Orcas remember what to copy: a deferred and interference-resistant imitation study.

Response facilitation has often been portrayed as a "low level" category of social learning, because the demonstrator's action, which is already in the observer's repertoire, automatically triggers that same action, rather than induces the learning of a new action. One way to rule out response facilitation consists of introducing a delay between the demonstrator's behavior and the observer's response to let their possible effects wear off. However, this may not rule out "delayed response facilitation" in which the subject could be continuously "mentally rehearsing" the demonstrated actions during the waiting period. We used a do-as-the-other-did paradigm in two orcas to study whether they displayed cognitive control regarding their production of familiar actions by (1) introducing a delay ranging from 60 to 150 s between observing and producing the actions and (2) interspersing distractor (non-target) actions performed by the demonstrator and by the subjects during the delay period. These two manipulations were aimed at preventing the mental rehearsal of the observed actions during the delay period. Both orcas copied the model's target actions on command after various delay periods, and crucially, despite the presence of distractor actions. These findings suggest that orcas are capable of selectively retrieving a representation of an observed action to generate a delayed matching response. Moreover, these results lend further support to the proposal that the subjects' performance relied not only on a mental representation of the specific actions that were requested to copy, but also flexibly on the abstract and domain general rule requested by the specific "copy command". Our findings strengthen the view that orcas and other cetaceans are capable of flexible and controlled social learning.

Prevalence of Cognitive Impairment and Dementia in Older Adults Living at High Altitude: A Systematic Review and Meta-Analysis.

INTRODUCTION: Dementia is a chronic disease with a variable prevalence throughout the world; however, this could be higher at high-altitude populations. We aimed to summarize the prevalence of cognitive impairment and dementia in older adults living at high altitude. METHODS: We searched in PubMed, Medline, Scopus, Web of Science, and Embase and included the studies published from inception to July 20, 2020, with no language restriction, which reported the frequency of cognitive impairment or dementia in older adults living at high-altitude populations. Random-effects meta-analyses were performed to calculate the overall prevalence and 95% confidence intervals (95% CI) of cognitive impairment and dementia. The risk of bias was evaluated using the Newcastle-Ottawa Scale (NOS) adapted for cross-sectional studies. RESULTS: Six studies were included (3,724 participants), and 5 of the 6 included studies were carried out in Latin America. The altitude ranged from 1,783 to 3,847 m, the proportion of women included varied from 38.7 to 65.6%, and the proportion of participants with elementary or illiterate educational level ranged from 71.7 to 97.6%. The overall prevalence of cognitive impairment was 22.0% (95% CI: 8-40, I2: 99%), and the overall prevalence of dementia was 11.0% (95% CI: 6-17, I2: 92%). In a subgroup analysis according to the instrument used to evaluate cognitive impairment, the prevalence of cognitive impairment was 21.0% (95% CI: 5-42, I2: 99%) in the MMSE group while the prevalence was 29.0% (95% CI: 0-78) in the non-MMSE group. CONCLUSIONS: The prevalence of cognitive impairment and dementia in older adults living at high altitude is almost twice the number reported in some world regions.

Association between depressive symptoms and disability in older adults of 12 high Andean communities from Peru.

OBJECTIVE: Our objective was to evaluate the association between depressive symptoms and disability in older adults residing in 12 high Andean communities in Peru. MATERIAL AND METHODS: We carried out a secondary data analysis of a cross-sectional study that included older adults (60 years or older) from 12 high Andean communities in Peru from 2013 to 2019. Depressive symptoms were defined as a score of two or more in the abbreviated Geriatric Depression Scale, while disability was defined as a score of less than 95 in the Barthel index. We also included sociodemographic characteristics, medical and personal history, and functional and performance-based tests. We used crude and adjusted Poisson regression models to evaluate the association of interest and estimated prevalence ratios (PR) with their respective 95% confidence intervals (95% CI). RESULTS: We included 442 older adults with a mean age of 73 ± 6.9 in the analysis; 63.1% (n = 279) were women, and 79.9% (n = 353) had no education or incomplete primary school. 50.9% (n = 225) of the participants had depressive symptoms, and 49.8% (n = 220) had disability. The adjusted Poisson regression model showed that depressive symptoms increased the probability of disability (adjusted PR = 1.67; 95% CI: 1.34-2.08; p < 0.001) in older adults living at high altitude. CONCLUSIONS: Depressive symptoms was associated with a greater probability of disability in older adults living at high altitude. Longitudinal studies are needed for better understanding of this association in high altitude populations along with timely interventions to reduce the impact of both geriatric syndromes.

