Community-based natural resource management in Roatan: Strengths and challenges.

This study explored the transformative journey of community-based natural resource management (CBNRM) in the Bay Islands National Marine Park, Honduras, revealing the interplay of cooperation, funding, and communication in fostering successful conservation initiatives. Using a mixed-method approach, we investigated the historical and legislative process and enabling conditions that led to the transition to CBNRM, based on Gruber's 12 key principles. In regards to the present CBNRM system, we looked at its strengths, its challenges, and whether its functioning is seen as satisfying by local resource-users. Findings showed that key CBNRM principles-including an enabling environment, conflict resolution, research-based decision-making, public trust, and monitoring-fostered the transition. Furthermore, satisfaction with reef management and perceived patrol effectiveness, which are pivotal aspects in CBNRM, exceeded 70% in Roatan. Challenges such as strengthening local institutions and enhancing compliance were identified. Nonetheless, co-managers are actively working to resolve these challenges by focusing on enforcement, diverse funding acquisition mechanisms and community participation. The study underscores the pivotal role of local NGOs and collaborative committees in facilitating successful CBNRM. By providing evidence-based insights, we highlight the efficacy of multilevel, co-management models in resource management and emphasize the value of adaptable strategies. These findings contribute to a deeper understanding of CBNRM dynamics in Latin America and the Caribbean, which may ultimately foster successful conservation initiatives in the Global South.

Factors associated with non-treatment for long-term illness among incarcerated individuals.

PURPOSE: The prison population is seldom studied and often overlooked in many countries despite their vulnerability to long-term illness. This study aims to explore the factors associated with the non-treatment for long-term illnesses among incarcerated individuals. DESIGN/METHODOLOGY/APPROACH: This study is a cross-sectional analysis. The authors conducted a secondary data analysis using information collected in the Peruvian census of incarcerated individuals. The study population consisted of incarcerated individuals diagnosed with a long-term illness. To evaluate the factors associated with non-treatment, the authors used a Poisson regression model. FINDINGS: The authors included 12,512 incarcerated individuals (age: 40.9 ± 13.1 years), and 39% of them did not receive treatment for their long-term illness. The authors observed that non-treatment was statistically associated with gender, age, having children, use of the Spanish language, sexual identity, judicial situation, penitentiary location, discrimination inside the penitentiary and health insurance before incarceration. However, only having children (prevalence ratio [PR]: 1.11, confidence interval [CI]95% 1.03-1.19), using the Spanish language (PR: 1.15, CI95%: 1.01-1.31), being in a penitentiary not in Lima (PR: 1.11, CI95%: 1.06-1.17) and perceiving discrimination inside the penitentiary (PR: 1.12, CI95% 1.06-1.18) increased the prevalence of non-treatment. ORIGINALITY/VALUE: Identifying the factors associated with non-treatment will allow us to implement measures for prioritizing groups and developing strategies for the evaluation, close follow-up of their health and management of comorbidities.

Nitrogen Isotopes Reveal High NOx Emissions from Arid Agricultural Soils in the Salton Sea Air Basin.

Air quality management commonly aims to mitigate emissions of oxides of nitrogen (NOx) from combustion, reducing ozone and particulate matter pollution. Despite such efforts, regulations have recently proven ineffective in rural areas like the Salton Sea Air Basin of Southern California, which routinely violates air quality standards. With $2 billion in annual agricultural sales and low population density, air quality in the region is likely influenced by year-round farming. We conducted NOx source apportionment using nitrogen stable isotopes of ambient NO2, which indicate a substantial contribution of soil-emitted NOx. The soil source strength was estimated based on the mean δ15N-NOx from each emission category in the California Air Resources Board's NOx inventory. Our annual average soil emission estimate for the air basin was 11.4 ± 4 tons/d, representing ~30% of the extant NOx inventory, 10× larger than the state's inventory. Therefore, the impact of soil NOx in agricultural regions must be re-evaluated.

Long-term suitability of an alternative host for rearing the sugarcane stalk borer parasitoid Tetrastichus howardi.

