Analyzing heterogeneity in Alzheimer Disease using multimodal normative modeling on imaging-based ATN biomarkers.

INTRODUCTION: Previous studies have applied normative modeling on a single neuroimaging modality to investigate Alzheimer Disease (AD) heterogeneity. We employed a deep learning-based multimodal normative framework to analyze individual-level variation across ATN (amyloid-tau-neurodegeneration) imaging biomarkers. METHODS: We selected cross-sectional discovery (n = 665) and replication cohorts (n = 430) with available T1-weighted MRI, amyloid and tau PET. Normative modeling estimated individual-level abnormal deviations in amyloid-positive individuals compared to amyloid-negative controls. Regional abnormality patterns were mapped at different clinical group levels to assess intra-group heterogeneity. An individual-level disease severity index (DSI) was calculated using both the spatial extent and magnitude of abnormal deviations across ATN. RESULTS: Greater intra-group heterogeneity in ATN abnormality patterns was observed in more severe clinical stages of AD. Higher DSI was associated with worse cognitive function and increased risk of disease progression. DISCUSSION: Subject-specific abnormality maps across ATN reveal the heterogeneous impact of AD on the brain.

Systemic resistance induced in tomato plants by Beauveria bassiana-derived proteins against tomato yellow leaf curl virus and aphid Myzus persicae.

BACKGROUND: Tomato (Solanum lycopersicum L.) is an economically important vegetable crop around the globe. Tomato yellow leaf curling (TYLC) is the most devastating viral disease posing a serious threat to tomato production throughout the tropical and subtropical world. Induction of microbe-mediated systemic resistance in plants has been of great interest in recent years as a novel microbiological tool in disease and insect pest management. This in-vitro study aimed to determine the effectiveness of different strains (BB252, BB72 and ARSEF-2860) of a hypocreal fungus Beauveria bassiana against TYLCV disease and aphid Myzus persicae. Potted tomato plants exogenously treated with conidial and filtrate suspensions of B. bassiana strains and of their partially purified or purified proteins were exposed to TYLCV inoculum and aphid M. persicae. RESULTS: Results showed a significant suppression of TYLCV disease severity index by the exogenous application of conidial, filtrate and protein treatments of all B. bassiana strains and this response was directly proportional to the treatment concentration. Similarly, mean fecundity rate of M. persicae was also significantly reduced by the highest concentration of ARSEF-2860-derived elicitor protein PeBb1, followed by the highest concentrations of BB252- and BB72-derived partially purified proteins. Moreover, these B. bassiana-derived proteins also caused a significant upregulation of most of the plant immune marker genes associated with plant defense. CONCLUSION: Overall, the study findings suggest that these B. bassiana strains and their partially purified or purified elicitor proteins could be effective biological tools for the management of TYLCV and aphid infestation on tomato plants. © 2023 Society of Chemical Industry.

Ulcerative colitis overall disease severity index predicts colectomy: a prospective cohort study

Background: ulcerative colitis (UC) overall disease severity index (DSI) has been established. A prospective cohort study was performed to find the value of DSI to predict colectomy within one and four years and explored the association between DSI and other indexes. Methods: the hospitalized UC patients were enrolled from March 2018 to January 2019 in this single center study. DSI, Truelove and Witts criteria, Mayo index and Seo index were assessed by medical records. Outcome was whether to undergo colectomy within one and four years and was obtained by telephone survey or medical records. Index values of predicting colectomy within one and four years were evaluated using receiver operating characteristics (ROC) curves. Results: one hundred and thirty-eight of 233 hospitalized UC patients were enrolled. Within one year, the follow-up period was less than one year for six patients and two patients had died. A further nine patients underwent colectomy. The Spearman correlation coefficient between DSI and Truelove and Witts criteria, Mayo index and Seo index were 0.730, 0.839 and 0.843, respectively. Using these indices to predict colectomy within one and four years, the area under the curve of DSI was more than those of other indices and the cut-off value of DSI was 79. Conclusions: a good correlation of DSI with other indexes was demonstrated. DSI can be used to predict the need for colectomy within one or four years (AU)

Validation of disease severity index for predicting complicated disease in Crohn's disease: A comparison study with Lémann index.

BACKGROUND: Disease Severity Index (DSI) provides comprehensive assessment of bowel damage (BD). AIMS: To evaluate DSI in patients with Crohn's disease (CD) at high risk of disease progression, compared to Lémann Index (LI). METHODS: Patients with CD in our center were reviewed consecutively between 2017 and 2019. DSI, LI, and complicated CD course were analyzed. RESULTS: The median LI and DSI of included 300 patients were 1.63 (IQR 1.25-3.13) and 42 (IQR 32-51), respectively. 152 patients (50.7%) experienced a complicated disease course (median 5.1 months; IQR 1.1-20.2). DSI (AUC 0.66; 95% CI 0.60-0.72) better predicted a complicated course of CD over LI (AUC 0.56; 95% CI 0.50-0.63; P = 0.007). The cumulative probability of complicated CD course in severe patients was higher than those with 'mild CD' (P < 0.001). The Cox analysis identified DSI>43 (HR 2.18; 95% CI 1.54-3.09; P < 0.001), B2/3 vs. B1 (HR 2.80; 95% CI 1.99-3.94; P < 0.001), and a higher level of CRP (HR 1.01; 95% CI 1.00-1.02; P = 0.005) as independent prognostic factors for complicated CD. However, LI was not associated with complicated CD (P = 0.164). CONCLUSIONS: Higher DSI was associated with complicated disease outcomes. DSI might play a better role than LI in identifying patients at high risks of disease progression.

