Morbidity and Mortality of Trauma Patients 55 and Older: A Study of Nontrauma Risk Factors.

Introduction: The American College of Surgeons (ACS) recommends that special considerations be made during triage of trauma patients aged ≥55 due to an observed increase in morbidity and mortality in this population. The geriatric population aged ≥65 represents 30% of all trauma patients. Our objective was to assess which pre-existing conditions (PECs) are associated with worse outcomes in trauma patients aged ≥55. Methods: Study population was selected from the local trauma registry (2020-22). Bi-variate analysis compared PEC status with outcomes controlling for each Injury Severity Score (ISS) category. Injury Severity Score was defined as mild (1-8), moderate (9-15), severe (16-24), and critical (≥25). Results: A total of 5,168 patients were identified (54.9% female, 56.7% age ≥75, 49.1% mild injury). Patients who had chronic renal failure (CRF) were at increased odds of mortality after adjusting for mild (adjusted odds ratio [aOR]: 2.63), moderate (aOR: 2.97), severe (aOR: 2.84), and critical (aOR: 2.62) injuries. Patients who had cirrhosis or congestive heart failure (CHF) were at increased odds of mortality after adjusting for mild (aOR: 3.03, 1.61), moderate (aOR: 3.63, 2.14), and severe (aOR: 3.46, 1.93) injuries, respectively. In addition, there was a relationship between having chronic obstructive pulmonary disease (COPD), dementia, anticoagulant therapy, or diabetes with unplanned intensive care unit (ICU) admission and development of acute kidney injury (AKI). Discussion: There is an association between certain pre-exiting conditions and worse outcomes. Early identification of these factors could provide a foundation for better interdisciplinary management, prevention of complications and associated mortality.

Emergency Surgical Treatment and Triage: Targeting Optimal Outcomes for Emergency Surgical Patients From Index Encounter Through Definitive Care.

BACKGROUND: Patients with emergency surgical conditions (ESCs) experience higher complication rates than those without emergency conditions. Our purpose was to improve time-based key performance indicators (KPIs) of care for ESC patients, including diagnostic workup, empiric stabilization, and referral to definitive care. METHODS: A rapid response program (ESTAT) was developed to screen for and coordinate optimal, timely care for a spectrum of high-risk ESCs, from the patient's index clinical encounter up to definitive care. The Mann-Whitney test assessed whether any differences in KPIs were statistically significant (P < .05) before compared to after the implementation of ESTAT. RESULTS: 98 patients were identified: 44 in ESTAT group (70% age ≥55, 57% male); 54 in control group (57% age ≥55, 44% male). There were significant decreases from time of index clinical encounter to resuscitation (5 min. vs 34 min., P < .001), to diagnostic imaging (52 min. vs 1 hr. 19 min., P = .004), and to definitive care (2 hr. 17 min. vs 3 hr. 51 min., P = .007) in the ESTAT group compared to the control group, respectively. DISCUSSION: Improving time-based KPIs for delivery of clinical services is a common goal of medical emergency response systems (MERS) in numerous specialties. Implementation of an ESTAT program provides a screening tool for at-risk patients and reduces time to stabilize, diagnose and triage to definitive surgical intervention. These time benefits may ultimately translate to reduced complication rates for ESC patients. ESTAT may also represent a patient onboarding mechanism for surgical specialty verification programs promoted by quality improvement committees of various professional societies.

Enterocytozoon bieneusi Infection after Hematopoietic Stem Cell Transplant in Child, Argentina.

We report a case of Enterocytozoon bieneusi infection in a pediatric hematopoietic stem cell transplant recipient in Argentina. Spores were visualized in feces using Calcofluor White and modified trichrome stainings. PCR and sequencing identified E. bieneusi genotype D in fecal samples and liver samples, confirming extraintestinal dissemination of the parasite.

Mumps vaccine effectiveness of a 3rd dose of measles, mumps, rubella vaccine in school settings during a mumps outbreak -- Arkansas, 2016-2017.

