Fishing for oil and meat drives irreversible defaunation of deepwater sharks and rays.

The deep ocean is the last natural biodiversity refuge from the reach of human activities. Deepwater sharks and rays are among the most sensitive marine vertebrates to overexploitation. One-third of threatened deepwater sharks are targeted, and half the species targeted for the international liver-oil trade are threatened with extinction. Steep population declines cannot be easily reversed owing to long generation lengths, low recovery potentials, and the near absence of management. Depth and spatial limits to fishing activity could improve conservation when implemented alongside catch regulations, bycatch mitigation, and international trade regulation. Deepwater sharks and rays require immediate trade and fishing regulations to prevent irreversible defaunation and promote recovery of this threatened megafauna group.

Assessing Cognitive Workload in Motor Decision-Making through Functional Connectivity Analysis: Towards Early Detection and Monitoring of Neurodegenerative Diseases.

Neurodegenerative diseases (NDs), such as Alzheimer's, Parkinson's, amyotrophic lateral sclerosis, and frontotemporal dementia, among others, are increasingly prevalent in the global population. The clinical diagnosis of these NDs is based on the detection and characterization of motor and non-motor symptoms. However, when these diagnoses are made, the subjects are often in advanced stages where neuromuscular alterations are frequently irreversible. In this context, we propose a methodology to evaluate the cognitive workload (CWL) of motor tasks involving decision-making processes. CWL is a concept widely used to address the balance between task demand and the subject's available resources to complete that task. In this study, multiple models for motor planning during a motor decision-making task were developed by recording EEG and EMG signals in n=17 healthy volunteers (9 males, 8 females, age 28.66±8.8 years). In the proposed test, volunteers have to make decisions about which hand should be moved based on the onset of a visual stimulus. We computed functional connectivity between the cortex and muscles, as well as among muscles using both corticomuscular and intermuscular coherence. Despite three models being generated, just one of them had strong performance. The results showed two types of motor decision-making processes depending on the hand to move. Moreover, the central processing of decision-making for the left hand movement can be accurately estimated using behavioral measures such as planning time combined with peripheral recordings like EMG signals. The models provided in this study could be considered as a methodological foundation to detect neuromuscular alterations in asymptomatic patients, as well as to monitor the process of a degenerative disease.

Implementación del mini-CEX en el pregrado médico: Una experiencia con simulación / Implementation of the Mini-CEX in Medical Undergraduate Education: A Simulation-Based Experience

Resumen La evaluación es un proceso sistemático que resulta en un juicio de valor para tomar decisiones. Los instrumentos empleados para obtener datos sobre el desempeño de los estudiantes requieren de un proceso sistemático y objetivo para su implementación. El mini-CEX es un instrumento de observación directa que ha sido empleado para la evaluación de la competencia clínica en los estudiantes de pre y posgrado desde su invención en 1955. Cuenta con diferentes evidencias de validez para su uso en distintos contextos educativos y clínicos. Permite realizar evaluaciones rápidas, acompañadas de realimentación y que proporcionan información relevante del desarrollo de la competencia clínica. El objetivo de este escrito es exponer la experiencia de la implementación del mini-CEX en el pregrado médico para la evaluación formativa de los estudiantes utilizando la simulación con pacientes estandarizados. Para lograr este objetivo se empleó la siguiente secuencia: búsqueda, planeación, integración y aplicación. Posterior a estos pasos se dan una serie de recomendaciones para la implementación del mini-CEX. Se concluye que la evaluación de la competencia clínica es importante para la mejora continua y permanente de los estudiantes de pre y posgrado. Es necesario sistematizar la evaluación ajustada siempre a objetivos y necesidades específicas de la evaluación.

Abstract Evaluation is a systematic process that results in a judgment to make decisions. The instruments used to obtain data on student performance require a systematic and objective process for their implementation. The mini-CEX is a direct observation tool that has been used for the evaluation of clinical competence in undergraduate and postgraduate students since its invention in 1955. It has different validity evidence for use in different educational and clinical contexts. It allows rapid evaluations, accompanied by feedback and providing relevant information on the development of clinical competence. The objective of this paper is to expose the experience of the implementation of the mini-CEX in the medical undergraduate for the formative evaluation of students using simulation with standardized patients. To achieve this goal, the following sequence was used: search, planning, integration, and application. After these steps we make some recommendations for the implementation of the mini-CEX. Its is concluded that the evaluation of clinical competence is important for the continuous and permanent improvement of undergraduate and graduate students. It is necessary to systematize the evaluation always adjusted to objectives and specific needs of the evaluation.

Comparative population genomics of manta rays has global implications for management.

Understanding population connectivity and genetic diversity is of fundamental importance to conservation. However, in globally threatened marine megafauna, challenges remain due to their elusive nature and wide-ranging distributions. As overexploitation continues to threaten biodiversity across the globe, such knowledge gaps compromise both the suitability and effectiveness of management actions. Here, we use a comparative framework to investigate genetic differentiation and diversity of manta rays, one of the most iconic yet vulnerable groups of elasmobranchs on the planet. Despite their recent divergence, we show how oceanic manta rays (Mobula birostris) display significantly higher heterozygosity than reef manta rays (Mobula alfredi) and that M. birostris populations display higher connectivity worldwide. Through inferring modes of colonization, we reveal how both contemporary and historical forces have likely influenced these patterns, with important implications for population management. Our findings highlight the potential for fisheries to disrupt population dynamics at both local and global scales and therefore have direct relevance for international conservation of marine species.

