Annatto-Enriched Egg Improves the Perception of Satiety in Healthy Adults-Randomized Clinical Trial: EGGANT Study.

Diet is one of the factors that prevents the development and death from cardiovascular diseases (CVD). It has been proposed that diets high in protein, which increase satiety, and with a high content of antioxidants, help reduce cardiovascular risk factors. The egg is one of the foods that produces greater satiety and provides antioxidants. In addition, due to its lipophilic matrix, it could improve the bioavailability of other dietary antioxidants such as Annatto. OBJECTIVE: This study evaluated the effects of egg and annatto-enriched egg consumption on satiety markers and CVD risk factors in healthy adults from Colombia. METHODS: A parallel randomized clinical trial was conducted, where one hundred and five (n = 105) men and women, divided into three groups, consumed daily for 8 weeks: (a) two eggs (egg group), or (b) two eggs with annatto (egg + annatto group), or (c) two egg whites (placebo group). RESULTS: The three groups were similar in gender distribution. No significant changes were found over time (before vs. after) in any of the groups nor between the groups in anthropometric variables, physical activity, eating profile, and ghrelin as an objective marker of satiety. In the egg + annatto group, subjective satiety increased (effect size 0.431; p < 0.05) after consumption. CONCLUSIONS: In healthy adults, the intake of two eggs, or two eggs with annatto daily for 8 weeks, did not result in significant changes in ghrelin; but eggs with annatto tend to increase the perception of satiety.

Biofortified Beverage with Chlorogenic Acid from Stressed Carrots: Anti-Obesogenic, Antioxidant, and Anti-Inflammatory Properties.

Using wounding stress to increase the bioactive phenolic content in fruits and vegetables offers a promising strategy to enhance their health benefits. When wounded, such phenolics accumulate in plants and can provide antioxidant, anti-inflammatory, and anti-obesogenic properties. This study investigates the potential of using wounding stress-treated carrots biofortified with phenolic compounds as a raw material to extract carrot juice with increased nutraceutical properties. Fresh carrots were subjected to wounding stress via slicing and then stored at 15 °C for 48 h to allow phenolic accumulation. These phenolic-enriched slices were blanched, juiced, and blended with orange juice (75:25 ratio) and 15% (w/v) broccoli sprouts before pasteurization. The pasteurized juice was characterized by its physicochemical attributes and bioactive compound content over 28 days of storage at 4 °C. Additionally, its antioxidant, anti-inflammatory, and anti-obesogenic potentials were assessed using in vitro assays, both pre- and post-storage. The results reveal that juice derived from stressed carrots (SJ) possessed 49%, 83%, and 168% elevated levels of total phenolics, chlorogenic acid, and glucosinolates, respectively, compared to the control juice (CJ) (p < 0.05). Both juices reduced lipid accumulation in 3T3-L1 cells and nitric oxide production in Raw 264.7 cells, without significant differences between them. SJ further displayed a 26.4% increase in cellular antioxidant activity. The juice's bioactive characteristics remained stable throughout storage time. In conclusion, the utilization of juice obtained from stressed carrots in a blend with orange juice and broccoli sprouts offers a promising method to produce a beverage enriched in bioactive compounds and antioxidant potential.

Kinetic Ultrasound-Assisted Extraction as a Sustainable Approach for the Recovery of Phenolics Accumulated through UVA Treatment in Strawberry By-Products.

Ultrasound-assisted extraction (UAE) is an efficient and sustainable method for extracting bioactive compounds from agro-industrial by-products. Moreover, it has been reported that ultraviolet A (UVA) radiation can induce the biosynthesis and accumulation of bioactive phenolic compounds. This study optimized the efficiency of ultrasound-assisted extraction (UAE) for recovering ultraviolet A (UVA)-induced phenolic compounds in strawberry by-products (RF-N). The impact of three factors (solid-liquid ratio, ethanol concentration, and ultrasound power) on total phenolic compound (TPC) kinetics using Peleg's model was investigated. The developed model showed a suitable fit for both RF-N and strawberry by-products treated with UVA (RF-E). The optimal UAE conditions obtained were of a 1:30 ratio, 46% ethanol, and 100% ultrasound power, resulting in an average yield of 13 g total phenolics kg-1. The bioaccessibility of phenolic compounds during in-vitro digestion was 36.5%, with agrimoniin being the predominant compound. UAE combined with UVA treatment increased the bioactivity of RF extracts, displaying significant anti-proliferative effects on HT29 and Caco-2 cancer cell lines, as well as anti-inflammatory potential and cellular antioxidant activity. The ultrasound proved to be a sustainable and effective technique for extracting phenolic compounds from RF, contributing to the valorization of strawberry agro-industrial by-products, and maximizing their nutraceutical potential.