Comparison of Ganoderma boninense Isolate's Aggressiveness Using Infected Oil Palm Seedlings.

Basal stem rot incidence caused by a white-rot fungus, Ganoderma boninense, is the major disease of oil palm in Southeast Asia. The rate of disease transmission and host damage are affected by variations in pathogen aggressiveness. Several other studies have used the disease severity index (DSI) to determine G. boninense aggressiveness levels while verifying disease using a culture-based method, which might not provide accurate results or be feasible in all cases. To differentiate G. boninense aggressiveness, we employed the DSI and vegetative growth measurement of infected oil palm seedlings. Disease confirmation was performed through scanning electron microscopy and molecular identification of fungal DNA from both infected tissue and fungi isolated from Ganoderma selective medium. Two-month-old oil palm seedlings were artificially inoculated with G. boninense isolates (2, 4A, 5A, 5B, and 7A) sampled from Miri (Lambir) and Mukah (Sungai Meris and Sungai Liuk), Sarawak. The isolates were categorized into three groups: highly aggressive (4A and 5B), moderately aggressive (5A and 7A), and less aggressive (2). Isolate 5B was identified as the most aggressive, and it was the only one to result in seedling mortality. Out of the five vegetative growth parameters measured, only the bole size between treatments was not affected. The integration of both conventional and molecular approaches in disease confirmation allows for precise detection.

Pathotype Characterization of Plasmodiophora brassicae, the Cause of Clubroot in Central Europe and Sweden (2016-2020).

Clubroot, caused by Plasmodiophora brassicae, is a crucial oilseed rape disease worldwide. Information on the virulence of P. brassicae populations is essential to apply disease control with proper clubroot-resistant cultivars. In 2016-2020, 84 isolates of P. brassicae were collected in the Czech Republic (CZ), Germany (DE), Poland (PL), and Sweden (SW). Pathotypes were designated using 17 Brassica hosts, including the European Clubroot Differentials (ECD), Somé set, and clubroot-resistant oilseed rape cv. Mendel. According to the ECD set, virulence analyses differentiated the isolates into 42 pathotypes. The most common pathotypes were 16/31/31 (in DE, PL, and SW) and 16/06/12 (in CZ, DE, and PL). Six pathotypes were found according to the Somé set, including 1-4 pathotypes per country. P1 was most prevalent in DE, PL, and SW, while P3 was abundant in CZ, DE, and PL. The current study provides clear evidence for a shift towards increased virulence in P. brassicae populations compared to previous studies. Several isolates overcame the resistance of cv. Mendel and of Brassica rapa genotypes ECD 01 to ECD 04. Considering all investigated samples, significant negative correlations were found between clubroot incidence and the frequency of oilseed rape in crop rotation, as for clubroot incidence and soil pH.

Occurrence and Distribution of Tomato Brown Rugose Fruit Virus Infecting Tomato Crop in Saudi Arabia.

During the growing season of 2021-2022, a total of 145 symptomatic tomato leaf and fruit samples were collected from different locations in Riyadh Region, Saudi Arabia, showing a moderate-to-severe mosaic with dark green wrinkling, blistering, narrowing, and deformation with necrosis spot on tomato leaves, while irregular brown necrotic lesions, deformation, and yellowing spots rendering the fruits non-marketable were observed on tomato fruits. These samples were tested serologically against important tomato viruses using enzyme-linked immunosorbent assay (ELISA), and the obtained results showed that 52.4% of symptomatic tomato samples were found positive for Tomato brown rugose fruit virus (ToBRFV), wherein 12 out of 76 samples were singly infected; however, 64 out of 145 had mixed infection. A sample with a single infection of ToBRFV was used for mechanical inoculation into a range of different host plants; symptoms were observed weekly, and the presence of the ToBRFV was confirmed by ELISA and reverse transcription-polymerase chain reaction (RT-PCR). A total RNA was extracted from selected ELISA-positive samples, and RT-PCR was carried out using specific primers F-3666 and R-4718, which amplified a fragment of 1052 bp. RT-PCR products were sequenced in both directions, and partial genome nucleotide sequences were submitted to GenBank under the following accession numbers: MZ130501, MZ130502, and MZ130503. BLAST analysis of Saudi isolates of ToBRFV showed that the sequence shared nucleotide identities (99-99.5%) among them and 99-100% identity with ToBRFV isolates in different countries. A ToBRFV isolate (MZ130503) was selected for mechanical inoculation and to evaluate symptom severity responses of 13 commonly grown tomato cultivars in Saudi Arabia. All of the tomato cultivars showed a wide range of symptoms. The disease severity index of the tested cultivars ranged between 52% and 96%. The importance ToBRFV disease severity and its expanding host range due to its resistance breaking ability was discussed.

