Epilepsy in inmate patients seen in a high complexity reference hospital in Colombia: A cross-sectional study.

OBJECTIVE: To describe the sociodemographic and clinical characteristics of imprisoned patients with epilepsy seen at Samaritana University Hospital (HUS) in Bogotá D.C., between January 2017 and November 2020. METHODS: Cross-sectional cohort study of inmate patients over 18 years of age seen at HUS between January 2017 and November 2020, with a discharge diagnosis of epilepsy. A descriptive univariate analysis of patient sociodemographic and clinical characteristics was carried out. RESULTS: Overall, 92 patients were included, 95.7% were males with a median age of 32 years (IQR: 26-44); 65% were assessed in the outpatient clinic; median hospital length of stay was 2 days (IQR: 0) and 7.6% required admission to the intensive care unit; 75% had focal onset epilepsy, 63.04% with undetermined etiology 31.52% with structural causes. Polytherapy was found in 53.3%, valproic acid being the most frequently used antiseizure medication in 59.78%; lack of adherence was reported in 15.22% and inadequate seizure control in 81.52%; status epilepticus occurred in 5.34%. A total of 31 EEG recordings and 53 brain images were performed, of which, 29% and 39.62%, respectively, were abnormal. Non-epileptic paroxysmal events were diagnosed in 5.34%, while organic or psychiatric comorbidities were found in 25%, and the use of psychoactive substances was documented in 17.39%. Upon discharge, 93.47% had no disability, and only 45.65% returned for outpatient follow-up. SIGNIFICANCE: The clinical profile was of men in the fourth decade of life with focal onset epilepsy characterized by high seizure frequency, most of whom were receiving antiseizure medication, with a high proportion of polytherapy. The results are a point of departure for prospective studies designed to identify points to intervene and improve healthcare for inmates with epilepsy. PLAIN LANGUAGE SUMMARY: Inmates are a vulnerable proportion of persons with epilepsy. In this group there are significant differences compared to the general population, especially with greater psychiatric comorbidity and worse control of epileptic seizures due to difficulties in accessing medical care, antiseizure medication and diagnostic tests. We found that the most characteristic population is made up of men in the fourth decade of life with a high frequency of seizures, most of whom were receiving multiple antiseizure medication This study is the first of its kind in Latin America and it is an initial approach to epilepsy in inmates.

First Report of Seropositivity to Trypanosoma cruzi in Mexican Afro-Descendants from Guerrero and Oaxaca States.

Mexican Afro-descendant is a population poorly studied in many aspects, between them the infectious diseases that they suffer. This population is mainly found in the country's Pacific (Oaxaca and Guerrero states) and Atlantic (Veracruz) coast. In these regions, a diversity of triatomine vectors of the Chagas disease is found. Also, all the genotypes of Trypanosoma cruzi DTUs have been reported. That is why the present study aimed to study the presence of antibodies against T. cruzi and cardiac pathology associated with the Chagas disease in the Mexican Afro-descendant population of Guerrero and Oaxaca. ELISA, Western blot, and recombinant antigen's ELISA were used to evaluate the seropositivity of these communities. Furthermore, an electrocardiographic study and evaluation of risk factors associated with T. cruzi infection in the Oaxaca and Guerrero populations were conducted. 26.77% of the analyzed population was positive for two serological tests. These percentages are higher than the previously reported for the mestizo population in similar studies. Electrocardiographic results showed cardiac disorder associated with the Chagas disease in the population. Also, risk factors were identified associated with the men's activities in the outdoor working areas.

Mothers' school starting age and infant health.

We study the effects of women's school starting age on the infant health of their offspring. In Spain, children born in December start school a year earlier than those born the following January, despite being essentially the same age. We follow a regression discontinuity design to compare the health at birth of the children of women born in January versus the previous December, using administrative, population-level data. We find small and insignificant effects on average weight at birth, but, compared to the children of December-born mothers, the children of January-born mothers are more likely to have very low birthweight. We then show that January-born women have the same educational attainment and the same partnership dynamics as December-born women. However, they finish school later and are (several months) older when they have their first child. Our results suggest that maternal age is a plausible mechanism behind our estimated impacts of school starting age on infant health.

