Critical systolic blood pressure threshold for endovascular aortic occlusion-A multinational analysis to determine when to place a REBOA.

BACKGROUND: Systolic blood pressure (SBP) is a potential indicator that could guide when to use a resuscitative endovascular balloon occlusion of the aorta (REBOA) in trauma patients with life-threatening injuries. This study aims to determine the optimal SBP threshold for REBOA placement by analyzing the association between SBP pre-REBOA and 24-hour mortality in severely injured hemodynamically unstable trauma patients. METHODS: We performed a pooled analysis of the aortic balloon occlusion (ABO) trauma and AORTA registries. These databases record the details related to the use of REBOA and include data from 14 countries worldwide. We included patients who had suffered penetrating and/or blunt trauma. Patients who arrived at the hospital with a SBP pre-REBOA of 0 mm Hg and remained at 0 mm Hg after balloon inflation were excluded. We evaluated the impact that SBP pre-REBOA had on the probability of death in the first 24 hours. RESULTS: A total of 1,107 patients underwent endovascular aortic occlusion, of these, 848 met inclusion criteria. The median age was 44 years (interquartile range [IQR], 27-59 years) and 643 (76%) were male. The median injury severity score was 34 (IQR, 25-45). The median SBP pre-REBOA was 65 mm Hg (IQR, 49-88 mm Hg). Mortality at 24 hours was reported in 279 (32%) patients. Math modeling shows that predicted probabilities of the primary outcome increased steadily in SBP pre-REBOA below 100 mm Hg. Multivariable mixed-effects analysis shows that when SBP pre-REBOA was lower than 60 mm Hg, the risk of death was more than 50% (relative risk, 1.5; 95% confidence interval, 1.17-1.92; p = 0.001). DISCUSSION: In patients who do not respond to initial resuscitation, the use of REBOA in SBPs between 60 mm Hg and 80 mm Hg may be a useful tool in resuscitation efforts before further decompensation or complete cardiovascular collapse. The findings from our study are clinically important as a first step in identifying candidates for REBOA. LEVEL OF EVIDENCE: Prognostic and Epidemiological; Level IV.

Acute appendicitis after closed abdominal trauma: A case report.

We present the case of a 14-year-old female patient with no clinical history who was admitted due to an impact on the abdomen and pelvis with a soccer ball during a match and who developed acute post-traumatic appendicitis. Acute appendicitis is one of the most common causes of acute abdomen. The diagnosis is mainly clinical and based on definitive history; however, the images can be decisive for the diagnosis. The etiology of acute appendicitis is well-reported in the literature, with the traumatic mechanism being one of the etiologies described. Acute post-traumatic appendicitis is rare; a timely diagnosis requires a high index of suspicion, a careful history, and a physical examination. Imaging with ultrasound or computed tomography is recommended if there is a discrepancy between the medical history and physical examination.

Resuscitative endovascular balloon occlusion of the aorta in civilian pre-hospital care: a systematic review of the literature.

BACKGROUND: Resuscitative endovascular balloon occlusion of the aorta (REBOA) is a damage control tool with a potential role in the hemodynamic resuscitation of severely ill patients in the civilian pre-hospital setting. REBOA ensures blood flow to vital organs by early proximal control of the source of bleeding. However, there is no consensus on the use of REBOA in the pre-hospital setting. This article aims to perform a systematic review of the literature about the feasibility, survival, indications, complications, and potential candidates for civilian pre-hospital REBOA. METHODS: A literature search was conducted using Medline, EMBASE, LILACS and Web of Science databases. Primary outcome variables included overall survival and feasibility. Secondary outcome variables included complications and potential candidates for endovascular occlusion. RESULTS: The search identified 8 articles. Five studies described the use of REBOA in pre-hospital settings, reporting a total of 47 patients in whom the procedure was attempted. Pre-hospital REBOA was feasible in 68-100% of trauma patients and 100% of non-traumatic patients with cardiac arrest. Survival rates and complications varied widely. Pre-hospital REBOA requires a coordinated and integrated emergency health care system with a well-trained and equipped team. The remaining three studies performed a retrospective analysis identifying 784 potential REBOA candidates. CONCLUSIONS: Pre-hospital REBOA could be a feasible intervention for a significant portion of severely ill patients in the civilian setting. However, the evidence is limited. The impact of pre-hospital REBOA should be assessed in future studies.