Asociación entre la infestación por el Demodex sp. y el acné vulgar grave. Estudio transversal de 168 pacientes / Association Between Demodex Infestation and Severe Acne Vulgaris: A Cross-Sectional Study of 168 Patients

Antecedentes y objetivos Existen antecedentes de asociación de la infestación por Demodex sp. y el acné vulgar. El objetivo fue evaluar si la infestación por Demodex sp. se asocia a acné vulgar grave en consultas externas del Hospital Regional Lambayeque. Material y métodos Estudio trasversal en 46 pacientes con acné grave y 92 pacientes con acné no grave. Se definió como acné vulgar grave al de los participantes que tuvieron un grado ≥ 3 con la escala de gravedad del acné en español (EGAE). La infestación por Demodex sp. se determinó mediante biopsia cutánea superficial, considerándose infestación si existieron más de 5 ácaros por cm2. Resultados El 60,9% de los participantes fueron del sexo masculino, con una mediana de edad de 18 años y un rango intercuartílico de 15 a 20 años, provenían del sector urbano (81,9%) y se encontró infestación por Demodex sp. en el 29,7%. En el análisis bivariado, se encontró asociación estadísticamente significativa entre acné vulgar grave e infestación por Demodex sp. (p=0,001), sexo (p=0,003), procedencia (p=0,015), antecedente paterno de acné (p=0,045), antecedente materno de acné (p=0,045) y tipo de piel (p<0,001). En el análisis multivariado la infestación por Demodex sp. estuvo 4,2 veces más asociada a acné vulgar grave (IC 95%: 1,6-10,9; p=0,003) ajustado por sexo, procedencia urbana, tratamiento previo, antecedentes paterno y materno de acné vulgar y presencia de piel grasa. Conclusiones La infestación por Demodex sp. se asocia al acné vulgar grave (AU)

Background and objectives Infestation with Demodex mites has been associated with acne vulgaris. The aim of this study was to explore the association between Demodex infestation and severe acne vulgaris in outpatients seen at Hospital Regional Lambayeque in Chiclayo, Peru. Material and methods We conducted a cross-sectional study of 46 patients with severe acne and 92 patients with nonsevere acne. Severe acne vulgaris was diagnosed if the score was 3 or more on the Spanish Acne Severity Scale (EGAE, in its Spanish acronym). Demodex infestation was diagnosed when a skin surface biopsy showed more than 5 mites/cm2. Results The patients had a median age of 18 years (interquartile range, 15-20 years), 60.9% were male, 81.9% lived in an urban area, and 29.7% were infested with Demodex mites. In the bivariate analysis, severe acne vulgaris was significantly associated with Demodex infestation (P=.001), sex (P=.003), residence (P=.015), a paternal history of acne (P=.045), a maternal history of acne (P=.045), and type of skin (P<.001). In the multivariate analysis, after adjustment for male sex, urban residence, previous treatment, maternal and paternal history of acne vulgaris, and an oily skin type, patients with Demodex infestation were 4.2 times more likely to have severe acne vulgaris (95% CI: 1.6-10.9, P=.003). Conclusion Demodex infestation was associated with severe acne vulgaris in outpatients at our hospital (AU)

[Translated article] Association Between Demodex Infestation and Severe Acne Vulgaris: A Cross-Sectional Study of 168 Patients / Asociación entre la infestación por el Demodex sp. y el acné vulgar grave: estudio transversal de 168 pacientes

Background and objectives Infestation with Demodex mites has been associated with acne vulgaris. The aim of this study was to explore the association between Demodex infestation and severe acne vulgaris in outpatients seen at Hospital Regional Lambayeque in Chiclayo, Peru. Material and methods We conducted a cross-sectional study of 46 patients with severe acne and 92 patients with nonsevere acne. Severe acne vulgaris was diagnosed if the score was 3 or more on the Spanish Acne Severity Scale (EGAE, in its Spanish acronym). Demodex infestation was diagnosed when a skin surface biopsy showed more than 5 mites/cm2. Results The patients had a median age of 18 years (interquartile range, 15-20 years), 60.9% were male, 81.9% lived in an urban area, and 29.7% were infested with Demodex mites. In the bivariate analysis, severe acne vulgaris was significantly associated with Demodex infestation (P=.001), sex (P=.003), residence (P=.015), a paternal history of acne (P=.045), a maternal history of acne (P=.045), and type of skin (P<.001). In the multivariate analysis, after adjustment for male sex, urban residence, previous treatment, maternal and paternal history of acne vulgaris, and an oily skin type, patients with Demodex infestation were 4.2 times more likely to have severe acne vulgaris (95% CI: 1.6-10.9, P=.003). Conclusion Demodex infestation was associated with severe acne vulgaris in outpatients at our hospital (AU)

Antecedentes y objetivos Existen antecedentes de asociación de la infestación por Demodex sp. y el acné vulgar. El objetivo fue evaluar si la infestación por Demodex sp. se asocia a acné vulgar grave en consultas externas del Hospital Regional Lambayeque. Material y métodos Estudio trasversal en 46 pacientes con acné grave y 92 pacientes con acné no grave. Se definió como acné vulgar grave al de los participantes que tuvieron un grado ≥ 3 con la escala de gravedad del acné en español (EGAE). La infestación por Demodex sp. se determinó mediante biopsia cutánea superficial, considerándose infestación si existieron más de 5 ácaros por cm2. Resultados El 60,9% de los participantes fueron del sexo masculino, con una mediana de edad de 18 años y un rango intercuartílico de 15 a 20 años, provenían del sector urbano (81,9%) y se encontró infestación por Demodex sp. en el 29,7%. En el análisis bivariado, se encontró asociación estadísticamente significativa entre acné vulgar grave e infestación por Demodex sp. (p=0,001), sexo (p=0,003), procedencia (p=0,015), antecedente paterno de acné (p=0,045), antecedente materno de acné (p=0,045) y tipo de piel (p<0,001). En el análisis multivariado la infestación por Demodex sp. estuvo 4,2 veces más asociada a acné vulgar grave (IC 95%: 1,6-10,9; p=0,003) ajustado por sexo, procedencia urbana, tratamiento previo, antecedentes paterno y materno de acné vulgar y presencia de piel grasa. Conclusiones La infestación por Demodex sp. se asocia al acné vulgar grave (AU)

Association Between Demodex Infestation and Severe Acne Vulgaris: A Cross-Sectional Study of 168 Patients. / Asociación entre la infestación por el Demodex sp. y el acné vulgar grave. Estudio transversal de 168 pacientes.