Evaluación de prevalencia de pacientes con necesidades paliativas en las plantas de hospitalización de agudos de oncología y medicina interna en 2 hospitales de tercer nivel de la Comunidad de Madrid / Evaluating the prevalence of patients with palliative needs in acute oncology and internal medicine hospitalization wards at two third-level hospitals in the Community of Madrid

Introducción: Los cuidados paliativos se demuestran útiles y eficientes en los pacientes que presentan dichas necesidades, pero es escasa aún la implementación de estos en el ars médica diaria de los médicos sin formación específica. El instrumento NECPAL (Instrumento para la Identificación de Personas en Situación de Enfermedad Crónica Avanzada y Necesidad de Atención Paliativa en Servicios de Salud y Sociales) se ha demostrado útil para identificar a estos pacientes y ayudar a la toma de decisiones. El objetivo principal de este estudio es conocer la prevalencia de pacientes con necesidades paliativas y si se produjo adecuación de medicina paliativa al alta en los pacientes NECPAL positivos. Material y métodos: Estudio observacional, retrospectivo, de cohortes, de pacientes hospitalizados en un periodo de 3 meses en las plantas de Medicina Interna y Oncología de 2 hospitales de tercer nivel, con la recogida de variables demográficas, identificación de necesidades paliativas y complejidad. Resultados: La prevalencia de pacientes con necesidades paliativas es alta (90 %) y de ellos cumplen criterios de complejidad el 32 % de los pacientes oncológicos y el 20 % de los no oncológicos. Pese a ello, el abordaje de las necesidades paliativas solo se produjo en el 18 % de los pacientes oncológicos y en el 18 % de los no oncológicos. La mortalidad de los pacientes identificados como NECPAL positivos a 12 meses fue del 96 % en los oncológicos y del 57 % en los no oncológicos. Conclusión: Pese a la alta prevalencia de pacientes con necesidades de cuidados paliativos en las plantas de hospitalización de Medicina Interna y Oncología y la alta mortalidad en el año siguiente a dicha hospitalización, la planificación de la atención es escasa. (AU)

Introduction: Palliative care has been shown to be useful and efficient in patients who present these needs, but its implementation in the daily medical practice of doctors without specific training is still scarce. The NECPAL instrument (Instrument for the Identification of People in a Situation of Advanced Chronic Illness and Need for Palliative Care in Health and Social Services) has been shown to be useful in identifying these patients and in helping decision-making. The main objective of this study was to determine the prevalence of patients with palliative needs, and whether there was adequacy of palliative measures at discharge in NECPAL-positive patients. Material and methods: An observational, retrospective, cohort study of patients hospitalized over a period of 3 months at the Internal Medicine and Oncology wards of two tertiary hospitals, with collection of demographic variables, and identification of palliative needs and complexity. Results: The prevalence of patients with palliative needs (90 %) and meeting complexity criteria is 32 % of cancer patients and 20 % of non-cancer patients. Despite this, addressing palliative needs only occurred in 18 % of cancer patients and 18 % of non-cancer patients. The mortality rate of patients identified as NECPAL-positive at 12 months was 96 % in cancer patients and 57 % in non-cancer patients. Conclusion: Despite a high prevalence of patients with palliative care needs in internal medicine and oncology hospitalization wards, and a high mortality rate in the year following said hospitalization, care planning is scarce. (AU)

An urgent call-to-action to protect the nonhuman primates and Indigenous Peoples of the Brazilian Amazon.

Primates are facing an impending extinction crisis. Here, we examine the set of conservation challenges faced by the 100 primate species that inhabit the Brazilian Amazon, the largest remaining area of primary tropical rainforest in the world. The vast majority (86%) of Brazil's Amazonian primate species have declining populations. Primate population decline in Amazonia has been driven principally by deforestation related to the production of forest-risk commodities including soy and cattle ranching, the illegal logging and setting of fires, dam building, road and rail construction, hunting, mining, and the confiscation and conversion of Indigenous Peoples' traditional lands. In a spatial analysis of the Brazilian Amazon, we found that 75% of Indigenous Peoples' lands (IPLs) remained forested compared with 64% of Conservation Units (CUs) and 56% of other lands (OLs). In addition, primate species richness was significantly higher on IPLs than on CUs and OLs. Thus, safeguarding Indigenous Peoples' land rights, systems of knowledge, and human rights is one of the most effective ways to protect Amazonian primates and the conservation value of the ecosystems they inhabit. Intense public and political pressure is required and a global call-to-action is needed to encourage all Amazonian countries, especially Brazil, as well as citizens of consumer nations, to actively commit to changing business as usual, living more sustainably, and doing all they can to protect the Amazon. We end with a set of actions one can take to promote primate conservation in the Brazilian Amazon.

