Association between type of phototherapy management and hospital and patient-related outcomes in neonates with non-haemolytic jaundice at an Australian community hospital.

AIM: To evaluate the associations between type of light-emitting diode phototherapy intervention and hospital and patient related outcomes in term neonates with non-haemolytic jaundice. METHODS: A retrospective observational study in a community hospital within a disadvantaged area in Australia was conducted. Data was extracted from hospital systems and medical records regarding the use of three types of phototherapy surface-area exposure for term neonates ≤28 days with non-haemolytic neonatal jaundice. Associations between type of phototherapy management and length of stay (LOS), rate of serum bilirubin (SBR) decline and duration of phototherapy were estimated using the general linear mixed model or linear regression. RESULTS: Of 102 neonates diagnosed with non-haemolytic jaundice between 1 June 2016 and 31 August 2017, 82 were included in final analyses. Neonates treated for jaundice during their first (birth) admission had a median LOS of 118 h for single-sided and 125 h for maximal double-sided phototherapy. Differences by phototherapy type were not statistically significant (P = 0.06). SBR rate of decline increased as surface-area of phototherapy increased (P < 0.001) with the fastest decline seen in maximal double-sided phototherapy. Estimated duration of phototherapy did not vary by phototherapy type but did vary by age at initiation of phototherapy (P = 0.006), with 16 fewer hours of phototherapy if commenced at ≥72 to <96 h versus ≥24 to 48 h of age (difference -16.4 h, 95% confidence interval -29.1 to -3.7 h). CONCLUSIONS: LOS and phototherapy duration were not associated with phototherapy type. Older neonates with neonatal jaundice required shorter phototherapy duration. Double-sided phototherapy was associated with faster reduction in SBR.

Psychometric properties of parent and child reported sleep assessment tools in children with cerebral palsy: a systematic review.

AIM: To determine whether any parent and child report sleep measure tools have been validated in children aged 0-18 years with cerebral palsy (CP). METHOD: A systematic search of five databases was performed up to June 2017. Studies were included if a sleep measure tool was used to evaluate sleep in children 0-18 years with CP based on international classifications of sleep. Sleep measures were assessed for psychometric data in children with CP. RESULTS: Only one paper which used the Schlaffragebogen für Kinder mit Neurologischen und Anderen Komplexen Erkrankungen (SNAKE) questionnaire met the study criteria. The four other measures frequently used in children with CP had no psychometric data available for their use in children with CP. The SNAKE questionnaire has been validated only in children with CP in Gross Motor Function Classification System level V. The Sleep Disturbance Scale for Children and the Pediatric Sleep Questionnaire had the strongest psychometric properties in typically developing children, but has not yet been validated in children with CP. INTERPRETATION: Current sleep measures being administered in typically developing children are also often used in children with CP, but have not been well validated in this group of children. WHAT THIS PAPER ADDS: There are no condition specific measures of sleep in children with cerebral palsy (CP). The Schlaffragebogen für Kinder mit Neurologischen und Anderen Komplexen Erkrankungen (SNAKE) questionnaire is validated for children with CP in Gross Motor Function Classification System level V. A framework to design a CP specific sleep questionnaire is provided.

High risk for obstructive sleep apnea hypopnea syndrome predicts new onset atrial fibrillation after cardiac surgery: a retrospective analysis.

PURPOSE: Obstructive sleep apnea hypopnea syndrome (OSAHS) is highly prevalent in patients undergoing coronary artery bypass surgery (CABG). OSAHS is a risk factor for the development of atrial fibrillation (AF), but the risk of AF in patients who are high risk for OSAHS is unclear. METHODS: A retrospective study was conducted on consecutive patients undergoing CABG from 2013 to 2015 without AF pre-operatively. Patients were categorized as low risk for OSAHS, high risk for OSAHS, or diagnosed OSAHS based on medical records review. All diagnosed OSAHS patients were on active treatment with positive airway pressure. Outcomes assessed were postoperative AF (POAF), postoperative length of stay, re-intubation, in-hospital mortality, and cost of hospitalization. RESULTS: Out of 209 eligible patients, 66.5% were low-risk for OSAHS, 18.7% high-risk for OSAHS, and 14.8% diagnosed/treated for OSAHS. POAF developed in 96 patients (45.9%) with greater frequency in high-risk OSAHS patients (69.2% high risk, 41.9% low risk, 40.3% diagnosed/treated, p = 0.01). In analyses adjusted for age, sex, ethnicity and comorbidities, high risk for OSAHS was associated with 2.9 greater odds (95% CI [1.2, 7.3], p = 0.02) for POAF while diagnosed/treated OSAHS was not associated with elevated risk (OR = 1.4, 95% CI [0.6, 3.6], p = 0.50) compared to patients at low risk for OSAHS. CONCLUSIONS: High risk for OSAHS is an independent predictor for POAF in patients undergoing CABG. In contrast, patients diagnosed and treated for their OSAHS are not at elevated risk of POAF. These findings support evaluation of a standardized OSAHS screening and treatment program as part of the pre-operative evaluation for elective CABG.

Impact of daily variable temperatures in life-history traits of tropical anurans.

Anuran embryos and tadpoles are daily exposed to wide thermal variations in their ponds, with maximum temperatures at midday. The aim of this research was to study the impact of three daily variable thermal environments (with maximum experimental temperatures between 10:00 and 16:00 hours), on the survival, developmental time and body size of metamorphs of four tropical anuran species from lowland habitats in Colombia. A total of 50 embryos (Gosner stage ten) to metamorphosis (Gosner stage 46) of Rhinella humboldti, Hypsiboas crepitans and Engystomops pustulosus were exposed to each one of the three daily variable temperature treatments: high temperature (mean = 27.5 °C; maximum temperature = 34 ± 1 °C; range = 23-35 °C), medium temperature (25.5 °C; 29 ± 1 °C; 23-30 °C), and low temperature (24 °C; 24 ± 1 °C; 23-25 °C). For the other species, Espadarana prosoblepon, 40 embryos to metamorphosis were exposed to each one of the following thermal treatments: high temperature (mean = 22 °C; maximum temperature = 25 ± 1 °C; range = 18-26 °C), medium temperature (20.5 °C; 22 ± 1 °C; 18-23 °C), and low temperature (19 °C; 19 ± 1 °C; 18-20 °C). For all species, the thermal variable environment with the highest temperature showed the greatest accumulated survival, reduced significantly the developmental time from embryos to metamorphs, and the snout-vent-length of metamorphs. Therefore, under field conditions where ponds are exposed to thermally variable environments, the highest temperatures may promote a decrease in the period of time to metamorphosis, and a positive increase for the anuran survival; nevertheless, extreme temperatures were also found in the microhabitat of the species studied, higher than their upper thermal limits reported, which suggest a vulnerable situation for them and other tropical anurans from similar habitats.