Microbiota composition and its impact on DNA methylation in colorectal cancer.

Colorectal cancer is a complex disease resulting from the interaction of genetics, epigenetics, and environmental factors. DNA methylation is frequently found in tumor suppressor genes to promote cancer development. Several factors are associated with changes in the DNA methylation pattern, and recently, the gastrointestinal microbiota could be associated with this epigenetic change. The predominant phyla in gut microbiota are Firmicutes and Bacteroidetes; however, an enrichment of Bacteroides fragilis, Fusobacterium nucleatum, and Streptococcus bovis, among others, has been reported in colorectal cancer, although the composition could be influenced by several factors, including diet, age, sex, and cancer stage. Fusobacterium nucleatum, a gram-negative anaerobic bacillus, is mainly associated with colorectal cancer patients positive for the CpG island methylator phenotype, although hypermethylation in genes such as MLH1, CDKN2A, MTSS1, RBM38, PKD1, PTPRT, and EYA4 has also been described. Moreover, Hungatella hathewayi, a gram-positive, rod-shaped bacterium, is related to hypermethylation in SOX11, THBD, SFRP2, GATA5, ESR1, EYA4, CDX2, and APC genes. The underlying epigenetic mechanism is unclear, although it could be implicated in the regulation of DNA methyltransferases, enzymes that catalyze the transfer of a methyl group on cytosine of CpG sites. Since DNA methylation is a reversible event, changes in gut microbiota could modulate the gene expression through DNA methylation and improve the colorectal cancer prognosis.

Elaboración de una base de referencia de composición corporal pediátrica para la provincia de Mendoza (Argentina)

R E S U M E N El objetivo fue elaborar una base de datos de referencia para composición corporal de sujetos pediátricos en la provincia de Mendoza (Argentina). Se obtuvieron datos de I4 variables de composición corporal (densidad y composición mineral ósea; masa magra y blanda; índice de masa corporal y magra, entre otros) de 198 sujetos (96 mujeres) de 4 a 19 años. Los sujetos se clasificaron en ocho grupos bienales; aquellos en etapa de transición puberal fueron clasificados según los estadios de Tanner: Las medidas se obtuvieron mediante densitometría dual de rayos-X en un equipo Lunar Prodigy DF+I6206. Para el análisis estadístico se usó Prism 5.4 en MS Win 7. Los valores de las variables analizadas aumentaron con la edad. Los valores en hombres siguen una tendencia lineal mientras en mujeres es sigmoidea, excepto el índice de masa corporal. Pacientes con igual edad, pero mayor estadio de Tanner, mostraron valores superiores de los componentes corporales. Las mujeres maduraron más tempranamente. Se concluyó que valores de las variables analizadas aumentaron con la edad y en menor medida, con las etapas de Tanner Los cambios son más precoces en mujeres y siguen diferentes cursos temporales en ambos sexos.

The objective was to develop a reference database for body composition of pediatric subjects in the province of Mendoza (Argentina). Data on I4 body composition variables (bone mineral density and composition; lean and soft mass; lean and body mass index, among others) were obtained from I98 subjects (96 women) aged 4 to 19 years. Subjects were classified into eight biennial groups; those in the pubertal transition stage were classified according to the Tanner stages. Measurements were obtained by dual X-ray densitometry on a Lunar Prodigy DF+I6206 instrument. For the statistical analysis, Prism 5.4 in MS Win 7 was used. The values of the variables analyzed increased with age. The values i n men follow a linear trend while in women it is sigmoid, except for the body mass index. Patients with the same age, but higher Tanner stage, showed higher values of body components. Women matured earlier It was concluded that the values of the variables analyzed increased with age and, to a lesser extent, with the Tanner stages. The changes are earlier and follow different time courses in women than in men.

O objetivo foi desenvolver um banco de dados de referência para composição corporal de indivíduos pediátricos na província de Mendoza (Argentina). Dados sobre I4 variáveis de composição corporal (densidade e composição mineral óssea; massa magra e massa mole; índice de massa magra e corporal, entre outras) foram obtidos de I98 indivíduos (96 mulheres) com idades entre 4 e I9 anos. Os sujeitos foram classificados em oito grupos bienais; aqueles no estágio de transição puberal foram classificados de acordo com os estágios de Tanner As medições foram obtidas por densitometria por dupla emissão de raios-X em um instrumento Lunar Prodigy DF+I6206. Para a análise estatística foi utilizado o Prism 5.4 no MS Win 7. Os valores das variáveis analisadas aumentaram com a idade. Os valores nos homens seguem uma tendência linear enquanto nas mulheres é sigmóide, com exceção do índice de massa corporal. Pacientes com a mesma idade, mas estágio de Tanner mais alto, apresentaram valores mais elevados de componentes corporais. As mulheres amadureceram mais cedo. Concluiu-se que os valores das variáveis analisadas aumentaram com a idade e, em menor grau, com os estágios de Tanner As mudanças são mais precoces e seguem cursos de tempo diferentes nas mulheres do que nos homens.

From rivers to ocean basins: The role of ocean barriers and philopatry in the genetic structuring of a cosmopolitan coastal predator.