[Impact of social support on limited mobility in older people in high Andean communities in PeruImpacto do apoio social na mobilidade reduzida em idosos de comunidades do altiplano andino no Peru]. / Impacto del soporte social sobre la movilidad limitada en personas mayores de comunidades altoandinas peruanas.

OBJECTIVE: To determine whether there is a relationship between physical mobility and lack of social support in elderly people living in high Andean communities in Peru. METHODOLOGY: Observational, analytical, retrospective study using the database of a previous cross-sectional study containing information on 449 people aged 60 years and over, who participated in the ANDES-FRAIL project. The dependent variable was mobility, evaluated using the Short Physical Performance Battery; the independent variable was social support, evaluated using an item from the Edmonton Frail Scale. Sociodemographic parameters, comorbidities, number of drugs commonly used, and scores received from several instruments were used as covariates. These included the Barthel Index to determine functionality in older people and the Yesavage questionnaire to evaluate depression in the elderly. Frequencies and percentages were calculated for the categorical variables. An adjusted model was developed using the variables that were statistically significant in the two-factor logistic regression analysis. RESULTS: The frequency of limited mobility in the studied population was 58.6% (n = 263) and the frequency of inadequate social support was 58.1% (n = 261); 70.7% of participants (n = 186) with inadequate social support had limited mobility. According to the adjusted regression model, inadequate social support would make it 2.5 times more likely (95% CI: 1.3-4.5) to have limited mobility, regardless of the confounding covariates. CONCLUSIONS: Lack of social support is associated with limited mobility in older people living in high Andean communities in Peru.

OBJETIVO: Determinar se existe relação entre mobilidade física e falta de apoio social em idosos que vivem em comunidades do altiplano andino no Peru. MÉTODOS: Estudo observacional analítico de coorte retrospectiva baseado em dados obtidos em uma pesquisa transversal anterior com 449 participantes, com idade de 60 anos ou mais, como parte do Projeto ANDES-FRAIL. A variável dependente foi a mobilidade, avaliada com o Short Physical Performance Battery, um instrumento que avalia o desempenho físico funcional com uma série curta de testes. A variável independente foi o apoio social, avaliado por um item da Escala de Fragilidade de Edmonton (The Edmonton Frail Scale, EFS). As covariáveis foram parâmetros sociodemográficos, presença de comorbidades, número de medicamentos de uso habitual e pontuação em vários instrumentos de avaliação, como o índice de Barthel de avaliação da independência funcional de idosos e a Escala de Depressão Geriátrica de Yesavage. Foram calculadas as frequências e as porcentagens das variáveis categóricas e elaborado um modelo ajustado com as variáveis com significância estatística na análise de regressão logística bifatorial. RESULTADOS: Na amostra estudada, 58,6% (n = 263) apresentavam mobilidade reduzida e 58,1% (n = 261) recebiam apoio social inadequado. Entre as pessoas com apoio social inadequado, 70,7% (n = 186) apresentavam mobilidade reduzida. De acordo com o modelo de regressão logística ajustado, a chance de ter mobilidade reduzida foi 2,5 vezes maior (IC 95% 1,3­4,5) quando o apoio social era inadequado, independentemente das covariáveis de confusão. CONCLUSÃO: A falta de apoio social está associada à mobilidade reduzida em idosos que vivem em comunidades do altiplano andino no Peru.