Acute toxicity and sublethal effects of the mixture glyphosate (Roundup Active) and Cosmo-Flux 411F to anuran embryos and tadpoles of four Colombian species.

Glyphosate is the most widely used herbicide in the world with application in agriculture, forestry, industrial weed control, garden and aquatic environments. However, its use is highly controversial for the possible impact on not-target organisms, such as amphibians, which are vanishing at an alarming and rapid rate. Due to the high solubility in water and ionic nature, the glyphosate requires of surfactants to increase activity. In addition, for the control of coca (Erythroxylum coca) and agricultural weeds in Colombia, formulated glyphosate is mixed and sprayed with the adjuvant Cosmo-Flux 411F to increase the penetration and activity of the herbicide. This study evaluates the acute toxic and sublethal effects (embryonic development, tadpole body size, tadpole swimming performance) of the mixture of the formulated glyphosate Roundup Active and Cosmo-Flux 411F to anuran embryos and tadpoles of four Colombian species under 96h laboratory standard tests and microcosms, which are more similar to field conditions as they include soil, sand and macrophytes. In the laboratory, embryos and tadpoles of Engystomops pustulosus were the most tolerant (LC50 = 3904 microg a.e./L; LC50=2 799 pg a.e./L, respectively), while embryos and tadpoles of Hypsiboas crepitans (LC50=2 203 microg a.e./L; LC50=1424 microgg a.e./L, respectively) were the most sensitive. R. humboldti and R. marina presented an intermediate toxicity. Embryos were significantly more tolerant to the mixture than tadpoles, which could be likely attributed to the exclusion of chemicals by the embryonic membranes and the lack of organs, such as gills, which are sensitive to surfactants. Sublethal effects were observed for the tadpole body size, but not for the embryonic development and tadpole swimming performance. In microcosms, no toxicity (LC50 could not be estimated), or sublethal responses were observed at concentrations up to fourfold (14.76 kg glyphosate a.e./ha) the highest field application rate of 3.69 kg glyphosate a.e./ha. Thus, toxicity was less in the microcosms than in laboratory tests, which may be attributed to the presence of sediments and organic matter which rapidly adsorb glyphosate and surfactants such as POEA. It is concluded that the mixture of glyphosate (Roundup Active) and Cosmo-Flux*411F, as used in the field, has a negligible toxic effect to embryos and tadpoles of the species tested in this study.

Thermal Relationship in Tropical Anurans from Two Contrasting Habitats Along an Elevation Gradient in Colombia.

Anurans are ectothermic organisms highly susceptible to variations in the environmental temperature that changes with elevation and between habitats in tropical mountains. The aim of this study was to evaluate the variation of body temperature (BT) of nocturnal anurans from two contrasting habitats (open and forest habitats) along an elevation gradient in Colombia. We measured the environmental temperatures (substrate and air) and BT of 135 adult frogs of 11 species from open and forest habitats at three elevational zones of an Andean Mountain. The BT had a positive and significant relationship with environmental temperatures and showed a higher thermal dependence for substrate than air temperature, which suggests that anurans are thermoconformers and potentially tigmotherms. Additionally, BT of anurans from both habitats decreased with the elevation, but species from open habitats had a higher BT than forest species. Therefore, the impact of environmental temperatures on anurans that live at a similar altitude level is not the same, as the type of habitat has a strong influence on their BT. This information is important to a better understanding of anuran thermal biology, refine conservation strategies, and to improve the predictive power of environmental data in forecasting the effects of climate change on small ectotherms such as amphibians.

Effects of noninvasive neuromodulation targeting the spinal cord on early learning of force control by the digits.

AIMS: Control of finger forces underlies our capacity for skilled hand movements acquired during development and reacquired after neurological injury. Learning force control by the digits, therefore, predicates our functional independence. Noninvasive neuromodulation targeting synapses that link corticospinal neurons onto the final common pathway via spike-timing-dependent mechanisms can alter distal limb motor output on a transient basis, yet these effects appear subject to individual differences. Here, we investigated how this form of noninvasive neuromodulation interacts with task repetition to influence early learning of force control during precision grip. METHODS: The unique effects of neuromodulation, task repetition, and neuromodulation coinciding with task repetition were tested in three separate conditions using a within-subject, cross-over design (n = 23). RESULTS: We found that synchronizing depolarization events within milliseconds of stabilizing precision grip accelerated learning but only after accounting for individual differences through inclusion of subjects who showed upregulated corticospinal excitability at 2 of 3 time points following conditioning stimulation (n = 19). CONCLUSIONS: Our findings provide insights into how the state of the corticospinal system can be leveraged to drive early motor skill learning, further emphasizing individual differences in the response to noninvasive neuromodulation. We interpret these findings in the context of biological mechanisms underlying the observed effects and implications for emerging therapeutic applications.

Intercostal artery laceration following thoracentesis.

Intercostal artery laceration is an unusual complication following thoracentesis, and has been reported only in elderly patients. We report a case of a 78-year-old man who developed a massive hemothorax following thoracentesis. Post-thoracentesis radiograph revealed a substantial increase in pleural fluid, and emergency chest tube insertion identified the hemothorax. He underwent right thoracotomy for repair of the intercostal artery laceration.

