Unsafe Practices of Motorcycle Riders in El Petén, Guatemala: A Community Observational Study and a Retrospective Institutional Review.

INTRODUCTION: Outcomes from trauma at the major referral hospital [Hospital Nacional de San Benito (HNSB)] in El Petén, Guatemala, have not been analyzed. Empirical evidence demonstrated a high number of motorcycle accidents (MAs). We hypothesized a large incidence of head trauma with poor outcomes in MAs compared to all other forms of blunt trauma. METHODS: Our hypothesis was tested by performing a community observational study and a retrospective chart review in El Petén, Guatemala. An independent observer catalogued 100 motorcycle riders on the streets of El Petén for riding practices as well as helmet utilization. HNSB does not have electronic medical records. For this study, we performed a retrospective chart review of randomly selected nonconsecutive trauma admission at HNSB between March 2018 and June 2023. Blunt trauma was compared between MAs versus all others. Variables were examined by parametric and nonparametric tests as well as contingency table analyses. RESULTS: Most motorcycles riders involved multiple individuals (2.61 ± 0.79/motorcycle). Seventy riders included children (median = 1.0 [Q1-Q3 range = 1.0-3.0]/motorcycle). Overall, only three riders were wearing helmets. Forty-one were women. Of patients presenting to HNSB with trauma, 91 charts were reviewed (33.0 [20.0-37.0] y old; male 89%), 76.7% were blunt, and 23.3% were penetrating trauma. Within blunt trauma, 57.1% were MAs versus 42.9% all others; P = 0.13. MAs were younger (29.5 [20.0-37.0] versus 34.0 [21.8-45.8] y old; P < 0.05) and of similar gender (male 82.5% versus 96.6%; P = 0.1). More MAs had a computed tomography (70.0% versus 30.0%; P < 0.01) and they were more likely to present with head trauma (72.5% versus 46.7%; P = 0.04) but similar Glasgow Coma Scale (15.0 [13.5-15.0] versus 15.0 [12.5-15.0]; P = 0.7). MAs were less likely to require surgical intervention (37.5% versus 56.7%; P = 0.05) but had similar hospital length of stay (4.0 [2-6] versus 4.0 [2-10.5] d; P = 0.5). CONCLUSIONS: Unsafe motorcycle practices in El Petén are staggering. Most trauma at HNSB is blunt, and likely from MAs. More patients with MAs presented with head trauma. However, severe trauma might be transferred to higher level hospitals or mortality might occur on scene, which will need further investigations. Assessment of mortality from trauma admissions is ongoing. These findings should lead to enforcement of safe motorcycle practices in El Petén, Guatemala.

Factors Associated With Major Lower Extremity Amputations in Diabetic Foot Infections at a County Hospital in Guatemala.

INTRODUCTION: Outcomes from diabetic foot infections (DFIs) at the major referral hospital (Hospital Nacional de San Benito) in El Petén, Guatemala have not been analyzed. We hypothesized that poor diabetic control might be associated with a high rate of major lower extremity amputations (mLEAs; above the ankle). METHODS: We performed a retrospective analysis at Hospital Nacional de San Benito between (8/14 and 6/23) in patients presenting with DFIs. Patients receiving mLEAs were compared with all others (AO = [trans-metatarsal amputations, toe amputations, incision and drainage, and antibiotic treatment]). Interviews surgeons were undertaken to ascertain reasons for index operation choice. Univariable and multivariable analyses were undertaken to determine factors associated with mLEAs. RESULTS: Of 110 patients with DFIs, there were 23 mLEAs (above the knee = 21, below the knee = 2). Age, duration with diabetes, and a prior ipsilateral minor amputation were associated with mLEAs. Multivariable analysis identified white blood cell count as significant for mLEA (odds ratio = 1.5 95% confidence interval [1.0 to 2.5]). Cited reasons for a high rate of above the knee amputation (AKAs) versus below the knee amputation were patient related (advanced disease, patient frailty, and poor compliance), systemic (lack of vascular equipment and knee immobilizer), and surgeon related. CONCLUSIONS: This cohort of patients presented with an average of 15 years with diabetes mellitus and poor adherence to diabetic treatment (40%). Many of these diabetic patients developed a DFI requiring mLEAs (21%), most of which were AKAs (91%). Efforts to minimize the number of AKA versus below the knee amputation require immediate attention. Programs to adhere to DM control and foot care in patients with DM are urgently needed.

Eutrophication assessment and environmental management perspectives of Tóbari: an arid subtropical coastal lagoon of the Gulf of California.