Measuring mesoscopic scales in complex fluids embedded with giant cylindrical micelles with diffusing wave spectroscopy micro-rheology.

This review paper presents a procedure for measuring the mesoscopic scales in micellar solutions embedded with giant cylindrical micelles using the mean square displacement determined with a quasi-elastic multiple light scattering method (diffusing wave spectroscopy) and theory. The mesoscopic scales of interest are the micelles' total contour length, persistence and entanglement lengths, and the mesh size of the entangled micellar network. All of them depend on the physicochemical parameters of the solutions and determine the rheological behavior. We present an assessment of the whole procedure, the scattering experiments performance, the recovery of optical parameters, which includes dealing with the light absorption and its treatment, and how to develop the micro-rheology for obtaining the mesoscopic scales in these complex fluids.

Sex Differences in Cognitive Abilities Among Children With the Autosomal Dominant Alzheimer Disease Presenilin 1 E280A Variant From a Colombian Cohort.

Importance: We previously reported that children with the autosomal dominant Alzheimer disease (ADAD) presenilin 1 (PSEN1) E280A variant had early life plasma biomarker findings consistent with amyloid ß overproduction. However, the cognitive functioning of children with this variant has not been characterized vs those without the variant. Objective: To test whether cognitive functioning of children with and without the PSEN1 E280A variant in the same ADAD cohort differed by genetic status (ie, PSEN1 variant) and sex. Design, Setting, and Participants: This cohort study was conducted among 1354 children (including 265 children with the variant) aged 6 to 16 years recruited from the Alzheimer Prevention Initiative Colombia Registry. Participants from the city of Medellín and surrounding suburban areas traveled to the University of Antioquia to undergo all procedures. Participants were administered a Spanish version of the Wechsler Intelligence Scale for Children, Fourth Edition (WISC-IV) to measure general cognitive functioning. Data were analyzed from July through November 2020. Main Outcomes and Measures: Univariate general linear models were used to characterize differences on WISC-IV cognitive performance by genetic status, sex, and the interaction of genetic status with sex. Urbanity, socioeconomic status, and education were entered as covariates. Results: Among 1354 children with ADAD (695 [51.3%] girls; mean [SD] age, 11.64 [2.64] years), there were 265 children with the variant (19.6%) and 1089 children without the variant (80.4%). Children with and without the variant did not differ by demographic variables or performance on WISC-IV indices. Irrespective of genetic status, boys had statistically significantly decreased mean scores on indices for working memory (90.27 [95% CI, 89.21-91.34] vs 92.99 [95% CI, 91.98-93.99]; mean difference = -2.72; P < .001), perceptual reasoning (91.56 [95% CI, 90.47-92.65] vs. 93.27 [95% CI, 91.23-94.30]; mean difference = -1.71; P = .03), and verbal comprehension (88.69 [95% CI, 87.54-89.84] vs. 90.81 [95% CI, 89.73-91.90]; mean difference = -2.12; P = .009) compared with girls. In the interaction between sex and genetic status, boys with the variant had worse mean working memory index performance (88.78 [95% CI, 86.86-90.70]) than girls with the variant (93.75 [95% CI, 91.95-95.55]; mean difference = -4.97; P = .001), as well as boys (91.77 [95% CI, 90.85-92.70]; mean difference = -2.99; P = .04) and girls (92.22 [95% CI, 91.32-93.13]; mean difference = -3.44; P = .009) without the variant. Conclusions and Relevance: This study found that boys with the PSEN1 variant had decreased working memory abilities compared with girls with the variant and boys and girls without the variant, suggesting a sex-specific genetic risk in early life cognitive performance among individuals with the PSEN1 variant. This increased risk of future cognitive difficulties among boys with the variant may have important downstream implications for learning and academic achievement and could be associated with sex differences seen in adulthood on episodic memory measures.