Consumo de suplementos alimenticios durante la pandemia de COVID-19: Un estudio transversal en deportistas mexicanos / Dietary Supplements Consumption During COVID-19 Pandemic: A Cross-Sectional Study in Mexican Athletes

Introducción: Durante la anterior contingencia sanitariaocasionada por el COVID-19, se presenció una amplia difu-sión de supuestos tratamientos para esta y otras enfermeda-des. Esto dio pie al empleo de suplementos alimenticios (SA)como una posible alternativa para la prevención de esta en-fermedad. El consumo de SA confiere un riesgo en aquellaspoblaciones donde la prevalencia de uso es elevada. Tal es elcaso de la comunidad deportiva, donde su consumo es unaactividad frecuente debido a sus efectos en el rendimiento de-portivo y composición corporal. Objetivo: Conocer la prevalencia del consumo de SA endeportistas mexicanos durante el COVID-19 e identificaraquellos que lo emplearon con la finalidad de prevenir la in-fección. Asimismo, explorar la asociación de consumo con lasvariables sexo, edad y ocupación. Materiales y métodos: Se llevó a cabo un estudio des-criptivo transversal correlacional en una muestra no probabi-lística por conveniencia compuesta por 351 deportistas de laregión noroeste de México. Se aplicó una encuesta a travésde la plataforma Google Forms que incluía preguntas relacio-nadas con la frecuencia de consumo de SA además de varia-bles sociodemográficas. Resultados: El 22,5% de los participantes estaba consu-miendo algún tipo de SA durante el confinamiento y 67,1%sostuvo la creencia de que el consumo de estos suplementoscontribuyó a la prevención del COVID-19. Se encontró unaasociación entre consumo y creencia (χ2(2) = 26,256, p < 0,05;Phi = 0,274). El uso de SA fue recomendado principalmentepor nutriólogos (39,2%), entrenadores (21,5%) y médicos(20,3%). Conclusiones: El consumo de SA fue relativamente bajocomparado con otras poblaciones. Sin embargo, la mayoríade los consumidores refirió que los SA contribuyen a la pre-vención del contagio por COVID-19. Gran parte de los consu-midores de SA acudió a un profesional de la salud para su re-comendación.(AU)

Introduction: During the previous health contingencycaused by COVID-19, there was a widespread disseminationof alleged treatments for this and other diseases. This led tothe use of dietary supplements (DS) as a possible alternativefor the prevention of this disease. DS consumption poses arisk in populations where the prevalence of use is high. Suchis the case in the sports community, where its consumption isa common activity due to its effects on sports performanceand body composition.Objective: To determine the prevalence of DS consump-tion in Mexican athletes during COVID-19 and identify thosewho used them to prevent infection. Additionally, to explorethe association between consumption and the variables ofgender, age, and occupation.Materials and Methods: A descriptive cross-sectional cor-relational study was conducted in a non-probabilistic conven-ience sample composed of 351 athletes from the northwest re-gion of Mexico. A survey was administered through the GoogleForms platform that included questions related to the frequencyof DS consumption as well as sociodemographic variables. Results: 22.5% of the participants were consuming sometype of DS during the lockdown, and 67.1% believed that theconsumption of these supplements contributed to the pre-vention of COVID-19. An association between consumptionand belief was found (χ2(2) = 26.256, p < 0.05; Phi = 0.274).The use of DS was primarily recommended by nutritionists(39.2%), coaches (21.5%), and physicians (20.3%). Conclusions: DS consumption was relatively low com-pared to other populations. However, the majority of DS con-sumers reported that DS contributed to the prevention ofCOVID-19 infection. A significant proportion of DS consumerssought recommendations from healthcare professionals.(AU)

Trastornos de la conducta alimentaria y ansiedad en estudiantes durante la pandemia por COVID-19: Un estudio transversal / Eating disorders and anxiety in students during the COVID-19 pandemic: A cross-sectional study

Introducción: La pandemia debido al coronavirus 2019(COVID-19) ha trastornado profundamente la vida cotidiana en todo el mundo, con profundos efectos negativos en la salud física y mental, principalmente en la población estudiantil. Objetivo: Determinar la prevalencia de riesgo de trastornos de la conducta alimentaria (TCA) y los niveles de ansiedad en estudiantes universitarios durante la pandemia por COVID-19. Asimismo, explorar la asociación de TCA y ansiedad con las variables sexo, edad, semestre y programa educativo. Materiales y métodos: Se realizó un estudio descriptivo transversal correlacional en una muestra no probabilística por conveniencia de 572 estudiantes de una universidad del no-roeste de México, previo consentimiento informado. Se diseñóun cuestionario en línea utilizando la plataforma de Google Forms que incluía cuatro preguntas de identificación, el instrumento Eating Attitudes Test 26 (EAT-26) y el Inventario de ansiedad BAI. Se calcularon estadísticas descriptivas, la prueba Chicuadrado para explorar la asociación entre variables categóricas y se calculó los Odds ratio (OR) e intervalode confianza por medio de la regresión logística considerando como variables dependientes riesgo de TCA y presencia de ansiedad en los modelos. Resultados: Dado el punto de corte de 20 para el EAT-26,se encontró 20.1% de estudiantes en riesgo de presentar TCA. El riesgo fue significativamente mayor en las mujeres(22.4%) en comparación a los hombres (14.7%) (χ2(1) =4.39; p < .001, Phi = -0.088). Predominaron niveles moderado de ansiedad (32.2%) y severo (24.3%) en los estudiantes. El riesgo de TCA puede aumentar hasta cuatro veces más si tiene síntomas de ansiedad (OR = 2.179; IC95%1.20, 3.97). Conclusiones: Una parte importante de los encuestados presentó conductas alimentarias de riesgo asociadas con los niveles de ansiedad mostrada durante la pandemia.(AU)

Introduction: Due to the 2019 coronavirus (COVID-19)pandemic, worldwide daily life has profoundly disrupted, withprofound negative effects on physical and mental health, primarily in the student population. Objetive: To determine the prevalence of eating disorder(ED) risk and anxiety levels in college students during theCOVID-19 pandemic. Additionally, to explore the association of ED and anxiety with gender, age, semester, and educational program variables.Materials and methods: A descriptive cros-sectionalcorrelational study was conducted in a non-probabilistic con-venience sample of 572 students from a university in north-western Mexico, with prior informed consent. An online questionnaire was designed using the Google Forms platform thatincluded four identification questions, the Eating AttitudesTest 26 (EAT-26) instrument and the BAI Anxiety Inventory.Descriptive statistics, Chi-square test were calculated to explore the association between categorical variables and OddsRatio (OR) and confidence interval were calculated by logisticregression considering as dependent variables risk of ED andpresence of anxiety in the models. Results: Given the cutoff point of 20 for the EAT-26,20.1% of students were found to be at risk of developing ED.The risk was significantly higher in females (22.4%) comparedto males (14.7%) (χ2(1) = 4.39; p < .001, Phi = -0.088).Moderate level of anxiety predominated in 32.2% of studentsand severe in 24.3%. The risk of ED may increase up to fourtimes more if anxiety symptoms are present (OR = 2.179;95%CI: 1.20, 3.97). Conclusions: A significant portion of respondents presented risky eating behaviors associated in the levels of anxiety displayed during the pandemic.(AU)