Electric field-guided collective motility initiation of large epidermal cell groups.

Recent research has elucidated mechanochemical pathways of single cell polarization, but much less is known about collective motility initiation in adhesive cell groups. We used galvanotactic assays of zebrafish keratocyte cell groups, pharmacological perturbations, electric field switches, particle imaging velocimetry, and cell tracking to show that large cell groups initiate motility in minutes toward the cathode. Interestingly, while PI3K-inhibited single cells are biased toward the anode, inhibiting PI3K does not affect the cathode-directed cell group migration. We observed that control groups had the fastest cathode-migrating cell at the front, while the front cells in PI3K-inhibited groups were the slowest. Both control and PI3K-inhibited groups rapidly repolarized when the electric field direction was reversed, and the group migration continued after the electric field was switched off. Inhibiting myosin disrupted the cohesiveness of keratocyte groups and abolished the collective directionality and ability to switch direction when the electric field is reversed. Our data are consistent with a model according to which cells in the group sense the electric field individually and mechanical integration of the cells results in coherent group motility.

Consumption of Eggs Alone or Enriched with Annatto (Bixa orellana L.) Does Not Increase Cardiovascular Risk in Healthy Adults-A Randomized Clinical Trial, the Eggant Study.

Most atherosclerotic cardiovascular diseases can be prevented by modifying lifestyles, including unhealthy diets. Eggs contain important carotenoids that may impact cardiovascular risk. The lipid nature of eggs can improve the bioavailability of other carotenoids, such as Annatto (Bixa orellana L.), with reported antioxidant properties. Although numerous studies have shown that there is no association between egg consumption and cardiovascular risk, there is still controversy. In addition, there is limited information about Annatto's effects on human health. This study evaluated the association between egg consumption and its enrichment with Annatto in lipid biomarkers of cardiovascular disease. In a parallel clinical trial, one hundred and five (n = 105) men and women were randomized by age, sex, and body mass index (BMI), and distributed into three groups. Subjects consumed daily, for 8 weeks, either two eggs, two eggs with Annatto, or two egg whites. Plasma lipids were measured by enzymatic colorimetric methods, plasma apolipoproteins and lipoprotein subfractions and size by nuclear magnetic resonance. There were no differences between groups in age, sex, and BMI. No significant changes were found over time or between groups in plasma triglycerides, LDL cholesterol, HDL cholesterol, apolipoprotein (apo) A1, apo B, or lipoprotein subfraction concentrations. In healthy adults, the intake of two eggs a day, or two eggs with Annatto for eight weeks, did not generate adverse changes in cardiovascular risk markers.

Change in metabolic parameters after switching from triple regimens with tenofovir alafenamide to dolutegravir-based dual therapy. Bi-lipid study.

INTRODUCTION: The use of tenofovir alafenamide (TAF) has been associated with increased cholesterol and body weight. Real-life data on the metabolic effects of switching from a TAF-based triple regimen to a dolutegravir (DTG)-based two-drug regimen (2-DR) are scarce. METHODS: A retrospective cohort study of patients who have switched from a triple TAF-based regimen to a 2-DR [DTG-lamivudine (DTG-3TC) or DTG- rilpivirine (DTG-RPV]) with at least 6 months of follow-up. The primary endpoint was the absolute change in lipid fractions at 6 months. Secondary outcomes were percentage changes in lipid fraction, effectiveness and safety at 6 and 12 months [intention to treat (ITT), missing = failures]. RESULTS: A total of 118 patients (87 on DTG-3TC, 31 on DTG-RPV) were included. Median age was 51 years (interquartile range: 43-59), 86% were male, CD4 T-cell count was 692 cells/µL, and 98% viral load (VL) < 50 copies/mL. At 6 months there was a decrease in total and low-density lipoprotein cholesterol of 10.7 mg/dL [95% confidence interval (CI): 2.2-19.1; p ≤ 0.001] and 8.3 mg/dL (95% CI: 0.74-15.9; p = 0.026), respectively. There was a reduction in cardiovascular risk from 4.5% at baseline to 4% at 12 months (p = 0.040). Virological effectiveness as determined by ITT analysis was 85.6% at 6 months and 66.1% at 12 months. Seven patients (5.9%) withdrew from the 2-DR and there was no virological failure. CONCLUSIONS: In real life, switching from a triple regimen with TAF to DTG-3TC or DTG-RPV dual therapy improves the lipid profile and is an effective and well-tolerated strategy.

