Accuracy of a Smartwatch to Assess Heart Rate Monitoring and Atrial Fibrillation in Stroke Patients.

(1) Background: Consumer smartwatches may be a helpful tool to screen for atrial fibrillation (AF). However, validation studies on older stroke patients remain scarce. The aim of this pilot study from RCT NCT05565781 was to validate the resting heart rate (HR) measurement and the irregular rhythm notification (IRN) feature in stroke patients in sinus rhythm (SR) and AF. (2) Methods: Resting clinical HR measurements (every 5 min) were assessed using continuous bedside ECG monitoring (CEM) and the Fitbit Charge 5 (FC5). IRNs were gathered after at least 4 h of CEM. Lin's concordance correlation coefficient (CCC), Bland-Altman analysis, and mean absolute percentage error (MAPE) were used for agreement and accuracy assessment. (3) Results: In all, 526 individual pairs of measurements were obtained from 70 stroke patients-age 79.4 years (SD ± 10.2), 63% females, BMI 26.3 (IQ 22.2-30.5), and NIHSS score 8 (IQR 1.5-20). The agreement between the FC5 and CEM was good (CCC 0.791) when evaluating paired HR measurements in SR. Meanwhile, the FC5 provided weak agreement (CCC 0.211) and low accuracy (MAPE 16.48%) when compared to CEM recordings in AF. Regarding the accuracy of the IRN feature, analysis found a low sensitivity (34%) and high specificity (100%) for detecting AF. (4) Conclusion: The FC5 was accurate at assessing the HR during SR, but the accuracy during AF was poor. In contrast, the IRN feature was acceptable for guiding decisions regarding AF screening in stroke patients.

Oral Administration of Silybin Protects Against MPTP-Induced Neurotoxicity by Reducing Pro-inflammatory Cytokines and Preserving BDNF Levels in Mice.

Parkinson's disease (PD) is the second most frequent neurodegenerative disease associated with motor dysfunction secondary to the loss of dopaminergic neurons in the nigrostriatal axis. Actual therapy consists mainly of levodopa; however, its long-term use promotes secondary effects. Consequently, finding new therapeutic alternatives, such as neuroprotective molecules, is necessary. Among these alternatives is silybin (Sb), the major bioactive flavonolignan in silymarin. Both exert neuroprotective effects, preserving dopamine levels and dopaminergic neurons when administered in the 1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine (MPTP) mouse PD model, being probably Sb the potential therapeutic molecule behind this effect. To elucidate the role of Sb in the PD model, we determined the dose-dependent conservation of striatal dopamine content following Sb oral administration. Then, we evaluated motor deficit tests using the best dopamine conservative dose of Sb and determined a cytokine-dependent inflammatory profile status, malondialdehyde as an oxidative stress product, and neurotrophic factors content in the MPTP-induced mouse PD model. Our results show that oral Sb at 100 mg/kg dose conserved about 60% dopamine levels. Also, Sb improved motor deficits, preserved neurotrophic factors content and mitochondrial function, reduced lipid peroxidation, diminished proinflammatory cytokines to basal levels, enhanced fractalkine production in the striatum and substantia nigra, and increased IL-10 and IL-4 levels in the substantia nigra in the MPTP mice. Thus, oral Sb may be a potential pharmacological PD treatment alternative.

The Healthy Native Youth Implementation Toolbox: Using Implementation Mapping to adapt an online decision support system to promote culturally-relevant sexual health education for American Indian and Alaska Native youth.

Background: American Indian and Alaska Native (AI/AN) youth experience serious disparities in sexual and reproductive health, including the highest teen birth rate among racial/ethnic groups, and disproportionate rates of sexually transmitted infections (STI), including HIV. A growing number of evidence-based programs (EBPs) that integrate the strengths and cultural teachings of Native communities exist. Yet, multiple factors, including lack of trained personnel, limited resources, and geographic isolation, may hinder their adoption and implementation. Innovative implementation strategies that facilitate the adoption and implementation of sexual health EBPs in Native communities may help reduce these disparities. Methods: We applied Implementation Mapping, a systematic planning framework that utilizes theory, empirical evidence, and community input, to adapt a theory-based, online decision support system, iCHAMPSS (CHoosing And Maintaining Effective Programs for Sex Education in Schools), to support underlying dissemination and implementation processes unique to Native communities. We used an iterative design process, incorporating input from Native practitioners and academicians, to ensure that the adapted decision support system reflects cultural identification, community values, and experiences. Results: Grounded in diffusion of innovations, organizational stage theory, and social cognitive theory, the Healthy Native Youth Implementation Toolbox supports Native practitioners through five phases (Gather, Choose, Prepare, Implement, and Grow) to adopt, implement, and maintain a culturally-relevant, age-appropriate sexual health EBP. The Toolbox provides tools, ready-to-use templates, and guidance to plan, implement, and grow a culturally-relevant adolescent health program with their Tribe or community. Hosted within the Healthy Native Youth website (www.healthynativeyouth.org), the Toolbox comprises: (1) a curriculum portal with access to 15 culturally-relevant, age-appropriate evidence-based health promotion programs for AI/AN youth; (2) a "resource library" comprising 20+ support tools, templates, and links to external resources, and (3) "stories from the field" comprising testimonials from experienced Native educators, who have implemented sexual health programs. Conclusion: There is a continued need to design, test, and evaluate D&I strategies that are relevant to Native communities. The Healthy Native Youth Implementation Toolbox contributes to the dissemination and implementation of evidence-based, culturally-relevant sexual health education programs in diverse Native communities. Implementation Mapping provided a systematic approach to guide the adaptation process and integrate community voice with the ultimate goal of enhancing sexual health equity among AI/AN youth.