He had it Comin': ERPs Reveal a Facilitation for the Processing of Misfortunes to Antisocial Characters.

Human sociality and prosociality rely on social and moral feelings of empathy, compassion, envy, schadenfreude, as well as on the preference for prosocial over antisocial others. We examined the neural underpinnings of the processing of lexical input designed to tap into these type of social feelings. Brainwave responses from 20 participants were measured as they read sentences comprising a randomly delivered ending outcome (fortunate or unfortunate) to social agents previously profiled as prosocial or antisocial individuals. Fortunate outcomes delivered to prosocial and antisocial agents aimed to tap into empathy and envy/annoying feelings, respectively, whereas unfortunate ones into compassion for prosocial agents and schadenfreude for antisocial ones. ERP modulations in early attention-capture (100-200 ms), semantic fit (400 ms), and late reanalysis processes (600 ms) were analyzed. According to the functional interpretation of each of these event-related electrophysiological effects, we conclude that: 1) a higher capture of attention is initially obtained in response to any type of outcome delivered to a prosocial versus an antisocial agent (frontal P2); 2) a facilitated semantic processing occurs for unfortunate outcomes delivered to antisocial agents (N400); and 3) regardless of the protagonist's social profile, an increased later reevaluation for overall unfortunate versus fortunate outcomes takes place (Late Positive Potential). Thus, neural online measures capture a stepwise unfolding impact of social factors during language comprehension, which include a facilitated processing of misfortunes when they happen to occur to antisocial peers (i.e., schadenfreude).

Falls Among the Elderly in Peruvian Andean Communities and the Rural far South of Brazil: Prevalence and Associated Factors.

Falls are the fifth leading cause of death and are one of the main causes of hospitalization. The literature about falls prevalence among older adults living in rural/remote communities in South America is scarce. To compare falls prevalence among the elderly in the Andes, Peru, and in the rural area of the municipality of Rio Grande, Rio Grande do Sul state, Brazil. Two separate cross-sectional studies were conducted in Peru, Andes (N = 413), and Brazil, Rio Grande, Rio Grande do Sul state (N = 1029). We stratified all data analysis according to location (Andes/Rio Grande). Characteristics of the samples were compared and the chi square test for proportions was used. Falls prevalence was then calculated for each independent variable and crude and adjusted prevalence ratios were estimated using Poisson Regression with robust variance. Falls prevalence in the last year was much higher in the Andes (64.1%) than in Rio Grande (25.3%). For most characteristics assessed, falls prevalence in Peru was at least double that found in Rio Grande. According to the adjusted analysis for the Andes, age (80 or more), being married, divorced and alcohol intake were significantly associated with falls. In Rio Grande, female gender and being in the 70-79 and 80 or more age ranges were associated with falls as well as those who self-rated their health as poor. This paper contributes to knowledge about falls prevalence among the elderly from rural and remote communities in two South American countries. Longitudinal multicentre studies with standardized methodologies are recommended.

Temporal arteritis, Sjögren's syndrome and mixed pain components as manifestations in a diabetic older adult: systematic review based on a case report.

Temporal arteritis (TA) is an inflammatory vascular disease common in the European population. It is mainly characterized by sudden onset headache. TA is rarely associated with other autoimmune diseases, such as Sjögren's syndrome (SS). We present the case of a Peruvian 71 year-old man with SS history, who was admitted to the emergency department due to severe headache evolved in 4 days, periocular pain and right ptosis. The authors also performed a systematic review of case reports or case series of patients diagnosed with both TA and SS. This temporal arteritis case is an atypical presentation because headache was characterized by mixed nociceptive and neuropathic pain components. Despite the infrequency, new studies should be carried out to identify comorbidities in TA patients.

Imitation of novel conspecific and human speech sounds in the killer whale (Orcinus orca).

