A sustainable activated carbon fiber/TiO2 cathode for the photoelectro-Fenton treatment of pharmaceutical pollutant enalapril.

In this work, a TiO2-decorated electrode was fabricated by dip coating activated carbon fibers (ACF) with TiO2, which were then used as a cathode for the photoelectro-Fenton (PEF) treatment of the pharmaceutical enalapril, an angiotensin-converting enzyme inhibitor that has been detected in several waterways. The TiO2 coating was found to principally improve the electrocatalytic properties of ACF for H2O2 production via the 2-e- O2 reduction, in turn increasing enalapril degradation by PEF. The effect of the current density on the mineralization of enalapril was evaluated and the highest TOC removal yield (80.5% in 3 h) was obtained at 8.33 mA cm-2, in the presence of 0.5 mmol L-1 of Fe2+ catalyst. Under those conditions, enalapril was totally removed within the first 10 min of treatment with a rate constant k = 0.472 min-1. In contrast, uncoated ACF only achieved 60% of TOC removal in 3 h at 8.33 mA cm-2. A degradation pathway for enalapril mineralization is proposed, based on the degradation by-products identified during treatment. Overall, the results demonstrate the promises of TiO2 cathodes for PEF, a strategy that has often been overlooked in favor of photoelectrocatalysis (PEC) based on TiO2-modified photoanodes.

A new approach of simultaneous adsorption and regeneration of activated carbon to address the bottlenecks of pharmaceutical wastewater treatment.

This study proposes a sustainable approach for hard-to-treat wastewater using sintered activated carbon (SAC) both as an adsorption filter and as an electrode, allowing its simultaneous electrochemical regeneration. SAC improves the activated carbon (AC) particle contact and thus the conductivity, while maintaining optimal liquid flow. The process removed 87 % of total organic carbon (TOC) from real high-load (initial TOC of 1625 mg/L) pharmaceutical wastewater (PWW), generated during the manufacturing of azithromycin, in 5 h, without external input of chemicals other than catalytic amounts of Fe(II). Kinetic modelling indicated that adsorption was the dominant process, while concomitant electrochemical degradation of complex organics first converted them to short-chain acids, followed by their full mineralization. In-situ electrochemical regeneration of SAC, taking place at the same time as the treatment, is a key feature of our process, enhancing its performance and ensuring its stable operation over time, while eliminating cleaning downtimes altogether. The energy consumption of this innovative process was remarkably low at 8.0×10-3 kWh gTOC-1. This study highlights the potential of SAC for treating hard-to-treat effluents by concurrent adsorption and mineralization of organics.

Purinergic P2X7 receptor-mediated inflammation precedes PTSD-related behaviors in rats.

Clinical evidence has linked increased peripheral pro-inflammatory cytokines with post-traumatic stress disorder (PTSD) symptoms. However, whether inflammation contributes to or is a consequence of PTSD is still unclear. Previous research shows that stress can activate purinergic P2X7 receptors (P2X7Rs) on microglia to induce inflammation and behavioral changes. In this investigation, we examined whether P2X7Rs contribute to the development of PTSD-like behaviors induced by single prolonged stress (SPS) exposure in rats. Consistent with the literature, exposing adult male and female rats to SPS produced a PTSD-like phenotype of impaired fear extinction and extinction of cue-induced center avoidance one week after exposure. Next, we examined if inflammation precedes the behavioral manifestations. Three days after SPS exposure, increased inflammatory cytokines were found in the blood and hippocampal microglia showed increased expression of the P2X7R, IL-1ß, and TNF-α, suggesting increased peripheral and central inflammation before the onset of impaired fear extinction. In addition, SPS-exposed animals with impaired fear extinction recall also had more Iba1-positive microglia expressing the P2X7R in the ventral hippocampus. To determine whether P2X7Rs contribute to the PTSD-related behaviors induced by SPS exposure, we gave ICV infusions of the P2X7R antagonist, A-438079, for one week starting the day of SPS exposure. Blocking P2X7Rs prevented the SPS-induced impaired fear extinction and extinction of cue-induced center avoidance in male and female rats, suggesting that SPS activates P2X7Rs which increase inflammation to produce a PTSD-like phenotype.

Three-Day Icatibant on Top of Standard Care in Patients With Coronavirus Disease 2019 Pneumonia: A Randomized, Open-Label, Phase 2, Proof-of-Concept Trial.