The continuous utilisation of an alternative host may influence parasitoid performance across successive generations due to conditioning in natal hosts. Tetrastichus howardi (Olliff) has successfully been reared using Tenebrio molitor L. pupae as a feasible alternative host. However, the extended rearing of T. howardi on this alternative host may impact the biological features of the parasitoids. Parasitoids were reared using T. molitor pupae for 30 consecutive generations. Quality criteria were assessed during the generations F5, F15, and F30, offering pupae of the target pest, Diatraea saccharalis (Fabr.), and compared with the F0 generation (parasitoids reared in D. saccharalis pupae). Criteria included assessments of parasitism performance, host selection, and wing form variation in the parasitoid wasps. Additionally, we examined the fecundity of T. howardi females that emerged from both hosts, considering their age, egg loading before and after one oviposition, as well as parasitism of sugarcane stalk borer pupae. Rearing T. howardi using pupae of T. molitor did not affect its biological traits or preference for the target pest for 30 generations. After parasitism, the parasitoid left the host pupa inside the stalk, and one oviposition was enough to kill D. saccharalis pupae and obtain viable parasitoid progeny. Female sexual maturation and egg loading occurred 72 and 96 h after parasitoid emergence. Egg-loading recovery after parasitism did not happen within 24 h. T. howardi can be reared for up to 30 generations using alternative hosts without compromising its parasitism performance or egg loading.

Cohort profile: The Assessing Imperial Valley Respiratory Health and the Environment (AIRE) study.

BACKGROUND: The Children's Assessing Imperial Valley Respiratory Health and the Environment (AIRE) study is a prospective cohort study of environmental influences on respiratory health in a rural, southeastern region of California (CA), which aims to longitudinally examine the contribution of a drying saline lake to adverse health impacts in children. OBJECTIVES: This cohort was established through a community-academic partnership with the goal of assessing the health effects of childhood exposures to wind-blown particulate matter (PM) and inform public health action. We hypothesize that local PM sources are related to poorer children's respiratory health. POPULATION: Elementary school children in Imperial Valley, CA. DESIGN: Prospective cohort study. METHODS: Between 2017 and 2019, we collected baseline information on 731 children, then follow-up assessments yearly or twice-yearly since 2019. Data have been collected on children's respiratory health, demographics, household characteristics, physical activity and lifestyle, via questionnaires completed by parents or primary caregivers. In-person measurements, conducted since 2019, repeatedly assessed lung function, height, weight and blood pressure. Exposure to air pollutants has been assessed by multiple methods and individually assigned to participants using residential and school addresses. Health data will be linked to ambient and local sources of PM, during and preceding the study period to understand how spatiotemporal trends in these environmental exposures may relate to respiratory health. PRELIMINARY RESULTS: Analyses of respiratory symptoms indicate a high prevalence of allergies, bronchitic symptoms and wheezing. Asthma diagnosis was reported in 24% of children at enrolment, which exceeds both CA state and US national prevalence estimates for children. CONCLUSIONS: The Children's AIRE cohort, while focused on the health impacts of the drying Salton Sea and air quality in Imperial Valley, is poised to elucidate the growing threat of drying saline lakes and wind-blown dust sources to respiratory health worldwide, as sources of wind-blown dust emerge in our changing climate.

A rare etiology of frequent ventricular ectopy: Embolic complication of a venous iliac stent to the right ventricle.

Peripheral venous stent migration is an exceedingly rare complication of endovascular stenting. In this clinical vignette, we present a case of a 74-year-old male with a history of endo-venous laser ablation therapy of the right greater saphenous vein complicated with an occlusion requiring a left iliac vein stent. The patient presented to the clinic months after the procedure with complaints of palpitations. Multimodality imaging revealed a stent that had become dislodged and was now located in the right ventricle, trapped within the tricuspid valve apparatus.

Patient Co-Creation Initiatives in the Ambulatory Care Setting during COVID-19: A Systematic Review.