Objectives: The largest mumps outbreak in the United States since 2006 occurred in Arkansas during the 2016-17 school year. An additional dose (third dose) of measles-mumps-rubella vaccine (MMR3) was offered to school children. We evaluated the vaccine effectiveness (VE) of MMR3 compared with two doses of MMR for preventing mumps among school-aged children during the outbreak. Study design: A generalized linear mixed effects model was used to estimate the incremental vaccine effectiveness (VE) of a third dose of MMR compared with two doses of MMR for preventing mumps. Methods: We obtained school enrollment, immunization status and mumps case status from school registries, Arkansas's immunization registry, and Arkansas's mumps surveillance system, respectively. We included students who previously received 2 doses of MMR in schools with ≥1 mumps case after the MMR3 clinic. We used a generalized linear mixed model to estimate VE of MMR3 compared with two doses of MMR. Results: Sixteen schools with 9272 students were included in the analysis. Incremental VE of MMR3 versus a two-dose MMR regimen was 52.7% (95% confidence interval [CI]: -3.6%‒78.4%) overall and in 8 schools with high mumps transmission it was 64.0% (95% CI: 1.2%‒86.9%). MMR3 VE was higher among middle compared with elementary school students (68.5% [95% CI: -30.2%‒92.4%] vs 37.6% [95% CI: -62.5%‒76.1%]); these differences were not statistically significant. Conclusion: Our findings suggest MMR3 provided additional protection from mumps compared with two MMR doses in elementary and middle school settings during a mumps outbreak.

Intra- and inter-annual variations in metal concentrations in the superficial water of a highly polluted urban basin of Argentina.

To protect ecosystems impacted by human activities and prevent their degradation, it is imperative to evaluate variations in the concentration of environmental pollutants over time. Here, we evaluated the intra- and inter-annual variations of several metals from 15 sites in the Matanza Riachuelo River basin (one of the most polluted in the world) and determined the physicochemical and meteorological parameters associated with these changes from 2008 to 2015. For this, in each site, we used Asymmetric Eigenvector Maps and Redundancy Analysis. The results highlighted temporal patterns of metal concentrations and several factors associated with them, perhaps related to the actions performed in the area since 2008. Additionally, we found that the effects of physicochemical and meteorological factors on metal concentrations were site-dependent, possibly related to the presence of different local sources of pollution or characteristics of the river in each site, such as its sediments. This approach could be applied to different scenarios (aquatic and terrestrial) and could provide a tool to help decision-makers address the harmful consequences of the continuous advance of human activities on human and ecosystem health.

What I Wish My Instructor Knew: How Active Learning Influences the Classroom Experiences and Self-Advocacy of STEM Majors with ADHD and Specific Learning Disabilities.

Our understanding of how active learning affects different groups of students is still developing. One group often overlooked in higher education research is students with disabilities. Two of the most commonly occurring disabilities on college campuses are attention-deficit/hyperactivity disorder (ADHD) and specific learning disorders (SLD). We investigated how the incorporation of active-learning practices influences the learning and self-advocacy experiences of students with ADHD and/or SLD (ADHD/SLD) in undergraduate science, technology, engineering, and mathematics (STEM) courses. Semistructured interviews were conducted with 25 STEM majors with ADHD/SLD registered with a campus disability resource center at a single university, and data were analyzed using qualitative methods. Participants described how they perceived active learning in their STEM courses to support or hinder their learning and how active learning affected their self-advocacy. Many of the active-learning barriers could be attributed to issues related to fidelity of implementation of a particular active-learning strategy and limited awareness of universal design for learning. Active learning was also reported to influence self-advocacy for some participants, and examples of self-advocacy in active-learning STEM courses were identified. Defining the supports and barriers perceived by students with ADHD/SLD is a crucial first step in developing more-inclusive active-learning STEM courses. Suggestions for research and teaching are provided.

Pulmonary Conventional Type 1 Langerin-Expressing Dendritic Cells Play a Role in Impairing Early Protective Immune Response against Cryptococcus neoformans Infection in Mice.