Bird species occupancy trends in Southeast Mexico over 1900-2020: Accounting for sighting record absences.

Long-term land-use change impacts tropical bird communities through population-level and functional diversity effects from habitat loss, degradation and fragmentation, leading to land management and conservation challenges. Assessing the temporal impacts of land-use change on occupancy patterns, population change and functional traits of bird species in tropical areas is limited by the treatment of nondetections as true absences or artefacts of low sampling effort during and throughout years. With this in mind, we developed a novel Bayesian species occupancy framework to account for species absences to evaluate bird community changes in Palenque, Chiapas, Mexico, where there is opportunity for study given exceptional records of change across habitats from rainforest to urban centres. We created a novel dataset of population trends for 244 bird species over the years 1900 to 2020 from published short-term field studies, expert field notes and community science pages. Our results show that open area species had higher population increases than forest specialists over time, represented most evidently by the turnover of rainforest specialists for urban species. Modelled influence of functional traits displayed the importance of main habitat types, body mass and habitat and dietary breadth as factors that associated with bird population trends. On average, species with body masses <6.6 and > 948.4 g showed decreasing trends, while all other species showed increasing or stable trends. Our findings illuminate the value of accounting for species absences from several data sources to discover long-term species population trends and affiliated functional traits whose preservation requires conservation and land management action to protect bird ecosystem services. Primary forest conservation is key to maintaining populations of habitat and dietary specialists, such as small understorey insectivorous and large frugivorous species. Protecting rare natural savanna patches from conversion to cattle pasture is vital to prevent further extirpation of native granivores and to slow colonization by exotic and invasive species.

El cambio a largo plazo en el uso de la tierra impacta a las comunidades de aves tropicales a través de los efectos de la diversidad funcional y a nivel de la población debido a la pérdida, degradación y fragmentación del hábitat, lo que lleva a desafíos de gestión y conservación de la tierra. La evaluación de los impactos temporales del cambio de uso de la tierra en los patrones de ocupación, el cambio de población y los rasgos funcionales de las especies de aves en áreas tropicales enfrenta limitaciones al considerar el tratamiento de las no detecciones como ausencias verdaderas o artefactos de bajo esfuerzo de muestreo durante el año y los años. La evaluación de los impactos temporales del cambio de uso de la tierra en los patrones de ocupación, el cambio de población y las características funcionales de las especies de aves en áreas tropicales está limitada por el tratamiento de las no detecciones como verdaderas ausencias o artefactos de bajo esfuerzo de muestreo durante y a lo largo de los años. Con esto en mente, desarrollamos un marco bayesiano novedoso de ocupación de especies para dar cuenta de las ausencias de especies para evaluar los cambios en la comunidad de aves en Palenque, Chiapas, México, donde existe la oportunidad de estudiar dados los registros excepcionales de cambios en los hábitats, desde la selva tropical hasta los centros urbanos. Creamos un nuevo conjunto de datos de tendencias de población para 244 especies de aves durante los años 1900 a 2020 a partir de estudios de campo a corto plazo publicados, notas de campo de expertos y páginas de ciencia comunitaria. Nuestros resultados muestran que las especies de áreas abiertas tuvieron aumentos de población más altos que los especialistas forestales a lo largo del tiempo, representado más evidentemente por la rotación de especialistas de bosques tropicales por especies urbanas. La influencia modelada de los rasgos funcionales mostró la importancia de los principales tipos de hábitat, la masa corporal y el hábitat y la amplitud de la dieta como factores asociados con las tendencias de la población de aves. En promedio, las especies con masas corporales <6,6 g y >948,4 g mostraron tendencias decrecientes, mientras que todas las demás especies mostraron tendencias crecientes o estables. Nuestros hallazgos iluminan el valor de contabilizar las ausencias de especies de varias fuentes de datos para descubrir tendencias de población de especies a largo plazo y rasgos funcionales afiliados cuya preservación requiere acción de conservación y manejo de la tierra para proteger los servicios ecosistémicos de las aves. La conservación de los bosques primarios es clave para mantener las poblaciones de especialistas en hábitat y dieta, como las especies insectívoras pequeñas del sotobosque y las especies frugívoras grandes. Proteger los raros parches naturales de sabana de la conversión en pastos para ganado es vital para evitar una mayor extirpación de los granívoros nativos y para retrasar la colonización por especies invasoras.