The Bull Shark (Carcharhinus leucas) faces varying levels of exploitation around the world due to its coastal distribution. Information regarding population connectivity is crucial to evaluate its conservation status and local fishing impacts. In this study, we sampled 922 putative Bull Sharks from 19 locations in the first global assessment of population structure of this cosmopolitan species. Using a recently developed DNA-capture approach (DArTcap), samples were genotyped for 3400 nuclear markers. Additionally, full mitochondrial genomes of 384 Indo-Pacific samples were sequenced. Reproductive isolation was found between and across ocean basins (eastern Pacific, western Atlantic, eastern Atlantic, Indo-West Pacific) with distinct island populations in Japan and Fiji. Bull Sharks appear to maintain gene flow using shallow coastal waters as dispersal corridors, whereas large oceanic distances and historical land-bridges act as barriers. Females tend to return to the same area for reproduction, making them more susceptible to local threats and an important focus for management actions. Given these behaviors, the exploitation of Bull Sharks from insular populations, such as Japan and Fiji, may instigate local decline that cannot readily be replenished by immigration, which can in turn affect ecosystem dynamics and functions. These data also supported the development of a genetic panel to ascertain the population of origin, which will be useful in monitoring the trade of fisheries products and assessing population-level impacts of this harvest.

Half a century of rising extinction risk of coral reef sharks and rays.

Sharks and rays are key functional components of coral reef ecosystems, yet many populations of a few species exhibit signs of depletion and local extinctions. The question is whether these declines forewarn of a global extinction crisis. We use IUCN Red List to quantify the status, trajectory, and threats to all coral reef sharks and rays worldwide. Here, we show that nearly two-thirds (59%) of the 134 coral-reef associated shark and ray species are threatened with extinction. Alongside marine mammals, sharks and rays are among the most threatened groups found on coral reefs. Overfishing is the main cause of elevated extinction risk, compounded by climate change and habitat degradation. Risk is greatest for species that are larger-bodied (less resilient and higher trophic level), widely distributed across several national jurisdictions (subject to a patchwork of management), and in nations with greater fishing pressure and weaker governance. Population declines have occurred over more than half a century, with greatest declines prior to 2005. Immediate action through local protections, combined with broad-scale fisheries management and Marine Protected Areas, is required to avoid extinctions and the loss of critical ecosystem function condemning reefs to a loss of shark and ray biodiversity and ecosystem services, limiting livelihoods and food security.

Posterior reversible encephalopathy syndrome during convalescence from COVID-19.

Background and aim: With an ever-increasing population of patients recovering form severe coronavirus disease 2019 (COVID-19), recognizing long-standing and delayed neurologic manifestations is crucial. Here, we present a patient developing posterior reversible encephalopathy syndrome (PRES) in the convalescence form severe coronavirus disease 2019 (COVID-19).Case presentation: A 61-year-old woman with severe (COVID-19) confirmed by nasopharyngeal real-time reverse transcription-polymerase chain reaction (RT-PCR) for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) required invasive mechanical ventilation 24-hours after admission. During her intensive care unit stay, she developed transient acute kidney injury and septic shock. She was extubated after 22 days. On day 25, she developed generalized tonic-clonic seizures. Magnetic resonance imaging (MRI) of the brain showed bilateral subcortical lesions on the parietal and occipital lobes and multiple micro-and macro-bleeds, consistent with PRES. At this point, RT-PCR for SARS-CoV-2 in a respiratory specimen and cerebrospinal fluid was negative. She was discharged home 35 days after admission on oral levetiracetam. Control MRI five months after discharge showed bilateral focal gliosis. On follow-up, she remains seizure-free on levetiracetam.Conclusions: PRES has been observed before as a neurological manifestation of acute COVID-19; to our knowledge, this is the first PRES case occurring in a hospitalized patient already recovered from COVID-19. A persistent proinflammatory/prothrombotic state triggered by SARS-CoV-2 infection may lead to long-standing endothelial dysfunction, resulting in delayed PRES in patients recovering from COVID-19. With a rapid and exponential increase in survivors of acute COVID-19, clinicians should be aware of delayed (post-acute) neurological damage, including PRES.

Stepping up to genome scan allows stock differentiation in the worldwide distributed blue shark Prionace glauca.

The blue shark Prionace glauca is a top predator with one of the widest geographical distributions of any shark species. It is classified as Critically Endangered in the Mediterranean Sea, and Near Threatened globally. Previous genetic studies did not reject the null hypothesis of a single global population. The blue shark was proposed as a possible archetype of the "grey zone of population differentiation," coined to designate cases where population structure may be too recent or too faint to be detected using a limited set of markers. Here, blue shark samples collected throughout its global range were sequenced using a specific RAD method (DArTseq), which recovered 37,655 genome-wide single nucleotide polymorphisms (SNPs). Two main groups emerged, with Mediterranean Sea and northern Atlantic samples (Northern population) differentiated significantly from the Indo-west Pacific samples (Southern population). Significant pairwise FST values indicated further genetic differentiation within the Atlantic Ocean, and between the Atlantic Ocean and the Mediterranean Sea. Reconstruction of recent demographic history suggested divergence between Northern and Southern populations occurred about 500 generations ago and revealed a drastic reduction in effective population size from a large ancestral population. Our results illustrate the power of genome scans to detect population structure and reconstruct demographic history in highly migratory marine species. Given that the management plans of the blue shark (targeted or bycatch) fisheries currently assume panmictic regional stocks, we strongly recommend that the results presented here be considered in future stock assessments and conservation strategies.