BACKGROUND: We aimed to evaluate icatibant, a competitive antagonist of the bradykinin B2 receptors, for the treatment of inpatients with coronavirus disease 2019 (COVID-19) pneumonia admitted in the early hypoxemic stage. METHODS: The randomized, open-label clinical trial of icatibant for COVID-19 pneumonia (ICAT·COVID, registered as NCT04978051 at ClinicalTrials.gov) was conducted in Barcelona. Inpatients requiring supplemental but not high-flow oxygen or mechanical ventilation were allocated (1:1) to treatment with either three 30-mg icatibant doses/d for 3 consecutive days plus standard care or standard care alone, and followed for up to 28 days after initial discharge. The primary and key secondary outcomes were clinical response on study day 10/discharge and clinical efficacy at 28 days from initial discharge, respectively. RESULTS: Clinical response occurred in 27 of 37 patients (73.0%) in the icatibant group and 20 of 36 patients (55.6%) in the control group (rate difference, 17.42; 95% confidence interval [CI], -4.22 to 39.06; P = .115). Clinical efficacy ensued in 37 patients (100.0%) in the icatibant group and 30 patients (83.3%) in the control group (rate difference, 16.67; 95% CI, 4.49-28.84; P = .011). No patient died in the icatibant group, compared with 6 patients (16.7%) in the control group (P = .011). All patients but 1 had adverse events, which were evenly distributed between study arms. No patient withdrew because of adverse events. CONCLUSIONS: Adding icatibant to standard care was safe and improved both COVID-19 pneumonia and mortality in this proof-of-concept study. A larger, phase 3 trial is warranted to establish the clinical value of this treatment. CLINICAL TRIALS REGISTRATION: NCT04978051.

Predictors of revisits within 1 year by patients after acute COVID-19: the HUBCOVID365 cohort study. / Predictores de revisita en pacientes con infección aguda COVID-19 con seguimiento al año: estudio de cohorte HUBCOVID365.

OBJECTIVES: To analyze the frequencies of 3 types of hospital revisits by patients after treatment for COVID-19 in the emergency department. MATERIAL AND METHODS: Retrospective observational study of consecutive patients who came to the emergency department in March and April 2020 and were discharged alive with a diagnosis of COVID-19. Baseline and acute episode data were collected and the patients were followed for 1 year. We analyzed variables associated with revisits for any reason, revisits related to COVID-19, and early COVID-19-related revisits (within 30 days). RESULTS: A total of 1352 patients with a mean age of 62.1 years (52.9% male) were studied. A total of 553 revisits were made by 342 patients (25.3%) for any reason; 132 (9.8%) revisited in relation to COVID-19 at least once. Of those, 103 (7.6%) revisited within 30 days (early) and 29 (2.2%) came later. COVID-19-related revisits were associated with thrombotic events (odds ratio [OR], 7.58; 95% CI, 1.75-32.81) and pulmonary fibrosis (OR, 4.95; 95% CI, 1.27-19.24); early revisits were inversely associated with follow-up management by a contracted health care support service (OR, 0.18; 95% CI, 0.03-0.92). Hospital admission during the initial visit was significantly associated with fewer revisits for any reason or related to COVID-19 at any time. CONCLUSION: Fewer than half the total number of emergency department revisits after initial care for COVID-19 were related to the novel coronavirus infection. Revisits occurred more often in the first 30 days after discharge. Later COVID-19-related revisits were uncommon, but given the large number of patients with this infection, such visits can be expected.

OBJETIVO: Analizar diferentes categorías de revisita (RV) al año en pacientes con infección COVID-19 que consultan en un servicio de urgencias hospitalario (SUH). METODO: Estudio observacional, retrospectivo, que incluyó pacientes consecutivos que consultaron al SUH en los meses de marzo y abril de 2020 con diagnóstico de COVID-19 y fueron dados de alta vivos del hospital. Se recogieron variables basales y del episodio agudo y se realizó un seguimiento al año. Se hicieron tres comparaciones identificando variables asociadas a la RV total, RV relacionada con COVID-19 (RCovid) y RCovid precoz (# 30 días). RESULTADOS: Se analizaron 1.352 pacientes con edad media de 62,1 años y 52,9% varones. En el seguimiento al año hubo 553 RV en 342 (25,3%) pacientes, 132 (9,8%) con al menos una RCovid, 103 (7,6%) precoz y 29 (2,2%) tardía. La RCovid se relacionó con la presencia de fenómenos trombóticos [OR 7,58 (IC 95%: 1,75-32,81)] y la fibrosis pulmonar [OR 4,95 (IC 95%: 1,27-19,24)]; y la RCovid precoz se relacionó inversamente con alta a dispositivo de soporte sanitario [OR 0,18 (IC 95%: 0,03-0,92)]. El ingreso hospitalario en el evento índice disminuyó la RV total y RCovid y las hospitalizaciones derivadas de esta RV de manera significativa a largo plazo. CONCLUSIONES: Menos de la mitad de la RV total tras una infección COVID-19 está relacionada con la infección, y es más frecuente en los primeros 30 días. La RCovid tardía no es frecuente, pero dado el elevado número de pacientes que han sido infectados por COVID-19 se debe tener en cuenta.