Background and Objectives: The COVID-19 pandemic has led to significant changes in ambulatory care to meet new healthcare demands. Materials and Methods: A review of 21 articles focusing on patient co-creation initiatives during the pandemic shows that integrating patient feedback was crucial in transforming care delivery. Results: Joint efforts between healthcare professionals and patients led to new patient-focused telemedicine platforms, more efficient appointment systems, and improved safety measures. These adaptations overcame care barriers and maintained continuity of care. Key themes identified include monitoring community health standards, combining technology with patient-provider communication, and enhancing patient participation in health research. Conclusions: These co-creation efforts not only boosted patient satisfaction and outcomes but also demonstrated the potential for long-term healthcare innovations beyond the pandemic. The review further illuminates that co-creation in healthcare, particularly in tracking community health trends, is a practical strategy that involves diverse stakeholders in shaping healthcare delivery. The widespread adoption of co-creation in outpatient care during the pandemic highlights its role in driving patient-centered behavioral changes through innovative methods like crowdsourcing and dialogue conferencing. The review also recognizes that co-creation has been instrumental in responding to demographic changes, enhancing resources, creativity, and problem-solving in municipal-volunteer collaborations. Additionally, the evolution of technology in patient-provider communication, from initial resistance in the 1990s to its current critical role, particularly during the COVID-19 pandemic, underscores its importance in enhancing healthcare service delivery and patient data communication. The review also emphasizes the need for ethically and accessibly designed technology, especially for vulnerable groups, and highlights the significance of patient involvement in healthcare research, advocating for user-centered design and shared decision-making to create truly patient-centric interventions.

Orbital atherectomy safety and efficacy: A comparative analysis of ostial versus non-ostial calcified coronary lesions.

BACKGROUND: The safety and efficacy of coronary orbital atherectomy (OA) for treatment of ostial lesions are not yet fully established. We sought to evaluate (OA) treatment of severely calcified ostial and non-ostial lesions. METHODS: A retrospective analysis of subjects treated with OA for severely calcified ostial and non-ostial lesions, at the Mount Sinai Medical Center, Miami Beach, Florida (MSMCMB) from January 2014 to September 2020, was completed. Study baseline characteristics, lesion and vessel characteristics, procedural outcomes, and in-hospital major adverse cardiovascular events (MACE) were analyzed and compared. RESULTS: A total of 609 patients that underwent PCI with OA were identified. The majority of patients (81.9 %) had non-ostial lesions, while 16.6 % had ostial lesions (of which 2.8 % classified as aorto-ostial) and 1.5 % had unknown lesion anatomy. The mean age of the overall cohort was 74.0 ± 9.3 years, and 63.5 % were male. All patients received drug-eluting stent (DES) placement, and the overall freedom from MACE was 98.5 %, with no significant difference observed between the ostial and non-ostial groups. The freedom from cardiac death and MI was also similar between the two groups. There were low rates of bleeding complications and severe angiographic complications, and no persistent slow flow/no reflow was reported. CONCLUSIONS: This study demonstrated no significant differences in in-hospital MACE outcomes between patients with ostial versus non-ostial lesions, indicating that OA is a safe and effective treatment option for both lesion types, including those classified as aorto-ostial.

Large-scale and regional climatic influences on surface temperature and precipitation in the South Shetland Islands, northern Antarctic Peninsula.

Using data from SCAR observations, ERA5 reanalysis, and regional climate model simulations (RACMO), we examined the influence of large- and regional-scale climate forcing on temperature and precipitation variations in the South Shetland Islands (SSI). Specifically, we focused on understanding how regional climate indices influence the temporal variability of temperature and precipitation on the SSI. Our findings indicate that both large- and regional-scale climate indices significantly impact the interannual and seasonal temperature variability in the SSI. For instance, the Amundsen Sea Low, characterised by low-pressure systems over the Amundsen Sea, and sea ice extent in the northwestern part of the Weddell Sea, exert a strong influence on temperature variability (r from -0.64 to -0.87; p < 0.05). In contrast, precipitation variability in this region is primarily controlled by regional climatic indices. Particularly, anomalies in atmospheric and surface pressure over the Drake Passage region strongly regulate the interannual variability of precipitation in the SSI (r from -0.46 to -0.70; p < 0.05). Large-scale climatic indices demonstrate low but statistically significant correlations, including the Southern Annular Mode and deep convection in the central tropical Pacific. Given the importance of temperature and precipitation in the glacier changes, we recommend assessing the impact of the Drake region on SSI glaciers.