Formación de grado en cuidados paliativos en las universidades de la Comunidad Autónoma de Madrid. Estudio descriptivo / Palliative care degree training at universities in the Autonomous Community of Madrid. A descriptive study

Introducción: En vista del desarrollo que se está produciendo en cuidados paliativos y las recomendaciones formativas llevadas a cabo por distintos planes estratégicos internacionales, nacionales y autonómicos, la Asociación Madrileña de Cuidados Paliativos (AMCP) realizó este estudio con el objetivo de definir la situación actual de la formación en cuidados paliativos en la Comunidad de Madrid en los grados de medicina, enfermería, psicología y trabajo social. Material y métodos: Para ello, se elaboró un cuestionario con los datos considerados relevantes según la evidencia, que fue enviado a las diferentes universidades para su cumplimentación durante el año 2021. En el caso de no obtener respuesta, la información se completó por parte del equipo investigador revisando las guías docentes oficiales.Resultados: A partir de los datos obtenidos provenientes de 46 grados universitarios analizados, encontramos que la formación específica en cuidados paliativos se encuentra en el 71,7 % de las universidades. En el 69,7 % de estas, esta formación no se imparte en una asignatura independiente; la media de ECTS (European Credit Transfer and Accumulation System) atribuidos a esta formación es de 3. En más de la mitad de estudios no hay prácticas obligatorias y los talleres o seminarios solo se encuentran en el 39,5 % de los planes formativos. El seminario más frecuente es el de “Malas noticias” en todos los estudios. Los temas más tratados son el “Abordaje emocional de paciente y familia”, seguido por el “Manejo de síntomas” y los “Aspectos éticos”. Conclusión: La formación en cuidados paliativos se hace presente cada vez más frecuentemente en las universidades madrileñas, habitualmente como parte de otras asignaturas. Los talleres, seminarios y las prácticas obligatorias son escasos. Los profesores son sobre todo titulares y sin formación específica. Hay que seguir trabajando para alcanzar los estándares marcados por las sociedades científicas respecto a formación. (AU)

Introduction: In view of the development that is taking place in the field of palliative care and the training recommendations given by different international, national and regional strategic plans, the Madrilenian Association of Palliative Care (AMCP) carried out this study with the aim of defining the current situation of training in palliative care within the medicine, nursing, psychology and social work degrees taught at universities in the Community of Madrid. Material and methods: To this end, a questionnaire was drawn up with the data considered relevant according to the evidence, which was sent to the different universities to be completed during the year 2021. If no response was received, the information was completed by the research team by reviewing the relevant official teaching guides. Results: From the data obtained from all 46 university degrees analysed, we found that specific training in palliative care is found in 71.7 % of universities. In 69.7 % of these, palliative care is not taught as an independent subject matter; the average number of ECTS (European Credit Transfer and Accumulation System) attributed to this training is 3. In more than 50 % of cases there are no compulsory internships, and workshops or seminars are only found in 39.5 % of the curricula. The most frequently taught seminar is “Breaking bad news”. The most frequently covered topics are “Emotional support of patients and their families”, followed by “Symptom management” and “Ethical aspects”. Conclusion: Training in palliative care is increasingly present in Madrid universities, usually as part of other subjects. Workshops, seminars, and compulsory internships are scarce. Teachers are mostly tenured, without specific training. We must continue working to achieve the standards set by scientific societies regarding training. (AU)

Global importance of Indigenous Peoples, their lands, and knowledge systems for saving the world's primates from extinction.

Primates, represented by 521 species, are distributed across 91 countries primarily in the Neotropic, Afrotropic, and Indo-Malayan realms. Primates inhabit a wide range of habitats and play critical roles in sustaining healthy ecosystems that benefit human and nonhuman communities. Approximately 68% of primate species are threatened with extinction because of global pressures to convert their habitats for agricultural production and the extraction of natural resources. Here, we review the scientific literature and conduct a spatial analysis to assess the significance of Indigenous Peoples' lands in safeguarding primate biodiversity. We found that Indigenous Peoples' lands account for 30% of the primate range, and 71% of primate species inhabit these lands. As their range on these lands increases, primate species are less likely to be classified as threatened or have declining populations. Safeguarding Indigenous Peoples' lands, languages, and cultures represents our greatest chance to prevent the extinction of the world's primates.