Ansiedad, estrés y calidad de sueño asociados a COVID-19 en universitarios del noroeste de México / Anxiety, stress and sleep quality associated to COVID-19 in university students in northwestern Mexico

Resumen Objetivo: Identificar los niveles de ansiedad, estrés percibido y calidad del sueño en universitarios del noroeste de México durante la pandemia por COVID-19 y examinar su asociación con variables sociodemográficas y con preguntas relacionadas con el COVID-19. Materiales y métodos: Estudio descriptivo, correlacional y transversal, en una muestra no probabilística de 1691 estudiantes. Se aplicaron encuestas en línea por medio de Google Forms. Se utilizó la prueba Ji-cuadrado (X2), la correlación de Spearman y análisis de regresión logística multivariado, se contó con aprobación de comité de ética y consentimiento informado de los participantes. Resultados: El 38.4% de los estudiantes presentaron ansiedad moderada y 36.5% severa. Predominó un nivel moderado de estrés (50.1%) y mala calidad del sueño (65.8%). La variable sexo se asoció con ansiedad (X2 = 88.87, p < .001), estrés percibido (X2 = 72.34, p < .001) y mala calidad del sueño (X2 = 31.26, p < .001). La regresión logística determinó que los estudiantes cuyos ingresos familiares disminuyeron a causa de la pandemia presentaron mayor riesgo de ansiedad (OR = 1.67, p =.001), estrés (OR= 1.57, p =.011) y mala calidad del sueño (OR = 1.46). Conclusiones: Más de la mitad de los estudiantes universitarios que participaron en esta investigación presentaron algún nivel de ansiedad, estrés y mala calidad de sueño durante la pandemia por COVID-19, por lo anterior, se requiere el desarrollo de programas de intervención psicosocial de salud mental dirigidos a estudiantes universitarios.

Abstract Objective: Identify the levels of anxiety, perceived stress, and sleep quality in university students in northwestern Mexico during the COVID-19 pandemic and examine their association to sociodemographic variables and questions related to COVID-19. Materials and methods: Descriptive, correlational, cross-sectional study in a non-probabilistic sample of 1691 students. Online surveys were administered using Google Forms. The chi-square test (X2), Spearman's correlation and multivariate logistic regression analysis were used, with the approval of the ethics committee and informed consent of the participants. Results: 38.4% of the students presented moderate anxiety and 36.5% severe anxiety. Moderate level of stress (50.1%) and poor sleep quality (65.8%) predominated. The sex variable was associated to anxiety (X2 = 88.87, p < .001), perceived stress (X2 = 72.34, p < .001) and poor sleep quality (X2 = 31.26, p < .001). Logistic regression determined that students whose family income decreased because of the pandemic were at higher risk of experiencing anxiety (OR = 1.67, p =.001), stress (OR= 1.57, p =.011), and poor sleep quality (OR = 1.46). Conclusions: More than half of the university students who participated in this study presented some level of anxiety, stress and poor sleep quality during the COVID-19 pandemic. Therefore, the development of psychosocial mental health intervention programs aimed at university students is required.

Toxicity of three organophosphate insecticides in anuran embryos at different temperatures / Toxicidad de tres insecticidas organofosforados en embriones de anuros a diferentes temperaturas

RESUMEN Los efectos de diferentes agroquímicos y de la temperatura han sido temas recurrentes en la investigación en anuros; sin embargo, estas variables se han abordado de manera independiente sin considerar que pueden ejercer una presión simultánea sobre las especies. Por esta razón, este trabajo tiene como objetivo determinar la toxicidad (a través de la Concentración Letal Media -CL50) de los insecticidas organofosforados clorpirifos, diazinón y monocrotofos, bajo tres regímenes térmicos (23, 28 y 33 ± 1 °C) sobre embriones de tres especies de anuros. De acuerdo a los valores de CL50, el insecticida clorpirifos fue el más tóxico, seguido del diazinón y del monocrotofos. Por su parte, de manera general se encontró un incremento de la toxicidad de los insecticidas organofosforados a la temperatura más alta de experimentación (33 °C). Además, el efecto de la temperatura se hizo más notorio para los organismos expuestos al clorpirifos, el insecticida más letal. Estos resultados sugieren un efecto negativo para la fauna acuática de anuros debido al actual uso desmesurado de este tipo de agroquímicos y a su interacción con la temperatura ambiental.

ABSTRACT In anurans, the effects of different agrochemicals and temperature have been recurrent topics in research; however, these variables are addressed independently without considering that they can exert a simultaneous pressure on the species. For this reason, this work aims to determine the toxicity (through the Medium Lethal Concentration -LC50) of the organophosphate insecticides: chlorpyrifos, diazinon and monocrotophos, under three thermal regimes (23, 28 and 33 ± 1 °C) on embryos ofthree species of anurans. According to the LC50 values, the chlorpyrifos insecticide was the most toxic, followed by diazinon and monocrotophos. On the other hand, an increase in the toxicity of the organophosphate insecticides studied was generally found at the highest experimental temperature (33 °C). In addition, the effect of temperature became more noticeable for the organisms exposed to chlorpyrifos, the most lethal insecticide. These results suggest a negative effect for the aquatic fauna of anurans due to the current excessive use of this type of agrochemicals and their interaction with environmental temperature.

Biological activities of Leptodeira annulata (banded cat-eyed snake) venom on vertebrate neuromuscular preparations.