Descripción de las características clínicas y la respuesta a tratamiento en pacientes con miastenia grave sin timoma sometidos a timectomía en una institución de alta complejidad de Cali, Colombia, 2010-2017 / Description of the clinical characteristics and response to treatment in patients with myasthenia gravis without thymoma undergoing thymectomy in a tertiary level care institution in Cali, Colombia, 2010-2017

Introducción. La miastenia grave es una enfermedad autoinmunitaria con una prevalencia mundial de 150 a 250 casos por 1 ́000.000 de habitantes. El tratamiento recomendado para la miastenia grave sin timoma es la timectomía total, la cual es la única alternativa de curación. Métodos. Se llevó a cabo un estudio descriptivo y retrospectivo de una serie de casos de pacientes adultos con miastenia grave sin timoma sometidos a timectomía, durante el periodo de 2010 a 2017. En el análisis estadístico descriptivo, se utilizaron frecuencias absolutas y porcentajes para las variables cualitativas y, para las variables cuantitativas, se utilizaron la mediana y el rango intercuartílico. Resultados. Veintiocho pacientes con miastenia grave sin timoma se sometieron a timectomía desde el año 2010 hasta el 2017. Se categorizaron según la clasificación del estado posterior a la intervención de la Myasthenia Gravis Foundation of America y se evidenció que 4 (14,3 %) pacientes presentaban remisión completa y el grado 3 de manifestaciones clínicas mínimas fue el más frecuente en 19 (67,9 %); 26 (92,9 %) tuvieron mejoría con respecto al cambio del estado clínico, en 2 (7,1 %) no se documentaron cambios y en ningún paciente hubo empeoramiento, exacerbación o muerte secundaria a la enfermedad. Conclusiones. A lo largo de siete años se practicó timectomía a 28 pacientes con diagnóstico de miastenia grave sin timoma, aproximadamente, en el 15 % de los pacientes hubo remisión completa, el grado 3 de manifestaciones mínimas fue el más frecuente y el 93 % presentó mejoría de su estatus clínico.

Structural Changes in Wormlike Micelles on the Incorporation of Small Photoswitchable Molecules.

Chromophores susceptible to light-induced trans-cis isomerization embedded in cylindrical micelles can modify micelles and their light-responsive performance. A small chromophore (4-(phenylazo)benzoate ion) is embedded in cylindrical micelles made of cetyltrimethylammonium bromide (CTAB) and sodium salicylate (NaSal) in water. The microstructure is examined by scanning electron microscopy (SEM) and nuclear magnetic resonance (NMR). Rheological behavior and the length scales of the micellar network are determined by rheology and microrheology. The chromophore substantially modifies the micelles even without UV irradiation. The larger is the chromophore concentration, the smaller is the micellar length. Additional length scales of the micellar network do not substantially vary even when NaCl is added. Chromophore incorporation also modifies the rheology of the micellar solution, although gradient shear banding is preserved. Viscosity decreases as the chromophore concentration increases, and viscoelastic spectra are modified, but when they are correctly rescaled, they can be superimposed. The addition of the chromophore makes the fluids more Maxwellian, particularly when NaCl is also added. When the chromophore is incorporated into the micelles, there is a response after UV irradiation, although it does not produce a significant rheological change.

Morphological, structural, thermal, compositional, vibrational, and pasting characterization of white, yellow, and purple Arracacha Lego-like starches and flours (Arracacia xanthorrhiza).

This work is focused on the chemical, structural, morphological, thermal, IR vibrational, and pasting characterization of isolated white, yellow, and purple Arracacha starches from Colombia. Inductive couple plasma showed that these starches are rich in potassium. Scanning Electron Microscopy (SEM) images show that the starch granules are formed by ovoid fully filled Lego-like starch microparticles, the circular cross-section has a diameter between 9 and 15µm and mayor axis between 20 and 30µm. Each one of these ovoids is formed by irregular wedge-shaped 6 to 10 isolated starch granules with an average size between 4 and 12µm. The amylose content ranged between 31 and 36%. Arracacha starches exhibited high viscosity values (between 20.000 and 28.000cP), which could be influenced by the high content of potassium ions, due to the C-H~K Van Der Waals interaction that was identified by using IR spectroscopy. According to the X-ray diffraction analysis, the starch patterns exhibited broad diffracted peaks which could be associated with the existence of nano-crystals and lamellae; the Differential Scanning calorimetry (DSC) result showed starches with a low gelatinization temperature of about 60°C.

