Manifestaciones orales del COVID-19 en Paraguay: resultados de una encuesta en línea

Introducción: Estudios previos han reportado que pacientes infectados con el virus del COVID-19, podrían manifestar sintomatologías a nivel de la cavidad oral. Objetivo: Evaluar la frecuencia de manifestaciones orales asociadas a COVID-19 en un segmento de la población paraguaya y determinar cuáles son las más prevalentes. Metodología: Estudio descriptivo de corte transversal. Fue realizada una encuesta electrónica de enero a marzo del 2022. Los datos fueron presentados como frecuencias y porcentajes y analizados mediante la prueba de chi-cuadrado. El análisis estadístico se realizó con el software R versión 4.0.3. Resultados: La muestra estuvo compuesta por 478 personas. El 79,50 % correspondió al sexo femenino y el 45,19 % tenía entre 25 y 34 años. El 65,48 % informó haber experimentado al menos 1 síntoma o signo oral durante el curso de COVID-19. La pérdida de la sensación de sabores amargos, seguida de la alteración del sabor de los alimentos y la pérdida de la percepción dulce, fueron los síntomas más comunes. Se encontró una proporción significativamente mayor de manifestaciones orales en el rango de 18-24 años (χ²; p= 0,003). Entre las personas que desarrollaron COVID-19 de forma moderada a severa hubo mayor número de manifestaciones de síntomas orales (χ²; p= 0,044). Discusión: Se identificó una alta frecuencia de manifestaciones orales en pacientes con casos de moderados a severos de COVID-19, destacándose los trastornos del gusto como los más predominantes. Los individuos más jóvenes fueron los más afectados.

Introduction: Previous studies have reported that patients infected with the COVID-19 virus could manifest symptoms in the oral cavity. Objective: To evaluate the frequency of oral manifestations associated with COVID-19 in a segment of the Paraguayan population and determine the most prevalent ones. Methods: Descriptive cross-sectional study. An electronic survey was conducted from January to March 2022. The data were presented as frequencies and percentages and analyzed using the chi-square test. Statistical analysis was performed with R software version 4.0.3. Results: The sample consisted of 478 individuals. 79.50% were female, and 45.19% were between 25 and 34 years old. 65.48% reported having experienced at least 1 oral symptom or sign during the course of COVID-19. The loss of the sensation of bitter tastes, followed by the alteration of the taste of foods and the loss of sweetness perception, were the most common symptoms. A significantly higher proportion of oral manifestations was found in the 18-24 age range (χ²; p= 0.003). Among people who developed COVID-19 in a moderate to severe form, a greater number of oral symptom manifestations were observed (χ²; p= 0.044). Discussion: A high frequency of oral manifestations was identified in patients with moderate to severe cases of COVID-19, with taste disorders standing out as the most predominant. Younger individuals were the most affected.

Methyl-Prednisolone Pulses and Prolonged Remission in Systemic Lupus Erythematosus: A Propensity Score Analysis of the Longitudinal Lupus-Cruces-Bordeaux Inception Cohort.

OBJECTIVES: To analyze the effect of methyl-prednisolone pulses (MP), given during the first year after the diagnosis of systemic lupus erythematosus (SLE), in achieving prolonged remission according to the degree of lupus activity at presentation. METHODS: Observational study of routine clinical care data of the Lupus Cruces-Bordeaux cohort. The endpoint was prolonged remission, i.e. during 5 consecutive yearly visits. The effect on remission of MP during the first year was analyzed in the whole cohort and according to the baseline SLEDAI-2K score: <6, 6-12 and >12, reflecting mild, moderate and severe activity, respectively. For adjustment, logistic regression with propensity score (PE) and other therapeutic covariates was performed. RESULTS: Two hundred thirty-three patients were included. Prolonged remission was achieved by 132 (57%) patients. MP were associated with prolonged remission (PE-adjusted OR 2.50, 95%CI 1.04-623, p=0.042). A strong clinical effect was seen among patients with moderate (adjusted OR 5.28, 95%CI 1.27-21.97, p=0.022) and with moderate-severe SLE activity (adjusted OR 4.07, 95%CI 1.11-14.82, p=0.033). The administration of MP resulted in reduced average doses of prednisone during the first year among patient with moderate (mean 6.6 vs 10.2 mg/d, p=0.017) and severe activity (mean 14 vs. 28 mg/d, p= 0.015). The odd of prolonged remission was increased by longer-term use of HCQ and decreased by higher initial doses of prednisone. CONCLUSIONS: This study supports the use of MP to induce prolonged remission in patients with SLE, particularly in those with moderate and severe activity. The extended use of HCQ also contributes to achieve prolonged remission. This article is protected by copyright. All rights reserved.

Accelerating SARS-CoV-2 genomic surveillance in a routine clinical setting with nanopore sequencing.