The physiological properties of colubrid snake venoms are largely unknown and less frequently investigated. In this study, we assessed the enzymatic properties and biological activities of Leptodeira annulata (banded cat-eyed snake) venom, an opistoglyphous snake from Colombia. The proteolytic, phospholipase A2 and amidolytic activities are assessed using colorimetric assays and the biological activities were analyzed in avian and mammalian neuromuscular preparations. L. annulata venom caused neuromuscular blockade in chick biventer cervicis (BC) preparations (40± 15% and 50± 3% of twitch reduction for 30 and 100 µg/ml, respectively; p < 0.05) following 120 incubation; 10 µg/ml of venom did not induce blockade. There was a mild reduction in contracture response to exogenous acetylcholine (110 µM) in BC preparations exposed to 10 and 30 µg of venom/ml (∼4% and ∼32% of reduction, respectively, p > 0.05, n = 4) compared to basal values whereas the highest concentration (100 µg/ml) abolished it after 120 min. The venom caused a significant reduction in contracture response elicited by KCl (∼58 and ∼90 of reduction for 30 and 100 µg/ml, respectively, p < 0.05, n = 4). In mouse phrenic nerve-diaphragm (PND) preparations, L. annulata venom induced a progressive muscle membrane depolarization [from -85.9 ± 1.6 mV (t0) to -72.2 ± 2.9 mV (t120), p < 0.05, n = 4); the postsynaptic receptors remained functional as shown by carbachol-induced depolarization. The morphological analyses showed a concentration-dependent number of pathological states in muscle fibers from both BC and PND preparations pre-exposed to venom. The venom showed high proteolytic activity and low phospholipase A2 activity; there was no evidence for serine protease activity. These results indicate that the neuromuscular effect induced by L. annulata venom resulted from damaged muscle fibers that lead to the blockade of twitches response. The findings suggest that the myotoxicity might be related to the presence of metalloproteases in this venom.

Predictors of mortality for nursing home-acquired pneumonia: a systematic review.

BACKGROUND: Current risk stratification tools, primarily used for CAP, are suboptimal in predicting nursing home acquired pneumonia (NHAP) outcome and mortality. We conducted a systematic review to evaluate current evidence on the usefulness of proposed predictors of NHAP mortality. METHODS: PubMed (MEDLINE), EMBASE, and CINAHL databases were searched for articles published in English between January 1978 and January 2014. The literature search elicited a total of 666 references; 580 were excluded and 20 articles met the inclusion criteria for the final analysis. RESULTS: More studies supported the Pneumonia Severity Index (PSI) as a superior predictor of NHAP severity. Fewer studies suggested CURB-65 and SOAR (especially for the need of ICU care) as useful predictors for NHAP mortality. There is weak evidence for biomarkers like C-reactive protein and copeptin as prognostic tools. CONCLUSION: The evidence supports the use of PSI as the best available indicator while CURB-65 may be an alternative prognostic indicator for NHAP mortality. Overall, due to the paucity of information, biomarkers may not be as effective in this role. Larger prospective studies are needed to establish the most effective predictor(s) or combination scheme to help clinicians in decision-making related to NHAP mortality.

Acute Toxicity of the Insecticide Cypermethrin (CYPERMON ® 20 EC) on Four Species of Colombian Anurans / Toxicidad aguda del insecticida cipermetrina (cypermon ® 20 ec) en cuatro especies de anuros colombianos

RESUMEN El insecticida cipermetrina (CY) es usado en la agricultura para el control de plagas; sin embargo, por su acción neurotóxica puede afectar organismos no blanco como los anuros. El objetivo del trabajo fue determinar la toxicidad (concentración letal media: CL50, y algunos efectos subletales: retrasos en el desarrollo, capacidad de natación y longitud total de las larvas) del insecticida CY (Cypermon® 20EC) expuesto durante 96 horas en embriones y renacuajos de cuatro especies de anuros bajo pruebas de laboratorio y microcosmos. Los embriones de Rhinella humboldti fueron los más sensibles en condiciones de laboratorio (CL50= 6,27 mg/L) y Boana xerophylla en microcosmos (CL50= 88,32 mg/ha), mientras que los de Engystomops pustulosus fueron los más resistentes (laboratorio: CL50= 1 1,80 mg/L; microcosmos: CL50= 1 12,37 mg/ha). Rhinella marina mostró una sensibilidad intermedia. En los renacuajos no fue posible calcular los valores CL50 debido a la alta mortalidad registrada en las concentraciones experimentales en laboratorio y microcosmos, las cuales fueron 40 y 122 veces menores al valor de aplicación del insecticida (500 mg/L y 1,52 mg/ha, respectivamente). Por otra parte, se encontró una reducción significante en la longitud total y la capacidad de natación de las larvas obtenidas de los embriones expuestos a la CY, pero no en el tiempo de desarrollo. En conclusión, la exposición a la cipermetrina provocó una letalidad alta en los renacuajos y efectos subletales en estadíos tempranos del desarrollo, por lo que a las concentraciones recomendadas de aplicación, este insecticida es tóxico para las especies de estudio.

ABSTRACT The cypermethrin (CY) insecticide is used in agriculture for the control of pests; however, due to its neurological action can affect non-target organisms such as anurans. The aim of this study was to evaluate the toxicity (median lethal concentration: LC50, and some sublethal effects: developmental delays, swimming performance and total length of larvae) of the insecticide CY (Cypermon® 20EC) exposed during 96 hours to embryos and tadpoles of four anuran species under laboratory and microcosm tests. The embryos of Rhinella humboldti were the most sensitive in laboratory conditions (LC50= 6.27 mg/L) and Boana xerophylla in microcosms (LC50= 88.32 mg/ha), whereas Engystomops pustulosus (laboratory: LC50= 1 1.80 mg/L, microcosms: LC50= 1 12.37 mg/ha) was the most resistant species. Rhinella marina showed an intermediate sensitivity. It was not possible to calculate the tadpole LC50 values due to the high mortality recorded in the experimental concentrations, both in laboratory and microcosms, which were 40 and 122 times lower than the value suggested for the application of the insecticide in field (500 mg/L and 1.52 mg/ha, respectively). On the other hand, it was found a significant decreasing in the total length and swimming performance of the larvae obtained from the embryos exposed to CY, but not in the embryonic developmental time. In conclusion, the exposure to the cypermethrin produced a high tadpole lethality and sublethal effects on developing embryos; therefore, under the recommended concentrations of field exposition, this insecticide is toxic for the study species.

