Improving the Composition and Bioactivity of Cocoa (Theobroma cacao L.) Bean Shell Extract by Choline Chloride-Lactic Acid Natural Deep Eutectic Solvent Extraction Assisted by Pulsed Electric Field Pre-Treatment.

An environmentally friendly method for the release of cocoa bean shell (CBS) extracts is proposed in this paper. This work aims to investigate the effect of pulsed electric field (PEF) pre-treatment on subsequent solid-liquid extraction (SLE) of metabolites with choline chloride-lactic acid natural deep eutectic solvent (NaDES) and bioactivity of cocoa bean shell (CBS) extract. Two different media for PEF application were evaluated: water and chlorine chloride-lactic acid. Total polyphenols (TPC), total flavonoids (TFC), individual major compounds, and antioxidant and antibacterial activity of CBS extracts were assessed. The performance of PEF-assisted extraction was compared with SLE and ultrasound-assisted extraction (UAE). The proposed method improved the release of TPC up to 45% and TFC up to 48% compared with the conventional extraction. The CBS extract showed medium growth inhibition of Escherichia coli and high growth inhibition of Salmonella sp, Listeria monocytogenes, and Staphylococcus aureus. Thus, an extract with enhanced antioxidant and antibacterial properties was obtained.

A Prospective, Multicenter, Evaluator-Blind, Randomized, Controlled Study of Belotero Balance (+), a Hyaluronic-Acid Filler with Lidocaine, for Correction of Infraorbital Hollowing in Adults.

BACKGROUND: The infraorbital hollow (IOH) is a concavity that interrupts the smooth transition between the lower eyelid and the cheek, resulting in a fatigued and aged appearance. Injectable fillers may be used to correct volume deficit in the under-eye area, restoring a more youthful appearance. OBJECTIVES: To demonstrate the effectiveness and safety of a Cohesive Polydensified Matrix® (CPM) hyaluronic acid (HA) filler with lidocaine (Belotero Balance® (+)) for correcting volume deficit in the IOH. METHODS: Eligible patients with a moderate or severe rating on the Merz Infraorbital Hollow Assessment Scale (MIHAS) were randomized 2:1 to treatment or control. Controls remained untreated until Week 8 and were then treated. Touch-up injections were allowed; retreatment was offered only in the treatment group. Effectiveness was evaluated by the MIHAS. Adverse events were recorded over a 76-week period. RESULTS: The estimated average response rate (≥ 1 point MIHAS improvement) was 80.6% [95% confidence interval (CI): 71.4%, 87.4%] in treated patients and 1.9% [95% CI: 0.3%, 10.2%] in controls at Week 8. The difference in estimated response rates was 78.7% [95% CI: 66.3%, 85.6%], demonstrating a statistically significant, superior response rate in treated patients compared to untreated controls. A total of 88/97 (90.7%) patients who responded to treatment at Week 8 retained improvement 48 weeks after treatment. Use of Belotero Balance (+) in the IOH had a favorable safety profile, with no unexpected adverse events reported. CONCLUSIONS: Belotero Balance (+) is a safe and effective treatment for correcting volume deficit in the IOH.

Arsenic, lead and cadmium concentration in food and estimated daily intake in the Cuban population and the health risks using a Total Diet Study.

This study estimates the intake of arsenic, lead and cadmium by the adult population (aged 18-91) of Cuba. The food consumption indices were obtained through 24-h dietary recall surveys applied to 450 people between October 2020 and March 2021. The Estimated Dietary Intake (EDI) of t-As (54.6 µg/day), Pb (118.5 µg/day) and Cd (35.1 µg/day) complied with Cuban legislation but was higher than the EDI for Cd established by the CONTAM Panel. The Target Hazard Quotients for the three contaminants were: iAs (0.220), Pb (0.409) and Cd (0.424), making the value of the Total Target Hazard Quotient 1.05, which indicates potential health risks for the population. Additionally, associated carcinogenic risks were: iAs (1.0·10-4), Pb (7.2·10-4) and Cd (25.9·10-4). Therefore, 10, 72 and 259 persons per 100,000 inhabitants are likely prone to developing cancer due to the ingestion of iAs, Pb and Cd, respectively.

Injection-related Visual Compromise.