Principal Drivers and Conservation Solutions to the Impending Primate Extinction Crisis: Introduction to the Special Issue.

Nonhuman primates are facing an impending extinction crisis with over 65% of species listed as Vulnerable, Endangered, or Critically Endangered, and 93% characterized by declining populations. Primary drivers of primate population decline include deforestation, principally for industrial agriculture and the production of food and nonfood commodities, much of which is exported to wealthy consumer nations, unsustainable bushmeat hunting, the illegal pet trade, the capture of primates for body parts, expanding road and rail networks, mining, dam building, oil and gas exploration, and the threat of emerging diseases. Over the next several decades, human population increase, agricultural expansion, and climate change are expected to contribute significantly to the loss of additional suitable habitat and a reduction in the viability of local primate populations. If we are to avoid this impending extinction crisis, primate researchers must prioritize projects designed to mitigate the effects of habitat change on ecosystems health and biodiversity, and play a greater role in conservation and environmental policy by educating global citizens and political leaders. In addition, the international community will need to work with governments in primate habitat countries to expand the number of protected areas that contain primate species (94 primate species have < 10% of their range in protected areas). In this special issue of the International Journal of Primatology, we bring together researchers from a wide range of disciplines to examine the current and future threats to primate population persistence, and present local, country, and regional solutions to protect primate species.

Circadian and homeostatic sleep-wake regulation of secretory immunoglobulin A (sIgA): Effects of environmental light and recovery sleep.

Secretory Immunoglobulin A (sIgA) builds the first line of the human immune defense. It is not clear whether the power of this defence line is constant across the 24-h day, depends on sleep pressure levels and can be influenced by external lighting conditions. Thus, in 10 healthy young volunteers, we retrospectively analyzed saliva samples for sIgA levels under strictly controlled laboratory conditions across 40 â€‹h of extended wakefulness under two lighting conditions (dim light 8 lx and blue-enriched light 250 lx, 9000 â€‹K) to test for circadian and homeostatic sleep-wake influences. We compared the temporal profile of sIgA with the circadian time course of melatonin and cortisol along with subjective sleepiness levels, assessed in the same study by Gabel et al. (2017). The 40-h time course of sIgA exhibited a clear circadian modulation with peak values in the mornings coinciding with the individuals' habitual rise-time. In addition, sIgA levels progressively increased throughout the 40 â€‹h of extended wakefulness and were temporally correlated with subjective sleepiness but not with subjective ratings of tension and discomfort. In contrast to the circadian profile of melatonin and cortisol, sIgA levels were not significantly altered by the lighting conditions. Unexpectedly, sIgA levels in the morning after recovery sleep from 40 â€‹h of extended wakefulness rose considerably by more than an order of magnitude (10 times more) compared to morning levels after baseline sleep. We have evidence that diurnal sIgA levels in humans are regulated by the circadian timing system, and challenging the status of the sleep-wake homeostat (i.e. extended wakefulness) boosts human sIgA levels. Thus, besides a person's circadian phase position, the first line of human immune defense also strongly depends on the person's sleep-wake history and actual sleepiness levels. In sum, the fight against pathogenic microorganisms by a key immunological component (sIgA) is modulated by two fundamental processes implicated in human sleep-wake regulation.

Use of glucocorticoids megadoses in SARS-CoV-2 infection in a spanish registry: SEMI-COVID-19.

OBJECTIVE: To describe the impact of different doses of corticosteroids on the evolution of patients with COVID-19 pneumonia, based on the potential benefit of the non-genomic mechanism of these drugs at higher doses. METHODS: Observational study using data collected from the SEMI-COVID-19 Registry. We evaluated the epidemiological, radiological and analytical scenario between patients treated with megadoses therapy of corticosteroids vs low-dose of corticosteroids and the development of complications. The primary endpoint was all-cause in-hospital mortality according to use of corticosteroids megadoses. RESULTS: Of a total of 14,921 patients, corticosteroids were used in 5,262 (35.3%). Of them, 2,216 (46%) specifically received megadoses. Age was a factor that differed between those who received megadoses therapy versus those who did not in a significant manner (69 years [IQR 59-79] vs 73 years [IQR 61-83]; p < .001). Radiological and analytical findings showed a higher use of megadoses therapy among patients with an interstitial infiltrate and elevated inflammatory markers associated with COVID-19. In the univariate study it appears that steroid use is associated with increased mortality (OR 2.07 95% CI 1.91-2.24 p < .001) and megadose use with increased survival (OR 0.84 95% CI 0.75-0.96, p 0.011), but when adjusting for possible confounding factors, it is observed that the use of megadoses is also associated with higher mortality (OR 1.54, 95% CI 1.32-1.80; p < .001). There is no difference between megadoses and low-dose (p .298). Although, there are differences in the use of megadoses versus low-dose in terms of complications, mainly infectious, with fewer pneumonias and sepsis in the megadoses group (OR 0.82 95% CI 0.71-0.95; p < .001 and OR 0.80 95% CI 0.65-0.97; p < .001) respectively. CONCLUSION: There is no difference in mortality with megadoses versus low-dose, but there is a lower incidence of infectious complications with glucocorticoid megadoses.