BACKGROUND AND OBJECTIVES: Infestation with Demodex mites has been associated with acne vulgaris. The aim of this study was to explore the association between Demodex infestation and severe acne vulgaris in outpatients seen at Hospital Regional Lambayeque in Chiclayo, Peru. MATERIAL AND METHODS: We conducted a cross-sectional study of 46 patients with severe acne and 92 patients with nonsevere acne. Severe acne vulgaris was diagnosed if the score was 3 or more on the Spanish Acne Severity Scale (EGAE, in its Spanish acronym). Demodex infestation was diagnosed when a skin surface biopsy showed more than 5 mites/cm2. RESULTS: The patients had a median age of 18 years (interquartile range, 15-20 years), 60.9% were male, 81.9% lived in an urban area, and 29.7% were infested with Demodex mites. In the bivariate analysis, severe acne vulgaris was significantly associated with Demodex infestation (P=.001), sex (P=.003), residence (P=.015), a paternal history of acne (P=.045), a maternal history of acne (P=.045), and type of skin (P<.001). In the multivariate analysis, after adjustment for male sex, urban residence, previous treatment, maternal and paternal history of acne vulgaris, and an oily skin type, patients with Demodex infestation were 4.2 times more likely to have severe acne vulgaris (95% CI: 1.6-10.9, P=.003). CONCLUSION: Demodex infestation was associated with severe acne vulgaris in outpatients at our hospital.

Genomic Regions Associated with Fusarium Wilt Resistance in Flax.

Modern flax cultivars are susceptible to many diseases; arguably, the most economically damaging of these is the Fusarium wilt fungal disease. Over the past decades international flax breeding initiatives resulted in the development of resistant cultivars. However, much remains to be learned about the mechanisms of resistance to Fusarium infection in flax. As a first step to uncover the genetic factors associated with resistance to Fusarium wilt disease, we performed a genome-wide association study (GWAS) using 297 accessions from the collection of the Federal Research Centre of the Bast Fiber Crops, Torzhok, Russia. These genotypes were infected with a highly pathogenic Fusarium oxysporum f.sp. lini MI39 strain; the wilt symptoms were documented in the course of three successive years. Six different single-locus models implemented in GAPIT3 R package were applied to a selected subset of 72,526 SNPs. A total of 15 QTNs (Quantitative Trait Nucleotides) were detected during at least two years of observation, while eight QTNs were found during all three years of the experiment. Of these, ten QTNs occupied a region of 640 Kb at the start of chromosome 1, while the remaining QTNs mapped to chromosomes 8, 11 and 13. All stable QTNs demonstrate a statistically significant allelic effect across 3 years of the experiment. Importantly, several QTNs spanned regions that harbored genes involved in the pathogen recognition and plant immunity response, including the KIP1-like protein (Lus10025717) and NBS-LRR protein (Lus10025852). Our results provide novel insights into the genetic architecture of flax resistance to Fusarium wilt and pinpoint potential candidate genes for further in-depth studies.

Influence of Soil-Borne Inoculum of Plasmodiophora brassicae Measured by qPCR on Disease Severity of Clubroot-Resistant Cultivars of Winter Oilseed Rape (Brassica napus L.).

Use of resistant cultivars is considered the most effective tool in managing clubroot. Three clubroot-resistant commercial winter oilseed rape (OSR) cultivars and a susceptible 'Cultivar mix' were evaluated for disease severity index (DSI) and yield performance in field soils, selected for varying abundance of natural inoculum of Plasmodiophora brassicae. Seven field trials were carried out during 2017-2019 in winter OSR crops, and comparative bioassays were performed in a growth chamber. Substantial variation in clubroot infection between years was observed in the field trials. For Cultivar mix, a negative correlation (y = -252.3ln(x) + 58,897.6) was found between inoculum density and seed yield in five trials, whereas no correlation was found for the resistant cultivars. In bioassays, Cultivar mix exhibited a significantly high correlation between DSIb and number of gene copies g-1 soil (R2 = 0.72). For resistant cvs., Mentor and Alister, correlation was R2 = 0.45 and 0.58, respectively, indicating that resistance was under pressure. In field trials, DSIf of the resistant cultivars was lower (<27). The recommendation is thus to use clubroot-resistant cultivars of OSR as part of Integrated Pest Management in situations where abundance of P. brassicae DNA exceeds 1300 gene copies g-1 soil.

Subepithelial autoimmune bullous dermatoses disease activity assessment and therapy.

Subepidermal (subepithelial) autoimmune blistering dermatoses are a group of rare skin disorders characterized by the disruption of the dermal-epidermal junction through the action of autoantibodies. The fourth article in this continuing medical education series presents the current validated disease activity scoring systems, serologic parameters, treatments, and clinical trials for bullous pemphigoid, mucous membrane pemphigoid, epidermolysis bullosa acquisita, bullous systemic lupus erythematosus, anti-p200 pemphigoid, linear IgA bullous dermatosis, and dermatitis herpetiformis.

Greenhouse Evaluation of Clubroot Resistant-Brassica napus cv. Mendel and Its Efficacy Concerning Virulence and Soil Inoculum Levels of Plasmodiophora brassicae.

