Exposure to endocrine disruptors promotes biofilm formation and contributes to increased virulence of Pseudomonas aeruginosa.

Anthropogenic activities contribute to the spread of chemicals considered as endocrine disruptors (ED) in freshwater ecosystems. While several studies have reported interactions of EDs with organisms in those ecosystems, very few have assessed the effect of these compounds on pathogenic bacteria. Here we have evaluated the impact of five EDs found in aquatic resources on the virulence of human pathogen P. aeruginosa. ED concentrations in French aquatic resources of bisphenol A (BPA), dibutyl phthalate (DBP), ethylparaben (EP), methylparaben (MP) and triclosan (TCS) at mean molar concentration were 1.13, 3.58, 0.53, 0.69, and 0.81 nM respectively. No impact on bacterial growth was observed at EDs highest tested concentration. Swimming motility of P. aeruginosa decreased to 28.4% when exposed to EP at 100 µM. Swarming motility increased, with MP at 1 nM, 10 and 100 µM (1.5-fold); conversely, a decrease of 78.5%, with DBP at 100 µM was observed. Furthermore, exposure to 1 nM BPA, DBP and EP increased biofilm formation. P. aeruginosa adhesion to lung cells was two-fold higher upon exposure to 1 nM EP. We demonstrate that ED exposure may simultaneously decrease mobility and increase cell adhesion and biofilm formation, which may promote colonisation and establishment of the pathogen.

Hydroalcoholic Extract of Rabbiteye Blueberry (Vaccinium ashei) Leaves Mitigates Unpredictable Chronic Mild Stress Model Inducing Depressive-Like Behavior in Rats.

Several studies reported that rabbiteye blueberry (Vaccinium ashei Reade) leaves present promising biological properties. To the best of our knowledge, no study investigated the possible application of their hydroalcoholic extract for treating mood disorders. Herein, we evaluated if the hydroalcoholic extract of rabbiteye blueberry (Vaccinium ashei Reade) leaves (HEV) promotes an antidepressant-like effect in rodents using chronic experimental approaches. The effect of repeated administration of HEV (50 mg/kg, p.o.) on the immobility time was assessed in the forced swimming test (FST) in an unpredictable chronic mild stress (UCMS) model. Repeated treatment with HEV reversed the depressive-like behavior induced by UCMS by reducing the immobility time. Besides, the exposure to HEV caused no changes in relative organ weights in rats submitted to UCMS. The results indicated that HEV administration presented antidepressant-like action devoid of toxic effects. Thus, it is possible to suggest its potential as a safe and accessible therapeutic tool in the management of depression and other related mood disorders.

The Natural Course of Pancreatic Cysts in Inflammatory Bowel Disease: Results of a Long-term Follow-up.

OBJECTIVES: The natural course of pancreatic cysts in inflammatory bowel disease (IBD) is unknown. We aim to describe the natural course of pancreatic cysts in IBD and evaluate long-term outcomes. METHODS: A database of patients with abdominal imaging diagnosis of pancreatic cysts (2008-2019) was reviewed. Patients with IBD and pancreatic cysts (study group) and pancreatic cysts without IBD (controls) were selected. Outcomes were measured at 1, 3, 5, and 10 years. Several logistic regression models were used for analysis. RESULTS: Of the 1789 patients evaluated, 1690 had pancreatic cysts without IBD, and 78 had IBD and pancreatic cysts. Majority of cysts were intraductal papillary mucinous neoplasms. Patients with IBD and pancreatic cysts were more likely to be diagnosed with pancreatic cysts at a younger age (P < 0.001) and were more likely to undergo surgical intervention at a younger age (P < 0.001). CONCLUSIONS: This is the first study to evaluate the natural course of pancreatic cysts in IBD patients. Patients with IBD were more likely to have pancreatic cysts detected at a younger age. Despite the early presentation, there were no differences in long-term outcomes. Patients with IBD with pancreatic cysts should be managed similarly to those without IBD.

Modulation of Amyloid-ß and Tau in Alzheimer's Disease Plasma Neuronal-Derived Extracellular Vesicles by Cerebrolysin® and Donepezil.