Lung dendritic cells (DC) are powerful antigen-presenting cells constituted by various subpopulations that differ in terms of their function and origin and differentially regulate cell-mediated antifungal immunity. The lung is the primary target organ of Cryptococcus neoformans and C. gattii infections, which makes it essential in the establishment of the first line of anti-cryptococcal defense. However, the lung-specific dynamics and function of DC subsets are poorly understood in cryptococcosis. In this study, we provide evidence for the in vivo function of a conventional langerin-expressing DC1 dendritic cell (LangDC1) population during the first week of intratracheal C. neoformans infection in mice. By using conditional depletion of LangDC1 after diphtheria toxin treatment of LangDTREGFP mice, we demonstrate that these animals better control the fungal infection and produce type 1 and 17 cytokines in the context of a type 2 immune response, favoring a predominance of iNOS over arginase-1 expression by pulmonary cells. Our results suggest that LangDC1 cells play a role in impairing immune response for the clearance of C. neoformans in the early stage of pulmonary infection.

Identification and validation of small molecule analytes in mouse plasma by liquid chromatography-tandem mass spectrometry: A case study of misidentification of a short-chain fatty acid with a ketone body.

Recently, there has been growing interest in short-chain fatty acids (SCFA) and ketone bodies (KB) due to their potential use as biomarkers of health and disease. For instance, these diet-related metabolites can be used to monitor and reduce the risk of immune response, diabetes, or cardiovascular diseases. Given the interest in these metabolites, different targeted metabolomic methods based on UPLC-MS/MS have been developed in recent years to detect and quantify SCFA and KB. In this case study, we discovered that applying an existing validated, targeted UPLC-MS/MS method to mouse plasma, resulted in a fragment ion (194 m/z) being originally misidentified as acetic acid (a SCFA), when its original source was 3-hydroxybutyric acid (a KB). Therefore, we report a modified, optimized LC method that can separate both signals. In addition, the metabolite coverage was expanded in this method to detect up to eight SCFA: acetic, propanoic, butyric, isobutyric, 2-methylbutyric, valeric, isovaleric, and hexanoic acids, two KB: 3-hydroxybutyric, and acetoacetic acids, and one related metabolite: 3-hydroxy-3-methylbutyric acid. The optimization of this method increased the selectivity of the UPLC-MS/MS method towards the misidentified compound. These findings encourage the scientific community to increase efforts in validating the original precursor of small molecule fragments in targeted methods.

A role for PchHI as the ABC transporter in iron acquisition by the siderophore pyochelin in Pseudomonas aeruginosa.

Iron is an essential nutrient for bacterial growth but poorly bioavailable. Bacteria scavenge ferric iron by synthesizing and secreting siderophores, small compounds with a high affinity for iron. Pyochelin (PCH) is one of the two siderophores produced by the opportunistic pathogen Pseudomonas aeruginosa. After capturing a ferric iron molecule, PCH-Fe is imported back into bacteria first by the outer membrane transporter FptA and then by the inner membrane permease FptX. Here, using molecular biology, 55 Fe uptake assays, and LC-MS/MS quantification, we first find a role for PchHI as the heterodimeric ABC transporter involved in the siderophore-free iron uptake into the bacterial cytoplasm. We also provide the first evidence that PCH is able to reach the bacterial periplasm and cytoplasm when both FptA and FptX are expressed. Finally, we detected an interaction between PchH and FptX, linking the ABC transporter PchHI with the inner permease FptX in the PCH-Fe uptake pathway. These results pave the way for a better understanding of the PCH siderophore pathway, giving future directions to tackle P. aeruginosa infections.

Mumps in Vaccinated Children and Adolescents: 2007-2019.

BACKGROUND: Despite a >99% reduction in US mumps cases after the introduction of mumps vaccine in 1967, outbreaks have occurred in schools and other settings involving vaccinated children and adolescents since 2006. METHODS: We analyzed mumps cases reported by US health departments to the National Notifiable Diseases Surveillance System. We present the incidence and vaccination status of pediatric cases (age <18 years) during 2007-2019 and describe demographic, clinical, and vaccination characteristics of pediatric cases reported during the most recent resurgence in 2015-2019. RESULTS: During 2007-2019, 9172 pediatric cases were reported, accounting for a median of 32% of all cases reported each year (range: 13%-59%). A median of 87% (range: 81%-94%) of pediatric patients each year had previously received ≥1 measles, mumps, and rubella (MMR) vaccine dose. During 2015-2019, of 5461 pediatric cases reported, only 2% of those with known import status (74%) were associated with international travel. One percent of patients had complications and 2% were hospitalized. Among patients aged ≥1 year with known vaccination status (72%), 74% of 1- to 4-year-olds had received ≥1 MMR dose and 86% of 5- to 17-year-olds had received ≥2 MMR doses. Since 2016, pediatric mumps cases have been reported in most US states each year (range: 38-45 states). CONCLUSIONS: Since 2007, one-third of US reported mumps cases occurred in children and adolescents, the majority of whom were vaccinated. Clinicians should suspect mumps in patients with parotitis or mumps complications, regardless of age, travel history, and vaccination status.