Vocal imitation is a hallmark of human spoken language, which, along with other advanced cognitive skills, has fuelled the evolution of human culture. Comparative evidence has revealed that although the ability to copy sounds from conspecifics is mostly uniquely human among primates, a few distantly related taxa of birds and mammals have also independently evolved this capacity. Remarkably, field observations of killer whales have documented the existence of group-differentiated vocal dialects that are often referred to as traditions or cultures and are hypothesized to be acquired non-genetically. Here we use a do-as-I-do paradigm to study the abilities of a killer whale to imitate novel sounds uttered by conspecific (vocal imitative learning) and human models (vocal mimicry). We found that the subject made recognizable copies of all familiar and novel conspecific and human sounds tested and did so relatively quickly (most during the first 10 trials and three in the first attempt). Our results lend support to the hypothesis that the vocal variants observed in natural populations of this species can be socially learned by imitation. The capacity for vocal imitation shown in this study may scaffold the natural vocal traditions of killer whales in the wild.

Vasodilators for women undergoing fertility treatment.

BACKGROUND: The rate of successful pregnancies brought to term has barely increased since the first assisted reproductive technology (ART) technique became available. Vasodilators have been proposed to increase endometrial receptivity, thicken the endometrium, and favour uterine relaxation, all of which could improve uterine receptivity and enhance the chances for successful assisted pregnancy. OBJECTIVES: To evaluate the effectiveness and safety of vasodilators in women undergoing fertility treatment. SEARCH METHODS: We searched the following electronic databases, trial registers, and websites: the Cochrane Gynaecology and Fertility Group (CGF) Specialised Register of controlled trials, the Cochrane Central Register of of Controlled Trials, via the Cochrane Register of Studies Online (CRSO), MEDLINE, Embase, PsycINFO, the Cumulative Index to Nursing and Allied Health Literature (CINAHL), Web of Knowledge, the Open System for Information on Grey Literature in Europe (OpenSIGLE), the Latin American and Caribbean Health Science Information Database (LILACS), clinical trial registries, and the reference lists of relevant articles. We conducted the search in October 2017 and applied no language restrictions. SELECTION CRITERIA: Randomised controlled trials (RCTs) comparing vasodilators alone or in combination with other treatments versus placebo or no treatment or versus other agents in women undergoing fertility treatment. DATA COLLECTION AND ANALYSIS: Four review authors independently selected studies, assessed risk of bias, extracted data, and calculated risk ratios (RRs). We combined study data using a fixed-effect model and assessed evidence quality using Grades of Recommendation, Assessment, Development and Evaluation Working Group (GRADE) methods. Our primary outcomes were live birth or ongoing pregnancy and vasodilator side effects. Secondary outcomes included clinical pregnancy, endometrial thickness, multiple pregnancy, miscarriage, and ectopic pregnancy. MAIN RESULTS: We included 15 studies with a total of 1326 women. All included studies compared a vasodilator versus placebo or no treatment. We judged most of these studies as having unclear risk of bias. Overall, the quality of evidence was low to moderate for most outcomes. The main limitations were imprecision due to low numbers of events and participants and risk of bias due to unclear methods of randomisation.Vasodilators probably make little or no difference in rates of live birth compared with placebo or no treatment (RR 1.18, 95% confidence interval (CI) 0.83 to 1.69; three RCTs; N = 350; I² = 0%; moderate-quality evidence) but probably increase overall rates of side effects including headache and tachycardia (RR 2.35, 95% CI 1.51 to 3.66; four RCTs; N = 418; I² = 0%; moderate-quality evidence). Evidence suggests that if 236 per 1000 women achieve live birth with placebo or no treatment, then between 196 and 398 per 1000 will do so with the use of vasodilators.Compared with placebo or no treatment, vasodilators may slightly improve clinical pregnancy rates (RR 1.45, 95% CI 1.19 to 1.77; 11 RCTs; N = 1054; I² = 6%; low-quality evidence). Vasodilators probably make little or no difference in rates of multiple gestation (RR 1.15, 95% CI 0.55 to 2.42; three RCTs; N = 370; I² = 0%; low-quality evidence), miscarriage (RR 0.83, 95% CI 0.37 to 1.86; three RCTs; N = 350; I² = 0%; low-quality evidence), or ectopic pregnancy (RR 1.48, 95% CI 0.25 to 8.69; two RCTs; N = 250; I² = 5%; low-quality evidence). All studies found benefit for endometrial thickening, but reported effects varied (I² = 92%) and ranged from a mean difference of 0.80 higher (95% CI 0.18 to 1.42) to 3.57 higher (95% CI 3.01 to 4.13) with very low-quality evidence, so we are uncertain how to interpret these results. AUTHORS' CONCLUSIONS: Evidence was insufficient to show whether vasodilators increase the live birth rate in women undergoing fertility treatment. However, low-quality evidence suggests that vasodilators may slightly increase clinical pregnancy rates. Moderate-quality evidence shows that vasodilators increase overall side effects in comparison with placebo or no treatment. Adequately powered studies are needed so that each treatment can be evaluated more accurately.