A Novel Bioinspired Algorithm for Mixed and Incomplete Breast Cancer Data Classification.

The pre-diagnosis of cancer has been approached from various perspectives, so it is imperative to continue improving classification algorithms to achieve early diagnosis of the disease and improve patient survival. In the medical field, there are data that, for various reasons, are lost. There are also datasets that mix numerical and categorical values. Very few algorithms classify datasets with such characteristics. Therefore, this study proposes the modification of an existing algorithm for the classification of cancer. The said algorithm showed excellent results compared with classical classification algorithms. The AISAC-MMD (Mixed and Missing Data) is based on the AISAC and was modified to work with datasets with missing and mixed values. It showed significantly better performance than bio-inspired or classical classification algorithms. Statistical analysis established that the AISAC-MMD significantly outperformed the Nearest Neighbor, C4.5, Naïve Bayes, ALVOT, Naïve Associative Classifier, AIRS1, Immunos1, and CLONALG algorithms in conducting breast cancer classification.

The effect of altruism on COVID-19 vaccination rates.

BACKGROUND: After the emergence of the first vaccines against the COVID-19, public health authorities have promoted mass vaccination in order to achieve herd immunity and reduce the effects of the disease. Vaccination rates have differed between countries, depending on supply (availability of resources) and demand (altruism and resistance to vaccination) factors. METHODS: This work considers the hypothesis that individuals' health altruism has been an important factor to explain the different levels of vaccination between countries, using the number of transplants as a proxy for altruism. Taking European Union's countries to remove, as far as possible, supply factors that might affect vaccination, we carry out cross-sectional regressions for the most favorable date of the vaccination process (maximum vaccination speed) and for each month during the vaccination campaign. RESULTS: Our findings confirm that altruism has affected vaccination rates against the COVID-19. We find a direct relationship between transplants rates (proxy variable) and vaccination rates during periods in which the decision to be vaccinated depended on the individual's choice, without supply restrictions. The results show that other demand factors have worked against vaccination: political polarization and belonging to the group of countries of the former Eastern bloc. CONCLUSIONS: Altruism is a useful tool to define future vaccination strategies, since it favors the individuals' awareness for vaccination.

Subjective Well-Being and Aversion to Macroeconomic Losses: New Evidence.

This work analyses the existence of asymmetric effects on the subjective well-being of the population of different countries in response to changes in the levels of aggregate income. Microdata from the Eurobarometer and the World Values Survey are used for the period 2000-2019. This period includes several economic changes, among which are the strong expansion at the beginning of the century, the Great Recession, and the subsequent recovery. Our study includes several groups of countries. In the broadest case, the study comprises a group of 83 countries and analyses the issue both from a global perspective as well as focusing particular attention on European countries. These asymmetric effects of economic activity are in line with behavioural economics and previous literature and allow us to determine a macroeconomic aversion to losses. The results obtained support the existence of asymmetric effects of changes in aggregate income on subjective well-being, and show that losses generated in recessions require a far more vigorous recovery if they are to be compensated for, and that they might even have permanent effects. Supplementary Information: The online version contains supplementary material available at 10.1007/s10902-021-00401-5.

Toxocariosis / Toxocariosis

RESUMEN La toxocariosis humana es una helmintozoonosis por invasión de las larvas de la especie Toxocara al organismo humano. Se adquiere al ingerir los huevos de larvas por falta de higiene de las manos, consumo de vegetales y carnes crudas, geofagía y aguas no tratadas. El serodiagnóstico se realiza por Elisa o Western Blot. Es una enfermedad altamente prevalente, en especial en países tropicales, en vía de desarrollo y sobre todo en áreas rurales. Hay diferentes formas de presentación clínica y entre ellas la del compromiso del sistema nervioso central. Su tratamiento es con antihelminticos.

SUMMARY Human toxocariasis is a helminthic zoonosis caused by the invasion of the larvae of the species Toxocara to the human organism. It is acquired by ingesting the eggs of larvae due to lack of hand hygiene, consumption of vegetables and raw meats, geophagy, and untreated water. The serodiagnosis is performed by ELISA or western blot. It is a highly prevalent disease especially in countries tropical, developing and especially in rural areas. There are different ways to clinical presentation and among them that of central nervous system involvement. Its treatment is with anthelmintics.