BACKGROUND: SARS-CoV-2 genomic analysis has been key to the provision of valuable data to meet both epidemiological and clinical demands. High-throughput sequencing, generally Illumina-based, has been necessary to ensure the widest coverage in global variant tracking. However, a speedier response is needed for nosocomial outbreak analyses and rapid identification of patients infected by emerging VOCs. An alternative based on nanopore sequencing may be better suited to delivering a faster response when required; however, although there are several studies offering side-by-side comparisons of Illumina and nanopore sequencing, evaluations of the usefulness in the hospital routine of the faster availability of data provided by nanopore are still lacking. RESULTS: We performed a prospective 10-week nanopore-based sequencing in MinION in a routine laboratory setting, including 83 specimens where a faster response time was necessary. The specimens analyzed corresponded to i) international travellers in which lineages were assigned to determine the proper management/special isolation of the patients; ii) nosocomial infections and health-care-worker infections, where SNP-based comparisons were required to rule in/out epidemiological relationships and tailor specific interventions iii) sentinel cases and breakthrough infections to timely report to the Public Health authorities. MinION-based sequencing was compared with the standard procedures, supported on Illumina sequencing; MinION accelerated the delivery of results (anticipating results 1-12 days) and reduced costs per sample by 28€ compared to Illumina, without reducing accuracy in SNP calling. CONCLUSIONS: Parallel integration of Illumina and nanopore sequencing strategies is a suitable solution to ensure both high-throughput and rapid response to cope with accelerating the surveillance demands of SARS-CoV-2 while also maintaining accuracy.

Flocculation of Cellulose Microfiber and Nanofiber Induced by Chitosan-Xylan Complexes.

This study aims to provide a comprehensive understanding of the key factors influencing the rheological behavior and the mechanisms of natural polyelectrolyte complexes (PECs) as flocculation agents for cellulose microfibers (CMFs) and nanofibers (CNFs). PECs were formed by combining two polyelectrolytes: xylan (Xyl) and chitosan (Ch), at different Xyl/Ch mass ratios: 60/40, 70/30, and 80/20. First, Xyl, Ch, and PEC solutions were characterized by measuring viscosity, critical concentration (c*), rheological parameter, ζ-potential, and hydrodynamic size. Then, the flocculation mechanisms of CMF and CNF suspensions with PECs under dynamic conditions were studied by measuring viscosity, while the flocculation under static conditions was examined through gel point measurements, floc average size determination, and ζ-potential analysis. The findings reveal that PEC solutions formed with a lower xylan mass ratio showed higher intrinsic viscosity, higher hydrodynamic size, higher z-potential, and a lower c*. This is due to the high molecular weight, charge, and gel-forming ability. All the analyzed solutions behave as a typical non-Newtonian shear-thinning fluid. The flocculation mechanisms under dynamic conditions showed that a very low dosage of PEC (between 2 and 6 mg PEC/g of fiber) was sufficient to produce flocculation. Under dynamic conditions, an increase in viscosity indicates flocculation at this low PEC dosage. Finally, under static conditions, maximum floc sizes were observed at the same PEC dosage where minimum gel points were reached. Higher PEC doses were required for CNF suspensions than for CMF suspensions.

Analysis of the Intestinal and Faecal Bacterial Microbiota of the Cervidae Family Using 16S Next-Generation Sequencing: A Review.

The Cervidae family has a wide distribution due to its adaptation to numerous ecological environments, which allows it to develop a diverse microbial community in its digestive tract. Recently, research has focused on the taxonomic composition and functionality of the intestinal and faecal microbiota of different cervid species worldwide, as well as their microbial diversity and variation under different associated factors such as age, sex, diet, distribution, and seasonal variation. In addition, there is special interest in knowing how cervids act as reservoirs of zoonotic pathogenic microorganisms, which represent a threat to public health. This review provides a synthesis of the growing field of microbiota determination in cervids worldwide, focusing on intestinal and faecal samples using 16S next-generation sequencing. It also documents factors influencing microbial diversity and composition, the microorganisms reported as pathogenic/zoonotic, and the perspectives regarding the conservation of these species. Knowing the interactions between bacteria and cervid health can drive management and conservation strategies for these species and help develop an understanding of their evolutionary history and the interaction with emerging disease-causing microorganisms.

Low-dose aspirin use in the first trimester of pregnancy and odds of congenital anomalies: A meta-analysis of randomized controlled trials.