Using a non-spin flip model to rationalize the irregular patterns observed in the activation of the C-H and Si-H bonds of small molecules by CpMCO (M = Co, Rh) complexes.

The activation of the C-H and Si-H bonds of CH(CH3)3 and SiH(CH3)3 molecules by organometallic compounds CpMCO (M = Co, Rh) has been investigated through DFT and CASSCF-MRMP2 calculations. In particular, we have analyzed the pathways joining the lowest-lying triplet and singlet states of the reactants with the products arising from the insertion of the metal atom into the C-H or Si-H bonds of the organic molecules. Channels connecting the reactants with the inserted structure Cp(CO)H-M-C(CH3)3 through the oxidative addition of the C-H bond of the organic molecule to the metal fragment were found only for the reaction CpRhCO + CH(CH3)3. However, inserted structures could also be obtained for the interactions of SiH(CH3)3 with CpCoCO and CpRhCO by two sequential reactions involving the formation and rebounding of the radical fragments Cp(CO)H-M + Si(CH3)3. According to this two-step reaction scheme, the complex CpCoCO is unable to activate the C-H bond of the CH(CH3)3 molecule due to the high energy at which the radical fragments Cp(CO)H-M + C(CH3)3 are located. The picture attained for these interactions is consistent with the available experimental data for this kind of reaction and allows rationalization of the differences in the reactivity patterns determined for them without using spin-flip models, as has been proposed in previous studies.

Cognitive impairment and hypertension in older adults living in extreme poverty: a cross-sectional study in Peru.

BACKGROUND: Previous studies have shown that hypertension is a risk factor for cognitive impairment, but whether this association is also present in extremely poor populations in Low Middle Income Countries settings remains to be studied. Understanding other drivers of cognitive impairment in this unique population also merits attention. METHODS: We performed a secondary analysis using data from the "Encuesta de Salud y Bienestar del Adulto Mayor", a regional survey conducted in an extremely poor population of people older than 65 years old from 12 Peruvian cities in 2012. The outcome variable was cognitive impairment, determined by a score of ≤7 in the modified Mini-Mental State Examination. The exposure was self-reported hypertension status. Variables such as age, gender, controlled hypertension, education level, occupation, depression and area of living (rural/urban) were included in the adjusted analysis. We used Poisson regression with robust variance to calculate prevalence ratios (PR) and 95% confidence interval (95% CI) adjusting for confounders. RESULTS: Data from 3842 participants was analyzed, 51.8% were older than 70 years, and 45.6% were females. The prevalence of cognitive impairment was 1.7% (95% CI 1.3%-2.1%). There was no significant difference on the prevalence of cognitive impairment between the group of individuals with hypertension in comparison with those without hypertension (PR = 0.64, 95% CI 0.33-1.23). CONCLUSIONS: The association described between hypertension and cognitive impairment was not found in a sample of extremely poor Peruvian older adults.