BACKGROUND: Plasma neuronal-derived extracellular vesicles (NDEV) contain proteins of pathological, diagnostic, and therapeutic relevance. OBJECTIVE: We investigated the associations of six plasma NDEV markers with Alzheimer's disease (AD) severity, cognition and functioning, and changes in these biomarkers after Cerebrolysin®, donepezil, and a combination therapy in AD. METHODS: Plasma NDEV levels of Aß42, total tau, P-T181-tau, P-S393-tau, neurogranin, and REST were determined in: 1) 116 mild to advanced AD patients and in 20 control subjects; 2) 110 AD patients treated with Cerebrolysin®, donepezil, or combination therapy in a randomized clinical trial (RCT). Samples for NDEV determinations were obtained at baseline in the NDEV study and at baseline and study endpoint in the RCT. Cognition and functioning were assessed at the same time points. RESULTS: NDEV levels of Aß42, total tau, P-T181-tau, and P-S393-tau were higher and those of neurogranin and REST were lower in mild-to-moderate AD than in controls (p < 0.05 to p < 0.001). NDEV total tau, neurogranin, and REST increased with AD severity (p < 0.05 to p < 0.001). NDEV Aß42 and P-T181-tau correlated negatively with serum BDNF (p < 0.05), and total-tau levels were associated to plasma TNF-α (p < 0.01) and cognitive impairment (p < 0.05). Combination therapy reduced NDEV Aß42 with respect to monotherapies (p < 0.05); and NDEV total tau, P-T181-tau, and P-S396-tau were decreased in Cerebrolysin-treated patients compared to those on donepezil monotherapy (p < 0.05). CONCLUSION: The present results demonstrate the utility of NDEV determinations of pathologic and synaptic proteins as effective AD biomarkers, as markers of AD severity, and as potential tools for monitoring the effects of anti-AD drugs.

The efficacy of dual therapy for eradicating H. pylori in a Colombian population

Abstract Background: Helicobacter pylori (H. pylori) affects 50% of the human population. The efficacy of the usual treatments has decreased due to increased antibiotic resistance, except for that of amoxicillin, tetracycline, furazolidone and bismuth. Recently, there has been a new interest in dual therapy with high-dose proton pump inhibitors (PPI) and amoxicillin as initial and rescue treatment. There are no studies on this topic in our setting. Objective: to determine the efficacy of dual therapy with high-dose IPP and amoxicillin for eradicating H. pylori. Materials and methods: this was a quasi-experimental study carried out from December 2019 to July 2020 in people over the age of 18 with histologically confirmed H. pylori. All received 40 mg of esomeprazole half an hour before breakfast, lunch and dinner, plus 1 gram of oral amoxicillin every eight hours for 14 days. Eradication was determined by fecal antigens (OnSiteTM H. pylori Biotech Inc.) after four weeks of treatment. Results: 108 patients with an average age of 67 years were included, 70% of whom were women. Eradication per protocol (PP) and intention to treat (ITT) was 86% (95%CI 79.4-92.5%) for both. In previously treated patients (26%) the efficacy was 85.7% (95%CI 71.8-99.5%). Adverse events were mild in 31%, especially nausea (16%) and abdominal distension (14%). Treatment was not suspended in any patient. Conclusion: Dual therapy is effective, easy to administer, and has few adverse effects. It would be a good option in our setting as initial or rescue therapy. Larger studies are needed to confirm our results. (Acta Med Colomb 2021; 46. DOI:https://doi.org/10.36104/amc.2021.2091).

Beyond Single Discrete Responses: An Integrative and Multidimensional Analysis of Behavioral Dynamics Assisted by Machine Learning.

