la Entreviosta Psiquiátrica Estandarizada (EPE); la prevalencia de transtornos psiquiátricos, grupo diagnóstico y subgrupos afectados; la relación entre las puntuaciones obtenidas entre la EPE y las subescalas de CGS (AU)

Prevalencia de trastornos mentales y factores de riesgo en una población de práctica médica general. / [Prevalence of mental disorders and risk factors in a population of a general medical practice]

The present paper reports the most relevant results from an epidemiologic survey that was carried out in a hospitals general practice service in Mexico. The survey comprises several issues such-as: the validity and standardization of the General Health Questionnaire (GHQ), a screening instrument, designed for the early detection of mental disorders, which is validated against the clinical criteria expressed through the Standardized Psychiatric Interview (SPI), the prevalence of psychiatric disorders which includes type of syndromes and affected subgroups, the relation between the ratings of the SPI and the scales of the GHQ (somatic symptoms, sleep disturbances, social disfunction and severe depression) with demographic variables. From the population attending the service during a period of 5 weeks, a total of 619 patients, to whom the GHQ was administered, were randomly selected. From this sample 364 patients were separately interviewed by means of the SPI. No significant differences were found between the sample and the population regarding age, sex, and educational level. The prevalence of mental disorders obtained for the mixed population was of 34

, being of 26

for men and of 36

for women. The only risk factor found for both populations was the low educational level of the head of the family. In the multiple regression analysis, significant differences were found among some groups in spite of the low predictive power of the studied variables.

El medico general en la deteccion de trastornos emocionales / The general practitioner in the detection of emotional disorders

Se comparo la eficacia del medico general con la del Cuestionario General de Salud de Goldberg en el descubrimiento de trastornos emocionales en la poblacion que asiste a la consulta externa de un hospital general. De la frecuencia total (33.3%) de trastornos emocionales estimada para esta poblacion, el medico general descubrio unicamente 15.9%, lo cual permitio identificar la tendencia del mismo hacia la sobreestimacion de los sujetos sin trastornos. El Cuestionario General de Salud mostro mayor eficacia al descubrir 25.6% de los pacientes con trastornos emocionales. Los resultados favorecen la utilizacion de instrumento como el cuestionario como medida de apoyo para el medico en el descubrimiento de trastornos mentales

Prevalencia de trastornos emocionales en personas de edad avanzada / Prevalence of emotional disorders in elderly

El Cuestionario General de Salud fue aplicado a una muestra de la poblacion que asistio a consulta medica general en un sanatorio privado de la ciudad de Mexico, en el transcurso de un mes. De esta poblacion se seleccionaron al azar 75 personas con edades superiores a los 65 anos con el fin de medir la sensibilidad y la especificidad del instrumento en personas de edad avanzada. Los resultados obtenidos por el Cuestionario General de Salud fueron confirmados por medio de la entrevista psiquiatrica estandarizada, que fue aplicada en forma independiente a quienes formaron la muestra en estudio. Los resultados informaron que a pesar de que el Cuestionario General de Salud no es recomendado para personas de edad avanzada, debido a la cronicidad de su sintomatologia general el instrumento si resalta variaciones considerables entre los resultados de las personas "casos" y los "no casos", detectando en forma eficaz a los primeros y encontrando un nivel de error comparable al obtenido por el estudio realizado en forma paralela al presente, en personas con edades entre 18 y 64 anos

Incidencia de infecciones por arbovirus encefalitógenos en México / Indice of arthropod-borne encephalitic diseases in Mexico

This article contains information on the incidence of arthropod-borne encephalitic diseases caused by EE, EEO, EEV, ESL and Ilheus arboviruses in the folloing Mexican states: Sonora, Tamaulipas, Nayarit, Jalisco, Federal District, Morelos, Veracruz, Tabasco, Campeche, Yucatan and Quintana Roo

Serological surveys in persons between the ages of 5 and 60 years show that the overall infection rate in these regions has remained low

In Xochimilco and Mexico City, D.F., which are 2,240 meters above sea level no cases of human encephalitis caused by the viruses covered by the survey have been encountered nor have any human cases due to ESL and Ilheus virus been reported in Coatetelco, Morelos, which lies on the Central Meseta at an altitude slightly below that of the Federal District. However, vectors and reservoirs of these viruses do exist in these regions

There have been no oubreaks of encephalitis with the exception of that which occurred in Campeche in 1962 and affected 13 persons. The finding of EEV in Campeche, subsequently confirmed by isolation of the virus, is of epidemiological interest not only for Mexico but for other countries since this virus had heretofore not been identified north of Panama

Since infection rates are low, the potential hazard presented in the areas in which there are virus vectors and reservoirs by the great number of susceptible persons in the population, namely ...(AU)