The global market for hyaluronic acid (HA)-based dermal fillers has experienced substantial growth, providing patients with an effective nonsurgical cosmetic option. According to the global market report, the HA dermal fillers market size is expected to grow to $8.5 billion in 2027 at an annual growth rate (CAGR) of 8.9%. However, despite their popularity, HA injections are not free of complications. Vascular occlusion, particularly involving the central retinal artery, represents a significant risk. This case report presents a 60-year-old woman who presented with binocular vertical diplopia after HA filler injection in the right tear trough area. Upon evaluation, the patient exhibited right hypertropia, suggesting right inferior rectus paresis due to vascular injury of the infraorbital artery. Prompt management with hyaluronidase and oral steroids resulted in the resolution of double vision. This case highlights the importance of recognizing potential complications during HA filler injections and emphasizes the need for early intervention to minimize adverse effects.

A deep learning LSTM-based approach for forecasting annual pollen curves: Olea and Urticaceae pollen types as a case study.

Airborne pollen can trigger allergic rhinitis and other respiratory diseases in the synthesised population, which makes it one of the most relevant biological contaminants. Therefore, implementing accurate forecast systems is a priority for public health. The current forecast models are generally useful, but they falter when long time series of data are managed. The emergence of new computational techniques such as the LSTM algorithms could constitute a significant improvement for the pollen risk assessment. In this study, several LSTM variants were applied to forecast monthly pollen integrals in Málaga (southern Spain) using meteorological variables as predictors. Olea and Urticaceae pollen types were modelled as proxies of different annual pollen curves, using data from the period 1992-2022. The aims of this study were to determine the LSTM variants with the highest accuracy when forecasting monthly pollen integrals as well as to compare their performance with the traditional pollen forecast methods. The results showed that the CNN-LSTM were the most accurate when forecasting the monthly pollen integrals for both pollen types. Moreover, the traditional forecast methods were outperformed by all the LSTM variants. These findings highlight the importance of implementing LSTM models in pollen forecasting for public health and research applications.

Exploración preliminar sobre las variables psicológicas implicadas en la adicción a redes sociales on-line / A preliminary exploration on psychological variables related to online social network addiction

El presente estudio examinó el papel de la ansiedad, la evitación experiencial y el sentido vital en el uso abusivo de redes sociales. Los participantes (N = 235: 172 mujeres, 62 hombres, 1 no-binario) completaron una breve encuesta dirigida a medir la evitación experiencial, la ansiedad y el sentido vital. Se llevaron a cabo análisis de regresión lineal y correlaciones controlando la influencia de la edad tanto para hombres como para mujeres. Los análisis de correlación parcial mostraron que, una vez controlada la edad de los participantes, tanto la evitación experiencial como la ansiedad y el sentido vital estuvieron relacionados con el uso abusivo de redes sociales en mujeres; sin embargo, para los varones, sólo la ansiedad se relacionó con un mayor uso de redes sociales. Para las mujeres la ecuación de regresión lineal que mejor predijo el uso abusivo de redes sociales incluyó un bajo sentido vital y una elevada evitación experiencial, mientras que para los varones sólo la ansiedad predijo el mayor uso de redes sociales. Los resultados obtenidos se discuten en relación con la investigación existente sobre el uso de las redes sociales, destacando el sentido vital como un posible factor protector y la importancia de una perspectiva de género para estudiar las redes sociales en línea. (AU)

This study examined the roles of anxiety, experiential avoidance and meaning in life in the abusive use of social networks. Participants in the study (N = 235: 172 women, 62 men, 1 non-binary) volunteered to complete a brief online survey measuring experiential avoidance, anxiety and meaning in life. Correlational and linear regression analyses were performed controlling for age in both the total sample and the subsamples of men and women. The partial correlation analyses showed that, once age was controlled for experiential avoidance, anxiety and meaning in life were related to the abusive use of social networks in women, while for men, only anxiety was significant. For women the linear regression equation which best predicted abusive use of social networks included little meaning in life and high experiential avoidance. For men, only anxiety was a possible predictive factor of abusive use of social networks. These results are discussed with regard to existing research on abusive use of social networks, noting the possible protective effect of meaning in life and calling greater attention to gender differences in behaviors related to online social networks. (AU)

Consensus on the detection and management of patients with depression and pain as an associated somatic symptom.