Uso de endoprótesis para el tratamiento de enfermedades no neoplásicas de la rodilla / Use of endoprosthesis for the treatment of non-neoplastic pathologies of the knee

Introducción: Las endoprótesis son el método de elección para la reconstrucción luego de las resecciones oncológicas. Los avances en los materiales y diseños permitieron expandir las indicaciones a enfermedades no neoplásicas. Su montaje intraoperatorio simple y rápido, y su estabilidad mecánica inmediata permiten una rehabilitación y una recuperación funcional tempranas. Sin embargo, la tasa de fallas es elevada, aunque distinta de la de las enfermedades oncológicas. Las causas predominantes son diferentes. Objetivos: Analizar nuestra experiencia con el uso de endoprótesis de rodilla y compararla con los estudios publicados, evaluando los resultados funcional y radiográfico, la supervivencia del implante y las causas de su eventual falla. Materiales y Métodos: Se seleccionaron pacientes con enfermedad no neoplásica compleja de rodilla que requirieran una reconstrucción con endoprótesis. Para el examen clínico y la evaluación funcional se utilizó el puntaje de la Musculoskeletal Tumor Society, y para las fallas de los implantes, la clasificación de Henderson y cols. modificada. Resultados:Se estudiaron 12 endoprótesis, con un seguimiento promedio de 3.8 años. Se registraron 2 fallas (18%), con un tiempo promedio hasta la falla de 47.5 meses. Una fue tipo 2 (aflojamiento aséptico) y la otra, tipo 4 (infección). No hubo otras complicaciones. En la evaluación funcional, el puntaje final medio fue del 76,6%. Conclusión: Nuestros resultados respaldan el uso de endoprótesis para enfermedades complejas no neoplásicas de rodilla en pacientes cuidadosamente seleccionados, pese a ser un procedimiento quirúrgico complejo y con muchas complicaciones. Nivel de Evidencia: IV

Introduction: Endoprosthesis is the gold standard for reconstruction after oncological resections. The advances regarding its materials and designs allowed for the expansion of the indications to non-neoplastic pathologies. Its simple and fast intraoperative assembly and its immediate mechanical stability allow for early rehabilitation and functional recovery. However, the failure rate is high, although it is different from oncological pathologies. The predominant causes are varied. Objectives: To analyze our experience in the use of knee endoprosthesis and compare it with the literature, evaluating functional outcomes, radiographic outcomes, implant survival and causes of eventual failure. Materials and Methods: Patients with complex non-neoplastic knee pathology that required reconstruction with endoprosthesis were selected. Clinical history, anamnesis, physical examination, and radiographs were reviewed. For clinical examination and functional evaluation, the MusculoSkeletal Tumor Society Score (MSTS Score) was used. For implant failures, the modified Henderson et al. classification was used. Results: 12 endoprostheses were studied, with an average follow-up of 3.8 years. Failures were recorded in 2 (18%), with a mean time to failure of 47.5 months. One type 2 failure (aseptic loosening) and one type 4 failure (infection) were recorded. No other complications were noted. For the functional evaluation, the mean final score was 76.6%. Conclusion: Our results support the use of endoprostheses for complex non-neoplastic knee diseases in carefully selected patients, despite being a complex surgical procedure with many complications.Keywords: Endoprosthesis; knee; infection; complications. Level of Evidence: IV

Psychological and Psychiatric Events Following Immunization with Five Different Vaccines against SARS-CoV-2.

BACKGROUND: Despite the high number of vaccines administered against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) worldwide, the information on the psychological/psychiatric adverse events following immunization (AEFI) with these newly developed vaccines remains scarce. OBJECTIVE: To describe the frequency of psychological/psychiatric symptoms among recipients of five different anti-SARS-CoV-2 vaccines and to explore the factors associated with their development reported in the nationwide Mexican registry of AEFI against SARS-CoV-2. METHODS: Descriptive study of all the psychological/psychiatric symptoms, including anxiety, panic attacks, insomnia, and agitation reported to the Mexican Epidemiological Surveillance System from 21 December 2020 to 27 April 2021, among adult (≥18 years old) recipients of 7,812,845 doses of BNT162b2, ChAdOx1 nCov-19, rAd26-rAd5, Ad5-nCoV, or CoronaVac. The factors associated with their development are determined by multivariate regression analysis. RESULTS: There were 19,163 AEFI reports during the study period; amongst them, 191 (1%) patients had psychological/psychiatric symptoms (median age of 41 years, interquartile range of 32-54; 149 [78%] women) for an observed incidence of 2.44 cases per 100,000 administered doses (95% confidence interval [CI] 2.12-2.82), 72.8% of psychiatric AEFIs were reported among recipients of BNT162b2. The median time from vaccination to symptom onset was 35 min (interquartile range: 10-720). Overall, the most common psychological/psychiatric symptoms were anxiety in 129 (67.5%) patients, panic attacks in 30 (15.7%), insomnia in 25 (13%), and agitation in 11 (5.7%). After adjusting for the confounding factors, the odds for developing psychological/psychiatric symptoms were higher for those concurrently reporting syncope (odds ratio [OR]: 4.73, 95% CI: 1.68-13.33); palpitations (OR: 2.47, 95% CI: 1.65-3.70), and dizziness (OR: 1.59, 95% CI: 1.10-2.28). CONCLUSION: In our population, psychological/psychiatric symptoms were extremely infrequent AEFIs. No severe psychiatric AEFIs were reported. Immunization stress-related responses might explain most of the detected cases.