Emergy Analysis for the Sustainable Utilization of Biosolids Generated in a Municipal Wastewater Treatment Plant.

This contribution describes the application of an emergy-based methodology for comparing two management alternatives of biosolids produced in a wastewater treatment plant. The current management practice of using biosolids as soil fertilizers was evaluated and compared to another alternative, the recovery of energy from the biosolid gasification process. This emergy assessment and comparison approach identifies more sustainable processes which achieve economic and social benefits with a minimal environmental impact. In addition, emergy-based sustainability indicators and the GREENSCOPE methodology were used to compare the two biosolid management alternatives. According to the sustainability assessment results, the energy production from biosolid gasification is energetically profitable, economically viable, and environmentally suitable. Furthermore, it was found that the current use of biosolids as soil fertilizer does not generate any considerable environmental stress, has the potential to achieve more economic benefits, and a post-processing of biosolids prior to its use as soil fertilizer improves its sustainability performance. In conclusion, this emergy analysis provides a sustainability assessment of both alternatives of biosolid management and helps decision-makers to identify opportunities for improvement during the current process of biosolid management.

Physicochemical properties of nixtamalized corn flours with and without germ.

This research studied the influence of the germ components on the physicochemical properties of cooked corn and nixtamalized corn flours as a function of the calcium hydroxide content (from 0 to 2.1 w/w) and steeping time (between 0 and 9h). A linear relationship was found between calcium content in germ and steeping time used during nixtamalization process. X-ray diffraction analysis showed that calcium carbonate is formed into the germ structure to 2.1 w/w of calcium hydroxide and 9h steeping time. The presence of the germ improves the development of peak viscosity in flours, and it is related to the increases in calcium concentration in germ and the formation of amylose-lipid complexes. No significant changes were observed in palmitic, stearic, oleic and linoleic acids of corn oil. The levels of further corn oil deterioration were 2.1 w/w of calcium hydroxide concentration and 9h of steeping time.

Hipotiroidismo y apnea del sueño / Hypothyroidism and sleep apnea

Resumen La salud es un derecho fundamental de todo ser humano, ya reconocido por la Ley Estatutaria de Salud (Ley 1751 de 2015). Esta ley devuelve la autonomía profesional al médico y para hacer buen uso de ella, debemos ejercer nuestra profesión dentro de un marco de autorregulación, ética, racionalidad y evidencia científica. Somos los médicos los llamados a liderar la identificación de los gastos innecesarios en salud, sin descuidar la calidad de la atención. Iniciamos aquí una serie de artículos en los que esperamos exponer, bajo evidencia científica, cuáles prácticas en medicina debemos continuar, mejorar o abolir con el fin de autorregularnos bajo conceptos éticos, de calidad y de racionalidad científica. El cuadro clínico del hipotiroidismo y de la apnea del sueño son bastantes similares, sin embargo cada una tiene unas características clínicas particulares que son las que debemos evaluar. ¿Se recomienda solicitar rutinariamente pruebas de función tiroidea a todos los pacientes con sospecha diagnóstica o diagnóstico confirmado de apnea del sueño?; ¿Se recomienda realizar un estudio del sueño a todos los pacientes con diagnóstico de hipotiroidismo clínico o subclínico?. No se recomienda realizar pruebas de función tiroidea a todos los pacientes con diagnóstico de apnea del sueño, así como tampoco hacer estudio del sueño a todos los pacientes con hipotiroidis-mo. Solo se recomienda hacer cuando la sospecha clínica lo amerite. Sugerimos la realización de investigaciones de costo/efectividad. (Acta Med Colomb 2016; 41: 138-140).