Who can go back to work when the COVID-19 pandemic remits?

This paper seeks to determine which workers affected by lockdown measures can return to work when a government decides to apply lockdown exit strategies. This system, which we call Sequential Selective Multidimensional Decision (SSMD), involves deciding sequentially, by geographical areas, sectors of activity, age groups and immunity, which workers can return to work at a given time according to the epidemiological criteria of the country as well as that of a group of reference countries, used as a benchmark, that have suffered a lower level of lockdown de-escalation strategies. We apply SSMD to Spain, based on affiliation to the Social Security system prior to the COVID-19 pandemic, and conclude that 98.37% of the population could be affected. The proposed system makes it possible to accurately identify the target population for serological IgG antibody tests in the work field, as well as those affected by special income replacement measures due to lockdown being maintained over a longer period.

Publisher Correction: Morphological, genotypic and metabolomic signatures confirm interfamilial hybridization between the ubiquitous kelps Macrocystis (Arthrothamnaceae) and Lessonia (Lessoniaceae).

An amendment to this paper has been published and can be accessed via a link at the top of the paper.

Caracterización de cardiopatías congénitas en Manizales 2010-2016 / Characterization of Congenital Heart Defects in Manizales 2010-2016 / Caracterização de cardiopatias congênitas em Manizales, Colômbia, 2010-2016

Resumen: Las cardiopatías congénitas son la tercera causa de malformaciones congénitas y una de las principales responsables de la mortalidad en periodo neonatal en el mundo; se originan a partir de alteraciones en el desarrollo embrionario. La incidencia es variable; en Colombia, se estima que afectan del 2 al 3 % de los recién nacidos vivos. En 2015, 20,8 % de los niños menores de cinco años afectados con cardiopatías congénitas fallecieron a causa de estas alteraciones. El presente es un estudio descriptivo y retrospectivo. Se incluyeron los datos de 252 historias clínicas de pacientes con diagnóstico de cardiopatía congénita entre los años 2010 y 2016, el 56 % de la población encontrada fue de sexo femenino. Predominaron las cardiopatías congénitas no cianosantes (87 %). La mayor prevalencia fue el ductus arterioso permeable (35,3 %). La ecocardiografía Doppler se utilizó en 98,4 % de los casos; con respecto al manejo, el 47,2 % de los pacientes estuvieron en seguimiento, siendo este más común que las alternativas médicas o quirúrgicas. En conclusión, el ductus arterioso permeable, la comunicación interventricular y la comunicación interatrial son las cardiopatías no ciano-santes más frecuentes en la población estudiada y se asocian a hipertensión pulmonar que ameritan mayor seguimiento. La tetralogía de Fallot fue la cardiopatía congénita cianosante más común.

Abstract: Congenital heart defects are the third cause of congenital malformations and one of the main causes of mortality in the neonatal period in the world; they originate from alterations in embryonic development. The incidence is variable; in Colombia, it is estimated that they affect 2 to 3% of live newborns. In 2015, 20.8% of children under the age of five affected with congenital heart defects died from these disorders. This is a descriptive and retrospective study. Data of 252 clinical records of patients diagnosed with congenital heart defect between 2010 and 2016 were included, showing that 56% of this population were female. Acyanotic Congenital Heart Diseases predominated (87%). The highest prevalence was patent ductus arteriosus (35.3%). Doppler echocardiography was used in 98.4% of cases; regarding management, 47.2% of patients were in follow-up, this being more common than medical or surgical alternatives. In conclusion patent ductus arteriosus, ventricular septal defect and interatrial septal defect are the most frequent acyanotic heart diseases in the population under study and they are associated with pulmonary hypertension that require higher follow-up. Tetralogy of Fallot was the most common cyanotic congenital heart disease.