Clubroot resistance of oilseed rape (OSR) cultivars frequently relies on a major resistance gene originating from cv. Mendel. The efficacy of this resistance was studied in greenhouse experiments using two Plasmodiophora brassicae isolates, which were either virulent (P1(+)) or avirulent (P1) on Mendel. Seeds of clubroot-susceptible cultivar Visby and clubroot-resistant cultivar Mendel were sown in soil mixtures inoculated with different concentrations of resting spores (101, 103, 105, and 107 resting spores/g soil). Clubroot severity, plant height, shoot and root weight as well as resting spore propagation were assessed for each isolate and cultivar separately at four dates after sowing. The OSR cultivars behaved significantly different in the measured parameters. The threshold of inoculum density to cause disease depended strongly on the virulence of the pathogen and susceptibility of the host plant. In Visby grown in soil infested with P1, clubroot symptoms and increases in root weight and the number of propagated resting spores occurred at inoculum levels of 101 resting spores and higher, whereas Mendel was not affected in soils under the three lowest inoculum densities. In contrast, the P1(+) isolate led to earlier and more severe symptoms, heavier galls, and a significantly higher number of new resting spores in both cultivars.

Carga horária de enfermagem aplicada ao paciente com infarto agudo do miocárdio / Nursing hour load applied to the patient with acute myocardial infarction / Carga horaria de enfermería aplicada al paciente con infarto agudo de miocardio

Objetivo: identificar a Carga Horaria de enfermagem aplicada ao Infarto agudo do Miocárdio, de acordo com a classificação de Killip. Método: pesquisa de campo com abordagem quantitativa, descritiva, exploratória, retrospectiva. Foram utilizados prontuários de pacientes que obtiveram como diagnostico inicial o Infarto Agudo do Miocárdio, e que apresentaram alterações nos marcadores bioquímicos Resultados: foram avaliados 200 prontuários. A partir dos dados obtidos conseguimos traçar uma progressão de carga horaria entre as categorias Killip, sobre as necessidades de assistência prestada. Conclusão: a carga horaria de enfermagem varia de acordo com a complexidade que o Infarto do Miocárdio pode manifestar. O paciente necessita de maior número de pessoal de enfermagem devido alta carga horaria para atender todas as intervenções necessárias

Objective: to identify the nursing time load applied to acute myocardial infarction, according to the Killip classification. field research with quantitative, descriptive, exploratory, retrospective approach. The medical records of patients Methods: who obtained an initial diagnosis of acute myocardial infarction and who presented alterations in the biochemical markers were used. Results: 200 medical records were evaluated. From the data obtained we were able to trace a progression of time load between the Killip categories, on the assistance needs provided. Conclusion: the nursing time load varies according to the complexity that the Myocardial Infarction can manifest. The patient needs a larger number of nursing personnel due to high workload to attend all necessary interventions

Objetivo: identificar la carga horaria de enfermería aplicada al infarto agudo de miocardio, de acuerdo con la clasificación de Killip. Métodos: investigación de campo con abordaje cuantitativo, descriptivo, exploratorio, retrospectivo. Se utilizaron prontuarios de pacientes que obtuvieron como diagnóstico inicial el Infarto Agudo del Miocardio, y que presentaron alteraciones en los marcadores bioquímicos. Resultados: se evaluaron 200 prontuarios. A partir de los datos obtenidos conseguimos trazar una progresión de carga horaria entre las categorías Killip, sobre las necesidades de asistencia prestada. Conclusión: la carga horaria de enfermería varía de acuerdo con la complejidad que el Infarto del Miocardio puede manifestar. El paciente necesita un mayor número de personal de enfermería debido a una alta carga horaria para atender todas las intervenciones necesarias

Alelos asociados al índice de severidad de la enfermedad Mal de Río Cuarto en germoplasma exótico de maíz / Alleles associated to disease severity index of Mal de Río Cuarto disease in maize exotic germplasm

RESUMEN El Mal de Río Cuarto (MRC) es una de las enfermedades virales más importantes del maíz en Argentina. El índice de severidad de enfermedad (ISE) permite combinar la incidencia y la severidad de una enfermedad en una métrica única. La reacción genotípica a MRC ha sido muy estudiada en poblaciones biparentales, sin embargo este carácter complejo no se ha analizado mediante estudios de mapeo por asociación. El objetivo del presente trabajo es identificar nuevos alelos de resistencia asociados con el ISE de la enfermedad MRC de maíz en un germoplasma exótico del Centro Internacional de Mejoramiento de Maíz y Trigo (CIMMYT). Una población de líneas de maíz del CIMMYT se evaluó fenotípicamente en ambientes donde la enfermedad es endémica. Los predictores del efecto genotípico (BLUP, best linear unbiased predictor) del ISE de MRC y 78.376 marcadores SNP (Single Nucleotide Polymorphism) se usaron para realizar el mapeo por asociación en 186 líneas de maíz. Los componentes de varianza y los valores de heredabilidad sugieren una amplia variabilidad genotípica en la población de líneas. El mapeo por asociación permitió identificar 11 posibles QTL de resistencia a MRC. La incorporación de germoplasma exótico en los programas de mejoramiento de maíz locales podría contribuir favorablemente a la creación de genotipos híbridos con mayor nivel de resistencia a MRC. La capacidad predictiva de los marcadores asociados con la resistencia a MRC indican que la selección asistida por marcadores es una herramienta recomendable para seleccionar genotipos resistentes a MRC.