Lipid Metabolite Biomarkers in Cardiovascular Disease: Discovery and Biomechanism Translation from Human Studies.

Lipids represent a valuable target for metabolomic studies since altered lipid metabolism is known to drive the pathological changes in cardiovascular disease (CVD). Metabolomic technologies give us the ability to measure thousands of metabolites providing us with a metabolic fingerprint of individual patients. Metabolomic studies in humans have supported previous findings into the pathomechanisms of CVD, namely atherosclerosis, apoptosis, inflammation, oxidative stress, and insulin resistance. The most widely studied classes of lipid metabolite biomarkers in CVD are phospholipids, sphingolipids/ceramides, glycolipids, cholesterol esters, fatty acids, and acylcarnitines. Technological advancements have enabled novel strategies to discover individual biomarkers or panels that may aid in the diagnosis and prognosis of CVD, with sphingolipids/ceramides as the most promising class of biomarkers thus far. In this review, application of metabolomic profiling for biomarker discovery to aid in the diagnosis and prognosis of CVD as well as metabolic abnormalities in CVD will be discussed with particular emphasis on lipid metabolites.

Pediatricians' Knowledge and Practices Related to Mumps Diagnosis and Prevention.

OBJECTIVES: To assess pediatricians' mumps knowledge and testing practices, to identify physician and practice characteristics associated with mumps testing practices, and to assess reporting and outbreak response knowledge and practices. STUDY DESIGN: Between January and April 2020, we surveyed a nationally representative network of pediatricians. Descriptive statistics were generated for all items. The χ2 test, t tests, and Poisson regression were used to compare physician and practice characteristics between respondents who would rarely or never versus sometimes or often/always test for mumps in a vaccinated 17-year-old with parotitis in a non-outbreak setting. RESULTS: The response rate was 67% (297 of 444). For knowledge, more than one-half of the pediatricians responded incorrectly or "don't know" for 6 of the 9 true/false statements about mumps epidemiology, diagnosis, and prevention, and more than one-half reported needing additional guidance on mumps buccal swab testing. For testing practices, 59% of respondents reported they would sometimes (35%) or often/always (24%) test for mumps in a vaccinated 17-year-old with parotitis in a non-outbreak setting; older physicians, rural physicians, and physicians from the Northeast or Midwest were more likely to test for mumps. Thirty-six percent of the pediatricians reported they would often/always report a patient with suspected mumps to public health authorities. CONCLUSIONS: Pediatricians report mumps knowledge gaps and practices that do not align with public health recommendations. These gaps may lead to underdiagnosis and underreporting of mumps cases, delaying public health response measures and contributing to ongoing disease transmission.

Disruption of the Interfacial Membrane Leads to Magnaporthe oryzae Effector Re-location and Lifestyle Switch During Rice Blast Disease.

To cause the devastating rice blast disease, the hemibiotrophic fungus Magnaporthe oryzae produces invasive hyphae (IH) that are enclosed in a plant-derived interfacial membrane, known as the extra-invasive hyphal membrane (EIHM), in living rice cells. Little is known about when the EIHM is disrupted and how the disruption contributes to blast disease. Here we show that the disruption of the EIHM correlates with the hyphal growth stage in first-invaded susceptible rice cells. Our approach utilized GFP that was secreted from IH as an EIHM integrity reporter. Secreted GFP (sec-GFP) accumulated in the EIHM compartment but appeared in the host cytoplasm when the integrity of the EIHM was compromised. Live-cell imaging coupled with sec-GFP and various fluorescent reporters revealed that the loss of EIHM integrity preceded shrinkage and eventual rupture of the rice vacuole. The vacuole rupture coincided with host cell death, which was limited to the invaded cell with presumed closure of plasmodesmata. We report that EIHM disruption and host cell death are landmarks that delineate three distinct infection phases (early biotrophic, late biotrophic, and transient necrotrophic phases) within the first-invaded cell before reestablishment of biotrophy in second-invaded cells. M. oryzae effectors exhibited infection phase-specific localizations, including entry of the apoplastic effector Bas4 into the host cytoplasm through the disrupted EIHM during the late biotrophic phase. Understanding how infection phase-specific cellular dynamics are regulated and linked to host susceptibility will offer potential targets that can be exploited to control blast disease.