Predictores de revisita en pacientes con infección aguda COVID-19 con seguimiento al año: estudio de cohorte HUBCOVID365 / Predictors of revisits within 1 year by patients after acute COVID-19: the HUBCOVID365 cohort study

Objetivo. Analizar diferentes categorías de revisita (RV) al año en pacientes con infección COVID-19 que consultan en un servicio de urgencias hospitalario (SUH). Método. Estudio observacional, retrospectivo, que incluyó pacientes consecutivos que consultaron al SUH en los meses de marzo y abril de 2020 con diagnóstico de COVID-19 y fueron dados de alta vivos del hospital. Se recogieron variables basales y del episodio agudo y se realizó un seguimiento al año. Se hicieron tres comparaciones identifican- do variables asociadas a la RV total, RV relacionada con COVID-19 (RCovid) y RCovid precoz (# 30 días). Resultados. Se analizaron 1.352 pacientes con edad media de 62,1 años y 52,9% varones. En el seguimiento al año hubo 553 RV en 342 (25,3%) pacientes, 132 (9,8%) con al menos una RCovid, 103 (7,6%) precoz y 29 (2,2%) tardía. La RCovid se relacionó con la presencia de fenómenos trombóticos [OR 7,58 (IC 95%: 1,75-32,81)] y la fibrosis pulmonar [OR 4,95 (IC 95%: 1,27-19,24)]; y la RCovid precoz se relacionó inversamente con alta a dispositivo de so- porte sanitario [OR 0,18 (IC 95%: 0,03-0,92)]. El ingreso hospitalario en el evento índice disminuyó la RV total y RCovid y las hospitalizaciones derivadas de esta RV de manera significativa a largo plazo. Conclusión. Menos de la mitad de la RV total tras una infección COVID-19 está relacionada con la infección, y es más frecuente en los primeros 30 días. La RCovid tardía no es frecuente, pero dado el elevado número de pacientes que han sido infectados por COVID-19 se debe tener en cuenta.

Objective. To analyze the frequencies of 3 types of hospital revisits by patients after treatment for COVID-19 in the emergency department. Methods. Retrospective observational study of consecutive patients who came to the emergency department in March and April 2020 and were discharged alive with a diagnosis of COVID-19. Baseline and acute episode data were collected and the patients were followed for 1 year. We analyzed variables associated with revisits for any reason, revisits related to COVID-19, and early COVID-19–related revisits (within 30 days). Results. A total of 1352 patients with a mean age of 62.1 years (52.9% male) were studied. A total of 553 revisits were made by 342 patients (25.3%) for any reason; 132 (9.8%) revisited in relation to COVID-19 at least once. Of those, 103 (7.6%) revisited within 30 days (early) and 29 (2.2%) came later. COVID-19–related revisits were associated with thrombotic events (odds ratio [OR], 7.58; 95% CI, 1.75–32.81) and pulmonary fibrosis (OR, 4.95; 95% CI, 1.27–19.24); early revisits were inversely associated with follow-up management by a contracted health care support service (OR, 0.18; 95% CI, 0.03–0.92). Hospital admission during the initial visit was significantly associated with fewer revisits for any reason or related to COVID-19 at any time. Conclusions. Fewer than half the total number of emergency department revisits after initial care for COVID-19 were related to the novel coronavirus infection. Revisits occurred more often in the first 30 days after discharge. Later COVID-19–related revisits were uncommon, but given the large number of patients with this infection, such visits can be expected.

Sex-dependent effects of microglial reduction on impaired fear extinction induced by single prolonged stress.

Single prolonged stress (SPS) is a preclinical rodent model for studying post-traumatic stress disorder (PTSD)-like behaviors. Previously we found that increased expression of the microglial marker Iba-1 in the ventral hippocampus after SPS exposure was associated with impaired fear extinction, suggesting that microglial activity contributed to the SPS-induced behavioral changes. To test this, we examined whether reducing microglia with the colony-stimulating factor 1 receptor blocker, PLX3397, in the diet would prevent the SPS-induced extinction impairment. Male rats exposed to SPS showed enhanced fear acquisition and impaired fear extinction memory. Adding PLX3397 to the diet prevented these behavioral changes. In contrast, PLX3397 did not prevent SPS from impairing fear extinction memory in the female rats. Despite the sex-dependent behavioral effects, we found a reduced number and area fraction of Iba-1+ microglia in both male and female rats suggesting that PLX3397 had similar effects on microglia in both sexes. Altogether, these results suggest that microglia contribute to the behavioral changes induced by SPS in male but not female rats.