Resumo: As cardiopatias congênitas são a terceira causa de malformações congênitas e uma das principais responsáveis pela mortalidade no período neonatal no mundo. São originadas a partir de alterações no desenvolvimento embrionário. A incidência é variável; na Colômbia, é estimado que afetam de 2 a 3 % dos recém-nascidos vivos. Em 2015, 20,8 % das crianças menores de cinco anos afetadas com cardiopatias congênitas faleceram por causa dessas alterações. Este estudo é descritivo e retrospectivo. Foram incluídos dados de 252 prontuários de pacientes com diagnóstico de cardiopatia congênita entre 2010 e 2016, 56 % da população encontrada foi do sexo feminino. Predominaram as cardiopatias congênitas não cianóticas (87 %). A maior persistência foi o dueto arterioso permeável (35,3 %). A ecocardiografìa Doppler foi utilizada em 98,4 % dos casos; quanto ao manejo, 47,2 % dos pacientes estiveram em seguimento, o que foi mais comum do que as alternativas médicas ou cirúrgicas. Em conclusão, o ducto arterioso permeável, a comunicação interventricular e a comunicação interatrial são as cardiopatias não cianóticas mais frequentes na população estudada e são associadas com a hipertensão pulmonar que merecem maior seguimento. A tetralogia de Fallot foi a cardiopatia congènita cianòtica mais comum.

Morphological, genotypic and metabolomic signatures confirm interfamilial hybridization between the ubiquitous kelps Macrocystis (Arthrothamnaceae) and Lessonia (Lessoniaceae).

Macrocystis pyrifera and Lessonia spicata are economically and ecologically relevant brown seaweeds that recently have been classified as members of two separated families within Laminariales (kelps). Here we describe for the first time the Macrocystis pyrifera x Lessonia spicata hybridization in the wild (Chiloe Island, Southeastern Pacific), where populations of the two parents exist sympatrically. Externally, this hybrid exhibited typical features of its parents M. pyrifera (cylindrical and flexible distal stipes, serrate frond margins and presence of sporophylls) and L. spicata (rigid and flat main stipe and first bifurcation), as well as intermediate features between them (thick unfused haptera in the holdfast). Histological sections revealed the prevalence of mucilage ducts within stipes and fronds (absent in Lessonia) and fully developed unilocular sporangia in the sporophylls. Molecular analyses confirmed the presence of the two parental genotypes for ITS1 nrDNA and the M. pyrifera genotype for two predominantly maternally inherited cytoplasmic markers (COI and rbcLS spacer) in the tissue of the hybrid. A metabolome-wide approach revealed that this hybrid is more chemically reminiscent to M. pyrifera. Nevertheless, several hits were identified as Lessonia exclusive or more remarkably, not present in any of the parent. Meiospores developed into apparently fertile gametophytes, which gave rise to F1 sporophytes that reached several millimeters before suddenly dying. In-vitro reciprocal crossing of Mar Brava gametophytes from both species revealed that although it is rare, interfamilial hybridization between the two species is possible but mostly overcome by pseudogamy of female gametophytes.

Giant kelp vegetative propagation: Adventitious holdfast elements rejuvenate senescent individuals of the Macrocystis pyrifera "integrifolia" ecomorph.

Recent findings on holdfast development in the giant kelp highlighted its key importance for Macrocystis vegetative propagation. We report here for the first time the development of adventitious holdfasts from Macrocystis stipes. Swellings emerge spontaneously from different areas of the stipes, especially in senescent or creeping individuals. After being manually fastened to solid substrata, these swellings elongated into haptera, which became strongly attached after 1 month. Within 4 months, new thalli increased in size and vitality, and developed reproductive fronds. Our results suggest the usage of these structures for auxiliary attachment techniques. These could act as a backup, when primary holdfasts are weak, and thus improve the survival rate of the giant kelp in natural beds.