Autophagy as a Target for Non-Immune Intrinsic Functions of Programmed Cell Death-Ligand 1 in Cancer.

Autophagy is a catabolic process that is essential to the maintenance of homeostasis through the cellular recycling of damaged organelles or misfolded proteins, which sustains energy balance. Additionally, autophagy plays a dual role in modulating the development and progression of cancer and inducing a survival strategy in tumoral cells. Programmed cell death-ligand 1 (PD-L1) modulates the immune response and is responsible for maintaining self-tolerance. Because tumor cells exploit the PD-L1-PD-1 interaction to subvert the immune response, immunotherapy has been developed based on the use of PD-L1-blocking antibodies. Recent evidence has suggested a bidirectional regulation between autophagy and PD-L1 molecule expression in tumor cells. Moreover, the research into the intrinsic properties of PD-L1 has highlighted new functions that are advantageous to tumor cells. The relationship between autophagy and PD-L1 is complex and still not fully understood; its effects can be context-dependent and might differ between tumoral cells. This review refines our understanding of the non-immune intrinsic functions of PD-L1 and its potential influence on autophagy, how these could allow the survival of tumor cells, and what this means for the efficacy of anti-PD-L1 therapeutic strategies.

Middle finger tenolysis using WALANT surgical technique in a pediatric patient: A case report.

INTRODUCTION AND IMPORTANCE: Wide Awake Local Anesthesia No Tourniquet (WALANT) is a surgical technique used in hand surgery that allows for active patient participation during surgery while avoiding the pain and discomfort associated with general anesthesia and tourniquets. Using this technique for tenolysis enables a surgeon to assess the repair intraoperatively. However, this technique is more commonly used in adults than in pediatric patients. We aimed to present a case that may contribute to the use of the WALANT technique on the pediatric population. CASE PRESENTATION: This case presents the successful use of the WALANT technique multiple times in a 7-year-old Hispanic male patient to repair recurrent tendon adhesions and joint contracture due to a prior gunshot wound that caused a comminuted, displaced fracture with intra-articular extension of the third finger. CLINICAL DISCUSSION: To the best of our knowledge, few reports and case series of WALANT hand surgery in children are available within the literature. The presented case is rare in terms of the mechanism of injury, the age of the patient, and the fact that multiple WALANT interventions were successfully performed on the same patient. CONCLUSION: Our findings showcase the potential of the WALANT technique on pediatric patients as an alternative to traditional techniques. Due to the scarcity of pediatric WALANT cases in the literature, and the benefits provided by the technique, this case report may be of clinical relevance.

Olfaction Response and Fertility Life Table Parameters of Tetrastichus howardi (Hymenoptera: Eulophidae) Parasitizing Plutella xylostella (Lepidoptera: Plutellidae) and the factitious host Tenebrio molitor (Coleoptera: Tenebrionidae).

Tetrastichus howardi (Olliff) (Hymenoptera: Eulophidae) parasitizes the diamond back moth Plutella xylostella (L.) (Lepidoptera: Plutellidae), but not much is known about its potential as a biocontrol agent. A rearing protocol has been established for this parasitoid on pupae of the factitious host Tenebrio molitor (L.) (Coleoptera: Tenebrionidae), with the aim of releasing it in the field to manage several lepidopteran species. The potential population growth of a parasitoid can be measured through fertility life tables and provide supporting information for using T. howardi in the management of P. xylostella. Also, the fitness and behavior of T. howardi reared on a factitious host can be indicators of its potential to control P. xylostella. Thus, in this study, the fertility life table parameters of T. howardi parasitizing P. xylostella were determined, as well as the effects of the natal host on the behavior of T. howardi towards host volatiles and parasitism rate. The results showed that net reproduction rate (Ro) and the intrinsic rate of population growth (rm) of T. howardi parasitizing P. xylostella were 13.6 (♀/♀) and 0.124 (♀/♀*day), respectively, whereas the mean generation time was 20.9 days. Moreover, the natal host (T. molitor or P. xylostella) did not affect the fitness, parasitism rate, or olfactory response of T. howardi. In general, regardless of the natal host, parasitoid females responded to volatiles of both host species and exhibited the same rate of parasitism on P. xylostella. Therefore, T. howardi reared on the factitious host maintains its attraction and potential to parasitize P. xylostella, and can contribute to the biological control of this pest.