BACKGROUND: Daily low-dose aspirin (LDA) is recommended in high-risk pregnancies. However, its safety profile in the first trimester has not been well documented. OBJECTIVES: To determine if LDA exposure during the first trimester of pregnancy is associated with higher odds of congenital structural anomalies. SEARCH STRATEGY: PubMed, Embase, Web of Science, Cochrane Central Register of Controlled Trials, and ClinicalTrials.gov were systematically searched. SELECTION CRITERIA: Randomized controlled trials (RCTs) that assigned participants to LDA (≤150 mg) or placebo/no intervention at less than 14 weeks of pregnancy were eligible. DATA COLLECTION AND ANALYSIS: Random-effects models were performed using the inverse-variance method to calculate pooled effect sizes. Quality of evidence was appraised according to Grading of Recommendations, Assessment, Development and Evaluations (GRADE) criteria. MAIN RESULTS: Eight RCTs that included 7564 participants assigned to receive daily LDA and 7670 participants that served as controls were analyzed. Low-certainty evidence showed no significant difference in the odds of congenital anomalies (odds ratio 0.87, 95% confidence interval 0.62-1.23, I2  = 0%). CONCLUSIONS: In this meta-analysis, there is no evidence to suggest safety concerns regarding LDA teratogenicity. However, given the overall low quality of evidence, further research (e.g. individual participant data meta-analysis) is needed to confirm LDA safety profile.

Population pharmacokinetics of sublingually administered tacrolimus in infants and young children with liver transplantation.

AIMS: Pharmacokinetics of tacrolimus after sublingual administration is not characterized in paediatric liver transplant patients. Therefore, we aimed to develop a population pharmacokinetic model of sublingually administered tacrolimus in patients who cannot swallow the capsules due to their age, sedation status and/or mechanical ventilation during the first weeks post-transplantation. METHODS: Demographic, clinical and pharmacological variables, including tacrolimus whole blood concentrations obtained from therapeutic drug monitoring and data from dense-sampling pharmacokinetic profiles, were recorded in 26 paediatric patients with biliary atresia who underwent liver transplantation between 2016 and 2021. Population pharmacokinetic analysis was performed with NONMEM v7.4. RESULTS: Disposition of tacrolimus was best characterized by a 2-compartment model with clearance achieving half of the maximum elimination capacity (CLMAX  = 4.1 L/h) at 4.6 days post-transplantation (T50 ). Compared to sedated patients, nonsedated status showed an increased first-order absorption rate constant (1.1 vs. 0.1 h-1 ) and a 24% reduction in bioavailability (FNS ) at 14 days post-transplant. The model was able to explain the oral absorption pattern in nonsedated patients as the result of gut bioavailability (0.9) and hepatic extraction ratio, with the latter being responsible for first-pass effects. Estimates of interindividual variability remained moderate (25.9% for the gut bioavailability) to high (79.8% for the apparent volume of distribution of the central compartment, and 101% for T50 ). CONCLUSION: A population pharmacokinetic model of sublingually administered tacrolimus in paediatric patients was developed to characterize different absorption mechanisms. Once the model is externally validated, the effect of post-transplant time on clearance and the sedation status may be considered in routine dosing management.

Láser de baja potencia como alternativa terapéutica al eritema multiforme idiopático. Informe de caso

El eritema multiforme es una enfermedad aguda de la piel y/o de las mucosas de naturaleza inmunológica, siendo está de etiología desconocida. Solo el 20% de los casos se dan en niños. El diagnóstico se basa en la historia clínica y el examen físico y el tratamiento no está sistematizado. La terapia con láser de baja potencia está siendo cada vez más utilizada en el campo estomatológico. El objetivo fue evidenciar los beneficios del láser de baja potencia como alternativa terapéutica. Este caso corresponde a un paciente de 10 años de edad, que acudió a la cátedra de Patología Bucal de la Facultad de Odontología de la Universidad Nacional de Asunción (UNA), derivado del Hospital General de Barrio Obrero con antecedentes de internación por presentar lesiones erosivas en labios, boca y máculas en toráx, abdomen, orejas y miembros. En el examen intraoral costras serohemáticas negruzcas en labios, lesiones ulceradas en lengua, piso de boca, paladar duro y mucosa yugal. Se procedió a hacer una lavado de la zona con agua oxigenada, en las áreas afectadas se colocó azul de metileno al 0,01% por 5 minutos, y para la aplicación de laserterapia se realizó una única sesión. El paciente mostró gran evolución a las 24 horas de la aplicación del tratamiento. A los 8 días estaba sin lesiones y asintomático. La fotobioestimulación a nivel celular que ofrece el láser de baja potencia es una herramienta verosímil que se suma a nuevas opciones terapéuticas.