A microbubble-assisted rotary tubular titanium cathode for boosting Fenton's reagents in the electro-Fenton process.

To improve cathodic H2O2 accumulation and Fe3+ reduction synchronously in the electro-Fenton (EF) process, a microbubble-assisted rotary tubular titanium cathode (MRTTC) was designed for the first time. By utilizing this MRTTC, H2O2 accumulation improved by 4.05-fold, along with a 200% enhancement in iron reduction compared to the conventional EF process. This promotion is mainly attributed to a considerably higher oxygen mass transfer, which reduces the thickness of the adhered diffusion layer. The oxygen mass transfer coefficient (KLa) also improved from 0.0073 s-1 to 0.012 s-1 at a rotational speed of 300 rpm. In addition, the microbubble-assisted cathode further improved the KLa to 0.047 s-1. The synergistic effect between the rotating and microbubble-assisted cathodes further intensified H2O2 accumulation in MRTTC. Apart from H2O2 promotion, the iron reduction rate was elevated because the newly formed O2-• provided an additional reduction pathway for Fe3+ reduction in addition to the cathodic path. The effectiveness of MRTTC was confirmed by treating a benchmark organic pollutant, sulfamerazine (SMR), where approximately 100% SMR decay was obtained in 3 h. The results show that MRTTC is a novel and promising design in EF for antibiotic wastewater treatment.

Measurement of total and free prostate specific antigen (PSA) in human serum samples using an ultra-microanalytical system.

Prostate specific antigen (PSA) is a serine protease used for the screening of prostate cancer. The total portion of PSA (tPSA) can be found in its free form (fPSA), or bound to other proteins forming a stable complex. A heterogeneous sandwich-type UltraMicro Enzyme-Linked ImmunoSorbent Assay (UMELISA) has been developed for the measurement of tPSA and fPSA in human serum samples. Strips coated with a high affinity monoclonal antibody (MAb) directed against PSA are used as solid phase, to ensure the specificity of the assay. Biotinylated MAbs specific for tPSA and fPSA ensured sensitivity, given the high affinity binding to streptavidin. The assay was completed in 1.5 h, with a measuring range 0.019-20 µg/L (tPSA), and 0.009-20 µg/L (fPSA). The intra- and inter-assay CV were lower than 9%. Recovery percentages were 96-105%. High correlations were found between the values of the UMELISA PSA standards and the International Reference Standards 96/670 (R2 = 0.9996) and 96/688 (R2 = 0.9989). The assay did not recognize any of the interfering molecules tested. Regression analysis of serum samples showed a good correlation with Roche Elecsys total PSA (n = 631, R2 = 0.986, ρc = 0.992), BioMérieux VIDAS TPSA (n = 631, R2 = 0.989, ρc = 0.993) and Roche Elecsys free PSA (n = 164, R2 = 0.973, ρc = 0.979), all with a relative difference below 15%, and a p < 0.001. A retrospective study of the use of UMELISA PSA in Cuba was carried out. The analytical performance characteristics of UMELISA PSA support its use for the quantification of tPSA and fPSA in human serum samples in a single kit, making it an affordable diagnostic assay available to Cuban Public Health System and developing countries. Between the years 2014-2020, more than 3 million Cuban patients have benefited from the test for free.

An enzyme immunoassay to determine human chorionic gonadotropin (HCG) in serum and urine samples using an ultra-microanalytical system.

The determination of Human Chorionic Gonadotropin (HCG) in biological fluids is of great interest in the early pregnancy diagnostics, the evaluation of pregnancy disorders, as a tumor marker, as a screening procedure for anti-doping control, and many other purposes. A simple sandwich-type UltraMicro Enzyme-Linked ImmunoSorbent Assay (UMELISA) has been developed for the measurement of HCG in serum and urine samples. Strips coated with a high affinity MAb directed against HCG are used as solid phase, to ensure the specificity of the assay. The HCG assay was completed in 1.5 h, with a measuring range of 0.76-400 mIU/mL. The intra- and inter-assay coefficients of variation were lower than 10 %, depending on the HCG concentrations evaluated. Recovery percentages were 96.43-97.16 % (serum) and 98.10-99.04 % (urine). The assay detected intact HCG, nicked HCG, HCG ß, and nicked HCG ß, and did not recognize any of the interfering molecules tested. Regression analysis showed a good correlation with Elecsys in serum (n = 1459, r = 0.952, ρc = 0.948) and urine (n = 869, r = 0.988, ρc = 0.978). A good correlation was also found with 84 RIQAS samples analyzed with the kits Elecsys (r = 0.969, ρc = 0.957), Architect (r = 0.982, ρc = 0.970), Dimension (r = 0.989, ρc = 0.977), and Bioscience (r = 0.992, ρc = 0.980), all with a p < 0.01. Comparison with transvaginal ultrasonography in early pregnancy detection showed a specificity and a sensitivity of 100 % (n = 2385, κ = 1). The analytical performance characteristics of UMELISA HCG endorse its use for the quantification of HCG in serum and urine samples. This assay will make a cost-effective diagnostic kit accessible to low-income countries and is now available in the Cuban Public Health System.