Meningitis por Listeria monocytogenes en paciente adulto mayor / Listeria Monocytogenes Meningitis In Elderly Patient

La meningitis por Listeria monocytogenes es una enfermedad grave y potencialmente mortal. Es la tercera causa de meningitis bacteriana a pesar de ser poco frecuente. Los recién nacidos, adultos mayores, gestantes y pacientes inmunocomprometidos son la población más afectada. Se presenta el caso de una paciente de 70 años con antecedente de hipertensión arterial, cáncer de tiroides no activo e ingesta esporádica de alimentos fuera de casa; que ingresa con síndrome febril de cinco días de evolución, leve cefalea e inapetencia. Al examen clínico presentó rigidez de nuca leve a moderada, sin hallazgos radiológicos significativos en el sistema nervioso central. Inició tratamiento antibiótico empírico, que fue continuado durante cuatro semanas al obtener resultado de hemocultivo y cultivo de líquido cefalorraquídeo positivos a Listeria monocytogenes. Se discute la importancia de considerar esta etiología en los diagnósticos de meningitis en la población adulta, ya que podría estar ocurriendo un cambio epidemiológico de su virulencia hacia poblaciones adultas

Listeria monocytogenes meningitis is a serious and life-threatening disease. It is the third cause of bacterial meningitis, despite being rare. Newborns, elderly, pregnant women and immunocompromised patients are the most affected population. We present the case of a 70-year-old patient with a history of hypertension, non-active thyroid cancer, with sporadic food intake outside the home, who is admitted with a 5-day evolution fever syndrome, slight headache and inappetence. On clinical examination, she presented mild to moderate neck stiffness, without significant radiological findings in the central nervous system. She started empirical antibiotic treatment, which was continued for 4 weeks, obtaining both blood culture and cerebrospinal fluid culture resulting positive for Listeria monocytogenes. The importance of considering this etiology in the diagnosis of meningitis in the adult population is discussed, since an epidemiological change of its virulence towards adult populations could be occurring.

Oral Silica Nanoparticles Lack of Neurotoxic Effects in a Parkinson's Disease Model: A Possible Nanocarrier?

Silica nanoparticles (SiO2-NP) are an option as drug carriers due to their biodegradability, biocompatibility, and capacity to bind themselves to other compounds. However, until now, the effect of these particles on the brain when neurodegeneration occurs is unknown. Hence, this work focused on the in vivo evaluation of the neurotoxic effects of SiO2-NP when oxidative and inflammation are present during the development of Parkinson's disease. To determine whether SiO2-NP may act as a non-neurotoxic carrier we evaluated if the intragastric administration (ig) of SiO2-NP of 150 nm (25, 50 and 100 mg/kg administered for five consecutive days) increased neuronal damage induced with 1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine (MPTP) administration. SiO2-NP administration did not further decrease cell viability assessed by MTT reduction, nor increased lipid peroxidation measured by TBARS or TNF α levels in the striatum and the substantia nigra in the MPTP model. Furthermore, we observed no additional reduction in striatal dopamine levels. The present results suggest that SiO2-NP of 150 nm are suitable nanocarrier for Parkinson's disease drugs without generating any additional damage.