Understanding behavioral systems as emergent systems comprising the environment and organism subsystems, include spatial dynamics as a primary dimension in natural settings. Nevertheless, under the standard approaches, the experimental analysis of behavior is based on the single response paradigm and the temporal distribution of discrete responses. Thus, the continuous analysis of spatial behavioral dynamics is a scarcely studied field. The technological advancements in computer vision have opened new methodological perspectives for the continuous sensing of spatial behavior. With the application of such advancements, recent studies suggest that there are multiple features embedded in the spatial dynamics of behavior, such as entropy, and that they are affected by programmed stimuli (e.g., schedules of reinforcement) at least as much as features related to discrete responses. Despite the progress, the characterization of behavioral systems is still segmented, and integrated data analysis and representations between discrete responses and continuous spatial behavior are exiguous in the experimental analysis of behavior. Machine learning advancements, such as t-distributed stochastic neighbor embedding and variable ranking, provide invaluable tools to crystallize an integrated approach for analyzing and representing multidimensional behavioral data. Under this rationale, the present work (1) proposes a multidisciplinary approach for the integrative and multilevel analysis of behavioral systems, (2) provides sensitive behavioral measures based on spatial dynamics and helpful data representations to study behavioral systems, and (3) reveals behavioral aspects usually ignored under the standard approaches in the experimental analysis of behavior. To exemplify and evaluate our approach, the spatial dynamics embedded in phenomena relevant to behavioral science, namely, water-seeking behavior and motivational operations, are examined, showing aspects of behavioral systems hidden until now.

Pancreatitis After Pancreaticojejunostomy Procedure? A Tale Involving the Tail of the Pancreas.

Recurrent acute pancreatitis (RAP) involving the tail of the pancreas after pancreaticojejunosotomy (PJP) is rare, has very challenging management, and there is minimal literature. We describe a case of idiopathic RAP, complicated with chronic pancreatitis that failed medical and endoscopic management and required PJP. Unfortunately, RAP recurred after PJP, and we describe his clinical course and management.

Do Not Skip the Retroflexion: A Case of Disseminated Anorectal Mucosal Melanoma.

Less than 4% of melanomas are of mucosal origin, with primary anorectal mucosal melanomas comprising a small subset. Mucosal melanomas are often diagnosed at an advanced stage due to delay in patient presentation and obscured tumor origins leading to a more aggressive behavior and less favorable prognosis when compared with cutaneous melanomas. We present a case of metastatic anorectal mucosal melanoma with a negative colonoscopy 1 year earlier.

Use of Piptatherum miliaceum to enable the establishment success of Salvia rosmarinus in Technosols developed from pyritic tailings.

With this study we aimed to assess the effect of the prior development of Piptatherum miliaceum (Pm) in a Technosol on the establishment of Salvia rosmarinus (Sr) as a cash crop. An experimental pot was performed with two biochar (BCh) doses (BCh1 and BCh2) mixed with marble waste and pyritic tailings, with and without Pm. After 12 months of Pm growth, the pots with this species were divided into two sets: Sr alone and Sr + Pm. An agricultural soil (AGR) was used as an external control. The results showed that the growth of Sr led to similar shoot biomass to AGR. Sr + Pm reduced shoot biomass by 50%. Total soil organic and recalcitrant C, and total and recalcitrant N showed the highest values in vegetated pots, with no effect of the BCh rate. The decrease in the soil metals availability was related with increases in soil pH. BCh1Sr + Pm treatment showed a microbial community structure more similar to AGR, related to higher fungal and bacterial abundance, enzyme activities and soluble carbon. Thus, growing Sr + Pm seems a suitable strategy to improve soil properties, including microbial abundance, with low translocation of metals. Although the BCh rate did not affect plant growth or soil physicochemical properties, the lowest rate contributed to the growth of soil microorganisms better. The simultaneous growth of Sr + Pm reduced biomass production, and a source of available nutrients is also recommended. Further studies are needed to test this strategy in the field, and to ensure its suitability and a constant biomass production.

Noise and landscape features influence habitat use of mammalian herbivores in a natural gas field.

Anthropogenic noise is a complex disturbance known to elicit a variety of responses in wild animals. Most studies examining the effects of noise on wildlife focus on vocal species, although theory suggests that the acoustic environment influences non-vocal species as well. Common mammalian prey species, like mule deer and hares and rabbits (members of the family Leporidae), rely on acoustic cues for information regarding predation, but the impacts of noise on their behaviour has received little attention. We paired acoustic recorders with camera traps to explore how average daily levels of anthropogenic noise from natural gas activity impacted occupancy and detection of mammalian herbivores in an energy field in the production phase of development. We consider the effects of noise in the context of several physical landscape variables associated with natural gas infrastructure that are known to influence habitat use patterns in mule deer. Our results suggest that mule deer detection probability was influenced by the interaction between physical landscape features and anthropogenic noise, with noise strongly reducing habitat use. In contrast, leporid habitat use was not related to noise but was influenced by landscape features. Notably, mule deer showed a stronger predicted negative response to roads with high noise exposure. This study highlights the complex interactions of anthropogenic disturbance and wildlife distribution and presents important evidence that the effects of anthropogenic noise should be considered in research focused on non-vocal specialist species and management plans for mule deer and other large ungulates.