Seasonality of reproductive events and early mortality in a colony of hamadryas baboons (Papio hamadryas hamadryas) over a 30-year period: Capital breeding and life history patterns in a food-provisioned population seasonally thermally stressed.

In environments where energy demands and resource availability vary seasonally, individuals are expected to time the optimal allocation of resources to support survival and reproduction. Although female baboons are regarded as all year round, capital breeders, we wondered how they would respond in an ecological scenario where food were not limiting, foraging effort were negligible, and they were thermally stressed during the cold winter. This study analyzes a 30-year database of conceptions, births, resumptions of postlactational ovarian activity, menarches, and prenatal and early postnatal reproductive failures recorded in a food-provisioned colony of hamadryas baboons located in a temperate zone (40°25'N) to search for seasonal patterns in their life-history patterns and explore its fitness consequences. The results show that the study females exhibited moderate seasonality and behaved like capital breeders; ovarian activity peaked during the period of benign weather conditions (spring and early summer) and births and lactation peaked during the period when they were thermally stressed and faced a negative energy balance (winter). Mistimed conceptions were more likely to fail than timed conceptions were, although this association could be artefactual due to the difficulty to accurately detect prenatal losses. Insolation and, to a lesser extent, temperature were positively associated with conceptions, resumptions of postlactational ovarian activity and onsets of menarche, and negatively associated with births. These findings highlight the extent of plasticity (width of peaks) and resiliency (retention of a capital breeding tactic even under highly seasonally thermally stressful cold conditions) in how primates can adjust their life history patterns and solve tradeoffs in a scenario of strong seasonal variation. Am. J. Primatol. 78:1149-1164, 2016. © 2016 Wiley Periodicals, Inc.

Comparing humans and nonhuman great apes in the broken cloth problem: Is their knowledge causal or perceptual?

When presented with the broken cloth problem, both human children and nonhuman great apes prefer to pull a continuous cloth over a discontinuous cloth in order to obtain a desired object resting on top. This has been interpreted as evidence that they preferentially attend to the functionally relevant cues of the task (e.g., presence or absence of a gap along the cloth). However, there is controversy regarding whether great apes' behavior is underpinned by causal knowledge, involving abstract concepts (e.g., support, connection), or by perceptual knowledge, based on percepts (e.g., contact, continuity). We presented chimpanzees, orangutans, and 2-, 3-, and 4-year-old children with two versions of the broken cloth problem. The Real condition, made with paper strips, could be solved based on either perceptual cues or causal knowledge. The Painted condition, which looked very similar, could be solved only by attending to perceptual cues. All groups mastered the Real condition, in line with previous results. Older children (3- and 4-year-olds) performed significantly better in this condition than all other groups, but the performance of apes and children did not differ sharply, with 2-year-olds and apes obtaining similar results. In contrast, only 4-year-olds solved the Painted condition. We propose causal knowledge to explain the general good performance of apes and humans in the Real condition compared with the Painted condition. In addition, we suggest that symbolic knowledge might account for 4-year-olds' performance in the Painted condition. Our findings add to the growing literature supporting the idea that learning from arbitrary cues is not a good explanation for the performance of apes and humans on some kinds of physical task.

A two-step reaction scheme leading to singlet carbene species that can be detected under matrix conditions for the reaction of Zr(3F) with either CH3F or CH3CN.

The results obtained from CASSCF-MRMP2 calculations are used to rationalize the singlet complexes detected under matrix-isolation conditions for the reactions of laser-ablated Zr((3)F) atoms with the CH3F and CH3CN molecules, without invoking intersystem crossings between electronic states with different multiplicities. The reaction Zr((3)F) + CH3 F evolves to the radical products ZrF· + ·CH3. This radical asymptote is degenerate to that emerging from the singlet channel of the reactants Zr((1)D) + CH3 F because they both exhibit the same electronic configuration in the metal fragment. Hence, the caged radicals obtained under cryogenic-matrix conditions can recombine through triplet and singlet paths. The recombination of the radical species along the low-multiplicity channel produces the inserted structures H3C-Zr-F and H2C=ZrHF experimentally detected. For the Zr((3)F) + CH3 CN reaction, a similar two-step reaction scheme involving the radical fragments ZrNC· + ·CH3 explains the presence of the singlet complexes H C-Zr-NC and H2 C=Zr(H)NC revealed in the IR-matrix spectra upon UV irradiation.