Impact of daily variable temperatures in life-history traits of tropical anurans / Impacto de las variaciones de la temperatura diaria en caracteres de historias de vida de los anuros tropicales

Abstract:Anuran embryos and tadpoles are daily exposed to wide thermal variations in their ponds, with maximum temperatures at midday. The aim of this research was to study the impact of three daily variable thermal environments (with maximum experimental temperatures between 10:00 and 16:00 hours), on the survival, developmental time and body size of metamorphs of four tropical anuran species from lowland habitats in Colombia. A total of 50 embryos (Gosner stage ten) to metamorphosis (Gosner stage 46) of Rhinella humboldti, Hypsiboas crepitans and Engystomops pustulosus were exposed to each one of the three daily variable temperature treatments: high temperature (mean = 27.5 °C; maximum temperature = 34 ± 1 °C; range = 23-35 °C), medium temperature (25.5 °C; 29 ± 1 °C; 23-30 °C), and low temperature (24 °C; 24 ± 1 °C; 23-25 °C). For the other species, Espadarana prosoblepon, 40 embryos to metamorphosis were exposed to each one of the following thermal treatments: high temperature (mean = 22 °C; maximum temperature = 25 ± 1 °C; range = 18-26 °C), medium temperature (20.5 °C; 22 ± 1 °C; 18-23 °C), and low temperature (19 °C; 19 ± 1 °C; 18-20 °C). For all species, the thermal variable environment with the highest temperature showed the greatest accumulated survival, reduced significantly the developmental time from embryos to metamorphs, and the snout-vent-length of metamorphs. Therefore, under field conditions where ponds are exposed to thermally variable environments, the highest temperatures may promote a decrease in the period of time to metamorphosis, and a positive increase for the anuran survival; nevertheless, extreme temperatures were also found in the microhabitat of the species studied, higher than their upper thermal limits reported, which suggest a vulnerable situation for them and other tropical anurans from similar habitats. Rev. Biol. Trop. 65 (1): 55-63. Epub 2017 March 01.

ResumenLos embriones y renacuajos de anuros están expuestos diariamente a amplias variaciones térmicas en sus estanques, con temperaturas máximas al mediodía. El objetivo de esta investigación fue estudiar el impacto de tres ambientes térmicos diariamente variables, con temperaturas máximas experimentales entre las 10:00 y las 16:00 horas, sobre la supervivencia, tiempo de desarrollo y tamaño corporal de metamorfos de cuatro especies de anuros tropicales de hábitat de tierras bajas de Colombia. 50 embriones (estadio de Gosner diez) hasta la metamorfosis (estadio de Gosner 46) de Rhinella humboldti, Hypsiboas crepitans y Engystomops pustulosus fueron expuestos a cada uno de tres tratamientos de temperatura variable diariamente: temperatura alta (promedio = 27.5 °C; temperatura máxima = 34 ± 1 °C; rango = 23-35 °C), temperatura media (25.5 °C; 29 ± 1 °C; 23-30 °C), y temperatura baja (24 °C; 24 ± 1 °C; 23-25 ºC). Para la otra especie de estudio, Espadarana prosoblepon, 40 embriones hasta la metamorfosis fueron expuestos a cada uno de los siguientes tratamientos térmicos: temperatura alta (promedio = 22 °C; temperatura máxima = 25 ± 1 °C; rango = 18-26 °C), temperatura media (20.5 °C; 22 ± 1 °C; 18-23 °C), y temperatura baja (19 °C; 19 ± 1 °C; 18-20 °C). Para todas las especies, los ambientes térmicos variables con las temperaturas más altas tuvieron la mayor supervivencia acumulada, redujeron significativamente el tiempo de desarrollo de los embriones a metamorfos y la longitud hocico-cloaca de los metamorfos. Por lo tanto, bajo condiciones de campo donde las charcas están expuestas a ambientes térmicamente variables, las temperaturas más altas pueden promover una disminución en el tiempo de la metamorfosis y un aumento positivo para la supervivencia de los anuros; sin embargo, también se encontraron temperaturas extremas en los microhábitats de las especies estudiadas, más altas que sus límites térmicos máximos reportados, lo que sugiere una situación vulnerable para estas especies y otros anuros tropicales con hábitat similares.

Toxicidad del herbicida propanil (propanil trust® 500ec) en embriones y renacuajos de tres especies de anuros / Toxicity of the Herbicide Propanil (Propanil Trust® 500EC) to Embryos and Tadpoles of three Anuran Species

El Propanil es un herbicida empleado en el control de arvenses que puede afectar organismos no blanco como los anuros. El objetivo del trabajo fue evaluar los efectos letales (concentración letal media, CL50) y subletales (retrasos en el desarrollo, longitud total y máxima distancia de natación) del Propanil (Propanil Trust® 500EC) sobre embriones y renacuajos de tres especies de anuros bajo condiciones de laboratorio y microcosmos, que incluyen algunos componentes de campo (sedimentos y material vegetal). La especie más sensible fue Rhinella humboldti (embriones: laboratorio CL50= 9,14 mg/L y microcosmos CL50= 83,92 mg/ha; renacuajos: laboratorio CL50= 5,09 mg/L y microcosmos CL50= 44,52 mg/ha), y la más resistente Hypsiboas crepitans (embriones: laboratorio CL50= 19,58 mg/L y microcosmos CL50= 179,53 mg/ha; renacuajos: laboratorio CL50= 16,54 mg/L y microcosmos CL50= 190,72 mg/ha). Engystomops pustulosus mostró una sensibilidad intermedia. En general, en laboratorio los CL50 indicaron una letalidad alta y se encontraron cambios significantes en la longitud total y la máxima distancia de natación de los organismos expuestos al Propanil, contrario a los resultados en microcosmos, aunque el tiempo de desarrollo embrionario no mostró diferencias entre tratamientos. Al comparar los CL50 se encontró que los renacuajos fueron más sensibles al herbicida que los embriones. En conclusión, el Propanil resultó tóxico para los embriones y renacuajos en condiciones de laboratorio pero tuvo un efecto menor en microcosmos. Esto demuestra que los componentes de campo de los microcosmos y la falta de renovación de las soluciones reducen la toxicidad del Propanil en los anuros de estudio.