El ruido de origen antropogénico es una perturbación compleja que provoca una variedad de respuestas en la fauna silvestre. La mayoría de los estudios que examina los efectos del ruido en fauna silvestre se enfoca en especies que se comunican con vocalizaciones, sin embargo, la teoría sugiere que el ambiente acústico es también un recurso clave para especies no-vocales. Especies de mamíferos comunes como el venado bura, liebres y conejos (miembros de la familia Leporidae), dependen de señales acústicas para detectar depredadores, pero los impactos del ruido en el comportamiento de estas especies han recibido poca atención de los investigadores. Usando grabadoras y cámaras trampa en conjunto, exploramos como los niveles diarios de ruido antropogénico generados por la extracción de gas natural impactaron la ocupación y detección de mamíferos herbívoros en un campo de extracción de energía en la fase de producción de desarrollo. Consideramos los efectos del ruido en el contexto de varias variables físicas del paisaje asociadas con la infraestructura del gas natural, que sabemos, influencian los patrones de uso de hábitat del venado bura. Nuestros resultados sugieren que la probabilidad de detección del venado bura fue influenciada por la interacción de las características físicas del paisaje y el ruido antropogénico, este último reduciendo de manera importante el uso de hábitat. En contraste, el uso de hábitat de lepóridos no se relacionó con ruido, pero fue influenciado por variables del paisaje. Notablemente, el venado bura mostro una predicción de respuesta fuerte a los caminos con niveles altos de ruido. Este estudio señala las complejas interacciones entre perturbaciones antropogénicas y la distribución de fauna silvestre. También presentamos evidencia importante que señala que los efectos del ruido antropogénico deben ser considerados en investigaciones enfocadas en especies especialistas no-vocales y planes de manejo para el venado bura y otros ungulados grandes.

Serum VEGF Predicts Clinical Improvement Induced by Cerebrolysin Plus Donepezil in Patients With Advanced Alzheimer's Disease.

Serum vascular endothelial growth factor (VEGF) increases with Alzheimer's disease (AD) severity and may prevent cognitive decline. However, information on the influence of AD drug therapy on circulating VEGF is limited. This study assessed changes in serum VEGF levels and its association with clinical and functional responses in mild to moderate AD patients who were treated with Cerebrolysin, donepezil, or the combined therapy in a randomized, controlled trial. Treatment with Cerebrolysin plus donepezil reduced elevated serum VEGF levels and improved functioning and cognition significantly compared with donepezil alone in patients with advanced AD, and treatment differences were more pronounced in patients with higher VEGF levels. Our results indicate that the combined therapy reversed the increase of serum VEGF in advanced AD, which was associated with cognitive and functional responses, particularly in patients with high baseline VEGF.

Epidemiology of Cholangiocarcinoma; United States Incidence and Mortality Trends.

BACKGROUND: Cholangiocarcinoma is an aggressive malignancy with few available studies assessing incidence and mortality. In this study, we aim to investigate trends of incidence and mortality in a large nation-wide epidemiologic study. METHODS: We used SEER 18 database to study cholangiocarcinoma cases in the US during 2000-2015. Incidence and mortality rates of cholangiocarcinoma were calculated by race and were expressed by 1,000,000 person-years. Annual percent change (APC) was calculated using joinpoint regression software. RESULTS: We reviewed 16,189 patients with cholangiocarcinoma, of which 64.4% were intrahepatic. Most patients were whites (78.4%), males (51.3%), and older than 65 years (63%). A total of 13,121 patients died of cholangiocarcinoma during the study period. Cholangiocarcinoma incidence and mortality were 11.977 and 10.295 and were both higher among Asians, males, and individuals older than 65 years. Incidence rates have significantly increased over the study period (APC=5.063%, P<.001), while mortality increased significantly over the study period (APC=5.964%, P<.001), but decreased after 2013 (APC=-25.029, P<.001). CONCLUSION: The incidence and mortality of cholangiocarcinoma were increasing in the study period with significant observed disparities based on race and gender.