Unconventional electro-Fenton process operating at a wide pH range with Ni foam cathode and tripolyphosphate electrolyte.

We propose an unconventional electro-Fenton (EF) system with a nickel-foam (Ni-F) cathode and tripolyphosphate (3-PP) electrolyte at near-neutral pH (EF/Ni-F-3-PP) to overcome pH restrictions in EF while preventing Ni-F corrosion. Response surface modelling was used to optimize the main operating parameters with a model prediction analysis (R2 = 0.99): pH = 5.8, Fe2+ = 3.0 mM and applied current = 349.6 mA. Among the three variables, the pH exerted the highest influence on the process. Under optimal conditions, 100 % of phenol removal was achieved in 25 min with a pseudo-first-order apparent rate constant (kapp) of 0.2 min-1, 3.2-fold higher than the kapp of EF/Ni-F with SO42- electrolyte at pH 3. A mineralization yield of 81.5 % was attained after 2 h; furthermore, it was found that 3-PP enhanced H2O2 accumulation by preventing bulk H2O2 decomposition. Finally, toxicity evaluation revealed the formation of toxic by-products at the early stages of treatment, which were totally depleted after 2 h, demonstrating the detoxifying capacity of the system. In conclusion, this study shows for the first time the potential of Ni-F as a cathode for EF under near-neutral conditions, rendered possible by the 3PP electrolyte. Under these conditions, the Ni-F corrosion issue could be alleviated.

Implementation of a community-based hypertension control program in Matanzas, Cuba.

Increased blood pressure is a leading risk factor for death worldwide, and improving the control of hypertension is a major health goal to reduce non-communicable disease. Thus, in 2016, as part of a regional effort between the Pan American Health Organization and Cuban Ministry of Public Health to reduce cardiovascular risk and disease, a community demonstration project was implemented to enhance hypertension control. The intervention project was in a population of 25 868 people served by the Carlos Verdugo Martínez Polyclinic in Matanzas, Cuba. The project implemented interventions currently recommended in the World Health Organization HEARTS modules, including a standardized clinical training program with certification for blood pressure measurement, routine screening for hypertension in clinics and in the community, a simple directive pharmacologic treatment algorithm, and a registry with performance reporting and feedback. Qualitative and quantitative program monitoring and evaluation was established. In a 2010 national survey, the prevalence of hypertension and the rate of hypertension control were estimated to be 31% and 36%, respectively. Following less than one year of the full implementation of the program, the prevalence of hypertension, proportion of the hypertensive population registered as having hypertension, proportion of those drug-treated who were controlled, and estimated population rate of control were 30%, 90%, 68%, and 58%, respectively. Based on these positive results, the program has been expanded to include another demonstration program initiated in a second region. In addition, preliminary efforts to disseminate and scale-up aspects of the program to the full Cuban population have started.

Prevalence and incidence of chronic kidney disease in Cuba.

Chronic kidney disease (CKD) is a health problem worldwide. This article's objective is to describe CKD's integration into Cuba's National Noncommunicable Diseases (NCD) Program and the main outcomes regarding the burden of CKD and associated risk factors in Cuba. Cuba offers free health services to all its citizens on the basis of a strong primary healthcare system focused on prevention. The CKD National Program is coordinated by the Institute of Nephrology and includes the National Program for Prevention of CKD, which addresses all levels of prevention. The following indicators for renal replacement treatment are from 2016. The incidence of new patients on dialysis was 109 per million population (pmp); the two main causes were hypertension (34.4%) and diabetes mellitus (29.2). In 6.3% of patients, CKD cause could not be determined because they presented at advanced stages. The prevalence of patients on dialysis was 289 pmp; 90% of dialysis patients were on hemodialysis. The main causes of death were cardiovascular diseases (30.25%), cerebrovascular diseases (11.1%), and infections (29.5%). The kidney transplant rate was 14.3 pmp. Kidney transplants performed with cadaveric donors were 86.5% of total, with living related donors 13.5%. The Isle of Youth Study (ISYS) was designed to assess predialysis chronic kidney disease patterns; its methodology has been published previously. Results: Risk factors: age > 59 years 32%, women 67.8%, overweight 34.3%, obesity 22.8%, hypertension 41.5%, diabetes 13%. Estimated CKD prevalence was 9.63%. The integration of CKD into Cuba's NCD Program has gathered knowledge of burden and trends of CKD and better risk factor control.