[Skin manifestations in patients with COVID-19. A prospective study]. / Manifestaciones cutáneas en pacientes con COVID-19. Estudio prospectivo.

As of March 2020, skin lesions associated with COVID-19 have been described. The objectives of the study were to characterize the skin lesions in these patients, analyze their temporal relationship, association with the severity of the disease, extracutaneous symptoms and laboratory parameters. A prospective, observational, analytical and cross-sectional study was conducted in hospitalized patients diagnosed with COVID-19. Dermatoses were classified as primary and secondary. Forty-five patients were included, 44.4% with primary dermatoses and 53.3% with secondary lesions. The mean age was 46 years (SD: 17), with a male predominance (68.9%). The primary lesions appeared after a median of 5 days (IQR: 3-10) from the onset of COVID-19 symptoms and the secondary ones after 14.5 days (IQR: 7-20). The primary dermatoses found were maculopapular rash (65%), urticarial (20%, half with vesicular lesions), livedo reticular (10%) and purpura (5%). The most frequent secondary dermatoses were adverse drug reactions (37.1%) and infectious dermatoses (25.9%). Maculopapular rash was associated with moderate COVID-19 and pressure injuries with severe COVID-19 (p < 0.05). The finding of neutrophilia was higher among those with secondary infectious dermatoses (p < 0.05). No significant differences were found when evaluating other laboratory parameters. This work shows the skin manifestations in patients hospitalized with COVID-19 in our environment. The most prevalent pattern was the maculopapular rash that was associated with the moderate form of the disease. The appearance of lesions 2 weeks after the onset of COVID-19 symptoms was associated with secondary dermatoses.

Desde marzo 2020 se describieron lesiones cutáneas asociadas a COVID-19. Los objetivos del estudio fueron caracterizar las lesiones cutáneas en estos pacientes, analizar su relación temporal, asociación con la gravedad de la enfermedad, los síntomas extracutáneos y parámetros de laboratorio. Es un estudio prospectivo, observacional, analítico y de corte transversal, en internados con diagnóstico de COVID-19. Se catalogaron las dermatosis en primarias y secundarias. Se incluyeron 45 pacientes, 44.4% con dermatosis primarias y 53.3% con lesiones secundarias. La edad media fue de 46 años (DS: 17), con predominio del sexo masculino (68.9%). Las lesiones primarias aparecieron luego de una mediana de 5 días (RIC: 3-10) del inicio de los síntomas de COVID-19 y las secundarias luego de 14.5 días (RIC: 7-20). Las dermatosis primarias fueron: exantema maculopapuloso (65%), urticariforme (20%, la mitad con lesiones vesiculosas), livedo reticular (10%) y púrpura (5%). Las dermatosis secundarias más frecuentes fueron reacciones adversas a fármacos (37.1%) y dermatosis infecciosas (25.9%). El exantema maculopapuloso se asoció a COVID-19 moderado y las lesiones por presión a COVID-19 grave (p < 0.05). El hallazgo de neutrofilia fue mayor entre aquellos con dermatosis infecciosas secundarias (p < 0.05). No se encontraron diferencias significativas al evaluar otros parámetros de laboratorio, ni síntomas extracutáneos. Este trabajo muestra las manifestaciones cutáneas en internados con COVID-19. El patrón más prevalente fue el exantema maculopapuloso que se asoció con la forma moderada de la enfermedad. La aparición de lesiones luego de las 2 semanas del inicio de los síntomas de COVID-19 se asoció a dermatosis secundarias.

Incidence of Guillain-Barré syndrome following SARS-CoV-2 immunization: Analysis of a nationwide registry of recipients of 81 million doses of seven vaccines.

BACKGROUND AND PURPOSE: Information on Guillain-Barré syndrome (GBS) as an adverse event following immunization (AEFI) against SARS-CoV-2 remains scarce. We aimed to report GBS incidence as an AEFI among adult (≥18 years) recipients of 81,842,426 doses of seven anti-SARS-CoV-2 vaccines between December 24, 2020, and October 29, 2021, in Mexico. METHODS: Cases were retrospectively collected through passive epidemiological surveillance. The overall observed incidence was calculated according to the total number of administered doses. Vaccines were analyzed individually and by vector as mRNA-based (mRNA-1273 and BNT162b2), adenovirus-vectored (ChAdOx1 nCov-19, rAd26-rAd5, Ad5-nCoV, and Ad26.COV2-S), and inactivated whole-virion-vectored (CoronaVac) vaccines. RESULTS: We identified 97 patients (52 males [53.6%]; median [interquartile range] age 44 [33-60] years), for an overall observed incidence of 1.19/1,000,000 doses (95% confidence interval [CI] 0.97-1.45), with incidence higher among Ad26.COV2-S (3.86/1,000,000 doses, 95% CI 1.50-9.93) and BNT162b2 recipients (1.92/1,00,000 doses, 95% CI 1.36-2.71). The interval (interquartile range) from vaccination to GBS symptom onset was 10 (3-17) days. Preceding diarrhea was reported in 21 patients (21.6%) and mild COVID-19 in four more (4.1%). Only 18 patients were tested for Campylobacter jejuni (positive in 16 [88.9%]). Electrophysiological examinations were performed in 76 patients (78.4%; axonal in 46 [60.5%] and demyelinating in 25 [32.8%]); variants were similar across the platforms. On admission, 91.8% had a GBS disability score ≥3. Seventy-five patients (77.3%) received intravenous immunoglobulin, received seven plasma exchange (7.2%), and 15 (15.5%) were treated conservatively. Ten patients (10.3%) died, and 79.1% of survivors were unable to walk independently. CONCLUSIONS: Guillain-Barré syndrome was an extremely infrequent AEFI against SARS-CoV-2. The protection provided by these vaccines outweighs the risk of developing GBS.