Advances in Interventional Endoscopic Ultrasound (EUS): A Technical Review.

Endoscopic ultrasound (EUS) has become the therapeutic intervention of choice for multiple diseases and continues to evolve rapidly. Its increasing use has allowed the development and adaptation of multiple, revolutionary devices and tools. Currently, there is paucity of randomized clinical trials evaluating multiple EUS-guided interventions and the vast majority of published data is heterogenous. However, the available literature on EUS-guided therapeutic interventions continues to expand and demonstrate its safety, efficacy and cost effectiveness in carefully selected patients when performed by expert endosonographers. The future of interventional EUS appears to be bright!

Temporal trends of incidence and mortality in Asian-Americans with pancreatic adenocarcinoma: an epidemiological study.

BACKGROUND: Pancreatic cancer is the fourth most common cause of cancer-related deaths in the United States, with an estimated 45,750 deaths in 2019. Mortality outcomes seem to differ based on the ethnicity of the patients, with most studies focusing on the mortality and survival of Caucasians and African Americans. Little attention has been given, however, to Asian-American patients diagnosed with pancreatic adenocarcinoma (PAC). In this study, we aimed to investigate mortality rates in Asian-American patients with PAC. METHODS: The SEER 13 registries (Surveillance, Epidemiology, and End-Results) of the National Cancer Institute were used to study PAC cases during 1992-2015. The incidence and incidence-based mortality rates per 100,000 person-years, and the annual percentage changes were calculated using SEER*stat software and Joinpoint regression software. RESULTS: A total of 5814 PAC cases in Asian-American patients were identified. Most patients were older than 60 years (77.6%) and had metastatic disease (55.8%). The overall incidence of PAC among Asian-Americans was 5.740 per 100,000 person-years (95% confidence interval [CI] 5.592-5.891]. Incidence rates were highest among males and patients older than 60 years. PAC incidence rates among Asian-Americans increased by 1.503% (95%CI 1.051-1.956; P<0.001) per year over the study period. PAC incidence rates increased over the study period for all sex, age, and stage subgroups. PAC incidence-based mortality among Asian-Americans increased by 4.535% (95%CI 3.538-5.541; P<0.001) per year over the study period. CONCLUSION: The incidence of PAC in Asian-Americans, as well as incidence-based mortality rates, are on the rise, irrespective of age, sex or stage subgroup.

Ecological Location of a Water Source and Spatial Dynamics of Behavior Under Temporally Scheduled Water Deliveries in a Modified Open-Field System: An Integrative Approach.

It has been reported in non-contingent schedules that the variety of patterns of behavior is affected by the temporal variation of water deliveries. While temporal variation is accomplished by delivering water at fixed or variable times, spatial variation is usually accomplished by varying the number of dispensers and distance among them. Such criteria do not consider the possible ecological relevance of the location of water dispensers. Nevertheless, it is plausible to suppose that the intersection of the programed contingencies (e.g., time-based schedules), the ecological differentiated space (e.g., open vs. closed zones), and the relative location of relevant objects and events (e.g., location of the water source-peripherical vs. center zone) could set up an integrated system with the behavioral patterns of the organism. In the present study, we evaluated the eco-functional relevance of two locations of the dispensers upon behavioral dynamics in Wistar rats using fixed and variable time schedules in a modified open-field system. In Experiment 1, three subjects were exposed to a fixed time 30-s water delivery schedule. In the first condition, the water dispenser was located at the center of the experimental chamber. In the second condition, the water dispenser was located at the center of a wall of the experimental chamber. Each location was present for 20 sessions. In Experiment 2, conditions were the same, but a variable time schedule was used. Routes, distance to the dispenser, recurrence patterns, time spent in zones, entropy, and divergence were analyzed. Our findings suggest a robust differential relevance of the location of the dispensers that should be considered in studies evaluating behavioral dynamics. Results are discussed from an integrative, ecological-parametric framework.

Temporal trends of pancreatic ductal adenocarcinoma in young adults in the United States: A Population-Based Study.