Infección por el virus de la hepatitis B en individuos con factores de exposición en Quibdó y Apartadó, Colombia / Hepatitis B Infections in Individuals with Exposure Factors in Quibdo and Apartado, Colombia

Antecedentes: Colombia presenta un patrón de prevalencia heterogéneo para la infección por virus de la hepatitis B (VHB) con regiones de alta, moderada y baja prevalencia. Objetivo: identificar los casos de infección por VHB y caracterizar los genotipos virales en población con factores de exposición en las ciudades de Quibdó y Apartadó, Colombia. Materiales y métodos: la población del estudio correspondió a 768 individuos asintomáticos con factores de exposición a la infección por VHB. El primer análisis fue la detección del antígeno de superficie del VHB (HBsAg) por prueba rápida. En las muestras de individuos positivos para esta prueba, se confirmó la presencia del HBsAg por ELISA y se detectó el genoma del VHB por reacción en cadena de la polimerasa (PCR). El genotipo viral fue determinado por secuenciación y análisis filogenético. Resultados: se identificaron 17/768 individuos con infección por VHB (2,2%) según la detección del HBsAg por prueba rápida y por ELISA. Los análisis filogenéticos permitieron la identificación de los genotipos F, (subgenotipos F3 y F1a) y A en las muestras. Conclusiones: se reporta por primera vez la circulación del subgenotipo F1a en Colombia y se confirma la circulación del subgenotipo F3 y el genotipo A.

Introduction: Colombia has a varied geographical pattern of prevalence of hepatitis B virus (HBV) infections with regions of high, moderate and low prevalences. Objective: The objective of this study was to identify cases of HBV infection and characterize viral genotypes in population with factors of exposure in the cities of Quibdo and Apartado, Colombia. Materials and Methods: The study population included 768 asymptomatic individuals with factors of exposure to HBV infections. An HBV surface antigen (HBsAg) rapid detection test was the first test used. Samples from individuals who tested positive were tested with ELISA to confirm the diagnosis and with PCR to detect the HBV genome. Viral genotypes were determined by sequencing and phylogenetic analysis. Results: Seventeen individuals (17/768, 2.2%) were diagnosed with HBV infections by both the Rapid Test and Elisa. Phylogenetic analyses allowed identification of genotypes F (F3 and Subgenotype F1a) and A in the samples. Conclusions: We report for the first time the presence of the F1a subgenotype in Colombia and confirme the presence of subgenotype F3 and genotype A.

Características epidemiológicas y clínicas y hallazgos de laboratorio de los niños menores de 15 años con cetoacidosis diabética atendidos en el Hospital Universitario San Vicente Fundación en Medellín, Colombia, entre enero de 2001 y diciembre de 2010 / Epidemiological, clinical and laboratory findings of children younger than 15 years with diabetic ketoacidosis admitted at San Vicente Fundación University Hospital in Medellín, Colombia, between January 2001 and December 2010

Introducción: la cetoacidosis diabética (CAD) es la complicación aguda más importante en los niños con diabetes mellitus. Nuestro objetivo fue determinar las características epidemiológicas y clínicas y los hallazgos de laboratorio de nuestra población pediátrica con CAD. Metodología: estudio descriptivo retrospectivo, de episodios de CAD en menores de 15 años, admitidos entre 2001 y 2010 al Hospital Universitario San Vicente Fundación (Medellín, Colombia) . Se obtuvo la información en las historias clínicas y se la analizó usando estadística descriptiva. Resultados: se incluyeron 98 episodios de CAD en 77 pacientes con edad promedio de 8,7 años, 57,1% de ellos, niñas y 23,4% sin afiliación al Sistema de Seguridad Social en Salud; 53,1% debutaron como CAD. De aquellos con diagnóstico previo de DM1, 64,4% no habían tenido adherencia al tratamiento. Al admitirlos, 42,8% tenían infección. El tiempo transcurrido entre el inicio de los síntomas y la consulta fue de 41 horas en los que tenían diagnóstico previo de DM1 y de 120 horas en los diagnosticados de novo. Predominó la CAD grave: 41,8%. El pH al ingreso fue 7,12 (DE: 0,12) . Durante el tratamiento 28,6% desarrollaron hipoglicemia y 5,1%, edema cerebral; la mortalidad fue 2%. Conclusiones: las características clínicas y de laboratorio de nuestros pacientes con CAD son similares a las reportadas en otros estudios. La falta de adherencia al tratamiento y las infecciones pueden ser una causa importante y evitable de descompensación.