Erythema multiforme is an acute disease of the skin and/or mucous membranes of an immunologic nature, the etiology of which is unknown. Only 20% of cases occur in children. Diagnosis is based on clinical history and physical examination and treatment is not systematized. Low power laser therapy is being increasingly used in the stomatological field. The objective was to demonstrate the benefits of low power laser as a therapeutic alternative. This case corresponds to a 10-year-old patient, who came to the Department of Oral Pathology of the Faculty of Dentistry of the National University of Asuncion (UNA), referred from the General Hospital of Barrio Obrero with a history of hospitalization for presenting erosive lesions on the lips, mouth and macules on the thorax, abdomen, ears and limbs. In the intraoral examination, blackish serohematic crusts on the lips, ulcerated lesions on the tongue, floor of the mouth, hard palate and jugal mucosa. The area was washed with hydrogen peroxide, methylene blue 0.01% was applied to the affected areas for 5 minutes, and only a single session was performed for the application of the laser therapy. The patient showed great evolution 24 hours after the application of the treatment. After 8 days he was completely free of lesions and asymptomatic. The photo-biostimulation at the cellular level offered by the low power laser is a credible tool that adds to new therapeutic options.

O eritema multiforme é uma doença aguda da pele e/ou mucosas de natureza imunológica, cuja etiologia é desconhecida. Apenas 20% dos casos ocorrem em crianças. O diagnóstico é baseado na história clínica e no exame físico. O tratamento não é sistematizado. A terapia laser de baixa potência é cada vez mais utilizada no campo estomatológico. O objectivo foi demonstrar os benefícios do laser de baixa potência como uma alternativa terapêutica. Este caso corresponde a um paciente de 10 anos de idade que veio ao Departamento de Patologia Oral da Faculdade de Odontologia da Universidade Nacional de Asunción (UNA) e foi encaminhado do Hospital Geral do Bairro Obrero com um historial de hospitalização por apresentar lesões erosivas nos lábios, boca e máculas no tórax, abdómen, orelhas e membros. No exame intraoral, crostas serohaemáticas negras nos lábios, lesões ulceradas na língua, chão da boca, palato duro e mucosa jugal. A área foi lavada com peróxido de hidrogénio, azul de metileno 0,01% foi aplicado nas áreas afectadas durante 5 minutos, e foi realizada uma única sessão de laserterapia. O paciente mostrou uma grande evolução 24 horas após a aplicação do tratamento. Após 8 dias, estava completamente livre de lesões e assintomático. A foto-biostimulação a nível celular oferecida pelo laser de baixa potência é uma ferramenta credível que se soma a novas opções terapêuticas.

Láser de baja potencia como alternativa terapéutica al eritema multiforme idiopático. Informe de caso

El eritema multiforme es una enfermedad aguda de la piel y/o de las mucosas de naturaleza inmunológica, siendo está de etiología desconocida. Solo el 20% de los casos se dan en niños. El diagnóstico se basa en la historia clínica y el examen físico y el tratamiento no está sistematizado. La terapia con láser de baja potencia está siendo cada vez más utilizada en el campo estomatológico. El objetivo fue evidenciar los beneficios del láser de baja potencia como alternativa terapéutica. Este caso corresponde a un paciente de 10 años de edad, que acudió a la cátedra de Patología Bucal de la Facultad de Odontología de la Universidad Nacional de Asunción (UNA), derivado del Hospital General de Barrio Obrero con antecedentes de internación por presentar lesiones erosivas en labios, boca y máculas en toráx, abdomen, orejas y miembros. En el examen intraoral costras serohemáticas negruzcas en labios, lesiones ulceradas en lengua, piso de boca, paladar duro y mucosa yugal. Se procedió a hacer una lavado de la zona con agua oxigenada, en las áreas afectadas se colocó azul de metileno al 0,01% por 5 minutos, y para la aplicación de laserterapia se realizó una única sesión. El paciente mostró gran evolución a las 24 horas de la aplicación del tratamiento. A los 8 días estaba sin lesiones y asintomático. La fotobioestimulación a nivel celular que ofrece el láser de baja potencia es una herramienta verosímil que se suma a nuevas opciones terapéuticas.

Erythema multiforme is an acute disease of the skin and/or mucous membranes of an immunologic nature, the etiology of which is unknown. Only 20% of cases occur in children. Diagnosis is based on clinical history and physical examination and treatment is not systematized. Low power laser therapy is being increasingly used in the stomatological field. The objective was to demonstrate the benefits of low power laser as a therapeutic alternative. This case corresponds to a 10-year-old patient, who came to the Department of Oral Pathology of the Faculty of Dentistry of the National University of Asuncion (UNA), referred from the General Hospital of Barrio Obrero with a history of hospitalization for presenting erosive lesions on the lips, mouth and macules on the thorax, abdomen, ears and limbs. In the intraoral examination, blackish serohematic crusts on the lips, ulcerated lesions on the tongue, floor of the mouth, hard palate and jugal mucosa. The area was washed with hydrogen peroxide, methylene blue 0.01% was applied to the affected areas for 5 minutes, and only a single session was performed for the application of the laser therapy. The patient showed great evolution 24 hours after the application of the treatment. After 8 days he was completely free of lesions and asymptomatic. The photo-biostimulation at the cellular level offered by the low power laser is a credible tool that adds to new therapeutic options.