Waste-wood-derived biochar cathode and its application in electro-Fenton for sulfathiazole treatment at alkaline pH with pyrophosphate electrolyte.

For the first time, a biomass-derived porous carbon cathode (WDC) was fabricated via a facile one-step pyrolysis of recovered wood-waste without any post-treatment. The WDC along with pyrophosphate (PP) as electrolyte were used in electro-Fenton (EF) at pH 8 for sulfathiazole (STZ) treatment. The H2O2 accumulation capacity of WDC was optimized via the following parameters: pyrolysis temperature, applied current and electrolyte. Results showed that the WDC cathode prepared at 900 °C achieved the highest H2O2 accumulation (13.80 mg L-1 in 3 h) due to its larger electroactive surface area (28.81 cm2). Interestingly, it was found that PP decreased the decomposition rate of H2O2 in solution as compared to conventional electrolyte, which resulted in higher H2O2 accumulation. PP allowed operating EF at pH of 8 due to the formation of Fe2+-PP complexes in solution. Moreover, Fe2+-PP was able to activate oxygen to produce OH. In this way, the degradation of STZ took place through four main pathways: 1) via OH from the Fe2+-PP complex, 2) via OH from EF reactions, 3) via surface OH at the boron doped diamond electrode (BDD) and 4) via SO4- from BDD activation. Finally, microtox tests revealed that some toxic intermediates were generated during WDC/BDD/PP EF treatment, but they were removed at the end of the process.

Incidencia de diagnóstico y tratamiento de la osteoporosis en pacientes con fractura de radio distal / Diagnosis and treatment incidence of osteoporosis in patients with distal radius fracture

Introducción: Las fracturas de radio distal en pacientes mayores son un indicador de osteoporosis. El objetivo de este estudio fue determinar el diagnóstico y el tratamiento de la osteoporosis en pacientes con fractura de radio distal, operados en nuestra institución, entre 2012 y 2014. Materiales y Métodos: Los datos se obtuvieron de entrevistas telefónicas a 41 pacientes mayores, operados por fracturas de radio distal. Las variables evaluadas fueron: sexo, edad, enfermedades asociadas, tabaquismo, fracturas previas, tratamiento antiosteoporótico previo o posterior a la fractura en cuestión, especialidad del médico que solicitó el tratamiento y realización o no de densitometría mineral ósea. Resultados: La muestra incluyó a 41 pacientes (32 mujeres). Veintiséis contaban con una densitometría antes de la fractura (15 con osteoporosis), 11 habían sufrido una fractura por osteoporosis, y sólo 7 recibían tratamiento antiosteoporótico cuando ocurrió la fractura. Luego de la cirugía, solo 4 de ellos continuó con el tratamiento. Se encontró cierta asociación entre una densitometría patológica y la presencia de diabetes tipo 2, no así con otras comorbilidades. La tasa de incidencia anual de osteoporosis, calculada entre todos los pacientes que se atendieron en nuestra institución, en 2014, fue alrededor del 1%. Los traumatólogos solicitaron el 1,5% de todas las densitometrías prescritas dicho año. Conclusiones: Este estudio sugiere que los traumatólogos que se desempeñan en nuestra institución tienen nula o poca participación en la prevención secundaria de la osteoporosis; por esta razón, se consideraría necesario un protocolo de prevención de fracturas secundarias a la osteoporosis. Nivel de Evidencia: IV

Introduction: Distal radius fractures in elderly patients are an indicator of osteoporosis. The aim of this study was to determine osteoporosis diagnosis and treatment rates in patients with distal radius fractures treated surgically at our institution between 2012 and 2014. Methods:Information of 41 patients who underwent surgical intervention for distal radius fracture was obtained through telephone interviews. There were several variables evaluated-age, sex, smoking, comorbidities, previous fractures, preoperative and postoperative osteoporosis treatments, specialty of the physicians prescribing osteoporosis treatment, and a DEXA scan performed. Results: The study included 41 patients (32 women). Twenty-six of them had a DEXA scan performed before the fracture (15 patients evidenced osteoporosis), 11 had suffered previous fractures secondary to osteoporosis. Only 7 patients were under osteoporosis treatment at the moment of the fracture. After surgery, only 4 patients continued treatment. Pathological DEXA scan results had certain degree of association with the presence of type 2 diabetes, but not with other comorbidities. The annual incidence rate of osteoporosis, calculated using all patients served at our institution in 2014, was about 1%. Orthopedic surgeons accounted for only 1.5% of the total number of DEXA scans prescribed that year. Conclusions: Our study suggests that there is poor prevention by orthopedic surgeons of secondary osteoporotic fractures, which is why a national prevention protocol for fractures secondary to osteoporosis would be necessary. Level of Evidence: IV

Plasticity of NMDA Receptors at Ventral Hippocampal Synapses in the Infralimbic Cortex Regulates Cued Fear.