INTRODUCTION: Globally, depression is the most common psychiatric disorder and is frequently associated with somatic symptom disorders, including pain as a physical symptom. There is a current need to improve the detection and management of the individuals in which depression and pain coexist. Hence, the aim of this document is to provide recommendations in the diagnosis and management of patients with major depressive disorder (MDD) who have pain as a physical symptom (PPS), in order to reduce the variability of clinical practice. MATERIAL AND METHODS: The methodology used is based on the internationally recognized RAND/UCLA consensus method. The scientific committee, consisted of a group of eight multidisciplinary experts, defined 12 clinically relevant questions. After the systematic review of the literature, the scientific committee assessed the evidence and developed recommendations. The panel group with 15 participants validated these recommendations using a single Delphi round. To conclude, there was a final consensus meeting held to redefine with minor modifications the final recommendations. RESULTS: The scientific committee developed a total of 19 recommendations on the diagnosis and detection, impact of PPS in MDD, treatment of MDD with associated PPS, use of healthcare resources, additional recommendations, and care coordination of these patients. Globally, a substantial level of agreement (≥80%) was reached on all items during the Delphi round. All the 19 achieved consensus, seven of them (37%) were agreed with unanimity during the Delphi round. The recommendations with higher consensus were in relation to diagnosis, impact of PPS in MDD, treatment and use of healthcare resources. CONCLUSIONS: Currently, the evidence base for patients with MDD and PPS is still being developed and this consensus statement aims to bridge that gap by providing practical recommendations.

Clinical Characteristics and Outcomes in Adults With Moderate-to-Severe Complexity Congenital Heart Disease Undergoing Palliation or Surgical Repair.

Background: Congenital heart disease (CHD) survival rate has improved dramatically due to advances in diagnostic and therapeutic techniques. However, concerning the unrepaired CHD population of moderate and severe complexity, the data regarding risk predictors and surgical outcomes are scarce. Our aim was to describe the surgical results and predictors of in-hospital outcomes in adult patients with moderate-to-severe complexity CHD that were not repaired in childhood. Methods: We conducted a retrospective cohort study that included 49 adult patients with moderate-to-complex CHD who were treated in a single medical centre. Clinical and echocardiographic variables were obtained on admission, after surgical procedures and during follow-up. Results: Most of the patients were female (66%). Left ventricular ejection fraction and right ventricular outflow tract fractional shortening were within the normal range. The median pulmonary artery systolic pressure was 37 (27-55) mm Hg. The median time was 118 (80-181) minutes for extracorporeal circulation and 76 (49-121) minutes for aortic cross-clamping. The most frequent complication was postoperative complete atrioventricular block (12.2%). In-hospital survival rate was 87.7%. The development of low cardiac output syndrome with predominant right ventricle failure in the postoperative period was the most important predictor of in-hospital death (P = 0.03). Conclusions: Deciding to treat adults with CHD is challenging in moderate and severe unrepaired cases. Adequate clinical, functional, and imaging evaluation is essential to determine each patient's suitability for surgical management and to achieve the best clinical outcome for this population.

Contexte: Grâce aux avancées réalisées en matière de techniques diagnostiques et thérapeutiques, la survie des patients atteints d'une cardiopathie congénitale s'est considérablement améliorée. Cependant, en ce qui concerne les personnes atteintes d'une cardiopathie congénitale non corrigée présentant une complexité modérée ou extrême, les données portant sur les facteurs de risque prédictifs ainsi que sur les résultats chirurgicaux sont rares. Notre objectif était de décrire les résultats chirurgicaux ainsi que les facteurs prédictifs des résultats obtenus en milieu hospitalier chez les patients adultes atteints d'une cardiopathie congénitale présentant une complexité modérée ou extrême qui n'a pas été corrigée pendant l'enfance. Méthodologie: Nous avons mené une étude de cohorte rétrospective comprenant 49 patients adultes atteints d'une cardiopathie congénitale modérée ou complexe qui ont reçu leurs traitements dans un seul centre médical. Les variables cliniques et échocardiographiques ont été obtenues au moment de l'admission, après les interventions chirurgicales et pendant la période de suivi. Résultats: Les patients étaient en majorité des femmes (66 %). La fraction d'éjection du ventricule gauche ainsi que la fraction de raccourcissement de la voie d'éjection ventriculaire droite sont demeurées dans les limites de la normale. La pression systolique médiane de l'artère pulmonaire a été de 37 mmHg (27-55 mmHg). Le temps médian écoulé pour la circulation extracorporelle a été de 118 minutes (80-181 minutes) et pour le clampage de la crosse aortique, de 76 minutes (49-121 minutes). Le bloc auriculo-ventriculaire postopératoire complet a été la complication la plus fréquente (12,2 %). Le taux de survie en milieu hospitalier a été de 87,7 %. Le développement du syndrome du faible débit cardiaque accompagné d'une insuffisance prédominante du ventricule droit durant la période postopératoire a constitué le principal facteur prédictif de décès à l'hôpital (p = 0,03). Conclusion: Il est difficile de traiter les adultes qui présentent une cardiopathie congénitale modérée ou sévère non corrigée. Il est essentiel que les évaluations cliniques, fonctionnelles et par imagerie soient réalisées de façon adéquate pour déterminer si une prise en charge chirurgicale convient aux patients et pour garantir les meilleurs résultats cliniques chez ces derniers.

