A species distribution model of the giant kelp Macrocystis pyrifera: Worldwide changes and a focus on the Southeast Pacific.

Worldwide climate-driven shifts in the distribution of species is of special concern when it involves habitat-forming species. In the coastal environment, large Laminarian algae-kelps-form key coastal ecosystems that support complex and diverse food webs. Among kelps, Macrocystis pyrifera is the most widely distributed habitat-forming species and provides essential ecosystem services. This study aimed to establish the main drivers of future distributional changes on a global scale and use them to predict future habitat suitability. Using species distribution models (SDM), we examined the changes in global distribution of M. pyrifera under different emission scenarios with a focus on the Southeast Pacific shores. To constrain the drivers of our simulations to the most important factors controlling kelp forest distribution across spatial scales, we explored a suite of environmental variables and validated the predictions derived from the SDMs. Minimum sea surface temperature was the single most important variable explaining the global distribution of suitable habitat for M. pyrifera. Under different climate change scenarios, we always observed a decrease of suitable habitat at low latitudes, while an increase was detected in other regions, mostly at high latitudes. Along the Southeast Pacific, we observed an upper range contraction of -17.08° S of latitude for 2090-2100 under the RCP8.5 scenario, implying a loss of habitat suitability throughout the coast of Peru and poleward to -27.83° S in Chile. Along the area of Northern Chile where a complete habitat loss is predicted by our model, natural stands are under heavy exploitation. The loss of habitat suitability will take place worldwide: Significant impacts on marine biodiversity and ecosystem functioning are likely. Furthermore, changes in habitat suitability are a harbinger of massive impacts in the socio-ecological systems of the Southeast Pacific.

Intracranial graft of bioresorbable polymer scaffolds loaded with human Dental Pulp Stem Cells in stab wound murine injury model.

The prevalence of central nervous system (CNS) dysfunction as a result of disease or trauma remains a clinically unsolved problem which is raising increased awareness in our aging society. Human Dental Pulp Stem Cells (hDPSCs) are excellent candidates to be used in tissue engineering and regenerative therapies of the CNS due to their neural differentiation ability and lack of tumorigenicity. Accordingly, they have been successfully used in animal models of spinal cord injury, stroke and peripheral neuropathies. The ideal therapy in brain injury should combine strategies aiming to protect the damaged lesion and, at the same time, accelerate brain tissue regeneration, thus promoting fast recovery while minimizing side or long-term effects. The use of bioresorbable nanopatterned poly(lactide-co-ɛ-caprolactone) (PLCL) polymeric scaffolds as hDPCSs carriers can represent an advantage for tissue regeneration. In this chapter, we describe the surgical procedures to implant functionalized bioresorbable scaffolds loaded with hDPSCs to improve the brain lesion microenvironment in an intracranial stab wound injury model severing the rostral migratory stream (RMS) that connects the brain subventricular zone (SVZ) and the olfactory bulb in nude mice. Additionally, we also describe the technical steps after animal sacrifice for histological tissue observation and characterization.

RUSHing to the Diagnosis: Aortic Abdominal Aneurysm Detected Using the Rapid Ultrasound for Shock and Hypotension (RUSH) Protocol in the Wards.

The rapid ultrasound for shock and hypotension (RUSH) protocol is a useful tool used in the emergency department (ED) when addressing the severity and etiology of shock. It was designed to be performed in under two minutes with evaluation of the pump (heart), tank (inferior vena cava, thoracic and abdominal compartments) and the pipes (large arteries and veins). However, its application or one similar should extend beyond the ED and into the hospital floor. Here we present an 80-year-old gentleman with a history of atrial fibrillation (A-Fib) on anticoagulation who arrived at the ED due to an episode of pre-syncope just prior to arrival. Initial EKG is concerning for A-Fib with rapid ventricular response (RVR) with a rate in the 130s. After fluid resuscitation patient improved and he was admitted to the telemetry floor for further cardiac workup and cardiology consultation. While waiting for a room in the ED, patient became hypotensive, diaphoretic and pale. After complaining of lower abdominal pain, the ED physician performed a RUSH which showed an abdominal aorta of 8 cm concerning for dissection. Diagnosis was confirmed with CT angiography of the abdomen and he was taken to the OR with successful repair of the abdominal aortic aneurysm (AAA). Patient made meaningful recovery and was discharged to in-patient rehab. The patient described in this vignette was delayed in the ED due to lack of beds on the floor. This allowed for quick ultrasound work-up by the ED physician which led to immediate recognition of the AAA and immediate response by the vascular surgery team. Should this patient have been on the hospital floor, it is unclear if such prompt steps would have occurred prior to patient's further hemodynamic demise.