Tratamiento de lesiones relacionadas con la dependencia en paciente con enfermedad degenerativa demencial con dependencia severa / Treatment of dependence-related lesions in a patient with dementia degenerative disease with severe dependence

El éxito de los resultados en la gestión avanzada de heridas depende de su correcta valoración. Objetivo: El objetivo de este caso clínico es presentar los resultados del tratamiento de una lesión relacionada con la dependencia combinada o mixta: úlcera por presión de categoría III como complicación de una lesión asociada a la humedad de grado 2A en zona sacra en una paciente con dependencia severa debido a enfermedad degenerativa demencial. Metodología: Gestión avanzada de heridas con apósitos especializados y cuidados de enfermería específicos; este caso cumple con los aspectos éticos de recogida de datos y autorización de familiar a cargo. Resultados: Cicatrización de las lesiones. Conclusiones: La correcta valoración permite proporcionar cuidados específicos y oportunos, con resultados favorables

The good results in wound scar depends on the correct classification. Objective: the objective of this clinical case is to present the results of the treatment of injury related to combined or mixed dependence: pressure ulcer category III as a complication of a lesion associated with grade 2A humidity in the sacral area in a patient with severe dependence due to disease Degenerative dementia. Methodology: Advanced wound management with specialized dressings and specific nursing care; this case complies with the ethical aspects of data collection and authorization of dependent family member. Results: Wound healing. Conclusions: The correct valuation allows the delivery of specific and timely care, with favorable results

Tumor abdominopélvico por actinomicosis en gestante / Abdominopelvic tumor due to actinomycosis in a pregnant woman

La actinomicosis es una infección poco frecuente causada por el Actinomyces spp, germen grampositivo, de naturaleza saprofita, ubicado en la boca, tracto genital y el tracto digestivo inferior. Su diagnóstico resulta difícil por la poca frecuencia y clínica muy variable. Se presenta el caso de una mujer de 28 años, de 34½ semanas de gestación, con masa pélvica y abdominal hipogástrica acompañada de dolor abdominal. Un día antes de su ingreso, se intensificó el dolor en fosa ilíaca derecha tipo contracción. Sometida a cesárea se obtuvo producto a término; de inmediato se realizó histerectomía y resección de tumor de pared abdominal más resección en bloque de la cúpula vesical más apendicectomía. La anatomía patológica informó actinomicosis. Se incide en la forma de presentación, en una paciente gestante con producto pretérmino y vivo, así como los signos y síntomas que ayudan a considerar este diagnóstico.

Actinomycosis is a rare infection caused by Actinomyces spp, a gram-positive germ of saprophytic nature, located in the mouth, genital tract and lower gastrointestinal tract. Its diagnosis is difficult because of its low frequency and variable clinical presentation. We report the case of a 28-year-old female, 34½ weeks pregnant, who presented a pelvic and hypogastric mass accompanied by abdominal pain. One day before admission, the contraction-like pain in the right iliac fossa intensified. The patient underwent a cesarean section and a full-term product was obtained. This surgery was followed by hysterectomy and resection of an abdominal wall tumor as well as en bloc resection of the vesical dome plus appendectomy. The pathology report informed actinomycosis. We focus on the presentation in a pregnant woman with a preterm and live product, as well as the signs and symptoms that help consider this diagnosis.

Antihypertensive responses of vasoactive androgens in an in vivo experimental model of preeclampsia.

Dehydroepiandrosterone (DHEA), testosterone (TES) and its 5-reduced metabolites induce a nongenomic vasorelaxation in several vascular beds of mammals; similarly these hormones produce systemic hypotensive and antihypertensive responses in normotensive and hypertensive male rats. Thus, it was hypothesized that the antihypertensive response of androgens, whose levels are elevated during gestation, protect against gestational hypertension. An animal model of preeclampsia was induced in female Wistar rats using DOCA-salt-treated pregnant (PT) and normal pregnant (NP) rats. In vivo experiments in conscious rats revealed that bolus intravenous injections of DHEA, TES, 5α- or 5ß-dihydrotestosterone (-DHT) log -1.0 to 2.0µmolk-1min-1, produced substantial transient reductions in arterial blood pressure (BP), without significant changes in heart rate (HR). Mean arterial blood pressure (MAP) was reduced significantly in both groups. PT rats were more sensitive to the antihypertensive responses of androgens than NP. DHEA and 5ß-DHT were the most potent to reduce MAP: 66±07 and 69±2.0mmHg in PT but only 33±0.5 and 35±1.2mmHg in NP rats, respectively. In isolated aortas of PT and NP, the concentration-response curves to each androgen (0.1-100µM) indicated that KCl-induced pre-contraction is more sensitive to all androgens than phenylephrine (Phe) pre-contractions. Notably, 5ß-DHT is the greatest vasorelaxant with KCl-induced contraction than with Phe contraction of both groups, suggesting a preferential blockade on L-VOCCs. TES exhibited minor vasorelaxing effect of aortas pre-contracted with KCl, compared to its precursor DHEA and its 5-reduced metabolites. These data show that these androgens exert acute vasorelaxing effects in vitro and remarkably, reduce the BP in vivo in PT and NP at term pregnancy. Moreover, a deficit in feto-placental androgen production during pregnancy may trigger the development of preeclampsia or gestational hypertension.