Inadequate use of antibiotics in the covid-19 era: effectiveness of antibiotic therapy.

BACKGROUND: Since December 2019, the COVID-19 pandemic has changed the concept of medicine. This work aims to analyze the use of antibiotics in patients admitted to the hospital due to SARS-CoV-2 infection. METHODS: This work analyzes the use and effectiveness of antibiotics in hospitalized patients with COVID-19 based on data from the SEMI-COVID-19 registry, an initiative to generate knowledge about this disease using data from electronic medical records. Our primary endpoint was all-cause in-hospital mortality according to antibiotic use. The secondary endpoint was the effect of macrolides on mortality. RESULTS: Of 13,932 patients, antibiotics were used in 12,238. The overall death rate was 20.7% and higher among those taking antibiotics (87.8%). Higher mortality was observed with use of all antibiotics (OR 1.40, 95% CI 1.21-1.62; p < .001) except macrolides, which had a higher survival rate (OR 0.70, 95% CI 0.64-0.76; p < .001). The decision to start antibiotics was influenced by presence of increased inflammatory markers and any kind of infiltrate on an x-ray. Patients receiving antibiotics required respiratory support and were transferred to intensive care units more often. CONCLUSIONS: Bacterial co-infection was uncommon among COVID-19 patients, yet use of antibiotics was high. There is insufficient evidence to support widespread use of empiric antibiotics in these patients. Most may not require empiric treatment and if they do, there is promising evidence regarding azithromycin as a potential COVID-19 treatment.

Real-Life Impact of Glucocorticoid Treatment in COVID-19 Mortality: A Multicenter Retrospective Study.

We aimed to determine the impact of steroid use in COVID-19 in-hospital mortality, in a retrospective cohort study of the SEMICOVID19 database of admitted patients with SARS-CoV-2 laboratory-confirmed pneumonia from 131 Spanish hospitals. Patients treated with corticosteroids were compared to patients not treated with corticosteroids; and adjusted using a propensity-score for steroid treatment. From March-July 2020, 5.262 (35.26%) were treated with corticosteroids and 9.659 (64.73%) were not. In-hospital mortality overall was 20.50%; it was higher in patients treated with corticosteroids than in controls (28.5% versus 16.2%, OR 2.068 [95% confidence interval; 1.908 to 2.242]; p = 0.0001); however, when adjusting by occurrence of ARDS, mortality was significantly lower in the steroid group (43.4% versus 57.6%; OR 0.564 [95% confidence interval; 0.503 to 0.633]; p = 0.0001). Moreover, the greater the respiratory failure, the greater the impact on mortality of the steroid treatment. When adjusting these results including the propensity score as a covariate, in-hospital mortality remained significantly lower in the steroid group (OR 0.774 [0.660 to 0.907], p = 0.002). Steroid treatment reduced mortality by 24% relative to no steroid treatment (RRR 0.24). These results support the use of glucocorticoids in COVID-19 in this subgroup of patients.

Dominance style is a key predictor of vocal use and evolution across nonhuman primates.

Animal communication has long been thought to be subject to pressures and constraints associated with social relationships. However, our understanding of how the nature and quality of social relationships relates to the use and evolution of communication is limited by a lack of directly comparable methods across multiple levels of analysis. Here, we analysed observational data from 111 wild groups belonging to 26 non-human primate species, to test how vocal communication relates to dominance style (the strictness with which a dominance hierarchy is enforced, ranging from 'despotic' to 'tolerant'). At the individual-level, we found that dominant individuals who were more tolerant vocalized at a higher rate than their despotic counterparts. This indicates that tolerance within a relationship may place pressure on the dominant partner to communicate more during social interactions. At the species-level, however, despotic species exhibited a larger repertoire of hierarchy-related vocalizations than their tolerant counterparts. Findings suggest primate signals are used and evolve in tandem with the nature of interactions that characterize individuals' social relationships.