O eritema multiforme é uma doença aguda da pele e/ou mucosas de natureza imunológica, cuja etiologia é desconhecida. Apenas 20% dos casos ocorrem em crianças. O diagnóstico é baseado na história clínica e no exame físico. O tratamento não é sistematizado. A terapia laser de baixa potência é cada vez mais utilizada no campo estomatológico. O objectivo foi demonstrar os benefícios do laser de baixa potência como uma alternativa terapêutica. Este caso corresponde a um paciente de 10 anos de idade que veio ao Departamento de Patologia Oral da Faculdade de Odontologia da Universidade Nacional de Asunción (UNA) e foi encaminhado do Hospital Geral do Bairro Obrero com um historial de hospitalização por apresentar lesões erosivas nos lábios, boca e máculas no tórax, abdómen, orelhas e membros. No exame intraoral, crostas serohaemáticas negras nos lábios, lesões ulceradas na língua, chão da boca, palato duro e mucosa jugal. A área foi lavada com peróxido de hidrogénio, azul de metileno 0,01% foi aplicado nas áreas afectadas durante 5 minutos, e foi realizada uma única sessão de laserterapia. O paciente mostrou uma grande evolução 24 horas após a aplicação do tratamento. Após 8 dias, estava completamente livre de lesões e assintomático. A foto-biostimulação a nível celular oferecida pelo laser de baixa potência é uma ferramenta credível que se soma a novas opções terapêuticas.

Enhancing Pectin Particles with Polymer Additives: Mitigating Rumen Degradation and Minimizing Yellowish Milk Color in Grazed Cows.

The pigments consumed in grazing give the milk from dual-purpose cows raised in tropical conditions a yellowish color, affecting the quality and price of the milk. This study aimed to develop an economical method with supplementary pectin to antagonize the availability of carotenes by designing microparticles with shellac and palm oil as a viable alternative to protect pectin degradation against rumen microbes. Three preparations of microparticles based on citrus pectin were synthesized: unprotected (PnP), protected with palm oil (PwP), and protected with palm oil and shellac (PwPL) microparticles. Samples were roughly characterized by spectroscopy and electron microscopy techniques. The effect of PnP, PwP, and PwPL on blood metabolites and physicochemical characteristics of the milk of grazing lactating cows was evaluated through in vivo assays. The release of citrus pectin from microparticles was determined as uronic acids using solutions with distinct pH, whereas its degradation was studied using in situ tests. Results revealed that PnP, PwP, and PwPL are amorphous structures with sizes that range from 60 to 265 nm or 750 to 3570 µm and have surface charges that range from -11.5 to -50.2 mV. Samples exhibited characteristic peaks during FTIR analyses that corresponded to O-H, C=O, and COOCH3 groups and bands within the UV-vis region that indicated the absorption of pectin. The EDS analysis revealed the presence of carbon, oxygen, or calcium in samples. The release of uronic acids was higher at pH 2-3 with PwPL. The in situ degradability of PnP, PwP, and PwPL was 99, 28.4, and 17.7%, respectively. Moreover, PwPL decreased the blood concentration of glucose, cholesterol, and lactate. In contrast, 100 g of pectin per animal daily during the feed process reduced yellow coloring. In conclusion, designing particles protected with lipids and polymers as shellac is an economical method that resists degradation at pH levels greater than five.

Single Nucleotide Polymorphisms and Dental Fluorosis: A Systematic Review.

Genetic factors contribute to susceptibility and resistance to fluoride exposure. The aim of this systematic review was to identify alleles/genotypes of single nucleotide polymorphisms (SNPs) associated with dental fluorosis (DF) and to identify them as protective or risk factors. PubMed, ScienceDirect, Cochrane Library, Scopus and Web of Science were searched for articles; the last search was performed in August 2022. Human studies that analyzed the relationship between SNPs and DF published in English were included; systematic reviews and meta-analyses were excluded. Methodological quality was graded using the Joanna Briggs Institute checklist and risk of bias was assessed using the Cochrane Collaboration's tool. Eighteen articles were included, 44% of which showed high methodological quality and data from 5,625 participants aged 6 to 75 years were analyzed. The SNPs COL1A2, ESR2, DLX1, DLX2, AMBN, TUFT1, TFIP11, miRNA17, and SOD2 were considered risk factors, and ESR1, MMP20, and ENAM were considered protective factors. In conclusion, there are alleles and genotypes of different single nucleotide polymorphisms involved in increasing or decreasing the risk of developing dental fluorosis.

Foliage of Tropical Trees and Shrubs and Their Secondary Metabolites Modify In Vitro Ruminal Fermentation, Methane and Gas Production without a Tight Correlation with the Microbiota.