Acute Hypersensitivity Reaction After Casirivimab/Imdevimab Infusion in a COVID-19-Positive Young Male: Myopericarditis or Kounis Syndrome?

Myocarditis has been a rare, but well-documented side effect of the mRNA-based vaccines against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) as well as a complication of viral infections including SARS-CoV-2. However, myopericarditis as a complication of monoclonal antibody infusion or as a complication of allergic reaction to antibody infusions might be underreported. We report the case of a 30-year-old man with a previous diagnosis of coronavirus disease 2019 (COVID-19) infection one week prior to presentation, unvaccinated for SARS-CoV-2, who was referred from a monoclonal infusion center where he received casirivimab/imdevimab and 15 minutes after the infusion began to complain of chills, chest pain, shortness of breath, and was hypotensive. In the infusion center, the patient received epinephrine and diphenhydramine and was directed to the ER, where the patient was febrile, tachycardic, and hypotensive. Initial troponin was 1.91 which peaked at 11.73 and CK-MB which peaked at 21.2. EKG had no ischemic changes. A two-dimensional echocardiogram showed an ejection fraction (EF) of about 45%, with a left ventricular dysfunction and trivial posterior pericardial effusion, and it was diagnosed as myopericarditis. On admission, he was started on full-dose enoxaparin, aspirin, fluid resuscitation, steroids, remdesevir, and bilevel positive airway pressure (BiPap) due to his respiratory compromise. Three days later, with clinical improvement, a repeat echocardiogram showed EF of 65%, with normal ventricular contractility and no pericardial effusion. The patient was discharged home with close cardiology follow-up. Though this could be a simple case of viral myopericarditis with troponinemia secondary to demand-ischemia, the differential should be broadened to complication of monoclonal antibody, given the sudden symptom onset after infusion completion and/or a possible Kounis syndrome. Though there have not been any reported cases of casirivimab/imdevimab causing myopericarditis, adverse cardiac events after monoclonal therapy have been reported mainly in cancer patients receiving monoclonal infusions.

Bitten to the Bone: A Case of Anxiety-Induced Osteomyelitis.

Onychophagia is a habitual nail-biting disorder, usually associated with mental or emotional diseases. It affects 20-30% of the population in all age groups. Human bites have the potential to become serious injuries due to high virulence in the human oral flora and may often require hospital admission, antibiotics and even debridement in the operating room. Thus, repetitive nail biting has the potential to be limb-threatening if not treated early and appropriately. We present a 49-year-old Spanish-speaking gentleman, with a past medical history of repetitive nail biting secondary to severe anxiety, major depression disorder, bilateral hand neuropathy secondary to diabetes mellitus (DM) type 2 who was initially admitted to the hospital due to cellulitis of the fingers with suspected osteomyelitis in the right hand. Anxiety was being treated by psychiatrist with paroxetine however, given no improvement and prolonged follow-ups, the primary care physician (PCP) added hydroxyzine and scheduled alprazolam in an attempt to minimize symptoms. Despite these efforts, patient continued with nail biting. On initial physical exam, the patient had a lack of fingernails and multiple wounds at various stages of healing across all digits. The distal and middle phalanges of the third right digit showed increased erythema and swelling and band tightening. Patient was started on broad-spectrum antibiotics. Initial radiography of the right hand was concerning for osteomyelitis which was later confirmed with Magnetic Resonance Imaging (MRI). Infectious disease specialist agreed on a course of cefepime, vancomycin and metronidazole. On admission, hand surgeon did not see a need for amputation and patient was treated conservatively. Due to minimal improvement after six days on IV antibiotics, patient underwent fasciotomy of the flexor compartment of the right middle finger after patient rejected hand surgeon's recommendation for amputation. He was discharged to a skilled nursing facility where he was to continue intravenous antibiotics for an additional four weeks. The vulnerable patient population of South Texas is predominately Hispanic, Spanish-speaking and uninsured. It is imperative to treat psychiatric disorders early to prevent complications, however, given the low numbers of psychiatrists in the Rio Grande Valley and even fewer who speak Spanish it is not unusual to find an appointment in more than six months. In this case, we observe how a trivial everyday behavior can lead to limb-threatening complications if not treated early and appropriately.