The pro-oxidant action of high-oxygen MAP on beef patties can be counterbalanced by antioxidant compounds from common hawthorn and rose hips.

The objective of this research was to evaluate the effectiveness of antioxidant-rich extracts from rose hip (Rosa canina L.; RC) and hawthorn (Crataegus monogyna Jacq.; CM) at minimizing the oxidative damage to proteins and lipids in beef patties subjected to a high­oxygen (HiOx-MAP) and vacuum (Vacuum) packaging atmosphere. The extracts of RC and CM were characterized by quantifying bioactive compounds, namely, phenolic compounds, tocopherols and vitamin C. Both fruits had high concentrations of bioactive compounds, with RC having the highest total phenolic and vitamin C content. Yet, CM was the most efficient in protecting beef patties against protein carbonylation, reducing, as a result, the instrumental toughness in cooked beef patties. The use of CM and RC extracts in beef patties significantly improved consumer purchase intention in HiOx-MAP packaging systems. The use of CM and RC extracts or their combination in future research would be an effective antioxidant means to decrease the pro-oxidative effects caused by HiOx-MAP in red meat.

Validación de la Escala Corta de Empatía (ece) para población mexicana / Validation of the Short Empathy Scale (ses) for the Mexican Population / Validação da Escala Curta de Empatia (ece) para a população mexicana

Díaz-Loving et al. (1986) diseñaron la Escala Multi- dimensional de Empatía (EASE), un instrumento culturalmente válido para población mexicana inspirado en la estructura conceptual del Índice de Reactividad Interpersonal (IRI) (Davis, 1980). En esta investigación presentamos evidencias de validez y confiabilidad de la Escala Corta de Empatía (ECE), una versión breve de la EASE aplicada a 674 participantes (50.8 % mujeres, 49.2 % hombres) mexicanos (M = 22.8 años, de = 9.2), además del IRI, preguntas de conductas prosociales y el Inventario de Personalidad de diez ítems como criterios externos de validez. El análisis factorial exploratorio mostró tres factores ­malestar personal, toma de perspectiva y compasión­ con niveles de confiabilidad adecuados. El análisis factorial confirmatorio verificó la estructura con indicadores de bondad de ajuste aceptables, obteniendo evidencias de equivalencia estructural para mujeres y hombres. Las relaciones de los tres factores de ECE con prosocialidad, personalidad y sexo proporcionan criterios de validez externa del instrumento.

The Multidimensional Empathy Scale (EASE), a culturally valid instrument for the Mexican population inspired by the conceptual structure of the Interpersonal Reactivity Index (IRI), from 1980, was designed in 1986. The article presents evidence of the validity and reliability of the short empathy scale (ECE), a short version of the EASE, applied to 674 Mexican partici- pants (50.8 % women, 49.2 % men; M = 22.8 years, sd = 9.2). They also answered questions on prosocial behaviors and the 10-item Personality Inventory as an external validity criterion. The exploratory factor analysis showed three factors (personal discomfort, perspective-taking, and compassion) with adequate levels of reliability. The confirmatory factor analysis verified the structure with acceptable goodness-of-fit indicators, obtaining evidence of structural equivalence for women and men. The relationships of the three ECE factors with prosociality, personality, and sex provide evidence of validity.

Diaz Loving et al. (1986) desenharam a Escala de Empatia Multidimensional (EASE), um instrumento cultu- ralmente válido para a população mexicana inspirado na estrutura conceitual do Índice de Reatividade Interpessoal (IRI) (Davis, 1980). Apresentamos evidências de validade e confiabilidade da escala curta de empatia (ECE), uma versão breve do EASE, aplicada a 674 participantes mexicanos (50.8 % mulheres, 49.2 % homens) (M = 22.8 anos, dP = 9.2). Além do IRI, rea- lizamos perguntas sobre comportamento pró-social e aplicamos o Inventário de Personalidade de 10 itens como critérios de validade externa. A análise fatorial exploratória mostrou três fatores (desconforto pessoal, tomada de perspectiva e compaixão) com níveis adequa- dos de confiabilidade. A análise fatorial confirmatória verificou a estrutura com indicadores de qualidade de ajuste aceitáveis, obtendo evidências de equivalência estrutural para mulheres e homens. As relações dos três fatores da ECE com pró-socialidade, personalidade e gênero fornecem critérios de validade externa para o instrumento.