Ruminants, mainly cattle, contribute to greenhouse gases (GHG) emissions as methane (CH4) is produced by ruminal fermentation. Hence, various anti-methanogenic feed strategies have been studied, including the use of plants with secondary metabolites. This study evaluated in vitro ruminal fermentation metrics, microbial composition by digital droplet PCR (ddPCR) and the CH4 production of the foliage of several tropical trees and shrubs: Leucaena leucocephala, Moringa oleifera, Albizia lebbeck, Enterolobium cyclocarpum, Piscidia piscipula, Brosimum alicastrum, Lysiloma latisiliquum, Guazuma ulmifolia, Cnidoscolus aconitifolius, Gliricidia sepium and Bursera simaruba, using Cynodon plectostachyus grass as control. The results showed a wide variation in the chemical composition of the foliage, as well as in the ruminal microbiota. The crude protein (CP) content ranged from 11 to 25%, whereas the content of condensed tannins (CT) and saponins (S) was from 0.02 to 7%, and 3.2 to 6.6%, respectively. The greatest dry matter degradability (DMD) after 72 h was 69% and the least 35%, the latter coinciding with the least gas production (GP). A negative correlation was found between the CT and CH4 production, also between protozoa and fungi with the SGMT group of archaea. We concluded that the foliage of some tropical trees and shrubs has a high nutritional value and the potential to decrease CH4 production due to its CT content.

Effect of Oxalic Acid Concentration and Different Mechanical Pre-Treatments on the Production of Cellulose Micro/Nanofibers.

The present work analyzes the effect of process variables and the method of characterization of cellulose micro/nanofibers (CMNFs) obtained by different treatments. A chemical pre-treatment was performed using oxalic acid at 25 wt.% and 50 wt.%. Moreover, for mechanical pre-treatments, a rotary homogenizer or a PFI mill refiner were considered. For the mechanical fibrillation to obtain CMNFs, 5 and 15 passes through a pressurized homogenization were considered. The best results of nanofibrillation yield (76.5%), transmittance (72.1%) and surface charges (71.0 µeq/g CMNF) were obtained using the PFI mill refiner, 50 wt.% oxalic acid and 15 passes. Nevertheless, the highest aspect ratio (length/diameter) determined by Transmission Electron Microscopy (TEM) was found using the PFI mill refiner and 25 wt.% oxalic acid treatment. The aspect ratio was related to the gel point and intrinsic viscosity of CMNF suspensions. The values estimated for gel point agree with those determined by TEM. Moreover, a strong relationship between the intrinsic viscosity [η] of the CMNF dispersions and the corresponding aspect ratio (p) was found (ρ[η] = 0.014 p2.3, R2 = 0.99). Finally, the tensile strength of films obtained from CMNF suspensions was more influenced by the nanofibrillation yield than their aspect ratio.

Carbapenem-resistant Enterobacteriaceae bloodstream infections: A case-control study from a pediatric referral hospital in Argentina.

Background: Antibiotic-resistant gram-negative bloodstream infections (BSI) remain a leading cause morbidity and mortality in pediatric patients with a high impact on the public health system. Data in resource-limited countries, including those in Latin America and the Caribbean region, are scarce. The aim of the study was to identify risk factors for acquiring carbapenem-resistant Enterobacteriaceae (CRE) bacteremia in children and to assess the use of resources. Methods: A retrospective case-control study was conducted to analyze demographic, epidemiological, clinical, microbiological, and outcome data as well as the use of resources between 2014 and 2019. Univariate and logistic regression analysis was performed in order to identify risk factors associated with CRE-BSI. The R software version 4.1.2 was used. Results: A total of 46 cases with CRE-BSI and 92 controls with gram-negative non-CRE-BSI were included. No statistical difference was observed regarding: median age (36 months; IQR, 11.2-117 vs. 48 months, IQR 13-119), male sex (50 vs. 60%), and underlying disease (98 vs. 91%) in cases vs. controls, respectively. The most frequent mechanism of CRE bacteremia were: KPC in 74%, OXA in 15%, and NDM in 6.5%. A total of 54.3% of cases vs. 32.6 % (p = 0.016) of controls were admitted to the pediatric intensive care unit (PICU), and 48 vs. 21% (p = 0.001) required mechanical ventilation. Bacteremia secondary to intra-abdominal infection was observed in 56.5% of cases vs. 35% of controls (p = 0.032). Previous colonization with CRE was detected in 76% of cases vs. 8% of controls. Combination antimicrobial treatment was most frequent in cases vs. control (100 vs. 56.5%). No difference was observed in median length of hospital stay (22 days; IQR, 19-31 in cases vs. 17.5 days; IQR, 10-31 in controls; p = 0.8). Overall case fatality ratio was 13 vs. 5.5%, respectively. The most statistically significant risk factors included previous PICU stay (OR, 4; 95%CI, 2-8), invasive procedures/surgery (OR, 3; 95%CI, 1-7), central venous catheter placement (OR, 6.5; 95%CI, 2-19), urinary catheter placement (OR, 9; 95%CI 4-20), mechanical ventilation (OR, 4; 95%CI, 2-10), liver transplantation (OR, 8; 95%CI, 2-26), meropenem treatment (OR, 8.4; 3.5-22.6) in univariate analysis. The logistic regression model used for multivariate analysis yielded significant differences for previous meropenem treatment (OR, 13; 95%CI, 3-77; p = 0.001), liver transplantation (OR, 13; 95%CI, 2.5-100; p = 0.006), and urinary catheter placement (OR, 9; 95%CI, 1.4-94; p = 0.03). Conclusion: CRE-BSI affects hospitalized children with underlying disease, mainly after liver transplantation, with previous urinary catheter use and receiving broad-spectrum antibiotics, leading to high PICU requirement and mortality. These risk factors will have to be taken into account in our region in order to establish adequate health policies and programs to improve antimicrobial stewardship.