Introduction: Diabetic ketoacidosis (DKA) is the most important acute complication in children with diabetes mellitus. Our objective was to determine the clinical and epidemiological characteristics, and the laboratory findings in the pediatric population with DKA at a third-level hospital in Medellín, Colombia. Methodology: A descriptive, retrospective study of DKA in children under 15 years. Information was obtained from the clinical records and analyzed with descriptive statistics. Results: 98 episodes of DKA in 77 patients were included. Average age of patients was 8.7 years, 57.1% were girls, and 23.4% had no health security coverage. In 53.1%, DKA was the presenting manifestation of DM. Out of those with previous DM1 diagnosis, 64.4% had not adhered to treatment. On admission, 42.8% had infections. Time between the onset of symptoms and the consultation was 41 hours in those with previous DM1 diagnosis, and 120 hours in the ones diagnosed de novo. Severe DKA was the predominant one: 41.8%. On admission, pH was 7.1 (SD: 0.12) . During treatment, 28.6% developed hypoglycemia and 5.1%, cerebral edema. Two patients died. Conclusions: Clinical and laboratory characteristics of our patients with DKA are similar to those reported by other authors. Lack of adherence to treatment and infections may be important and avoidable causes of decompensation.

El caso de una buena práctica de Educación Médica / A case of good practice in medical education

Introducción: las características más importantes de un profesor exitoso en el área de la educación superior en Medicina y áreas afines, según investigaciones realizadas, para los estudiantes son: el saber en la respectiva disciplina, los valores y la formación pedagógica del profesor. Materiales y métodos: esta es una investigación cualitativa, de enfoque hermenéutico. A partir del análisis de las percepciones de los estudiantes del último año de Medicina de la Universidad de Antioquia sobre sus profesores, se seleccionó el profesor más significativo en su formación de pregrado. Para indagar sobre él se utilizaron diferentes instrumentos: encuesta y entrevistas a profundidad a los estudiantes; grupos focales con estudiantes, colegas, pacientes y familiares del profesor elegido. Resultados: el análisis de los datos permitió obtener tres categorías: el profesor como persona, el profesor como docente y el profesor como médico. Para los estudiantes son de gran importancia los valores y las cualidades humanas del profesor quien es un ejemplo para seguir: respeto por la individualidad, interés por propiciar el desarrollo de las potencialidades, refuerzo positivo, empatía, responsabilidad, coherencia entre lo que se piensa y lo que se hace. Conclusiones: los estudiantes afirman que la huella que deja un profesor en su formación médica está en relación con las actitudes y valores personales, los cuales destacan por encima de la idoneidad en la respectiva disciplina y las competencias pedagógicas.

Introduction: According to the results of research, students consider that the most important characteristics of a successful professor in the area of higher education in Medicine and related areas are: knowledge in the respective discipline, values and pedagogic formation. Materials and methods: This was a qualitative research with hermeneutical approach. The most significant professor for undergraduate medical training was selected by analyzing the perceptions of students in the last year of the career. To further inquire about him/her, different instruments were used, namely: surveys and in-depth interviews with students and focal groups with the latter and with coworkers, patients and relatives of the selected professor. Results: Three categories were established based on the analysis of data: the professor as a person, the professor as a teacher and the professor as a doctor. The following values and human qualities of the professor were found to be of great importance for students because he/she is a model to follow: respect for their individuality, interest in promoting the development of their potentials, positive reinforcement, responsibility and coherence between the way he/she thinks and how he/she acts. Conclusions: Students state that the trace left by a professor during their medical training relates to his/ her attitudes and personal values, which stand above suitability in the respective discipline and teaching skills.

Heterogenic solid biofuel sampling methodology and uncertainty associated with prompt analysis.

Accurate determination of the properties of biomass is of particular interest in studies on biomass combustion or cofiring. The aim of this paper is to develop a methodology for prompt analysis of heterogeneous solid fuels with an acceptable degree of accuracy. Special care must be taken with the sampling procedure to achieve an acceptable degree of error and low statistical uncertainty. A sampling and error determination methodology for prompt analysis is presented and validated. Two approaches for the propagation of errors are also given and some comparisons are made in order to determine which may be better in this context. Results show in general low, acceptable levels of uncertainty, demonstrating that the samples obtained in the process are representative of the overall fuel composition.