Percutaneous Coronary Intervention and Discretionary Atherectomy in Patients with Aortic Stenosis: 2016-2019 National Inpatient Sample.

BACKGROUND: Patients with aortic stenosis (AS) usually have concomitant calcified coronary artery disease (CAD) requiring atherectomy to improve lesion compliance and odds of successful percutaneous coronary intervention (PCI). However, there is a paucity of data regarding PCI with or without atherectomy in patients with AS. METHODS: The National Inpatient Sample (NIS) database was queried from 2016 through 2019 using ICD-10 codes to identify individuals with AS who underwent PCI with or without atherectomy (Orbital Atherectomy [OA], Rotational or Laser Atherectomy [non-OA]). Temporal trends, safety, outcomes, costs, and correlates of major adverse cardiovascular events (MACE) were assessed using discharge weighted data. RESULTS: Hospitalizations of 45,420 AS patients undergoing PCI with or without atherectomy were identified and of those, 88.6 %, 2.3 %, and 9.1 % were treated with PCI-only, OA, or non-OA, respectively. There was an increase in PCIs (8855 to 10,885), atherectomy [OA (165 to 300) and non-OA (795 to 1255)], and intravascular ultrasound (IVUS) use (625 to 1000). The median cost of admission was higher in the atherectomy cohorts ($34,340.77 in OA, $32,306.2 in non-OA) as compared to the PCI-only cohort ($23,683.98). Patients tend to have decreased odds of MACE with IVUS guided atherectomy and PCI. CONCLUSIONS: This large database revealed a significant increase in PCI with or without atherectomy in AS patients from 2016 to 2019. Considering the complex comorbidities of AS patients, the overall complication rates were well distributed among the different cohorts, suggesting that IVUS guided PCI with or without atherectomy in patients with AS is feasible and safe.

Risk of death, hospitalization and intensive care unit admission by SARS-CoV-2 variants in Peru: a retrospective study.

OBJECTIVES: Peru has had the highest death toll from the pandemic worldwide; however, it is not clear what the effects of the different variants on these outcomes are. The study aimed to evaluate the risk of death, hospitalization, and intensive care unit (ICU) admission rates of COVID-19 according to the SARS-CoV-2 variants detected in Peru from March 2020-February 2022. METHODS: Retrospective study using open-access databases were published by the Peruvian Ministry of Health. Databases of genomic sequencing, death, COVID-19 cases, hospitalization and ICU, and vaccination were used. Crude and adjusted Cox proportional hazards regressions with clustered variances were modeled to calculate the hazard ratio (HR) of outcomes by variant. RESULTS: Lambda variant had the highest risk of death (HR 1.92, 95% CI 1.37-2.68), whereas the Delta variant had the lowest risk (HR 0.50, 95% CI 0.31-0.82). Mu variant had the highest risk of hospitalization (HR: 2.39, 95% CI 1.56-3.67), Omicron the lowest (HR 0.45, 95%CI 0.23-0.90), and Gamma had the highest ICU admission rate (HR 1.95, 95%CI 1.40-2.71). CONCLUSION: SARS-CoV-2 variants showed distinctive risks of clinical outcomes, which could have implications for the management of infected persons during the pandemic.

Stigmatization towards healthcare personnel during the first COVID-19 wave in Central and Northern Mexico.