Propanil is an herbicide used to control weeds that can affect non-target organisms such as anurans. The aim of this study was to assess the lethal (median lethal concentration, LC50) and sublethal effects (delays in development, total length and maximum swimming distance) of Propanil (Propanil Trust® 500EC) on embryos and tadpoles of three species of anurans under laboratory and microcosm conditions, which include some field components (sediments and vegetal materials). The most sensitive species was Rhinella humboldti (embryos: laboratory LC50= 9.14 mg/L and microcosm LC50= 83.92 mg/ha; tadpoles: laboratory LC50= 5.09 mg/L and microcosm LC50= 44.52 mg/ha), whereas the most resistant was Hypsiboas crepitans (embryos: laboratory LC50= 19.58 mg/L and microcosm LC50= 179.53 mg/ha; tadpoles: laboratory LC50= 16.54 mg/L and microcosm LC50= 190.72 mg/ha). Engystomops pustulosus showed an intermediate sensitivity. In general, in laboratory the LC50 indicated a high lethality and were found significant changes in the total length and maximum swimming distance of the organisms exposed to Propanil, as opposed to the microcosm results, although the time of embryonic development did not show differences between treatments. Comparing the LC50, it was established that tadpoles were more sensitive to the herbicide than embryos. In conclusion, the Propanil was toxic to embryos and tadpoles in laboratory tests but had a low effect in microcosms. This demonstrates that the field components of the microcosms and the lack of solution renewals notably decrease the toxicity of Propanil on the anurans studied.

Utilidad de la ecografía clínica en una unidad de cuidados paliativos / Usefulness of bedside ultrasound in a palliative care unit

Introducción y objetivo: La ecografía clínica o “a pie de cama” es una herramienta cada vez más utilizada en la práctica médica habitual dada su portabilidad, inocuidad y rapidez de realización. Todo ello permite la toma de decisiones instantánea y una menor dependencia de un médico especialista en radiodiagnóstico. Existe escasa literatura acerca de la ecografía clínica en el ámbito de cuidados paliativos. El objetivo del presente estudio es describir la utilidad de la ecografía clínica en una unidad de cuidados paliativos (UCP). Material y métodos: Estudio observacional descriptivo de pacientes ingresados en una UCP entre enero y julio de 2019. Se realizaron ecografías clínicas a todos los pacientes que precisaban de una mayor precisión diagnóstica para realizar un abordaje paliativo terapéutico adecuado y efectivo. Resultados: De los 202 pacientes que ingresaron se realizaron 44 ecografías (21,8 %). Las sospechas diagnósticas principales fueron: ascitis, retención aguda de orina, derrame pleural y enfermedad tromboembólica. El uso de la ecografía clínica significó una modificación de diagnóstico en el 52,3 % de los pacientes. Con ello se pudieron evitar el 69,5 % de las posibles maniobras invasivas que hubieran resultado fútiles, fundamentalmente paracentesis evacuadoras y sondajes vesicales. Conclusiones: La ecografía clínica resultó útil para confirmar o descartar diagnósticos inciertos, especialmente sospechas de ascitis y retenciones agudas de orina, mejorando la precisión diagnóstica. La certeza en el diagnóstico permite adecuar el tratamiento y evitar maniobras invasivas fútiles, mejorando así el confort del paciente. (AU)

Introduction and objectives: The use of bedside ultrasound as a regular tool in clinical practice has increased steadily over the past few years due to its many advantages. It is safe, fast, and portable. It allows physicians to make decisions on the spot, thus depending less on an expert radiologist. Currently, there is a lack of literature on clinical ultrasound in the setting of palliative care. The present study aimed to describe the usefulness of clinical ultrasound in a palliative care unit at a hospice health center. Materials and methods: A descriptive observational study of patients admitted to a palliative care unit between January and July 2019. Clinical ultrasound examinations were performed on all patients who needed enhanced diagnostic accuracy for the provision of an adequate, effective therapeutic/palliative approach. Results: There were 202 patients admitted, and 44 of them had a sonogram performed (21.8 %). The main diagnostic suspicions were: ascites, acute urine retention, pleural effusion, and thromboembolic event. The use of clinical ultrasound entailed a modification of the initial diagnostic suspicion in 52.3 % of cases. As a result, 69.5 % of futile invasive techniques, mainly paracentesis and bladder catheters, were avoided. Conclusions: Clinical ultrasound is useful for confirming or discarding uncertain diagnoses, especially the diagnostic suspicion of ascites and acute urinary retention, improving diagnostic accuracy. Certainty in a diagnosis allows the physician to adapt treatment and to avoid futile invasive techniques, thus improving patient comfort. (AU)

Acute toxicity and sublethal effects of the mixture glyphosate (Roundup® Active) and Cosmo-Flux®411F to anuran embryos and tadpoles of four Colombian species / Toxicidad aguda y efectos subletales de la mezcla glifosato (Roundup® Activo) y Cosmo-Flux®411F en embriones y renacuajos de cuatro especies de anuros colombianos

Glyphosate is the most widely used herbicide in the world with application in agriculture, forestry, industrial weed control, garden and aquatic environments. However, its use is highly controversial for the possible impact on not-target organisms, such as amphibians, which are vanishing at an alarming and rapid rate. Due to the high solubility in water and ionic nature, the glyphosate requires of surfactants to increase activity. In addition, for the control of coca (Erythroxylum coca) and agricultural weeds in Colombia, formulated glyphosate is mixed and sprayed with the adjuvant Cosmo-Flux®411F to increase the penetration and activity of the herbicide. This study evaluates the acute toxic and sublethal effects (embryonic development, tadpole body size, tadpole swimming performance) of the mixture of the formulated glyphosate Roundup® Active and Cosmo-Flux®411F to anuran embryos and tadpoles of four Colombian species under 96h laboratory standard tests and microcosms, which are more similar to field conditions as they include soil, sand and macrophytes. In the laboratory, embryos and tadpoles of Engystomops pustulosus were the most tolerant (LC50=3 904µg a.e./L; LC50=2 799µg a.e./L, respectively), while embryos and tadpoles of Hypsiboas crepitans (LC50=2 203µg a.e./L; LC50=1 424µg a.e./L, respectively) were the most sensitive. R. humboldti and R. marina presented an intermediate toxicity. Embryos were significantly more tolerant to the mixture than tadpoles, which could be likely attributed to the exclusion of chemicals by the embryonic membranes and the lack of organs, such as gills, which are sensitive to surfactants. Sublethal effects were observed for the tadpole body size, but not for the embryonic development and tadpole swimming performance. In microcosms, no toxicity (LC50 could not be estimated), or sublethal responses were observed at concentrations up to fourfold (14.76kg glyphosate a.e./ha) the highest field application rate of 3.69kg glyphosate a.e./ha. Thus, toxicity was less in the microcosms than in laboratory tests, which may be attributed to the presence of sediments and organic matter which rapidly adsorb glyphosate and surfactants such as POEA. It is concluded that the mixture of glyphosate (Roundup® Active) and Cosmo-Flux®411F, as used in the field, has a negligible toxic effect to embryos and tadpoles of the species tested in this study.