Time stability and connectivity analysis with an intracortical 96-channel microelectrode array inserted in human visual cortex.

Objective.Microstimulation via electrodes that penetrate the visual cortex creates visual perceptions called phosphenes. Besides providing electrical stimulation to induce perceptions, each electrode can be used to record the brain signals from the cortex region under the electrode which contains brain state information. Since the future visual prosthesis interfaces will be implanted chronically in the visual cortex of blind people, it is important to study the long-term stability of the signals acquired from the electrodes. Here, we studied the changes over time and the repercussions of electrical stimulation on the brain signals acquired with an intracortical 96-channel microelectrode array implanted in the visual cortex of a blind volunteer for 6 months.Approach.We used variance, power spectral density, correlation, coherence, and phase coherence to study the brain signals acquired in resting condition before and after the administration of electrical stimulation during a period of 6 months.Main results.Variance and power spectral density up to 750 Hz do not show any significant trend in the 6 months, but correlation coherence and phase coherence significantly decrease over the implantation time and increase after electrical stimulation.Significance.The stability of variance and power spectral density in time is important for long-term clinical applications based on the intracortical signals collected by the electrodes. The decreasing trends of correlation, coherence, and phase coherence might be related to plasticity changes in the visual cortex due to electrical microstimulation.

Radiografías periapicales y panorámicas como herramientas para la predicción temprana de osteoporosis / Periapical and panoramic radiographs as tools for early prediction of osteoporosis

Introducción: La osteoporosis es una enfermedad del sistema esquelético provocada por una disminución progresiva de la densidad mineral ósea y el deterioro de la microarquitectura, que aumenta el riesgo de fracturas. Por tanto, se hace necesario adoptar medidas de diagnóstico que permitan la detección temprana de alteraciones de la densidad mineral. Dado que las radiografías dentales son rutinarias y permiten examinar las estructuras óseas de los maxilares, se han propuesto como herramientas primarias de diagnóstico de osteoporosis. Objetivo: Examinar la viabilidad y el avance del uso de radiografías periapicales y panorámicas como predictoras tempranas de osteoporosis. Comentarios principales: Fue realizada una revisión bibliográfica sobre cómo las radiografías periapicales y panorámicas, junto con técnicas de aprendizaje automático e índices morfométricos, pueden ser predictores tempranos de osteoporosis. Consideraciones globales: Radiografías panorámicas y periapicales pueden ayudar en la predicción precoz de osteoporosis. Para ello el odontólogo debe contar con amplia experiencia en la interpretación de imágenes radiográficas o ser especialista en radiología oral o cirugía maxilofacial. Por otro lado, existen herramientas computacionales fundamentadas en aprendizaje automático que han mostrado resultados de identificación de osteoporosis comparables a los arrojados por radiólogos. Estas herramientas pueden servir de apoyo a profesionales menos experimentados. Los odontólogos están llamados a ser los primeros inspectores de cambios anómalos en la densidad ósea. Deben remitir oportunamente los pacientes con sospecha de osteoporosis al médico especialista(AU)

Introduction: Osteoporosis is a disease of the skeletal system caused by a gradual reduction in bone mineral density and deterioration of the microarchitecture, raising the risk of fracture. It is therefore necessary to implement diagnostic actions allowing early detection of mineral density alterations. Given the fact that dental radiographs are routine practice and make it possible to examine the bone structure of maxillae and mandibles, they have been proposed as primary tools for osteoporosis diagnosis. Objective: Examine the viability of and progress in the use of periapical and panoramic radiographs as early predictors of osteoporosis. Main remarks: A review was conducted about the combined use of panoramic and periapical radiographs. Both are machine learning techniques and morphometric indices. General considerations: Panoramic and periapical radiographs may be useful for early prediction of osteoporosis. To achieve this end, dentists should have broad experience interpreting radiographic images or be specialists in oral radiology or maxillofacial surgery. On the other hand, computer tools based on machine learning are available which have obtained results in osteoporosis identification comparable to those obtained by radiologists. Those tools may support the work of less experienced professionals. Dentists should be the first to detect anomalous bone density changes, timely referring patients suspected of osteoporosis to the corresponding specialist(AU)

Manifestaciones cutáneas en pacientes con COVID-19. Estudio prospectivo / Skin manifestations in patients with COVID-19. A prospective study