Disruptive Model That Explains for the Long-Lived Triplet States Observed for 2-Thiocytosine upon UVA Radiation.

The possible role of radical species in the formation of the long-lived triplet states observed for 2-thiocytosine upon UV irradiation was theoretically investigated. It is predicted that the radical fragments arising from the homolytic rupture of the NH group of the thiobase can be yielded upon ultraviolet-A radiation. Recombination of the radicals through the most favorable singlet channel yields the lowest-lying tautomer of the 2-thiocytosine (the amino-thiol form) through a barrierless pathway. The rebounding of the radical fragments along the triplet channels that emerge from the attack of the hydrogen to the nitrogen atoms next to the C-S bond leads to stable structures for the amino-thion-N1H and amino-thion-N3H tautomers. These results allow for the rationalization of the near-unity triplet yields observed when this pure light-atom organic molecule is exposed to UV irradiation, without invoking intersystem crossings between the electronic states of different spin-multiplicities. A similar study for cytosine showed that the energy required to induce the homolytic breaking of the N-H bond of the nucleobase is not attainable under UVA radiation. This result is consistent with the experimental fact that no triplet states are observed when this molecule is exposed to that light.

[Severe asthma: Pathophysiology, diagnosis, and treatment]. / Asma grave: fisiopatología, diagnóstico y tratamiento.

Severe asthma is an entity with a complex diagnosis, requiring an adequate differential diagnosis and identification of endotypes for a correct approach and therapeutic process. In the present review, we show a synthesis of the current literature on the diagnosis, pathophysiology, and management of severe asthma, having critically analyzed the evidence in search engines such as Medline, Scopus, and Embase.

El asma grave es una enfermedad compleja, que requiere un enfoque y diagnóstico diferencial ordenado e identificación de endotipos para el correcto abordaje y tratamiento. El tratamiento farmacológico cuenta cada vez con más moléculas a disposición del personal médico para el control efectivo de los síntomas. Esta revisión muestra una síntesis de la bibliografía actual acerca del diagnóstico, fisiopatología y tratamiento del asma grave, mediante la lectura crítica previa de la evidencia científica en buscadores como Medline, Scopus y Embase.

Correlation between Instrumental Activities of Daily Living and muscle mass in older adults: impact of comorbidities.

Background: There is evidence that sarcopenia and functionality are closely related. However, the association between geriatric syndromes, such as dependence, on instrumental activities and sarcopenia could be affected by the presence of certain comorbidities, such as overweight, obesity, diabetes, and chronic obstructive pulmonary disease (COPD). Therefore, the present study aimed to determine the association between instrumental activities of daily living and muscle mass in the elderly and evaluate the impact of certain comorbidities on this association. Methods: This was a retrospective analytical observational study, including 1897 patients. Muscle mass was measured with calf circumference, and instrumental activities were measured with the Lawton index. Results: Among different parameters studies, a statistical correlation was found in a stratified regression analysis between the Lawton index score and muscle mass in patients who were overweight (p value:0.001 ;beta coefficient: 0.08), obese (p value: 0.001 ; beta coefficient: 0.05), had diabetes (p value: 0.012 ;beta coefficient: 0.03), and had COPD (p value:0.001 ;beta coefficient:0.03). Conclusion: The correlation between muscle mass and instrumental activities of daily living should be evaluated individually according to the needs of each participant and according to their comorbidities, promoting patient-centered geriatric medicine.

Association between Subclinical Hypothyroidism and Glycemic Control in Older Adults in a Medical Center in Peru.