Cardiac Laterality: Surgical Results of Right Atrial Isomerism.

Right atrial isomerism (RAI) is a complex entity with varying diagnostic and treatment outcomes due to its rarity. Treatment options range from palliative to corrective surgeries, resulting in heterogeneous outcomes. The aim of this study was to analyze the results obtained after cardiac surgery in patients with RAI. A retrospective study was conducted, including patients diagnosed with RAI who underwent cardiac surgery. Their follow-up was from 1 January 2010 to 31 March 2020. Demographic characteristics and perioperative conditions were described. Thirty-eight patients were included, the median age was 4 years (IQR 2-9.2) and 57.9% were men. The main diagnoses were atrioventricular canal (63.2%) and pulmonary stenosis (55.3%). The most common surgical procedures were modified Blalock-Taussig shunt (65.8%) and total cavopulmonary connection with an extracardiac conduit fenestrated without cardiopulmonary bypass (15.9%). We did not find any factors associated with negative outcomes in these patients. The overall survival was 86.8%, with a better outcome in those who did not require reintubation (log rank, p < 0.01). The survival of RAI was similar to other centers. Individuals with RAI should be evaluated rigorously to determine an adequate repair strategy, considering high morbidity and mortality.

How prevalent is COVID-19 vaccine hesitancy in low-income and middle-income countries and what are the key drivers of hesitancy? Results from 53 countries.

OBJECTIVES: This study aims to estimate the levels of COVID-19 vaccine hesitancy in 53 low-income and middle-income countries, differences across population groups in hesitancy, and self-reported reasons for being hesitant to take the COVID-19 vaccine. METHODS: This paper presents new evidence on levels and trends of vaccine hesitancy in low-income and middle-income countries based on harmonised high-frequency phone surveys from more than 120 000 respondents in 53 low-income and middle-income countries collected between October 2020 and August 2021. These countries represent a combined 53% of the population of low-income and middle-income countries excluding India and China. RESULTS: On average across countries, one in five adults reported being hesitant to take the COVID-19 vaccine, with the most cited reasons for hesitancy being concerns about the safety of the vaccine, followed by concerns about its efficacy. Between late 2020 and the first half of 2021, there tended to be little change in hesitancy rates in 11 of the 14 countries with available data, while hesitancy increased in Iraq, Malawi and Uzbekistan. COVID-19 vaccine hesitancy was higher among female, younger adults and less educated respondents, after controlling for selected observable characteristics. CONCLUSIONS: Country estimates of vaccine hesitancy from the high-frequency phone surveys are correlated with but lower than those from earlier studies, which often relied on less representative survey samples. The results suggest that vaccine hesitancy in low-income and middle-income countries, while less prevalent than previously thought, will be an important and enduring obstacle to recovery from the pandemic.

Reappraising personal values in cancer: Meaning-in-life adaptation, meaningfulness, and quality of life.

OBJECTIVE: This study explores the reappraisal of personal values among people with cancer post-diagnosis and its connections to meaningfulness, encompassing personal meaning and sense of meaning, and various dimensions of quality of life. METHODS: A total of 144 patients with diverse cancer types and a control group comprising 158 healthy adults with similar demographic characteristics completed the Valued Living Questionnaire-Perceived Change, the Personal Meaning Profile-Brief, the Portrait Values Questionnaire, and the Functional Assessment of Chronic Illness Therapy-Spiritual Well-Being. RESULTS: Cancer patients displayed a substantial values reappraisal compared to healthy adults. They reported an increased significance of social areas and self-transcendental values, including close relationships (family, partner, and friends), spirituality, citizenship, and universalism, as well as an increased importance of self-care and self in general. Conversely, cancer patients assigned less importance to work and self-enhancement values such as stimulation, power, and achievement. Cluster analysis revealed that patients who reappraised their values exhibited higher meaningfulness and better indicators of quality of life, including spiritual and physical well-being, compared to patients who did not modify their value system. CONCLUSIONS: These findings underscore the importance of assessing and promoting meaning-in-life adaptability among people with cancer, with potential applications in meaning-centered therapies and interventions aimed at enhancing psychological flexibility.