Resumen Desde marzo 2020 se describieron lesiones cutáneas asociadas a COVID-19. Los objetivos del estudio fueron caracterizar las lesiones cutáneas en estos pacientes, analizar su relación temporal, asociación con la gravedad de la enfermedad, los síntomas extracutáneos y parámetros de laboratorio. Es un estudio prospectivo, observacional, analítico y de corte transversal, en internados con diagnóstico de COVID-19. Se catalogaron las dermatosis en primarias y secundarias. Se incluyeron 45 pacientes, 44.4% con dermatosis primarias y 53.3% con lesiones secundarias. La edad media fue de 46 años (DS: 17), con predominio del sexo masculino (68.9%). Las lesiones primarias aparecieron luego de una mediana de 5 días (RIC: 3-10) del inicio de los síntomas de COVID-19 y las secundarias luego de 14.5 días (RIC: 7-20). Las dermatosis primarias fueron: exantema maculopapuloso (65%), urticariforme (20%, la mitad con lesiones vesiculosas), livedo reticular (10%) y púrpura (5%). Las dermatosis secundarias más frecuentes fueron reacciones adversas a fármacos (37.1%) y dermatosis infecciosas (25.9%). El exantema maculopapuloso se asoció a COVID-19 moderado y las lesiones por presión a COVID-19 grave (p < 0.05). El hallazgo de neutrofilia fue mayor entre aquellos con dermatosis infecciosas secundarias (p < 0.05). No se encontraron diferencias significativas al evaluar otros parámetros de laboratorio, ni síntomas extracutáneos. Este trabajo muestra las manifestaciones cutáneas en internados con COVID-19. El patrón más prevalente fue el exantema maculopapuloso que se asoció con la forma moderada de la enfermedad. La aparición de lesiones luego de las 2 semanas del inicio de los síntomas de COVID-19 se asoció a dermatosis secundarias.

Abstract As of March 2020, skin lesions associated with COVID-19 have been described. The objectives of the study were to char acterize the skin lesions in these patients, analyze their temporal relationship, association with the severity of the disease, extracutaneous symptoms and laboratory parameters. A prospective, observational, analytical and cross-sectional study was conducted in hospitalized patients diagnosed with COVID-19. Dermatoses were clas sified as primary and secondary. Forty-five patients were included, 44.4% with primary dermatoses and 53.3% with secondary lesions. The mean age was 46 years (SD: 17), with a male predominance (68.9%). The primary lesions appeared after a median of 5 days (IQR: 3-10) from the onset of COVID-19 symptoms and the secondary ones after 14.5 days (IQR: 7-20). The primary dermatoses found were maculopapular rash (65%), urticarial (20%, half with vesicular lesions), livedo reticular (10%) and purpura (5%). The most frequent secondary dermatoses were adverse drug reactions (37.1%) and infectious dermatoses (25.9%). Maculopapular rash was associated with moderate COVID-19 and pressure injuries with severe COVID-19 (p < 0.05). The finding of neutrophilia was higher among those with secondary infectious dermatoses (p < 0.05). No significant differences were found when evaluating other laboratory parameters. This work shows the skin manifestations in patients hospitalized with COVID-19 in our environment. The most prevalent pattern was the maculopapular rash that was associated with the moderate form of the disease. The appearance of lesions 2 weeks after the onset of COVID-19 symptoms was associated with secondary dermatoses.

Limites e potencialidades da assistência domiciliar pediátrica em um município do estado do Ceará / Limits and Potentials of Pediatric Home Care in a Ceará State municipality

O Serviço de Atenção Domiciliar (SAD) é o serviço complementar aos cuidados realizados na atenção básica e em serviços de urgência, substitutivo ou complementar à internação hospitalar. Diante disso, tem-se como objetivo do estudo, conhecer os limites e potencialidades da assistência domiciliar pediátrica do Programa Melhor em Casa, em um município do estado do Ceará. A escolha pelo público pediátrico se deu pelas suas especificidades, além da dificuldade dos outros níveis de atenção prestarem cuidados domiciliares a este público. Trata-se de uma pesquisa avaliativa, de abordagem qualitativa. Utilizou-se a avaliação da tríade estrutura-processo-resultado definida no referencial teórico-metodológico de Donabedian. Para este estudo, consideramos os dados e análises referentes à dimensão processo. No que concerne à coleta de dados, foram realizadas entrevistas semiestruturadas a partir do roteiro adaptado de Oliveira Neto com os profissionais que atuam de forma direta no atendimento ao público pedi-átrico no município. As falas foram registradas com a utilização de gravador, além de registro em diário de Campo, destinado a anotações de manifestações com uso de linguagem não verbal como gestos, posturas e expressões faciais. Para tratamento dos dados, foi feita a análise temática dos discursos proposta por Minayo, subsidiada pelo software N VIVO 11 plus. A palavra mais frequente nos discursos foi "criança" (158 vezes), seguida de "atenção" (107 vezes), "cuidados" (80 vezes), "paciente" (76 vezes) e "domiciliar" (73 vezes). Vê-se que a palavra mais fre-quente denota a importância dada ao cuidado centrado no usuário, no caso, na criança. Na divisão de categorias, de acordo com a análise do discurso, foi mais presente a Interação com a RAS (39, 02%), seguida pela categoria do Processo Estrutura-Dependentes (PED) com 27,64, Relações de Trabalho (RT) com 26,02% e Processos Profis-sional-Dependentes (PPD) com 7,32%. Dentre as limitações encontradas destaca-se a fragmentação da rede, falta de insumos, transporte e inexistência de algumas categorias profissionais. Como potencialidades expõe-se a mini-mização do número de internações pediátricas no município, como também a melhoria da qualidade de recuperação no âmbito do lar (AU)