Evaluation of the Anti-transpirant Activity of ABA Receptor Agonists in Monocot and Eudicot Plants.

ABA receptor agonists capable of improving plant performance under drought conditions have been described during the last years. However, monocot and eudicot plant species respond differently to various agonists. Here, we provide a detailed methodology to evaluate the anti-transpirant activity of ABA receptor agonists in both monocot and eudicot plant species using infrared imaging and image data analysis. Plant growth conditions, chemical application, and infrared image analysis are explained in detail to evaluate the anti-transpirant activity of ABA receptor agonists in the eudicot model Arabidopsis thaliana and in the C4-monocot model Setaria viridis.

Getting Ahead: A Resident Led Quality Improvement Project to Increase Diabetic Nephropathy Screening in an Underserved Hispanic-Predominant Population.

Introduction: Diabetes is the leading cause of end-stage renal disease (ESRD) in the United States (US), with 37 million having chronic kidney disease. Despite national guidelines recommendations for diabetic nephropathy screening with urine albumin-to-creatinine ratio (UACR), less than 50% receive full screening.Our Internal Medicine residents led a quality improvement project to increase diabetic nephropathy screening rate with UACR in our resident clinic by 50% in one academic year. Methods: We conducted the resident-led quality improvement project from July 2021 to April 2022. We reviewed the electronic medical records (EMR) from our clinic pre-intervention July 2020 to June 2021 and compared this to post intervention July 2021 to March 2022 determining the nephropathy screening rates in patients with diabetes. Our interventions included resident education, pre and post surveys to test foundational knowledge, adding UACR in the affordable laboratory order form and establishing normal reference range of UACR in the EMR. Results: We collected 217 patients with diabetes, 27% were uninsured, 38% had Medicare/Medicaid and 90% identified as Hispanic. Comparing pre to post intervention, there was a significant change of 45 (20.7%) vs 71 (32.7%) patients screened for diabetic nephropathy with a UACR. The correct average score of knowledge-based questions was 82% on the pre survey, which increased to 88% in the post survey. Conclusion: Our study showed promising results on improving diabetic nephropathy screening. The comprehensive approach including resident education about diabetic nephropathy screening with UACR and more so facilitating the order set in the EMR were key to achieve this goal.

Comparative mites and cockroaches sensitization study in three cities of Mexico.

BACKGROUND: In Mexico there are few research papers dealing with mites and cockroaches sensibilizing in patients suffering from respiratory allergies and even less susceptibility comparative studies to the same between cities having different climatic and geographic characteristics. OBJECTIVES: To research in a prospective study skin sensibilizing to eighy different mites and two cockroaches species in patients with respiratory allergies in three cities of Mexico: Monterrey, NL, Tampico, Tamps., and Irapuato, Gto., in order to determine if there are sensibilizing differences due to climatic and geographic conditions. PATIENTS AND METHODS: Skin tests were performed by scarification in 58 patients suffering diverse respiratory allergies such as bronchial asthma, allergic rhinitis, allergic rhinoconjunctivitis and combinations of the same. Tests were performed on 18 patients from Monterrey, 20 from Tampico and 20 from Irapuato. Mites used were: Dermatophagoides pteronyssinus, Dermatophagoides farinae, Blomia tropicalis, Tyrophagus putrescientiae, Lepidoglyphus destructor, Euroglyphus maynei, Acarus siro, Dermatophagoides microceras and 2 cockroaches species, Periplaneta americana and Blatella germanica. RESULTS: Of the total 58 patients, the most important and frequent reactions were produced by D. pteronyssinus, D. farinae and E. maynei, which were found in 40, 33 and 32 patients respectively, then D. microceras in 21 patients, A. siro in 18, and B. tropicalis in 13 patients. In Tampico, the mite with the most frequent susceptibility was E. maynei, in Monterrey and Irapuato the most relevant were D. farinae and D. pteronyssinus, respectively. In Tampico, B. tropicalis was positive in 8 patients vs only 4 in Monterrey and 1 in Irapuato. The skin response to cockroaches was not important and the city with most positives was Irapuato with 6 patients responding to B. germanica, and 3 to P. americana; in Tampico 5 patients reacted to P. americana and 3 to B. germanica, and in Monterrey skin reactivity was slight and only 2 patients reacted to P. americana and 1 to B. germanica. Only 2 patients out of 58 in the study resulted in negative skin tests to mites and cockroachs allergens. CONCLUSIONS: Only 2 patients out of 58 in the study resulted in negative skin tests, which demonstrates the high sensibilizing capacity from mite and cockroach allergens in patients suffering from respiratory allergies. Although the patient group is small, it reveals that mites from the Pyroglyphidae families D. pteronyssinus, D. farinae and E. maynei are the most sensibilizing in the three cities under research, without regards of geographic and climatic conditions as they were the most frequent skin reactants and produced greater skin symptoms in patients, with several differences in respect to skin reactivity, as they were greater in Monterrey than Tampico and Irapuato. Although there is crossed reactivity between mites of the Pyroglyphidae family, it might be convenient to routinely include E. maynei in the skin test panel practiced to patients with respiratory allergies in the cities under research, and maybe also B. tropicalis in Tampico. In comparison with mites, cockroaches produced little skin reactivity in the patients.