El glifosato es el herbicida más usado en el mundo con aplicaciones para la agricultura, control de malezas forestales, industriales, en jardines y ambientes acuáticos. Sin embargo, su uso es altamente controversial por el posible impacto sobre organismos no blanco, como los anfibios, los cuales están desapareciendo a una tasa alarmantemente rápida. Debido a su alta solubilidad en agua y naturaleza iónica, el glifosato requiere de surfactantes para incrementar su actividad. Además, para el control de Erythroxylum coca y de malezas en la agricultura en Colombia, el glifosato formulado es mezclado y rociado con el coadyuvante Cosmo-Flux®411F para incrementar la penetración y actividad del herbicida. Este estudio evalúa los efectos tóxicos agudos y subletales (desarrollo embrionario, tamaño corporal y desempeño natatorio de los renacuajos) de la mezcla del glifosato formulado Roundup® Activo con el Cosmo-Flux®411F en embriones y renacuajos de cuatro especies de anuros colombianos, bajo pruebas de 96h en condiciones estándar de laboratorio y microcosmos, que son más similares a las condiciones de campo al incluir tierra, arena y macrófitas. En laboratorio, los embriones y renacuajos de Engystomops pustulosus fueron los más tolerantes (CL50=3 904µg a.e./L; CL50=2 799µg a.e./L, respectivamente), mientras que los embriones y renacuajos de Hypsiboas crepitans fueron los más sensibles (CL50=2 203µg a.e./L; CL50=1 424µg a.e./L, respectivamente). R. humboldti y R. marina presentaron una toxicidad intermedia. Los embriones fueron más tolerantes a la mezcla que los renacuajos, lo cual podría ser atribuido a la exclusión de los químicos por las membranas embrionarias y a la falta de órganos, como las branquias, que son más sensibles a los surfactantes. Se observaron efectos subletales en el tamaño corporal de los renacuajos, pero no en el desarrollo embrionario ni el desempeño natatorio de los renacuajos. En microcosmos no se observaron efectos tóxicos ni respuestas subletales a concentraciones hasta cuatro veces (14.67kg glifosato a.e./ha) la tasa de aplicación más alta de 3.69kg glifosato a.e./ha. Por lo tanto, la toxicidad fue menor en los microcosmos que en las pruebas de laboratorio, lo que puede ser atribuido a la presencia de sedimentos y materia orgánica que absorbe rápidamente el glifosato y surfactantes como el POEA. Se concluye que la mezcla del glifosato (Roundup® Activo) y Cosmo-Flux®411F, como se aplica en campo, tiene un efecto tóxico bajo en los embriones y renacuajos de las especies estudiadas.

Evaluación de l toxicidad de dos agroquímicos,roundup® activo y cosmo-flux®4111f, en renacuajos de anuros Colombiaoss / Toxicity Assesment of Two Agrochemicals, Roundup® Active and Cosmo-Flux®411F, to Colombian Anuran Tadpoles

El Roundup® Activo es un herbicida elaborado a base de glifosato ampliamente utilizado en Colombia para el control de malezas. Sin embargo, para su aplicación requiere ser mezclado con un coadyuvante que facilite su acción, tal como el Cosmo-Flux®411F el cual mejora la adherencia y fijación del herbicida en las hojas de las plantas. El objetivo de este estudio fue determinar la concentración letal media (CL50) y algunos efectos subletales (cambios en el tamaño corporal y en el desempeño natatorio) del Roundup® Activo y del Cosmo-Flux®411F en renacuajos de cuatro especies de anuros colombianos expuestos bajo condiciones controladas de laboratorio y en microcosmos. La especie más sensible a la exposición del Roundup® Activo fue Hypsiboas crepitans (Laboratorio: CL50 = 1414 µg a.e. de glifosato/L y microcosmos: CL50= 4 kg a.e. de glifosato/ha) y para el Cosmo-Flux®411F Rhinella humboldti (Laboratorio: CL50= 319 mg/L y microcosmos: CL50 = 632,3 L/ha). En laboratorio y microcosmos, la exposición al Roundup® Activo no alteró el tamaño corporal ni el desempeño natatorio de los renacuajos, mientras que el Cosmo-Flux®411F generó alteraciones del tamaño corporal pero no afectó el desempeño natatorio. Al comparar los CL50 de los dos agroquímicos con las concentraciones empleadas en campo, el Roundup® Activo generó un riesgo moderado mientras que el Cosmo-Flux®411F no resultó letal. Además, el Roundup® Activo fue notablemente más tóxico que el Cosmo-Flux®411F.

Roundup® Active is an herbicide based on glyphosate widely used in Colombia for control of illicit crops and weeds. However, it must be mixed with an adjuvant that facilitates its action, such as the Cosmo-Flux®411F which improves the adhesion and fixation of the herbicide into the leaves of the plants. The aim of this study was to determine the median lethal concentration (LC50) and some sublethal effects (changes in body size and swimming performance) of the Roundup® Active and the Cosmo-Flux®411F to tadpoles of four Colombian anuran species exposed under laboratory and microcosm conditions. The most sensitive species to exposure of Roundup® Active was Hypsiboas crepitans (Laboratory: LC50= 1414 µg a.e. glyphosate/L; microcosm: LC50= 4 kg a.e. glyphosate/ha), and for Cosmo-Flux®411F was Rhinella humboldti (Laboratory: LC50= 319 mg/L; microcosm: LC50= 632.3 L/ha). In laboratory and microcosms, Roundup® Active did not alter the tadpole body size nor the swimming performance, while the Cosmo-Flux®411F generated changes in the body size but not in the swimming performance. Comparing the LC50 of the two agrochemicals with respect to concentrations used in field, the Roundup® Active exerted a moderate risk whereas the Cosmo-Flux®411F was not lethal. In addition, the Roundup® Active was notably more toxic than the Cosmo-Flux®411F.