The evidence all over the world shows an alarming increase in the stigmatization of health personnel during the COVID-19 pandemic. We sought to explore possible psychological factors that help explain the disposition to stigmatize health personnel in the central and northern regions of Mexico. Two studies explore possible psychological factors to explain the disposition to stigmatize healthcare personnel (HP) in Mexico during the COVID-19 pandemic. In study one, 520 participants responded to three instruments that measure the disposition to stigmatize, the perceived contagion risk, and the positive beliefs towards HP. Results showed a generalized low disposition to stigmatization, where only a small percentage obtained high scores. A regression analysis identified that stigmatization towards HP can derive mainly from the perception of risk of contagion, although positive beliefs of HP decrease this disposition. The second study extends this finding by analyzing responses of 286 participants to seven instruments measuring factors hypothesized as predictors towards stigmatization: uncertainty generated by the pandemic, selfish strategies to face off the pandemic, social capital, trust in institutions, perceived vulnerability of contagion, perceived risk of contagion, and positive beliefs towards HP. A path analysis reveals that the main predictor of stigmatization is the perceived risk of contagion, increased by the strategy of selfishness, and the uncertainty generated by the pandemic. These results are discussed emphasizing the importance of cooperation and community ties to prevent the stigmatization of HP in the context of sanitary emergencies generated by contagious diseases.

Coronary Steal Syndrome Secondary to Large Coronary to Pulmonary Artery Fistulas.

Coronary artery fistulas represent rare congenital or acquired defects in the coronary circulation. We describe a case of bilateral coronary to pulmonary artery fistulas resulting in coronary artery steal syndrome in a patient with a history of valve-sparing aortic repair surgery.

Dual Antiplatelet Therapy in Patients Aged 75 Years and Older with Coronary Artery Disease: A Meta-Analysis and Systematic Review.

Objectives: This systematic review and meta-analysis evaluates the safety and efficacy of dual antiplatelet therapy (DAPT) in elderly patients with acute coronary syndrome (ACS). Background: The safety and efficacy of DAPT in elderly patients with ACS is not well characterized. Methods: We performed a systematic literature review to identify clinical studies that reported safety and efficacy outcomes after DAPT for ACS in elderly patients. The primary outcomes of primary efficacy endpoint rates and bleeding event rates were reported as random effects risk ratio (RR) with 95% confidence interval. No prior ethical approval was required since all data are public. Results: Our search yielded 660 potential studies. We included 8 studies reporting on 29,217 patients. There was a higher risk of bleeding event rates in elderly patients treated with prasugrel or ticagrelor when compared to clopidogrel with a risk ratio of 1.17 (95% CI 1.08 to 1.27, p < 0.05). There was no difference in primary efficacy endpoint rates between elderly patients treated with prasugrel or ticagrelor when compared to clopidogrel with a risk ratio of 0.85 (95% CI 0.68 to 1.07, p=0.17). Conclusions: This systematic review and meta-analysis suggests that DAPT with prasugrel or ticagrelor compared to clopidogrel is associated with a higher risk of bleeding events in elderly patients with ACS. There was no difference in the primary efficacy endpoints between the two treatment groups.

Determinantes de la inseguridad alimentaria y su asociación con prácticas de alimentación y lactancia materna en el primer año de vida.

OBJETIVO: analizar los determinantes de la Inseguridad Alimentaria (IA) y su relación con las Prácticas de Alimentación (PA) y las Prácticas de Lactancia Materna (PLM) en el primer año de vida. MÉTODOS: análisis de tipo cuantitativo sobre el binomio madre-hijo de una cohorte en México. Los datos de interés fueron el estado de seguridad alimentaria (SA), las PA y las PLM. Se desarrolló un modelo de regresión para evaluar determinantes asociados a la IA y un análisis de medias para determinar el impacto de la IA en las PA y las PLM. RESULTADOS: el 54.1% de hogares presentó algún grado de IA. Las madres con pareja (OR = 0.25; p = 0.05) y con escolaridad superior (OR = 0.50; p = 0.04) tuvieron menor riesgo de padecer IA. En contraste, los hogares con mujeres mayores de 25 años estuvieron más expuestos a la IA (OR = 3.0; p = 0.00). Los hogares con IA introducen alimentos no recomendados como dulces, galletas o pastelitos (p = 0.00) y bebidas no lácteas azucaradas (p = 0.05) de forma prematura.Conclusiones:la IA requiere mayor atención por sus efectos en las PA y las PLM, las cuales son consideradas como factores asociados al desarrollo de mala nutrición.