Long-Term Exposure to Fine and Coarse Particulate Matter and COVID-19 Incidence and Mortality Rate in Chile during 2020.

BACKGROUND: Several countries have documented the relationship between long-term exposure to air pollutants and epidemiological indicators of the COVID-19 pandemic, such as incidence and mortality. This study aims to explore the association between air pollutants, such as PM2.5 and PM10, and the incidence and mortality rates of COVID-19 during 2020. METHODS: The incidence and mortality rates were estimated using the COVID-19 cases and deaths from the Chilean Ministry of Science, and the population size was obtained from the Chilean Institute of Statistics. A chemistry transport model was used to estimate the annual mean surface concentration of PM2.5 and PM10 in a period before the current pandemic. Negative binomial regressions were used to associate the epidemiological information with pollutant concentrations while considering demographic and social confounders. RESULTS: For each microgram per cubic meter, the incidence rate increased by 1.3% regarding PM2.5 and 0.9% regarding PM10. There was no statistically significant relationship between the COVID-19 mortality rate and PM2.5 or PM10. CONCLUSIONS: The adjusted regression models showed that the COVID-19 incidence rate was significantly associated with chronic exposure to PM2.5 and PM10, even after adjusting for other variables.

Determinants of a Variety of Deviant Behaviors: An Analysis of Family Satisfaction, Personality Traits, and Their Relationship to Deviant Behaviors Among Filipino Adolescents.

In previous decades, numerous involvements of adolescents in deviant behavior have been increasing, and previous researchers examined different variables that may influence these phenomena. This study was designed to look for the possible predictors of deviant behavior, as well as its association with family satisfaction and personality traits. The study was conducted on 1500 participants ages 12-19 years old from selected schools in Nueva Ecija. The researchers used the Deviant Behavior Variety Scale (DBVS) by Sanches et al. (2016). It consists of 19 items (minor and severe) of a variety of deviant action such as thefts, drug and alcohol consumption, verbal and physical aggression, possession of weapons, vandalism, truancy, lies and defiance of authority, and selling drugs among adolescents (Sanches et al., 2016). Out of 1500 samples, 1227 met the criteria for the deviant behavior scale. Descriptive and Inferential statistics such as Mean, sd, frequency, percentage, Regression analysis, Pearson-correlation, and Mann Whitney U test were used to analyze this study. The research found that there are differences in levels of deviant behavior (Minor and Severe infractions) among sexes. Results showed that female participants have higher tendency to engage in minor infractions of deviant acts, while males had a higher rate of participation in severe infractions of deviant acts. Moreover, there is a negative/inverse association between family satisfaction and deviant behavior. This implies that respondents who participate more in deviant behaviors are found to be less satisfied with their family life, while respondents who participate less in deviant behavior are more satisfied in their family life. Lastly, the current study found that personality trait-agreeableness is found to be the best predictor of deviant behavior among adolescents.

Inside and Out: Factors That Support and Hinder the Self-Advocacy of Undergraduates with ADHD and/or Specific Learning Disabilities in STEM.

Self-advocacy is linked to the success and retention of students with disabilities in college. Self-advocacy is defined as communicating individual wants, needs, and rights to determine and pursue required accommodations. While self-advocacy is linked to academic success, little is known about how students with disabilities in science, technology, engineering, and mathematics (STEM) practice self-advocacy. We previously developed a model of self-advocacy for STEM students with attention-deficit/hyperactivity disorder (ADHD) and/or specific learning disabilities (SLD). Here, we use this model to examine what factors support or hinder self-advocacy in undergraduate STEM courses. We conducted semistructured interviews with 25 STEM majors with ADHD and/or SLD and used qualitative approaches to analyze our data. We found internal factors, or factors within a participant, and external factors, the situations and people, described by our participants, that influenced self-advocacy. These factors often interacted and functioned as a support or barrier, depending on the individuals and their unique experiences. We developed a model to understand how factors supported or hindered self-advocacy in STEM. Supporting factors contributed to a sense of comfort and security for our participants and informed their perceptions that accommodation use was accepted in a STEM course. We share implications for research and teaching based on our results.