Abstract Health is a fundamental right of every human being, as recognized by the Statutory Health Law (Law 1751 of 2015). This law puts professional autonomy to the doctor, and to make good use of it we must exercise our profession within a framework of self-regulation, ethics, rationality and scientific evidence. We the physicians are the ones who are called to lead the identification of unnecessary health expenses without sacrificing quality of care. We begin here a series of articles in which we expect expose, on scientific evidence, which medical practices must we continue, improve or abolish in order to self-regulate us under ethical, quality and scientific rationality concepts. The clinical picture of hypothyroidism and sleep apnea are quite similar, yet each has unique clinical features that are what we have to assess. Is it recommended routinely request thyroid tests to all patients with suspected or confirmed diagnosis of sleep apnea?. Is it recommended to perform a sleep study to all patients diagnosed with clinical or subclinical hypothyroidism?. It is not recommended practice thyroid function tests to all patients diagnosed with sleep apnea, nor do sleep study to all patients with hypothyroidism. It is recommended only when the clinical suspicion warrants it. We suggest carry out cost / effectiveness research. (Acta Med Colomb 2016; 41: 138-140).

Analysis of the pasting profile in corn starch: Structural, morphological, and thermal transformations, Part I.

This work is focused on the understanding of the apparent viscosity profile of corn starch, in terms of the physicochemical and morphological changes that take place during the thermal profile of starch-water suspension to its respective gel formation. A mathematical model was used to obtain the experimental operating conditions that satisfy the Froude number. Freeze drying samples are studied in different stages along the pasting profile. Changes in the structural properties of the samples are studied using X-ray diffraction, and the morphological changes are followed using scanning electron microscopy, differential scanning calorimetry was used to analyze the thermal changes in starch. The changes in the pasting profile are associated with structural, thermal,and morphological changes of the system and the analysis of the physicochemical transformation that occur during the pasting profile are explained. The finding in this work does not show evidence of gel retrogradation at the end of the cooling process.

Analysis of thermal pasting profile in corn starch rich in amylose and amylopectin: Physicochemical transformations, part II.

This work focused on the study of the behaviors of the apparent viscosity profiles of isolated corn starches rich in amylose and amylopectin, through the physicochemical and morphological changes that take place during the thermal profile and the gel formation. Frozen dry samples were studied at different stages along the pasting profile. Changes in the structural properties of the samples were studied using X-ray diffraction, and the morphological changes were followed using scanning electron microscopy, differential scanning calorimetry was used to analyze the thermal changes. The changes in the pasting profile (curve of apparent viscosity) were associated with structural, thermal, and morphological changes of the starch-water suspension. From the results obtained, a new interpretation of the parameters measured with the pasting profile is introduced. In this work does not show evidence of retrogradation at the end of the cooling process for starch rich in amylopectin and that starch rich in amylose does not develop viscosity.

Perfil de Calidad de Vida relacionada con la salud del adolescente, 1970-2013: meta-análisis / Profile of health related Quality of Life of adolescent, 1970-2013: meta-analysis

Objetivo: describir el impacto de diferentes enfermedades sobre la calidad de vida relacionada con la salud (CVRS) del adolescente a partir de investigaciones publicadas entre 1970 y 2013. Materiales y métodos: revisión sistemática con meta-análisis en 6 bases datos multidisciplinarias, aplicando un protocolo con las etapas de identificación,tamización, elección e inclusión. Se extrajeron los promedios de los puntajes de cada dominio del instrumento de medición de CVRS Pediatric Quality of life inventory TM.Las enfermedades se clasificaron según la CIE-10. Se calcularon índices de Kappa,frecuencias absolutas, relativas y medidas de resumen. Resultados: se incluyeron 7 1investigaciones en 22425 adolescentes con enfermedades endocrinas, del sistema digestivo, de la sangre, enfermedad renal crónica, artritis, neoplasias, enfermedades cardiacas, mentales, VIH y sanos. En el dominio físico los pacientes más afectados fueron quienes tenían osteosarcoma (43,5±30,3) y los menos afectados VIH (92,1±7,4);en el dominio sicosocial quienes presentaron menor puntaje fueron los de síndromede hipermovilidad (51,9±13,1) y los de mayor puntaje los que tenían talasemias(77,4±17,2), en el dominio escolar el mayor puntaje fue de pacientes con enfermedades congénitas (78,2±15,2). Conclusión: el estudio de la CVRS del adolescente dacuenta del impacto de las enfermedades en los dominios físico, sicosocial, emocional,social y escolar; y orienta a los clínicos y demás personas que se encargan de esta población, para un tratamiento holístico de la enfermedad que trasciende el enfoque biológico tradicional.