Interplay between feed efficiency indices, performance, rumen fermentation parameters, carcass characteristics and meat quality in Pelibuey lambs.

Feed efficiency was measured in thirty Pelibuey noncastrated male lambs using the residual feed intake (RFI) and residual intake and gain (RIG). The lambs were fattened for 92 d and then slaughtered, with the aim of identifying the interplay between feed efficiency indices (FEIs) and performance, rumen fermentation parameters, carcass characteristics and meat quality traits from the 15 intermediate and most extreme lambs for each FEI. The mean values of the classes were -0.09, 0.00, and 0.09 kg DM/d for low, medium and high RFI, respectively. The RIG indicators were 2.6, -0.1, and -2.7, for high, medium and low, respectively. The lambs with high-RIG had a higher (P ≤ 0.05) average daily gain and improved feed conversion. Lambs with low-RFI and high-RIG had higher (P < 0.05) values of meat cooking loss. Efficient lambs had improved feed utilization without affecting the carcass characteristics or meat quality (except for cooking loss).

Mechano-Chemical Synthesis, Structural Features and Optical Gap of Hybrid CH3NH3CdBr3 Perovskite.

Hybrid methyl-ammonium (MA:CH3NH3+) lead halide MAPbX3 (X = halogen) perovskites exhibit an attractive optoelectronic performance that can be applied to the next generation of solar cells. To extend the field of interest of these hybrid materials, we describe the synthesis by a solvent-free ball-milling procedure, yielding a well crystallized, pure and moisture stable specimen of the Cd tribromide counterpart, MACdBr3, which contains chains of face-sharing CdBr6 octahedra in a framework defined in the Cmc21 (No 36) space group. The details of the structural arrangement at 295 K have been investigated by high angular resolution synchrotron x-ray diffraction (SXRD), including the orientation of the organic MA units, which are roughly aligned along the c direction, given the acentric nature of the space group. UV-vis spectra unveil a gap of 4.6 eV, which could be useful for ultraviolet detectors.

High strength biobased films prepared from xylan/chitosan polyelectrolyte complexes in the presence of ethanol.

The effect of different ethanol concentrations (0; 3; 9; 12 and 16 wt%) on the degree of ionization of xylan and chitosan, the characteristics of polyelectrolyte complex (PEC) suspensions, and the derived films, were exhaustively analyzed through several analytical techniques. Results indicate that the degree of ionization of both polyelectrolytes was reduced, whereas particle sizes and z-potential values of PEC suspensions were remarkably modified. As ethanol concentration was increased up to 12 wt%, the crystallinity of films decreased. Furthermore, the stress at break increased from 45 to 75 MPa. Wet stress-strain results were promising (up to 5.0 MPa, 55%) for all films. Although water vapor permeability was not modified, the swelling capacity was favorably reduced (12%). Results reveal that, for preparing films, it might not be necessary to remove all the ethanol used for xylan precipitation and purification.