Home Care Service (HCS) is the complementary service to primary care and emergency services, replacing or complementing hospital admissions. Therefore, the aim of this study is to know the limits and potentials of pediatric home care of the Melhor em Casa (Better at home) Program in a Ceará state municipality. The choice of pediatric care was due to its specificities, in addition to the difficulty of other levels of care to provide home care to these patients. It is an evaluative research, with a qualitative approach. In order to do that, the eval-uation of the triad: structure-process-result, defined by Donabedian theoretical-methodological referencial, was used. For this study, we considered data and analysis referring to the process dimension. Regarding data collection, semi-structured interviews were carried out, based on the script adapted by Oliveira Neto, with pro-fessionals who work directly with the pediatric population in the municipalities. The speeches were recorded, in addition to records in a research journal, intended for notes of non-verbal language such as gestures, postures and facial expressions. In order to process the data, the thematic analysis of the speeches proposed by Minayo was carried out, supported by the NVIVO 11 plus software. The most frequent word in the speeches was "child" (158 times), followed by "attention" (107 times), "care" (80 times), patient (76 times) and home (73 times). It can be observed that the most frequent word denotes the importance given to patient-centered care, in this case, the child. According to the discourse analysis, on categories division, Interaction with the Health Care Network (HCN) was more present (39.02%), followed by the Structure-Dependent Process category (SDP) with 27.64, Work Relations (WR) with 26.02% and Professional-Dependent Processes (PDP) with 7.32%. Among the limitations faced, we can pinpoint: the network fragmentation, lack of supplies, transport and specialized profes-sionals. As a potential, we could pinpoint: the decrease of pediatric hospitalizations, as well as the improvement of the quality of recovery at home (AU)

Urgencia odontopediátrica asociada a Bola Adiposa de Bichat: informe de un caso / Pediatric dental emergency associated with Bichat ́s fat pad: a case report

Objetivo: Presentar la resolución quirúrgica de un caso clínico poco frecuente en un paciente pediátrico luego de ha- ber sufrido la herniación traumática de la Bola Adiposa de Bichat. Caso clínico: Un paciente de 3 años concurre a la guar- dia del Hospital Interzonal Especializado Materno Infantil "Don Victorio Tetamanti" de Mar del Plata, luego de haber sufrido un traumatismo que le provocó el desplazamiento par- cial de la Bola Adiposa de Bichat. Si bien este tipo de urgencias es poco frecuente, es impor- tante tener los conocimientos para un correcto diagnóstico y tratamiento (AU))

Aim: To present the surgical resolution of an infrequent clinical case in a pediatric patient who suffered traumatic herniation of Bichat's fat pad. Clinical case: A 3-year-old patient who visited the Emergency Service at the "Don Victorio Tetamanti" Hospital in Mar del Plata after suffering a trauma which caused the partial displacement of Bichat's fat pad. Although this type of emergency is quite rare, it is important to know how to per- form proper diagnosis and treatment (AU)

Stroke Among SARS-CoV-2 Vaccine Recipients in Mexico: A Nationwide Descriptive Study.

BACKGROUND AND OBJECTIVES: Information on stroke among severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) vaccines remains scarce. We report stroke incidence as an adverse event following immunization (AEFI) among recipients of 79,399,446 doses of 6 different SARS-CoV-2 vaccines (BNT162b2, ChAdOx1 nCov-19, Gam-COVID-Vac, CoronaVac, Ad5-nCoV, and Ad26.COV2-S) between December 24, 2020, and August 31, 2021, in Mexico. METHODS: This retrospective descriptive study analyzed stroke incidence per million doses among hospitalized adult patients (≥18 years) during an 8-month interval. According to the World Health Organization, AEFIs were defined as clinical events occurring within 30 days after immunization and categorized as either nonserious or serious, depending on severity, treatment, and hospital admission requirements. Acute ischemic stroke (AIS), intracerebral hemorrhage (ICH), subarachnoid hemorrhage (SAH), and cerebral venous thrombosis (CVT) cases were collected through a passive epidemiologic surveillance system in which local health providers report potential AEFI to the Mexican General Board of Epidemiology. Data were captured with standardized case report formats by an ad hoc committee appointed by the Mexican Ministry of Health to evaluate potential neurologic AEFI against SARS-COV-2. RESULTS: We included 56 patients (31 female patients [55.5%]) for an overall incidence of 0.71 cases per 1,000,000 administered doses (95% CI 0.54-0.92). Median age was 65 years (interquartile range [IQR] 55-76 years); median time from vaccination to stroke (of any subtype) was 2 days (IQR 1-5 days). In 27 (48.2%) patients, the event was diagnosed within the first 24 hours after immunization. The most frequent subtype was AIS in 43 patients (75%; 0.54 per 1,000,000 doses, 95% CI 0.40-0.73), followed by ICH in 9 (16.1%; 0.11 per 1,000,000 doses, 95% CI 0.06-0.22) and SAH and CVT, each with 2 cases (3.6%; 0.03 per 1,000,000 doses, 95% CI 0.01-0.09). Overall, the most common risk factors were hypertension in 33 (58.9%) patients and diabetes in 22 (39.3%). Median hospital length of stay was 6 days (IQR 4-13 days). At discharge, functional outcome was good (modified Rankin Scale score 0-2) in 41.1% of patients; in-hospital mortality rate was 21.4%. DISCUSSION: Stroke is an exceedingly rare AEFI against SARS-CoV-2. Preexisting stroke risk factors were identified in most patients. Further research is needed to evaluate causal associations between SARS-COV-2 vaccines and stroke.