Effect of choline chloride-based deep eutectic solvents on polyphenols extraction from cocoa (Theobroma cacao L.) bean shells and antioxidant activity of extracts.

The effective extraction of natural compounds from cocoa bean shells using deep eutectic solvents could contribute to the sustainable valorization of this waste material. The objective of this study was to: (1) analyze the extraction kinetics of polyphenols released from cocoa (Theobroma cacao L.) bean shells (CBS) by the solid-liquid extraction method using choline chloride-based deep eutectic solvents (ChCl-DES) and their aqueous solutions; (2) investigate the effect of choline chloride-based deep eutectic solvents (ChCl-DES) aqueous solutions on in-vitro antioxidant capacity and the main individual compounds of the extracts. ChCl-DES were prepared with lactic acid, glycerol, and ethylene glycol in a 1:2 ratio. Aqueous solutions (30%, 40%, and 50% water) to obtain solvents with different physicochemical properties were performed. The total phenolic content (TPC) was determined by the Folin-Ciocalteu method. The solution of Fick's law model for plate geometry particles was applied to fit the experimental data and calculate the effective diffusivity coefficient (De). The antioxidant capacity of the extracts was analyzed by a combination of 2,2-diphenyl-1-(2,4,6-trinitrophenyl) hydrazyl (DPPH) free radical scavenging capacity and ferric-reducing antioxidant power (FRAP) assays. The main bioactive compounds were quantified by high-performance liquid chromatography. The results showed that the type of hydrogen bond donor influences the total phenolic content, antioxidant activity and the main individual compounds in the extracts. Moreover, the washing/diffusion mechanism adequately depicts the extraction kinetics data for total phenolic content. However, the influence of an additional mechanism that enhanced the extraction capacity of deep eutectic solvents compared with organic solvent was confirmed.

Abordaje terapéutico de cardiopatías congénitas en el síndrome de Down / Congenital heart disease in Down's syndrome

Resumen Antecedentes: El síndrome de Down es la anomalía cromosómica más frecuente y se asocia con defectos cardiacos congénitos, elementos clínicos de una alta morbilidad y mortalidad infantil. Objetivo: Describir los desenlaces clínicos de los pacientes con síndrome de Down sometidos a cirugía e intervencionismo como tratamiento de las cardiopatías congénitas en esta institución. Material y métodos: Estudio retrospectivo que incluyó pacientes menores de 18 años con síndrome de Down y patología cardiaca asociada durante los últimos 10 años. Las variables estudiadas fueron: peso, talla, sexo, edad, tipo de cardiopatía, procedimiento correctivo, tiempo de estancia intrahospitalaria y en unidad de terapia intensiva, morbilidad y mortalidad. Resultados: 368 pacientes pediátricos fueron llevados a corrección quirúrgica o intervencionista, de los cuales 197 (54%) pertenecían al sexo femenino, la mediana de edad fue de 24 meses (rango intercuartílico [RIQ]: 14-48) en el grupo quirúrgico y de 36 meses (RIQ: 17-85) en el intervencionista. Las cardiopatías congénitas más frecuentes fueron: persistencia del conducto arterioso (31%), comunicación interventricular (28%), canal atrioventricular (CAV) (20%), comunicación interauricular (16%) y tetralogía de Fallot con el 4% respectivamente. La estancia hospitalaria fue de 9 días (RIQ: 7-15) en el grupo quirúrgico y de 3 días (RIQ: 2-5) en el hemodinámico. Las morbilidades fueron infección postoperatoria en 30 pacientes (14%) y en 19 pacientes (9%) bloqueo atrioventricular completo. La mortalidad global incluyendo tanto el quirúrgico como el intervencionista fue del 2%. Conclusiones: Los resultados terapéuticos, quirúrgicos e intervencionistas, en los niños con síndrome de Down y cardiopatías congénitas han mejorado en forma muy satisfactoria. Es de destacar la menor prevalencia del CAV en la población mexicana. Es indispensable realizar evaluación cardiológica a los niños con síndrome de Down y aquellos con cardiopatías congénitas llevarlos a corrección de manera oportuna para favorecer la sobrevida y calidad de vida.