The medial prefrontal cortex (mPFC) processes contextual information from the hippocampus to generate appropriate fear responses. In rodents, one path for sending contextual information to the mPFC is via the direct projections from the ventral hippocampus (vHC) to the infralimbic cortex (IL). Plasticity in the synaptic communication from the vHC to the IL could contribute to the behavioral changes produced by the acquisition and extinction of conditioned fear. To examine this possibility, we used optogenetic stimulation of vHC synapses in brain slices from trained rats. We found that fear acquisition reduced NMDA receptor (NMDAR) currents at vHC synapses onto IL pyramidal neurons. The depression of NMDAR currents reversed more efficiently after extinction in the conditioning context than extinction in a novel context. Moreover, a cohort of animals that exhibited poor extinction retrieval failed to reverse the plasticity induced by fear conditioning. In addition, ex vivo application of brain-derived neurotrophic factor (BDNF), which is known to simulate extinction in IL, reversed this conditioning-induced plasticity mimicking extinction. Therefore, we have identified a novel mechanism that modulates conditioned fear via changes in NMDAR current at vHC synapses onto IL pyramidal neurons. Disruption of this mechanism could contribute to the abnormal contextual modulation of fear seen in posttraumatic stress disorder (PTSD).

CARACTERIZACIÓN Y USO DE LOS RESIDUOS SÓLIDOS GENERADOS POR EMPRESAS DEL SECTOR METALMECÁNICO EN LA CIUDAD DE MANIZALES / CHARACTERIZATION AND USE OF SOLID WASTE PRODUCED BY COMPANIES OF THE METALLURGICAL INDUSTRY IN THE CITY OF MANIZALES

Este artículo presenta los resultados de la caracterización de los residuos sólidos en las empresas más importantes del sector metalmecánico de la ciudad de Manizales. Inicialmente, se estableció la conceptualización normativa y teórica que fundamenta los aspectos relacionados con los residuos industriales, luego se hizo énfasis en los residuos sólidos del sector metalmecánico. Se planteó, como parte de la metodología, un instrumento para la recolección de la información basado en el Catálogo Europeo de Residuos. El instrumento permitió el registro de la información de acuerdo a la estructura básica de una empresa metalmecánica y los posibles residuos que se pueden generar a lo largo de la secuencia del proceso productivo, además de su manejo y disposición. Se encontró que los residuos con mayor volumen de generación son los metálicos, cartón, papel y madera que, en conjunto, representan aproximadamente el 84% del total. El 67% de los residuos generados se están aprovechando directamente por las empresas, donde la donación corresponde al 12%. Finalmente, aunque se conoce la disposición de los residuos, no se sabe con exactitud el impacto, en términos del grado de aprovechamiento.

This paper presents the results of the characterization of solid waste in the most important companies in the metallurgical industry in the city of Manizales. Initially, the normative and theoretical conceptualization that substantiate the aspects related to industrial waste was established and then, emphasis was placed on solid waste in the metallurgical sector. An instrument for the collection of information based on the European Waste Catalog was proposed as part of the methodology. The instrument allowed the registration of the information according to the basic structure of a metallurgic industry and the possible waste that can be generated throughout the sequence of the production process, in addition to its management and disposal. It was found that the waste with the highest volume of generation are metal, cardboard, paper, and wood, which together represent approximately 84% of the total. The 67% of the waste generated is being used directly by the companies and the donation corresponds to 12%. Finally, although the disposal of the waste is known, the impact in terms of the degree of use is not known exactly.

Simplex based three-dimensional eigenray search for underwater predictions.

A solution for the calculation of three-dimensional (3D) eigenrays based on Simplex optimization, implemented in a 3D Gaussian beam model, is investigated in this paper. The validation and performance of the solution were analyzed through comparisons against an equivalent (flat) two-dimensional waveguide, and against results of a tank scale experiment presented in Sturm and Korakas [(2013). J. Acoust. Soc. Am. 133(1), 108-118], in which cross-slope propagation in a wedge waveguide with a mild slope was considered. It was found that the search strategy based on Simplex optimization was able to calculate efficiently and accurately 3D eigenrays, thus providing predictions of arrival patterns along cross-slope range, which replicated elaborate patterns of mode shadow zones, intra-mode interference, and mode arrivals. A remarkable aspect of the search strategy was its ability to provide accurate values of initial eigenray elevation and azimuth, within the accuracy defined for the eigenray to arrive at the location of a given hydrophone.