Objective: To determine whether there is an association between subclinical hypothyroidism and glycemic control in older adults who received care at the "Centro Médico Naval" from 2010 to 2015. Methods: This retrospective analytical study analyzed a secondary database of the care of elderly in the study hospital. The sample was comprised of 1,385 older adults. To detect an association between variables, the Poisson regression with robust variance was used at a significance level of 95%. The analyses were carried out with the STATA 16 program. Results: Of the elderly 45.6% were between 71 and 80 years old; 58.4% were women and 43.8% had a normal body mass index. There was evidence of inadequate glycemic control in 8.1% and subclinical hypothyroidism in 15.2% of the elderly patients. Subclinical hypothyroidism was more frequent in the inadequate glycemic control vs. adequate glycemic control populations (41.1% vs. 13.0%). In the multivariance analysis, subclinical hypothyroidism (aPR = 2.22 95% CI [1.47-3.36]) was independent factor associated with inadequate glycemic control (p < 0.001). Conclusions: A significant association was detected between subclinical hypothyroidism and inadequate glycemic control in older adults who presented at the "Centro Médico Naval" from 2010 to 2015.

Acute abdomen following COVID-19 vaccination: a systematic review.

Purpose: Conduct a systematic review of case reports and case series regarding the development of acute abdomen following coronavirus disease 2019 (COVID-19) vaccination, to describe the possible association and the clinical and demographic characteristics in detail. Materials and Methods: This study included case report studies and case series that focused on the development of acute abdomen following COVID-19 vaccination. Systematic review studies, literature, letters to the editor, brief comments, and so forth were excluded. PubMed, Scopus, EMBASE, and Web of Science databases were searched until June 15, 2023. The Joanna Briggs Institute tool was used to assess the risk of bias and the quality of the study. Descriptive data were presented as frequency, median, mean, and standard deviation. Results: Seventeen clinical case studies were identified, evaluating 17 patients with acute abdomen associated with COVID-19 vaccination, which included acute appendicitis (n=3), acute pancreatitis (n=9), diverticulitis (n=1), cholecystitis (n=2), and colitis (n=2). The COVID-19 vaccine most commonly linked to acute abdomen was Pfizer-BioNTech (messenger RNA), accounting for 64.71% of cases. Acute abdomen predominantly occurred after the first vaccine dose (52.94%). All patients responded objectively to medical (88.34%) and surgical (11.76%) treatment and were discharged within a few weeks. No cases of death were reported. Conclusion: Acute abdomen is a rare complication of great interest in the medical and surgical practice of COVID-19 vaccination. Our study is based on a small sample of patients; therefore, it is recommended to conduct future observational studies to fully elucidate the underlying mechanisms of this association.

Evaluation of Factors Influencing Handgrip Strength Asymmetry in Older Peruvian Adults.

BACKGROUND: Sarcopenia is a musculoskeletal disease involving the reduction of muscle mass, strength, and performance. Handgrip strength (HGS) measurements included in frailty assessments are great biomarkers of aging and are related to functional deficits. We assessed the association between potential influencing factors and HGS asymmetry in older Peruvian adults. METHODS: We used a database of the Peruvian Naval Medical Center "Cirujano Santiago Távara" located in Callao, Peru. All the patients included were ≥60 years old and had an HGS measurement in the dominant and non-dominant hand. RESULTS: From a total of 1,468 patients, 74.66% had HGS asymmetry. After adjustment, calf circumference weakness (adjusted prevalence ratio [aPR]=1.08; 95% confidence interval [CI], 1.01-1.15), falls risk (aPR = 1.08; 95% CI, 1.02-1.16), and an altered Lawton index (aPR=0.92; 95% CI, 0.84-0.99) were associated with HGS asymmetry. CONCLUSION: Our findings suggest that HGS asymmetry should be measured along with other geriatric assessments used to evaluate health outcomes in the elderly to enhance health promotion and prevention aimed at preserving muscle strength to curb functional limitations in the elderly.