INTRODUCTION: Pancreatic Ductal Adenocarcinoma (PDAC) is an uncommon yet fatal malignancy with numerous recent reports detailing a significant increase in the overall incidence lately. However, there is limited literature on recent incidence rates of the disease in young individuals. In this study we evaluate PDAC incidence in the US among young patients. METHODS: Data from 2000 to 2017 was obtained from the Surveillance Epidemiology and End Results 'SEER' database and analyzed using the SEER*stat software. The overall incidence, incidence trends, and survival were calculated. RESULTS: We selected 667 PDAC patients who met our inclusion criteria. We found the incidence of PDAC among young individuals to be 1.016 (95% CI, 0.940-1.096) per 1,000,000 person-years. Incidence rates were stable over the study period. Higher incidence was found among males [1.240 (95% CI, 1.122-1.366)] and blacks [1.226 (95% CI, 0.999-1.490)]. The 5-year relative survival of young patients with PDAC was 6.8%. CONCLUSIONS: Among young adults, pancreatic cancer incidence has been stable over the study duration. However, disparities between subpopulations exist and further studies are warranted to better understand those observed differences.

Principales causas de mortalidad infantil. Hospital Pediátrico- Docente Hermanos Cordové. Manzanillo. 1987-2018 / Main causes of infant mortality. Pediatric Hospital - Teaching Brothers Cordové. Chamomile 1987-2018 / Principais causas de mortalidade infantil. Hospital Pediátrico - Professores Irmãos Cordové. Camomila 1987-2018

RESUMEN Introducción: la mortalidad infantil ha sido definida internacionalmente como el número de defunciones que ocurren en una población pediátrica durante su primer año de vida; representa el riesgo de morir de los niños menores de un año de edad. Conocer la estructura de causas de la mortalidad infantil y cada uno de sus componentes resulta un insumo indispensable para la planificación estratégica de políticas públicas. Objetivo: describir las principales causas de mortalidad infantil en el Hospital Pediátrico- Docente Hermanos Cordové, de Manzanillo durante el período 1987-2018. Método: se realizó un estudio observacional, descriptivo, longitudinal, retrospectivo. El universo de estudio estuvo constituido por 248 fallecidos menores de un año en la institución durante el periodo de referencia. Se tuvieron en cuenta las siguientes variables:causa básica de muerte, causa directa de muerte y causacontribuyente de muerte. Resultados: los principales resultados fueron los siguientes: sobresalió la bronconeumonía bacteriana con el 33,1 % como causa básica de muerte. El 41,9 % de las defunciones presentaron otras causas, el shock séptico despuntó con el 37,1 %. Conclusiones: dentro de las causas directa de muerte, la desnutrición fue la principal causa contribuyente representada por 21 niños.

ABSTRACT Introduction: infant mortality has been defined internationally as the number of deaths that occur in a pediatric population during their first year of life; It represents the risk of death of children under one year of age. Knowing the structure of causes of infant mortality and each of its components is an indispensable input for strategic public policy planning. Objective: to describe the main causes of infant mortality at the Hermana Cordové Pediatric-Teaching Hospital in Manzanillo during the period 1987-2018. Method: an observational, descriptive, longitudinal, retrospective study was carried out. The universe of study consisted of 248 deaths under one year of age in the institution during the reference period. The following variables were taken into account: basic cause of death, direct cause of death and contributing cause of death. Results: the main results were the following: bacterial bronchopneumonia stood out with 33.1% as the basic cause of death. 41.9% of deaths had other causes, septic shock was 37.1%. Conclusions: Within the direct causes of death, malnutrition was the main contributing cause represented by 21 children.

RESUMO Introdução: a mortalidade infantil foi definida internacionalmente como o número de mortes que ocorrem em uma população pediátrica durante o primeiro ano de vida; Representa o risco de morte de crianças menores de um ano de idade. Conhecer a estrutura das causas da mortalidade infantil e cada um de seus componentes é um insumo indispensável para o planejamento estratégico de políticas públicas. Objetivo: descrever as principais causas de mortalidade infantil no Hospital Pediátrico-Hermanos Cordové, em Manzanillo, no período de 1987 a 2018. Método: estudo observacional, descritivo, longitudinal, retrospectivo. O universo do estudo consistiu em 248 óbitos menores de um ano de idade na instituição durante o período de referência. Foram consideradas as seguintes variáveis: causa básica da morte, causa direta da morte e causa contribuinte da morte. Resultados: os principais resultados foram os seguintes: broncopneumonia bacteriana destacou-se com 33,1% como causa básica de morte. 41,9% das mortes tiveram outras causas, o choque séptico foi de 37,1%. Conclusões: Nas causas diretas da morte, a desnutrição foi a principal causa contribuinte representada por 21 crianças.