Anticoncepción en mujeres epilépticas / Contraception in epileptic women

Resumen La elección de un método anticonceptivo considerado como altamente efectivo en mujeres epilépticas en edad fértil es importante, ya que requiere al momento de indicarlos tener en cuenta los criterios de elegibilidad y las posibles interacciones farmacológicas entre determinados tipos de fármacos anticonvulsivantes (principalmente las inductoras enzimáticas del sistema hepático P450 como: carbamacepina, fenitoína, fenobarbital, oxacarbamacepina, eslicarbazepina, rufinamida, lacosamida y topiramato en dosis altas) y ciertos métodos anticonceptivos (anticonceptivos orales combinados o solo con progesterona e implantes de progesterona subdérmicos) pudiendo acelerar el metabolismo de estas últimas con el consiguiente riesgo de fracaso o viceversa, reduciendo la concentración plasmática (como por ejemplo; lamotrigina) predisponiendo a crisis epilépticas, riesgo de embarazos no deseados, abortos, teratogenicidad por valproato, complicaciones materno fetal y dificultad en el manejo de la actividad epiléptica durante la gestación. En caso de asociarse ambas medicaciones, se debe considerar el uso combinado con un método de barrera u optar por la utilización de inyección de depósito de acetato de medroxiprogesterona o dispositivo intrauterino como anticoncepción. Está demostrado que el asesoramiento sobre planificación familiar en la primera consulta puede influenciar en la elección del método anticonceptivo y el inicio temprano de ácido fólico en caso de búsqueda de fertilidad. En conclusión, se debe analizar junto con las pacientes epilépticas las diferentes opciones terapéuticas con el fin de lograr y optimizar la mejor meta de cada uno.

Abstract The choice of a contraceptive method considered highly effective in epileptic women of childbearing age is important, since it requires taking into account the eligibility criteria and the possible pharmacological interactions between certain types of anti-seizure drugs (mainly enzyme inducers drugs of the hepatic system P450 such as: carbamazepine, phenytoin, phenobarbital, oxacarbamazepine, eslicarbazepine, rufinamide, lacosamide and topiramate in high doses) and certain contraceptive methods (oral contraceptives combined or only with progesterone and subdermal progesterone implants), which may accelerate the metabolism of the latter with the consequent risk of failure or vice versa, reduction of plasma concentration (such as lamotrigine) predisposing to seizures, risk of unwanted pregnancies, abortions, teratogenicity due to valproato, maternalfetal complications and difficulty in the management of epileptic activity during pregnancy. In case of prescribing both medications, the combined use with a barrier method should be considered or the use of a depot injection of medroxyprogesterone acetate or intrauterine device as contraception should be considered. Family planning counseling at the first visit has been shown to influence the choice of the contraceptive method and the early initiation of folic acid in the search for fertility. In conclusion, the different therapeutic options should be analyzed together with the epileptic patients in order to achieve and optimize the best goal for each one.

Role of Two Metacaspases in Development and Pathogenicity of the Rice Blast Fungus Magnaporthe oryzae.