Abstract Background: Down syndrome is the most common chromosomal abnormality, it is associated with a wide variety of congenital heart defects, being considered as clinical elements of high infant morbidity and mortality. Objective: To describe the clinical outcomes of patients with Down syndrome undergoing surgery and interventionism as treatment for congenital heart disease at this Institution. Material and methods: 368 patients with Down syndrome and associated congenital heart disease were diagnosed. The variables studied were weight, stature, sex, age, type of heart disease, corrective procedure, length of stay in the hospital and intensive care unit, morbidity and mortality. Results: 368 pediatric patients underwent surgical or interventional correction. Of which 197 (54%) were female, the median age was 24 months (interquartile range [IQR]: 14-48) in the surgical group and 36 months (IQR: 17-85) in the interventional group. The most frequent congenital heart diseases were: PCA (31%), IVC (28%), CAV (20%), ASD (16%) and tetralogy of Fallot with 4% respectively. Hospital stay was 9 days (IQR: 7-15) in the surgical group and 3 days (IQR: 2-5) in the hemodynamic group. Morbidities were postoperative infection in 30 patients (14%) and complete atrioventricular block in 19 patients (9%). Overall mortality including both surgical and interventional was 2%. Conclusions: The therapeutic, surgical and interventional results in children with Down syndrome and congenital heart disease have improved very satisfactorily. The lower prevalence of the atrioventricular canal in the Mexican population is noteworthy. It is essential to carry out a cardiological evaluation of children with Down syndrome and those with congenital heart disease to correct them in a timely manner to promote survival and quality of life.

[Hipersensibility to red tattoo ink, review of a case]. / Hipersensibilidad a tinta roja de tatuaje, revisión a propósito de un caso.

Introduction: The hypersensitivity reaction associated with tattoo ink and its management represent a growing challenge, despite having precedents in diagnostic and treatment experience in other reports or case series in recent decades, no one has been found homogeneous offer that is effective and safe. Therefore, a review is presented with what has been described in pathophysiological theories, as well as therapeutic proposals and the response found in related cases that have been reported to date. Clinical case: 30-year-old male, with dermatosis located on the right upper extremity, affecting the inner side of the forearm and the outer side of the arm, unilateral, asymmetric, monomorphic in appearance, made up of an artificial macula, caused by red ink (tattoo), with development of papular-like lesions in original trace, pruritic, referred evolution time of one month. Tattoo completion time of 5 and 2 years on the outer side of the right arm and inner side of the ipsilateral forearm, respectively. Conclusions: According to antecedents in other reports and case series, including the experience of our patient, there is no proven efficacy with the use of topical immunomodulators, in turn, patients who shows complete improvement until the elimination of the allergen, either from excisional or laser.

Introducción: la reacción de hipersensibilidad asociada a tinta de tatuaje y su manejo representan un reto diagnóstico y terapéutico, ya que no se ha realizado una guía de manejo homogénea, eficaz y segura. Por lo que se presenta una revisión con lo que se ha descrito en teorías fisiopatológicas, así como las propuestas terapéuticas y la respuesta encontrada en los casos relacionados que se han reportado. Caso clínico: paciente hombre de 30 años que inicia con dermatosis localizada en extremidad superior derecha, unilateral, asimétrica, de aspecto monomorfo, constituida por mácula artificial, provocada por tinta roja (tatuaje), con desarrollo de lesiones de aspecto papular en trazo original, pruriginosa, tiempo de evolución referido de un mes. El hallazgo histopatológico corresponde a reacción de cuerpo extraño con respuesta parcial a esteroide tópico de baja potencia. Conclusiones: según antecedentes en otros reportes y series de casos, incluyendo la experiencia con nuestro paciente, no existe una eficacia aplicable para la mayoría de los pacientes con el uso de inmunomodulares tópicos, ya que muestran mejoría completa hasta la eliminación del hapteno, ya sea de forma escicional o con láser.

Xanthogranuloma of the Eyelid: A Case Report.