Correlación entre síntomas gastrointestinales funcionales y la histopatología de la mucosa gástrica, incluyendo la infección por Helicobacter pylori, en Lima, Perú.

OBJECTIVE: This study aims to investigate the relationship between functional gastrointestinal disorders and histopathology characteristics, including H. pylori infection, of gastric mucosa, at Cayetano Heredia National Hospital, Lima-Peru, in 2013. MATERIALS AND METHODS: 112 patients were interviewed prospectively between June and July 2013 in the gastroenterology service. Dyspepsia, irritable bowel syndrome, and postprandial distress syndrome were characterized using the Rome III Survey. RESULTS: Pathology results were determined by gastric biopsies obtained by endoscopy. Of the patients interviewed, biopsy results were obtained for 101. 22.8% had atrophy, 24.8% had intestinal metaplasia, 57.4% presented with H pylori. CONCLUSIONS: Using chi-square analysis, no statistically significant relationship could be identified between clinical presentation and biopsy results.

Correlación entre síntomas gastrointestinales funcionales y la histopatología de la mucosa gástrica, incluyendo la infección por Helicobacter pylori, en Lima, Perú / Correlation between functional gastrointestinal disorders and gastric mucosa histopathology findings, including Helicobacter pylori infection, in Lima, Peru

This study aims to investigate the relationship between functional gastrointestinal disorders and histopathology characteristics, including H. pylori infection, of gastric mucosa, at Cayetano Heredia National Hospital, Lima-Peru, in 2013. Materials and methods: 112 patients were interviewed prospectively between June and July 2013 in the gastroenterology service. Dyspepsia, irritable bowel syndrome, and postprandial distress syndrome were characterized using the Rome III Survey. Results: Pathology results were determined by gastric biopsies obtained by endoscopy. Of the patients interviewed, biopsy results were obtained for 101. 22.8% had atrophy, 24.8% had intestinal metaplasia, 57.4% presented with H pylori. Conclusions: Using chisquare analysis, no statistically significant relationship could be identified between clinical presentation and biopsy results...

El objetivo de este estudio fue investigar la correlación que existe entre la presencia de síntomas gastrointestinales y los hallazgos histopatológicos de la biopsia gástrica incluyendo la presencia de la infección por Helicobacter pylori. Materiales y métodos: Este estudio prospectivo comprendió a 112 pacientes que se incluyeron entre junio y julio de 2013 en el Servicio de Gastroenterología del Hospital Nacional Cayetano Heredia, Lima-Perú a los que se les hizo endoscopía y biopsia gástrica. Los síntomas de dispepsia, síndrome de intestino irritable y síndrome de distrés post prandial fueron obtenidos usando las encuestas de Roma III. Resultados: De los pacientes a los que se les hizo la encuesta sólo en 101 se les evaluó la biopsia. 22,8% tuvo atrofia, 24,8% presentó metaplasia intestinal, y en 57,4% se reportó la infección por Helicobacter pylori. Conclusiones: Usando el análisis con chi-cuadrado no se pudo establecer ninguna correlación estadísticamente significativa entre la presentación clínica y los resultados de las biopsias...

Fístula arteriovenosa pulmonar. Presentación de un caso clínico y revisión bibliográfica / Arteriovenous pulmonary fistula. A clinical case and bibliography review

La fístula arteriovenosa pulmonar congénita es la conexión directa de arteriolas pulmonares con vénulas pulmonares sin interposición de capilares. El resultado hemodinámico es un shunt de sangre arterial dentro de una baja resistencia; la magnitud de los efectos periféricos locales y sistémicos dependen de la localización, diámetro y número de comunicaciones vasculares y constituye una rara causa de cianosis en la edad pediátrica. Presentamos un caso clínico de una paciente con fístula arteriovenosa pulmonar postraumática. Femenino de nueve años, iniciando su padecimiento posterior a un traumatismo a nivel de tórax, con cianosis peribucal y en extremidades superiores e inferiores de 18 meses de evolución sin otra sintomatología agregada. Fue valorada en su lugar de origen por los servicios de cardiología, neumología y hematología, sin diagnóstico específico. A su ingreso es valorada integralmente, se realiza electrocardiograma, ecocardiograma, placas radiológicas de tórax, tomografía axial de tórax, broncoscopia y broncografía, con resultados normales. Se realiza centellografía perfusoria pulmonar, reportándose zonas de hipoperfusión difusa e irregular; solicita cineangiografía y se confirma diagnóstico de fístulas arteriovenosas en pulmón izquierdo. Se intervino quirúrgicamente y se realizó lobectomía izquierda. Actualmente su evolución clínica es satisfactoria y no hay evidencias de cianosis