ABSTRACT Mal de Río Cuarto (MRC) is one of the most important viral diseases of maize in Argentina. The disease severity index (DSI) allows to combine the incidence and severity of a disease in a single metric. The genotypic reaction to MRC has been extensively studied in biparental populations. However, this complex trait has not been analyzed by genome-wide association studies (GWAS). The aim of this work is to identify new resistance alleles associated with DSI of MRC in an exotic germplasm from the International Maize and Wheat Improvement Center (CIMMYT). A population of maize lines from CIMMYT was phenotypically evaluated in environments in the area where the disease is endemic. The predictors of genetic effects (BLUP, best linear unbiased predictor) and 78,376 SNP markers (Single Nucleotide Polymorphism) were used to perform the GWAS in 186 maize lines. The values of variance components and mean-basis heritability suggest a wide genotypic variability in the population. The GWAS allowed to identify 11 putative QTL of resistance to MRC. The incorporation of exotic germplasm into local maize breeding programs could contribute favorably to the creation of hybrids with a higher level of resistance to MRC. The predictive ability of associated markers with MRC resistance indicates that marker-assisted selection is an advisable tool for selecting MRC resistant genotypes.

Assessment of ventilatory function in patients with spinocerebellar ataxia type 2 / Avaliação da função ventilatória em pacientes com ataxia espinocerebelar tipo 2

Abstract Subclinical ventilatory dysfunction is observed in individuals with spinocerebellar ataxias (SCA). No studies have correlated ventilatory dysfunction to clinical and functional decline in SCA2. Objective: To evaluate the relationship between the values of peak expiratory flow (PEF), maximum inspiratory pressure (MIP), and presence of respiratory complaints with age, disease duration, age at onset of symptoms, balance scores, independence in basic (ADL) and instrumental (IADL) Activities of Daily Living (ADLs), and severity of ataxia (SARA) in individuals with SCA2. Methods: Cross-sectional study evaluating age, disease duration, age at onset of symptoms, scores in the Berg Balance Scale and in the SARA, Functional Independence Measure and Lawton's scale, values of PEF and MIP, and the presence of respiratory complaints. Results: The study included 36 individuals with SCA2, with a mean age of 42.5±2.4 years, disease duration of 7.6±8.2 years, age 33.7±11.5 years at onset of symptoms, and 9.9±10.3 points in the SARA scale. The lowest PEF values correlated with the longer disease duration (p=0.021). The lowest values of PEF and MIP correlated with greater balance impairment (p=0.019 and p=0.045, respectively), increased degree of dependence in the ADL (p=0.006 and p=0.050, respectively) and IADL (p=0.003 and p=0.001, respectively) scales, and highest severity of ataxia (p=0.00 and p=0.017, respectively). Respiratory complaints were observed in 12 (33.3%) individuals and were not related to age, disease duration, age at onset of symptoms, balance, independence, ataxia severity, or PEF and MIP values. Conclusion: Ventilatory dysfunction, even when asymptomatic, is related to balance impairment, independence, and ataxia severity in individuals with SCA2.

Resumo Disfunção ventilatória subclínica tem sido observada em indivíduos com ataxias espinocerebelares (SCA). Não existem estudos relacionando disfunção ventilatória ao declínio clínico e funcional na SCA2. Objetivo: Avaliar a relação dos valores de Pico de Fluxo Expiratório (PFE), Pressão Inspiratória Máxima (PIMAX) e presença de queixas respiratórias com idade, tempo de doença, idade de início dos sintomas, escore de equilíbrio, independência para atividades básicas (AVD) e instrumentais (AIVD) de vida diária e gravidade da ataxia (SARA) em indivíduos com SCA2. Métodos: Estudo transversal, considerando: idade, tempo de doença, idade de início dos sintomas, escores nas Escalas SARA, Equilíbrio de Berg, Medida da Independência Funcional e de Lawton, valores de PFE, PIMAX e queixas respiratórias. Resultados: Foram avaliados 36 indivíduos com SCA2 com média de 42,5±2,4) anos de idade, 7,6±8,2 anos de tempo de doença, 33,7±11,5 anos de idade de início dos sintomas e 9,9±10,3 pontos na escala SARA. Os menores valores de PFE estiveram relacionados ao maior tempo de doença (p=0,021). Os menores valores de PFE e PIMAX estiveram relacionados ao maior comprometimento do equilíbrio (p=0,019; p=0,045, respectivamente), maior dependência para ADV (p=0,006; p=0,050, respectivamente) e AIVD (p=0,003; p=0,001, respectivamente) e maior gravidade da ataxia (p=0,006; p=0,017, respectivamente). Foram observadas queixas respiratórias em 12 (33,3%) indivíduos que não estiveram relacionadas à idade, idade de início dos sintomas, tempo de doença, equilíbrio, independência, gravidade da ataxia, ou valores de PFE e PIMAX. Conclusão: A disfunção ventilatória, mesmo quando assintomática, está relacionada ao comprometimento do equilíbrio, à independência e à gravidade da ataxia em indivíduos com SCA2.