Principales causas de mortalidad infantil. Hospital Pediátrico Docente Hermanos Cordové. Manzanillo. 1987-2018 / Main causes of infant mortality. Pediatric Hospital Teaching Brothers Cordové. Chamomile 1987-2018

Introducción: la mortalidad infantil ha sido definida internacionalmente como el número de defunciones que ocurren en una población pediátrica durante su primer año de vida; representa el riesgo de morir de los niños menores de un año de edad. Conocer la estructura de causas de la mortalidad infantil y cada uno de sus componentes resulta un insumo indispensable para la planificación estratégica de políticas públicas. Objetivo: describir las principales causas de mortalidad infantil en elHospital Pediátrico Docente Hermanos Cordové, de Manzanillo durante el período 1987-2018. Método: se realizó un estudio observacional, descriptivo, longitudinal, retrospectivo. El universo de estudio estuvo constituido por 248 fallecidos menores de un año en la institución durante el periodo de referencia. Se tuvieron en cuenta las siguientes variables: causa básica de muerte, causa directa de muerte y causacontribuyente de muerte. Resultados: los principales resultados fueron los siguientes: sobresalió la bronconeumonía bacteriana con el 33,1 por ciento como causa básica de muerte. El 41,9 por ciento de las defunciones presentaron otras causas, el shockséptico despuntó con el 37,1 por ciento. Conclusiones: dentro de las causas directas de muerte, la desnutrición fue la principal causa contribuyente representada por 21 niños(AU)

Introduction: infant mortality has been defined internationally as the number of deaths that occur in a pediatric population during their first year of life; it represents the risk of death of children under one year of age. Knowing the structure of causes of infant mortality and each of its components is an indispensable input for strategic public policy planning. Objective: to describe the main causes of infant mortality at the Hermanos Cordové Pediatric Teaching Hospital in Manzanillo during the period 1987-2018. Method: an observational, descriptive, longitudinal, retrospective study was carried out. The universe of study consisted of 248 deaths under one year of age in the institution during the reference period. The following variables were taken into account: basic cause of death, direct cause of death and contributing cause of death.Results: the main results were the following: bacterial bronchopneumonia stood out with 33.1 percent as the basic cause of death. 41.9 percent of deaths had other causes, septic shock was 37.1 percent. Conclusions: Within the direct causes of death, malnutrition was the main contributing cause represented by 21 children(EU)

Revised Marshall Score: A New Approach to Stratifying the Severity of Acute Pancreatitis.

BACKGROUND: Modified Marshall Score is one of the severity scores for acute pancreatitis (AP) and is included in the Revised Atlanta Classification, but given its utilization of a set serum creatinine level (sCr), it may misclassify stable patients with chronic kidney disease (CKD) to a more severe class just due to their elevated sCr. AIMS: Our study aims to evaluate the role of CKD in AP and the possibility of utilizing acute kidney injury (AKI) into developing a new scoring system. METHODS: We retrospectively reviewed the electronic medical records of three hundred consecutive patients who were diagnosed with AP during hospitalization. Multiple demographic variables and clinical course indices were collected. Univariate logistic regression was then applied to predict mortality and ICU admission. Finally, receiver operating curve was utilized to compare original versus New Revised Marshall Score. RESULTS: Two hundred and eight-four (284) patients had a definitive diagnosis of AP. When comparing patients who had AKI on admission to those without AKI, the AKI group showed statistically significant higher mortality rate (5.6% vs. 1.1%, p = 0.04). Finally, we substituted the renal part of Marshall Score with our AKIN and we plotted the New "Revised" Marshall Score, which showed a higher AUROC compared to the original modified version (C-statistics 0.93 vs. 0.89, p < 0.05). CONCLUSION: We found that AKI predicts mortality and outperforms the use of a fixed sCr value alone. The use of our New Revised Marshall Score can accurately classify AP severity, avoiding misclassification of AP severity and providing better patient care.