Effectiveness and optimum level of protected methionine in fattening pig diets / Efectividad y nivel óptimo de metionina protegida en dietas para cerdos en engorde / Eficácia e nível ideal de metionina protegida em dietas para suínos de engorda

Abstract Background: Methionine (Met) requirements have not been clearly established for fattening pigs due to their metabolic interrelationships and its bioavailability for protein synthesis. Objective: To determine the optimum level of regular crystalline or protected Met in pig diets from nursery to finishing. Methods: A total of 48 crossbred pigs (11.74±1.72 kg of initial body weight) were used. The treatments consisted of adding four levels (0.00, 0.05, 0.10, 0.15% in addition to dietary content) and two types of Met (regular and protected) to pig diets. Results: Nursery, Finishing I, and II pigs fed protected Met increased daily feed intake (DFI; p≤0.10). Protected Met raised daily weight gain (DWG) in nursery pigs and increased backfat thickness (BT) in nursery and grower pigs (p≤0.10). In Finishing I pigs, protected Met increased DWG and improved carcass characteristics (p≤0.10). In nursery and grower pigs, an extra 0.15% Met decreased feed:gain ratio (FGR; p≤0.10). In grower and Finishing II pigs fed extra 0.05% Met improved DWG and extra 0.10% Met reduced plasma urea concentration (p≤0.10). Conclusions: Feeding protected Met in pig diets increases DWG, DFI and BT. Increasing 0.05-0.15% Met level improves FGR, DWG, potentially reducing nitrogen excretion to the environment.

Resumen Antecedentes: los requerimientos de metionina (Met) para cerdos en crecimiento no han sido claramente establecidos, lo que se debe a sus relaciones metabólicas y su biodisponibilidad para la síntesis proteica. Objetivo: determinar el nivel óptimo de Met regular o protegida en dietas para cerdos en crecimiento. Métodos: Se utilizaron un total de 48 cerdos híbridos (11,74±1,72 kg peso vivo inicial). Los tratamientos consistieron en niveles incrementales (0,00, 0,05, 0,10, 0,15% adicionales al contenido de la dieta) y dos tipos de Met (regular y protegida) en la dieta. Resultados: los cerdos en iniciación, Finalización I, y II, alimentados con Met protegida tuvieron un mayor consumo diario de alimento (DFI; p≤0,10). La Met protegida aumentó la ganancia diaria de peso (DWG) durante la etapa de iniciación, e incrementó el grosor de la grasa dorsal (BT) en iniciación y levante (p≤0,10). Durante Finalización I, la Met protegida aumentó la DWG y mejoró las características de la canal (p≤0,10). Durante iniciación y levante, 0,15% extra de Met disminuyó la conversión alimenticia (FGR; p≤0,10). Los cerdos en levante y Finalización II alimentados con 0,05% extra de Met mejoraron la DWG y con 0.10% extra de Met redujeron la concentración de urea en plasma (p≤0,10). Conclusiones: el uso de Met protegida incrementa DWG, DFI y BT. El aumento del nivel de Met de 0,05-0,15% mejora FGR y DWG, y podria disminuir la excreción de nitrógeno al ambiente.

Resumo Antecedentes: os requisitos de metionina (Met) para suínos de engorda não foram claramente estabelecidos devido às suas relações metabólicas e sua biodisponibilidade para a síntese de proteínas. Objetivo: determinar o nível ideal de Met regular ou protegida em dietas para suínos de engorda. Métodos: foram utilizados 48 suínos híbridos (11,74±1,72 kg de peso vivo inicial). Os tratamentos consistiram em quatro níveis (0,00, 0,05, 0,10, 0,15% mais) e dois tipos (regular e protegida) de Met em dietas para suínos de engorda. Resultados: suínos no início, finalização I e II alimentados com Met protegida aumentaram o consumo diário de ração (DFI; p≤0,10). Met protegido aumentou o ganho de peso diário (DWG) em suínos na iniciação e, aumentou espessura da gordura dorsal (BT) em suínos em iniciação e crescimento (p≤0,10). Nos suínos finalização I, Met protegido aumentou DWG e melhorou as características do canal (p≤0,10). Para suínos de iniciação e crescimento, 0,15% extra de Met diminuiu conversão alimentar (FGR; p≤0,10). No crescimento e finalização II, a adição de 0,05% de Met melhoraram o DWG e com 0,10% reduziram a concentração de uréia (p≤0,10). Conclusões: o uso de Met protegida melhora DWG, DFI e BT. O nível de Met aumentado de 0,05-0,15% melhora FGR e DWG; além disso, a excreção de nitrogênio ambiental pode ser diminuída.

Design, Implementation and Evaluation of an Emotional Education Program: Effects on Academic Performance.

Background: In recent decades, the amount of research on social and emotional learning programs in schools has increased significantly, showing a great number of positive student outcomes, including greater ability to perceive, understand and manage emotions, better attitudes about self and others, less aggressive and/or disruptive behavior, higher levels of psychological well-being and improvement in academic performance among others. The purpose of this research was the design and implementation of the OKAPI emotional education program. A multidimensional program based on cooperative learning methodology. Methods: 86 students of Primary Education, from 3rd to 5th grade (45 students in the experimental unit and 41 in the control group). Results: The implementation of the OKAPI has a positive impact on academic achievement. Conclusion: This program shows the convenience of incorporating programs that can be integrated into school life and can be applied by the teaching staff using both social emotional learning and school climate approaches.