We report on the case of a Hispanic woman with necrobiotic xanthogranuloma (NBX) whose disease was managed based on her symptoms. She underwent a diagnostic and debulking surgical intervention and surveillance for hematologic malignancy. This 56-year-old patient presented with a six-year history of enlarging masses and swelling around her eyes, with intermittent inflammation, associated pain, and occasional redness. Her past medical history was remarkable for asthma and nasal polyps. Upon external examination, she had severe fullness of the upper lids with yellow plaques and palpable masses along them, nontender palpation, the absence of visible erythema, and blepharoptosis in both eyes. The patient presented with bilateral visual field constriction due to mechanical obstruction. An orbital computed tomography scan revealed a dense diffuse lesion involving the pre- and postseptal tissues and invading the orbit of the right eye. A facial magnetic resonance imaging scan revealed infiltration of the postseptal spaces within both orbits. A skin and soft tissue biopsy from the bilateral periorbital regions of both eyes confirmed the diagnosis of NBX. A workup for underlying hematologic malignancies, including plasma cell dyscrasias and lymphoproliferative disorders, was unremarkable. The patient underwent diagnostic and debulking surgery in an attempt to improve her visual function. Subsequently, she was scheduled for ongoing monitoring of her disease progression.

Phylogenetic discordance and integrative species delimitation in the Mammillaria haageana species complex (Cactaceae).

Species complexes consist of very close phylogenetic relatives, where morphological similarities make it difficult to distinguish between them using traditional taxonomic methods. Here, we focused on the long-standing challenge of species delimitation in the Mammillaria haageana complex, a group that presents great morphological diversity that makes its taxonomy a puzzle. Our work integrates genomic, morphological, and ecological data to establish the taxonomic limits in the M. haageana complex, and we also studied the evolutionary relationships with the remainder of the M. ser. Supertextae species. Our genetic analyses, as well as morphological and ecological evidence, led us to propose that the M. haageana complex is made up of six distinct entities (M. acultzingensis, M. conspicua, M. haageana, M. lanigera, M. meissneri, and M. san-angelensis), mainly as a result of ecological speciation. A recent taxonomic proposal considered these taxa as a single species; therefore, we propose their recognition at the species level. Our results also show a high level of incomplete lineage sorting rather than reticulation, which is especially likely in recently diverged species such as those comprising M. ser. Supertextae. The species hypotheses proposed here may be useful in future extinction risk assessments and conservation strategies.

Sinus node dysfunction during transcatheter assessment and stent correction of sinus venosus atrial septal defects.

Covered stent correction of a superior sinus venosus atrial septal defect is increasingly performed as an alternative to surgical repair. While sinus node dysfunction requiring pacemaker implantation may be required after surgical repair, this has not been previously reported after covered stent implantation. We reviewed the experience in two interventional centers. Balloon inflation in the superior vena cava was used to confirm the anomalous pulmonary vein drainage would be unobstructed after stent implantation. During balloon testing in 62 consecutive patients, we assessed gradients across the pulmonary vein to left atrium while monitoring the rhythm. We observed the outcomes after covered stent correction in 51 patients. In a single patient, significant bradycardia and pauses developed on repeat balloon testing and the procedure was abandoned without stent implantation. In another patient, there was no sign of sinus node dysfunction during balloon testing but several hours after stent implantation, the patient became symptomatic from sinus bradycardia and pauses and had a pacemaker implanted 3 days later. Over a year later there are some signs of improvement in sinus node function. While sinus node dysfunction has not been described previously during balloon testing or after stent implantation, this report demonstrates for the first time that it may occur. Larger registries are therefore required to monitor for this uncommon complication.

Pulmonary arterial hypertension in children with congenital heart disease: a deeper look into the role of endothelial progenitor cells and circulating endothelial cells to assess disease severity.