Poder preditivo de uma escala de alerta precoce para deterioração clínica de pacientes críticos / Poder predictivo de una escala de alerta precoz para el deterioro clínico de pacientes críticos / Predictive power of an early warning scale for clinical deterioration of critically ill patients

Objetivo: avaliar o poder preditivo de uma escala de alerta precoce modificada para identificação de deterioração clínica em pacientes críticos. Método: estudo descritivo, quantitativo, em hospital de ensino, com 214 indivíduos na unidade de terapia intensiva, por meio de revisão dos prontuários, de março a dezembro de 2018. Resultados: o tempo médio de permanência foi de 10,42 dias e as doenças respiratórias consideradas a principal causa de admissão. Dentre a população estudada, 136 (63,6%) obtiveram alta e 78 (36,4%) foram a óbito. Dos 78 pacientes (36,4%), a média do escore da escala de alerta precoce para deterioração na admissão foi de 3,410 e a média que antecedeu o óbito foi de 5,000. Conclusão: considerou-se a escala de alerta precoce utilizada neste estudo, um instrumento fidedigno para identificação da deterioração clínica, recomendando-a para prevenção de parada cardiorrespiratória em adultos no ambiente hospitalar.

To evaluate the predictive power of a modified early warning scale to identify clinical deterioration in critically ill patients. Method: a descriptive, quantitative study in a teaching hospital with 214 individuals in the intensive care unit, through medical records review, from March to December 2018. Results: the average length of stay was 10.42 days and the respiratory diseases considered the main cause of admission. Among the population studied, 136 (63.6%) were discharged and 78 (36.4%) died. Of the 78 patients (36.4%), the mean early warning scale score for admission deterioration was 3.410 and the mean before death was 5,000. Conclusion: the early warning scale used in this study was considered a reliable instrument to identify clinical deterioration, recommending it for the prevention of cardiorespiratory arrest in adults in the hospital environment.

Objetivo: evaluar el poder predictivo de una escala de alerta temprana modificada para identificar el deterioro clínico en pacientes críticos. Método: estudio descriptivo y cuantitativo en un hospital universitario con 214 personas en la unidad de cuidados intensivos, por revisión de registros médicos, de marzo a diciembre de 2018. Resultados: la duración promedio de la estadía fue de 10.42 días y el enfermedades respiratorias consideradas principal causa de ingreso. Entre la población estudiada, 136 (63.6%) fueron dados de alta y 78 (36.4%) murieron. De los 78 pacientes (36,4%), la puntuación media de la escala de advertencia temprana para el deterioro de la admisión fue de 3.410 y la media antes de la muerte fue de 5.000. Conclusión: la escala de alerta utilizada en este estudio se consideró un instrumento confiable para identificar el deterioro clínico, recomendándolo para la prevención del paro cardiorrespiratorio en adultos en el entorno hospitalario.

Gravidade dos transtornos relacionados a substâncias nas pessoas em tratamento nos Centros de Atenção Psicossocial de Álcool e outras Drogas / Severity of substance-related disorders in people being treated at Psychosocial Care Centers for Alcohol and other Drugs

Resumo: Os transtornos relacionados a substâncias são considerados um problema de saúde pública, caracterizados por alterações cognitivas, comportamentais e fisiológicas, ocasionando prejuízos em diversas áreas da vida da pessoa. Sua gravidade pode ser avaliada pelas consequências negativas relacionadas às dimensões socioeconômica, familiar, financeira, clínica e legal. Trata-se de um estudo quantitativo transversal, com o objetivo geral de avaliar a gravidade dos transtornos relacionados a substâncias nas pessoas em tratamento nos Centros de Atenção Psicossocial de Álcool e outras Drogas. A amostra foi por conveniência e composta por pessoas maiores de 18 anos que estavam em tratamento. Os dados foram coletados no período de abril a novembro de 2018, mediante a aplicação do Instrumento Addiction Severity Index 6 (ASI-6). Os resultados foram apresentados de maneira descritiva e estratificados por sexo. Da amostra constituída de 137 pessoas, 89,1% (122) era do sexo masculino e 10,9% (15) do feminino. A média da idade do total de participantes foi de 41,7 anos (±12,5). Em relação à raça e estado conjugal, 46,0% (63) se declararam brancos e 41,6% (57), solteiros. A média de filhos por pessoa foi de 1,48 (±1,46). No que se refere a condições de moradias, 28,5% (39) apresentavam histórico de situação de rua. A baixa escolaridade foi caracterizada em 44,5% (61) dos participantes. Quanto à caracterização das condições de saúde física, 21,4% (30) relataram ter Hipertensão Arterial Sistêmica. Com relação a condições de saúde psicológicas/psiquiátricas, 32,1% (44) apresentaram alguma comorbidade mental. No que concerne aos transtornos relacionados a substâncias, exceto o álcool, a principal substância considerada problema foi a cocaína/crack 94,4% (68). O uso do álcool foi considerado a substância de principal problema para 72,2% (65) das pessoas. No que se refere à caracterização familiar, 40,9% (56) das pessoas estavam em um relacionamento amoroso e 59,1% (91) tinham vínculo familiar. Em relação aos aspectos legais, 10,9% (15) das pessoas tinham históricos de prisão antes dos 18 anos. Na avaliação do escore da gravidade dos transtornos relacionados a substâncias em sete áreas afetadas na vida da pessoa, as áreas de maiores escores de gravidade, sucessivamente, foram família/crianças, 57,8 (±8,6), Álcool, 52,8 (± 10,9) e Família/Problemas Sociais, 51,0 (±8,9). Considerando as consequências dos Transtornos Relacionados a Substâncias para a pessoa, a família e a sociedade bem como o intenso aumento do uso de substâncias no Brasil e no mundo, concluise que os resultados deste estudo podem contribuir com subsídios para o cuidado à pessoa e à família com vistas a minimizar a gravidade deste problema.