Cognitive maps in the wild: revealing the use of metric information in black howler monkey route navigation.

When navigating, wild animals rely on internal representations of the external world - called 'cognitive maps' - to take movement decisions. Generally, flexible navigation is hypothesized to be supported by sophisticated spatial skills (i.e. Euclidean cognitive maps); however, constrained movements along habitual routes are the most commonly reported navigation strategy. Even though incorporating metric information (i.e. distances and angles between locations) in route-based cognitive maps would likely enhance an animal's navigation efficiency, there has been no evidence of this strategy reported for non-human animals to date. Here, we examined the properties of the cognitive map used by a wild population of primates by testing a series of cognitive hypotheses against spatially explicit movement simulations. We collected 3104 h of ranging and behavioural data on five groups of black howler monkeys (Alouatta pigra) at Palenque National Park, Mexico, from September 2016 through August 2017. We simulated correlated random walks mimicking the ranging behaviour of the study subjects and tested for differences between observed and simulated movement patterns. Our results indicated that black howler monkeys engaged in constrained movement patterns characterized by a high path recursion tendency, which limited their capacity to travel in straight lines and approach feeding trees from multiple directions. In addition, we found that the structure of observed route networks was more complex and efficient than simulated route networks, suggesting that black howler monkeys incorporate metric information into their cognitive map. Our findings not only expand the use of metric information during route navigation to non-human animals, but also highlight the importance of considering efficient route-based navigation as a cognitively demanding mechanism.

Socially mediated overlap in vocal interactions between free-ranging black howler monkeys.

"Conversation rules" such as overlap avoidance and coordinated overlap have been reported in nonhuman animals, and seem to be adaptive responses to the requirements of social life. Some species display both patterns in an apparently flexible way, but the social factors mediating their respective usage remain poorly documented. We investigated the potential social factors guiding the usage of these temporal rules during collective howling in six free-ranging groups of black howler monkeys (Alouatta pigra). First, we found that adult males' vocalizations rarely overlap those of other callers while most adult females' calls overlap other members' calls, especially that of other females. Second, whereas some call types (notably affiliative calls) are typically emitted without overlap, roars (agonistic loud calls) overlap more frequently. Third, coordinated overlap is more frequent during intergroup competition. Our findings support the hypothesis that overlap avoidance and coordinated overlap are two different (here sex-related) vocal alliance social behaviors, at least for some nonhuman primates. More comparative investigations are now needed to explore further their evolutionary trajectories in this lineage.

Inappropriate antibiotic use in the COVID-19 era: Factors associated with inappropriate prescribing and secondary complications. Analysis of the registry SEMI-COVID.

BACKGROUND: Most patients with COVID-19 receive antibiotics despite the fact that bacterial co-infections are rare. This can lead to increased complications, including antibacterial resistance. We aim to analyze risk factors for inappropriate antibiotic prescription in these patients and describe possible complications arising from their use. METHODS: The SEMI-COVID-19 Registry is a multicenter, retrospective patient cohort. Patients with antibiotic were divided into two groups according to appropriate or inappropriate prescription, depending on whether the patient fulfill any criteria for its use. Comparison was made by means of multilevel logistic regression analysis. Possible complications of antibiotic use were also identified. RESULTS: Out of 13,932 patients, 3047 (21.6%) were prescribed no antibiotics, 6116 (43.9%) were appropriately prescribed antibiotics, and 4769 (34.2%) were inappropriately prescribed antibiotics. The following were independent factors of inappropriate prescription: February-March 2020 admission (OR 1.54, 95%CI 1.18-2.00), age (OR 0.98, 95%CI 0.97-0.99), absence of comorbidity (OR 1.43, 95%CI 1.05-1.94), dry cough (OR 2.51, 95%CI 1.94-3.26), fever (OR 1.33, 95%CI 1.13-1.56), dyspnea (OR 1.31, 95%CI 1.04-1.69), flu-like symptoms (OR 2.70, 95%CI 1.75-4.17), and elevated C-reactive protein levels (OR 1.01 for each mg/L increase, 95% CI 1.00-1.01). Adverse drug reactions were more frequent in patients who received ANTIBIOTIC (4.9% vs 2.7%, p < .001). CONCLUSION: The inappropriate use of antibiotics was very frequent in COVID-19 patients and entailed an increased risk of adverse reactions. It is crucial to define criteria for their use in these patients. Knowledge of the factors associated with inappropriate prescribing can be helpful.