Biopsia de piel en urticaria cronica / Biopsy of the skin in chronic urticaria

El objeto del presente trabajo, fue evaluar la biopsia de piel como método diagnóstico en la urticaria crónica, ya que el estudio sistemático de este síndrome a menudo es negativo en el 70%-80% de los casos. Recientemente Phanuphak detectó vasculitis en el 2% de sus pacientes, lo que nos motivó a buscar tal entidad en los nuestros. Estudiamos 25 pacientes, 15 mujeres y 10 hombres (21 a 70 años), todos con urticaria crónica cotidiana, de los cuales 25 tuvieron edema de la dermis e infiltrado perivascular de PMN, y uno tuvo vasculitis leucocitoclásica. Conclcuimos que la biopsia de piel sólo es útil en algunos casos de urticaria, ya que la vasculitis no es común en esta entidad (P < 0.00005), a diferencia de lo señalado por otros autores

Epidemiología del SIDA y prevalencia del HIV en derechohabientes del hospital regional de Petróleos Mexicanos, Salamanca, Gto / AIDS epidemiology and HIV prevalence in patients of the Regional Hospital of Mexican Petroleum in Salamanca, Gto

Se efectuó un estudio de prevalencia de HIV en trabajadores y derechohabientes petroleros, encontrándose una prevalencia de 3.7 por 1000 pruebas en derechohabientes y de 3.4 en trabajadores. El único mecanismo de transmisión que se encontró en adultos fué la vía sexual. Se detectaron dos casos de SIDA pediátricos, ambos mecanismos de transmisión perinatal. Por investigación epidemiológica de seropositivos al HIV se encontraron siete de los 16 infectados detectados. Encontramos tres casos de SIDA con una letalidad a la fecha del 66% y con un promedio de sobrevida de cuatro meses, una vez hecho el diagnóstico. Se efectúan comparaciones con algunas ciudades seleccionadas de México, Brasil y Estados Unidos. Se concluye que la relación de costo-beneficio no es buena cuando se aplica la prueba a población abierta, por lo que sólo debe efectuarse a grupos de alto riesgo. Asimismo es muy importante efectuar la investigación epidemiológica de seropositivos y casos con lo cual se logra vislumbrar la mayor parte de la porción oculta del iceberg del SIDA

Utilidad del multitest en el diagnóstico de las enfermedades alérgicas / Multitest usefulness in the allergenic diseases diagnosis

Se utilizaron al azar dos grupos de 30 pacientes con diagnóstico de rinitis y/o asma alérgicas, para conocer la sensibilidad y especificidad del multitest en el diagnóstico de tales enfermedades, comparado con las pruebas intradérmicas y Rast, a siete alergenos más comunes de esta zona, y el grado de aceptación de los pacientes. Al evaluar la preferencia del paciente, la mayoría prefirió multitest porque les dolió menos (p=0.000001); sin embargo, la prueba intradérmica demostró tener mayor sensibilidad y especificidad corroborando por Rast que multitest cuando se evaluaron polvo (P=000001) y dermatophagoides farinae (P>0.01), aunque no hubo diferencias con los otros alergenos y el testigo. Nosotros concluimos que el multiest es un método de diagnóstico útil, seguro y confiable para evaluar la respuesta alérgica en los pacientes; sin embargo, cuando el cuadro clínico sea sugestivo de alergia y el mutitest sea negativo, deberán practicarse pruebas intradérmicas.