Physicochemical, morphological, and rheological characterization of Xanthosoma robustum Lego-like starch.

This work presents the physicochemical and pasting characterization of isolated mafafa starch and mafafa flour (Xanthosoma robustum). According to SEM images of mafafa starches in the tuber, these starches form Lego-like shaped structures with diameters between 8 and 35 µm conformed by several starch granules of wedge shape that range from 2 to 7 µm. The isolated mafafa starch is characterized by its low contents of protein, fat, and ash. The starch content in isolated starch was found to be 88.58% while the amylose content obtained was 35.43%. X-ray diffraction studies confirm that isolated starch is composed mainly by amylopectin. These results were confirmed by differential scanning calorimetry and thermo gravimetric analysis. This is the first report of the molecular parameters for mafafa starch: molar mass that ranged between 2×10(8) and 4×10(8) g/mol, size (Rg) value between 279 and 295 nm, and molecular density value between 9.2 and 9.7 g/(mol nm(3)). This study indicates that mafafa starch shows long chains of amylopectin this fact contributes to higher viscosity development and higher gel stability. The obtained gel phase is transparent in the UV-vis region. The viscosity, gel stability and optical properties suggest that there is potential for mafafa starch applications in the food industry.

Úlceras cutáneas y neuropatía trombótica como manifestaciones iniciales en un paciente con síndrome antifosfolípido / Cutaneous ulcers and thrombotic neuropathy as first manifestations in a patient with antiphospholipid syndrome

Se presenta el caso de un hombre de 34 años con cuadro clínico crónico de úlceras cutáneas y monoparesia inferior izquierda. Electromiografía que evidencia neuropatía sensitiva del nervio fibular superficial izquierdo; estudios ecográficos sin evidencia de enfermedad arteriovenosa. El paciente no presentó mejoría de lesiones cutáneas con inmunosupresión agresiva. En la biopsia de piel y de nervio sural se encontraron trombos y ausencia de infiltrado inflamatorio compatibles con vasculopatía y neuropatía trombóticas. Se documentó la presencia de anticoagulante lúpico, TPT prolongado y anticuerpos anti-B2 glicoproteína 1 positivos.

This following case report describes a 34 years-old man with chronic clinical skin ulcers and left lower monoparesis. Electromyography revealed sensory neuropathy of the left superficial fibular nerve; the ecographic studies showed absence of artery or venous disorder. The patient showed no improvement of skin lesions with aggressive immunosuppression. The biopsy of the skin and the sural nerve reported thrombi and absence of inflammatory infiltrates; findings that support the diagnosis of thrombotic vasculopathy and neuropathy. The presence of lupus anticoagulant, prolonged PTT and positive anti-B2 glycoprotein antibodies were documented.

Implementación y aplicación de algoritmos Retinex al preprocesamiento de imágenes de retinografía color / Implementation and application of Retinex algorithms to the preprocessing of retinography color images

La retinopatía diabética es una enfermedad causada por complicaciones de la retina, con evolución progresiva. Esta patología se detecta en las imágenes de fondo de ojo que, en la mayoría de los casos, presentan iluminación no uniforme. En este trabajo se implementaron y aplicaron cuatro algoritmos de la teoría Retinex a imágenes de fondo de ojo, con el fin de proporcionar una mejor iluminación, para una posterior visualización o procesamiento, buscando detectar con mayor exactitud la presencia o no de la enfermedad y poder hacer un seguimiento más acertado

Diabetic retinopathy is a disease caused by complications of the retina, with progressive evolution. This pathologyis detected on the fundus eye images, which in most cases have non-uniform illumination. In this paper four type of algorithms, based on the Retinex theory, were implemented and applied to fundus images in order to provide better illumination for later visualization or processing. The purpose was to find more accuracy to detect the presence or not of the disease and thus to get a more accurate approach of diagnosis