Endothelial progenitor cells and circulating endothelial cells have been proposed as useful markers of severity and disease progression in certain vascular diseases, including pulmonary arterial hypertension. Our study focused on evaluating the levels of circulating endothelial progenitor cells and circulating endothelial cells in patients with congenital left-to-right shunts and pulmonary hypertension undergoing definitive repair. Endothelial progenitor cells (identified by simultaneous co-expression of CD45dim, CD34 + and KDR2 + surface antibodies) and circulating endothelial cells (identified by simultaneous co-expression of inherent antibodies CD45-, CD31+, CD146 + and CD105+) were prospectively measured in seventy-four children (including children with Down syndrome), median age six years (2.75-10), with clinically significant left-to-right shunts undergoing transcatheter or surgical repair and compared to thirty healthy controls. Endothelial progenitor cells and, particularly, circulating endothelial cells were significantly higher in children with heart disease and pulmonary arterial hypertension when compared to controls. Endothelial progenitor cells showed significant correlation with pulmonary vascular resistance index when measured both systemically (r = 0.259; p = 0.026) and in the superior vena cava (r = 0.302; p = 0.009). Children with Down syndrome showed a stronger correlation between systemic cellularity and pulmonary vascular resistance index (r = 0.829; p = 0.002). Endothelial progenitor cells were reduced along their transit through the lung, whereas circulating endothelial cells did not suffer any modification across the pulmonary circulation. In children with yet to be repaired left-to-right shunts, endothelial progenitor cells and circulating endothelial cell counts are increased compared to healthy subjects.

High-Dose vs. Low-Dose Dexamethasone in Patients With COVID-19: A Cohort Study in Rural Central America.

To compare the clinical outcomes of a low dose dexamethasone strategy vs. a high-dose dexamethasone strategy in hypoxemic COVID-19 patients. A retrospective observational study comparing low-dose (8 mg) and high-dose dexamethasone (24 mg) of COVID-19 patients admitted from September 1, 2020 to October 31, 2020 in a hospital in Honduras. We included 81 patients with confirmed COVID-19 who required oxygen therapy. The mean age was similar between groups (57.49 vs. 56.95 years). There were more male patients in the group of 24 mg ( p = 0.01). Besides, patients on the 24 mg dose had more prevalence of hypertension ( p = 0.052). More patients in the 24 mg group had a higher rate of invasive mechanical ventilation (15.00% vs. 2.56%, p = 0.058). When evaluating the association between the high dose group and outcomes, we find no significant association with mortality, nosocomial infections, high flow mask, invasive mechanical ventilation, or the need for vasopressors. We find no significant differences in the Kaplan-Meier analysis regarding the survival (log-rank p -value = 0.315). We did not find significant differences between the use of 24 mg and 8 mg of dexamethasone in hypoxemic COVID-19 patients.

Murine macrophage-based iNos reporter reveals polarization and reprogramming in the context of breast cancer.

As part of the first line of defense against pathogens, macrophages possess the ability to differentiate into divergent phenotypes with varying functions. The process by which these cells change their characteristics, commonly referred to as macrophage polarization, allows them to change into broadly pro-inflammatory (M1) or anti-inflammatory (M2) subtypes, and depends on the polarizing stimuli. Deregulation of macrophage phenotypes can result in different pathologies or affect the nature of some diseases, such as cancer and atherosclerosis. Therefore, a better understanding of macrophage phenotype conversion in relevant models is needed to elucidate its potential roles in disease. However, there are few existing probes to track macrophage changes in multicellular environments. In this study, we generated an eGFP reporter cell line based on inducible nitric oxide synthase (iNos) promoter activity in RAW264.7 cells (RAW:iNos-eGFP). iNos is associated with macrophage activation to pro-inflammatory states and decreases in immune-suppressing ones. We validated the fidelity of the reporter for iNos following cytokine-mediated polarization and confirmed that reporter and parental cells behaved similarly. RAW:iNos-eGFP cells were then used to track macrophage responses in different in vitro breast cancer models, and their re-education from anti- to pro-inflammatory phenotypes via a previously reported pyrimido(5,4-b)indole small molecule, PBI1. Using two mouse mammary carcinoma cell lines, 4T1 and EMT6, effects on macrophages were assessed via conditioned media, two-dimensional/monolayer co-culture, and three-dimensional spheroid models. While conditioned media derived from 4T1 or EMT6 cells and monolayer co-cultures of each cancer cell line with RAW:iNos-eGFP cells all resulted in decreased fluorescence, the trends and extents of effects differed. We also observed decreases in iNos-eGFP signal in the macrophages in co-culture assays with 4T1- or EMT6-based spheroids. We then showed that iNos production is enhanced in these cancer models using PBI1, tracking increased fluorescence. Collectively, this work demonstrates that this reporter-based approach provides a facile means to study macrophage responses in complex, multicomponent environments. Beyond the initial studies presented here, this platform can be used with a variety of in vitro models and extended to in vivo applications with intravital imaging.