Upwelling regime off the Cabo Frio region in Brazil and impact on acoustic propagation.

This work introduces a description of the complex upwelling regime off the Cabo Frio region in Brazil and shows that ocean modeling, based on the feature-oriented regional modeling system (FORMS) technique, can produce reliable predictions of sound speed fields for the corresponding shallow water environment. This work also shows, through the development of simulations, that the upwelling regime can be responsible for the creation of shadow coastal zones, in which the detection probability is too low for an acoustic source to be detected. The development of the FORMS technique and its validation with real data, for the particular region of coastal upwelling off Cabo Frio, reveals the possibility of a sustainable and reliable forecast system for the corresponding (variable in space and time) underwater acoustic environment.

Enfermedades no transmisibles: factores de riesgo y acciones para su prevención y control en Cuba

[RESUMEN]. Las enfermedades no transmisibles (ENT) representan uno de los mayores desafíos para el desarrollo en el siglo XXI, debido al devastador impacto social, económico y de la salud pública que provocan. El propósito de este artículo es describir la evolución y los factores de riesgo de las ENT en Cuba, principalmente en el período 1990–2015, reseñar las acciones emprendidas por el Ministerio de Salud Pública y destacar los desafíos más importantes para su prevención y control. La información contenida proviene de los datos colectados y publicados por la Dirección de Registros Médicos y Estadísticas de Salud, investigaciones sobre los factores de riesgo, otros estudios fundamentados y la documentación de acciones integrales. La mortalidad en Cuba está determinada por cuatro grandes problemas de salud: enfermedades cardiovasculares, tumores malignos, enfermedades crónicas de las vías respiratorias inferiores y diabetes mellitus, que en conjunto causan el 68,0% de los fallecimientos. La tendencia del cáncer es al ascenso y la enfermedad renal crónica emerge como un grave problema de salud. Cuba cuenta con una línea de base conocida sobre los factores de riesgo, de ellos la hipertensión y el consumo de tabaco son los principales relacionados con la mortalidad por ENT. En consonancia con la importancia de estas enfermedades se aprecian hitos e intervenciones de impacto positivo, así como brechas y desafíos en el marco del Plan de Acción Mundial de la Organización Mundial de la Salud para el enfrentamiento a las ENT.

[ABSTRACT]. Non-communicable diseases (NCDs) represent one of the greatest challenges for development of the 21st century due to their devastating social, economic and public health impact. The objective of this article are to describe the evolution and risk factors for NCDs in Cuba, mainly in the period 1990–2015, to outline actions undertaken by the Ministry of Public Health of Cuba, and to highlight the most important challenges with a focus on their prevention and control. The information is based on data collected and published by the Directorate of Medical Records and Health Statistics, research on risk factors, other studies and documentation of comprehensive actions. Mortality in Cuba is determined by four major health problems: cardiovascular diseases, malignant tumors, chronic diseases of the lower respiratory tract and diabetes mellitus, which together cause 68.0% of deaths. Cancer presents a growing trend, and chronic kidney disease emerges as a serious health problem. Cuba has a known baseline on risk factors, and hypertension and tobacco consumption are the main factors related to NCDs mortality. In line with the importance of these diseases, there are milestones and interventions with a positive impact, as well as gaps and challenges within the framework of the World Health Organization’s Global Action Plan for the Prevention and Control of NCDs.

[RESUMO]. As doenças não transmissíveis (DNT) representam um dos maiores desafios do século 21 para o desenvolvimento devido ao desvastador impacto social, econômico e de saúde pública que elas causam. O objetivo deste artigo é descrever a evolução e os fatores de risco das doenças não transmissíveis em Cuba, principalmente no período de 1990–2015, para delinear as ações realizadas pelo Ministério da Saúde Pública de Cuba e destacar os desafios mais importantes para sua prevenção e controle. A informação vem dos dados coletados e publicados pela Diretoria de Registros Médicos e Estatísticas de Saúde, pesquisa sobre fatores de risco, outros estudos fundamentados e documentação de ações abrangentes. A mortalidade em Cuba é determinada por quatro principais problemas de saúde: doenças cardiovasculares, tumores malignos, doenças crônicas do trato respiratório inferior e diabetes mellitus, que em conjunto causam 68,0% das mortes. O câncer tem uma tendência crescente, e a doença renal crônica surge como um grave problema de saúde. Cuba tem uma linha de base conhecida sobre os fatores de risco, dos quais a hipertensão e o consumo de tabaco são os principais relacionados à mortalidade por DNT. Em consonância com a importância dessas doenças, há marcos e intervenções com impacto positivo, bem como lacunas e desafios no âmbito do Plano de Ação Mundial da Organização Mundial da Saúde para enfrentar as doenças não transmissíveis.