Rice blast disease caused by Magnaporthe oryzae is a devastating disease of cultivated rice worldwide. Infections by this fungus lead to a significant reduction in rice yields and threats to food security. To gain better insight into growth and cell death in M. oryzae during infection, we characterized two predicted M. oryzae metacaspase proteins, MoMca1 and MoMca2. These proteins appear to be functionally redundant and can complement the yeast Yca1 homologue. Biochemical analysis revealed that M. oryzae metacaspases exhibited Ca2+-dependent caspase activity in vitro Deletion of both MoMca1 and MoMca2 in M. oryzae resulted in reduced sporulation, delay in conidial germination, and attenuation of disease severity. In addition, the double ΔMomca1mca2 mutant strain showed increased radial growth in the presence of oxidative stress. Interestingly, the ΔMomca1mca2 strain showed an increased accumulation of insoluble aggregates compared to the wild-type strain during vegetative growth. Our findings suggest that MoMca1 and MoMca2 promote the clearance of insoluble aggregates in M. oryzae, demonstrating the important role these metacaspases have in fungal protein homeostasis. Furthermore, these metacaspase proteins may play additional roles, like in regulating stress responses, that would help maintain the fitness of fungal cells required for host infection.IMPORTANCEMagnaporthe oryzae causes rice blast disease that threatens global food security by resulting in the severe loss of rice production every year. A tightly regulated life cycle allows M. oryzae to disarm the host plant immune system during its biotrophic stage before triggering plant cell death in its necrotrophic stage. The ways M. oryzae navigates its complex life cycle remain unclear. This work characterizes two metacaspase proteins with peptidase activity in M. oryzae that are shown to be involved in the regulation of fungal growth and development prior to infection by potentially helping maintain fungal fitness. This study provides new insights into the role of metacaspase proteins in filamentous fungi by illustrating the delays in M. oryzae morphogenesis in the absence of these proteins. Understanding the mechanisms by which M. oryzae morphology and development promote its devastating pathogenicity may lead to the emergence of proper methods for disease control.

[Contraception in epileptic women]. / Anticoncepción en mujeres epilépticas.

The choice of a contraceptive method considered highly effective in epileptic women of childbearing age is important, since it requires taking into account the eligibility criteria and the possible pharmacological interactions between certain types of anti-seizure drugs (mainly enzyme inducers drugs of the hepatic system P450 such as: carbamazepine, phenytoin, phenobarbital, oxacarbamazepine, eslicarbazepine, rufinamide, lacosamide and topiramate in high doses) and certain contraceptive methods (oral contraceptives combined or only with progesterone and subdermal progesterone implants), which may accelerate the metabolism of the latter with the consequent risk of failure or vice versa, reduction of plasma concentration (such as lamotrigine) predisposing to seizures, risk of unwanted pregnancies, abortions, teratogenicity due to valproato, maternal- fetal complications and difficulty in the management of epileptic activity during pregnancy. In case of prescribing both medications, the combined use with a barrier method should be considered or the use of a depot injection of medroxyprogesterone acetate or intrauterine device as contraception should be considered. Family planning counseling at the first visit has been shown to influence the choice of the contraceptive method and the early initiation of folic acid in the search for fertility. In conclusion, the different therapeutic options should be analyzed together with the epileptic patients in order to achieve and optimize the best goal for each one.

La elección de un método anticonceptivo considerado como altamente efectivo en mujeres epilépticas en edad fértil es importante, ya que requiere al momento de indicarlos tener en cuenta los criterios de elegibilidad y las posibles interacciones farmacológicas entre determinados tipos de fármacos anticonvulsivantes (principalmente las inductoras enzimáticas del sistema hepático P450 como: carbamacepina, fenitoína, fenobarbital, oxacarbamacepina, eslicarbazepina, rufinamida, lacosamida y topiramato en dosis altas) y ciertos métodos anticonceptivos (anticonceptivos orales combinados o solo con progesterona e implantes de progesterona subdérmicos) pudiendo acelerar el metabolismo de estas últimas con el consiguiente riesgo de fracaso o viceversa, reduciendo la concentración plasmática (como por ejemplo; lamotrigina) predisponiendo a crisis epilépticas, riesgo de embarazos no deseados, abortos, teratogenicidad por valproato, complicaciones materno fetal y dificultad en el manejo de la actividad epiléptica durante la gestación. En caso de asociarse ambas medicaciones, se debe considerar el uso combinado con un método de barrera u optar por la utilización de inyección de depósito de acetato de medroxiprogesterona o dispositivo intrauterino como anticoncepción. Está demostrado que el asesoramiento sobre planificación familiar en la primera consulta puede influenciar en la elección del método anticonceptivo y el inicio temprano de ácido fólico en caso de búsqueda de fertilidad. En conclusión, se debe analizar junto con las pacientes epilépticas las diferentes opciones terapéuticas con el fin de lograr y optimizar la mejor meta de cada uno.