Abstract: Drug-related disorders are considered a public health problem, featuring cognitive, behavioral and physiological disorders, thus hindering several areas of an individual's life. Severity can be assessed by the negative consequences related to socioeconomic, familiar, financial, clinical and legal dimensions. It is a crosscut, quantitative study, aiming to assess the severity of substance-related disorders in people undergoing treatment at Psychosocial Care Centers for Alcohol and other Drugs. The convenience sampling comprised individuals older than 18 years, undergoing treatment. Data were gathered between April and November, 2018, by applying the Addiction Severity Index 6 (ASI) instrument. Results were presented in a descriptive way and stratified by gender. The sample entailed 137 people, 89.1% (122) were males, and 10.9% (15) were females. Mean age of all participants was 41.7 years (±12.5). Regarding race and marital status, 46.0% (63) claimed that they were Caucasian, and 41.6¨(57), single. The average number of children per person was 1.48 (±1.46). Regarding housing, 28.5% (39) had a history of homelessness, living on the streets. Low schooling featured 44.5% (61) of the participants. As for their profile of physical health status, 21.4% (30) reported Systemic Arterial Hypertension. In relation to their psychological/psychiatric health, 32.1% (44) featured a mental comorbidity. Regarding substance-related disorders, apart from alcohol abuse, the potential problem drug was cocaine/crack for 94.4% (68). Alcohol was considered the potential problem substance for 72.2% (65) of the individuals. As for the family profile, 40.9% (56) of the individuals were engaged in a loving relationship, and 59.1% (91) had family ties. In relation to the legal aspects, 10.9% (15) of the subjects had been arrested before 18 years old. Assessing the scoring of severity of drug-related disorders in 7 affected areas, the areas with the highest evidenced scores of severity were, successively, family/children, 57.8 (±8.6), Alcohol, (52.8) (±10.9) and Family/Social Problems, 51.0 (± 8.9). Considering the outcomes from Substance-Related Disorders to individuals, families and society, and the increasing substance abuse in Brazil and in the world, it was concluded that the results in this study may contribute to ground individuals' and families' care, in order to minimize the severity of this problem.

Índice de comorbilidad de Charlson aplicado a pacientes de Medicina Interna: estudio multicéntrico

RESUMEN Introducción: la comorbilidad es la presencia de enfermedades coexistentes o adicionales en relación al diagnóstico inicial o enfermedad guía. Es más frecuente en ancianos y contribuye a la aparición de eventos adversos de salud como mayor duración de la internación y mortalidad hospitalaria. Objetivo: determinar el efecto de las comorbilidades en la duración de la internación y en la mortalidad intrahospitalaria de los pacientes ingresados en el Servicio de Clínica Médica del Hospital Nacional (Itauguá, Paraguay) y del Hospital Militar Central (Asunción, Paraguay) entre marzo y julio del 2019. Materiales y métodos: se aplicó diseño de cohortes prospectivas en base al índice de comorbilidad de Charlson con punto de corte en 3 puntos. Ingresaron al estudio todos los varones y mujeres, mayores de 16 años, ingresados al Servicio de Clínica Médica del Hospital Nacional (Itauguá, Paraguay) y del Hospital Militar Central (Asunción, Paraguay) entre marzo y julio 2019. Se aplicó muestreo no probabilístico de casos consecutivos. Se midieron dos variables dependientes: duración de la hospitalización y mortalidad intrahospitalaria. Se calculó RR (IC 95%) y se consideró significativa toda p<0,05. El estudio respetó las normas éticas. Resultados: se incluyeron 543 sujetos, con predominio del sexo masculino (56%). La edad media fue 52±20 años. La mediana del índice de Charlson fue 2 puntos. No se detectó asociación estadísticamente significativa entre la severidad de este índice y la duración de la internación pero la mortalidad intrahospitalaria fue mayor con índice de Charlson ≥4: 6,5% vs 14,5% (p 0,005). Conclusiones: la mediana del índice de Charlson en dos Servicios de Clínica Médica fue 2. Se halló asociación estadísticamente significativa entre este índice y la mortalidad hospitalaria.

ABSTRACT Introduction: Comorbidity is the presence of coexisting or additional diseases in relation to the initial diagnosis or guiding disease. It is more frequent in the elderly and contributes to the occurrence of adverse health events such as longer hospitalization and hospital mortality. Objective: To determine the effect of comorbidities on the length of hospitalization and in-hospital mortality of patients admitted to the Medical Clinic Services of the National Hospital (Itauguá, Paraguay) and the Central Military Hospital (Asunción, Paraguay) between March and July 2019 Materials and methods: Prospective cohort design was applied based on the Charlson comorbidity index with a 3-point cut-off point. All men and women, older than 16 years who were admitted to the Medical Clinic Services of the National Hospital (Itauguá, Paraguay) and the Central Military Hospital (Asunción, Paraguay) between March and July 2019, entered into the study. Non-probabilistic sampling of consecutive cases was applied. Two dependent variables were measured: length of hospitalization and in-hospital mortality. RR (95% CI) was calculated and all p<0.05 was considered significant. The study respected ethical standards. Results: Five hundred forty-three subjects were included, and there was male predominance (56%). The mean age was 52 ± 20 years. The median Charlson index was 2 points. No statistically significant association was detected between the severity of this index and the length of hospitalization, but in-hospital mortality was higher with a Charlson index ≥4: 6.5% vs. 14.5% (p 0.005). Conclusion: The median Charlson index in two Medical Clinic Services was 2. A statistically significant association was found between this index and in-hospital mortality.