Coastal lagoons are vulnerable to eutrophication processes. In this study, we evaluate the eutrophication process in the restricted, arid subtropical Tóbari coastal lagoon, located in the eastern coast of the Gulf of California, where the main source of nutrient inputs and other pollutants is agricultural wastewater from the Yaqui Valley. The Assessment of Estuarine Trophic Status (ASSETS) model and the Trophic State Index (TRIX) were used to evaluate eutrophication. Overall, ASSETS showed that the Tóbari lagoon has a moderate eutrophication process, with seasonal symptoms of hypoxia, increased phytoplankton biomass, dominance of macroalgae (indicative of nutrient enrichment), and blooms development of potentially harmful algae species. The TRIX showed that the lagoon is mesotrophic most of the year. Challenges of environmental management detected correspond to reducing the input of nutrients and others contaminants from anthropic sources: agriculture, shrimp farming, livestock, and urban zones.

Probiotic Bacterium and Microalga Interaction on Rearing Kumamoto Oyster Crassostrea sikamea Spat.

This study assessed in vitro interaction between Bacillus bacteria and microalgae and their posterior in vivo effect on rearing Kumamoto oyster Crassostrea sikamea. The probiotic strains Bacillus licheniformis (MAt32), B. subtilis (MAt43) and B. subtilis (GAtB1) were individually inoculated in triplicate into 250 mL flasks containing 1 × 104 colony forming units (CFU) mL-1 of bacteria and 4.5 × 104 cell mL-1 of microalgae (Isochrysis galbana or Chaetoceros calcitrans) to evaluate their growth during a 7-day culture. Single cultures of microalgae or bacilli served as control. Additionally, C. sikamea spat was treated for 28 days with four single/combined bacillus treatments in triplicate at a concentration of 1 × 106 CFU mL-1 as follows: (a) control, without treatments; (b) combination of two antibiotics (10 mg L-1); (c) B. licheniformis; (d) B. subtilis; (e) B. subtilis subtilis and (f) mixed bacilli. The results showed a significantly (P < 0.05) increased growth of Bacillus strains co-cultured with microalgae, while the growth of I. galbana co-cultured with bacteria was not reduced significantly (P > 0.05) compared with the control group. C. sikamea spat treated with Bacillus showed significantly (P < 0.05) higher growth and survival than the control group. In this study, C. calcitrans microalgae were susceptible to the presence of probiotic bacteria. Nonetheless, this reduction in microalgal growth observed in vitro increased growth and survival of C. sikamea spat exposed to probiotic bacteria when compared to spat without probiotics.

Progressive disseminated histoplasmosis in Latin America and the Caribbean in people receiving highly active antiretroviral therapy for HIV infection: A systematic review.

Histoplasmosis is the most clinically significant mycosis in Latin America; still it has been neglected in people with human immunodeficiency virus (HIV). There is limited information about its contribution to morbidity and mortality in this population. We conducted a systematic review of scientific literature to provide an estimation of the frequency and mortality of histoplasmosis among people with HIV receiving highly active antiretroviral therapy (HAART) in Latin America, and factors associated with mortality. We searched articles in PubMed, Scopus, WHO Global health library, and Scielo using different combination of terms including "histoplasmosis" and HAART. We identified 949 articles, removed 662 duplicated; screened 287 abstracts; reviewed full text of 53 articles; and selected 15 articles that provided information on the number of patients studied, included patients receiving ART, and reported any measure of frequency estimate for qualitative synthesis. Studies were conducted in Argentina (n = 4), Brazil (n = 6), Colombia (n = 2), French Guyana and the Bahamas (=2), and Guatemala (n = 1). Heterogeneity of studies characteristics precluded any aggregated estimates. Histoplamosis was frequent in these cohort studies and mortality was high despite the use of HAART. Low CD4 counts, delayed HAART initiation and poor adherence were related to increased incidence, poor prognosis and increased mortality, respectively. Histoplasmosis may be an important contributor to mortality in people with HIV in Latin America. Diagnostic delays represent an important limitation for improving care of patients suspected to have histoplasmosis. Reducing histoplasmosis diagnostic delays and therapy initiation is needed to further decrease mortality.

Evaluating the efficacy of artificial intelligence tools for the automation of systematic reviews in cancer research: A systematic review.

To evaluate the performance accuracy and workload savings of artificial intelligence (AI)-based automation tools in comparison with human reviewers in medical literature screening for systematic reviews (SR) of primary studies in cancer research in order to gain insights on improving the efficiency of producing SRs. Medline, Embase, the Cochrane Library, and PROSPERO databases were searched from inception to November 30, 2022. Then, forward and backward literature searches were completed, and the experts in this field including the authors of the articles included were contacted for a thorough grey literature search. This SR was registered on PROSPERO (CRD 42023384772). Among the 3947 studies obtained from search, five studies met the preplanned study selection criteria. These five studies evaluated four AI tools: Abstrackr (four studies), RobotAnalyst (one), EPPI-Reviewer (one), and DistillerSR (one). Without missing final included citations, Abstrackr eliminated 20%-88% of titles and abstracts (time saving of 7-86 hours) and 59% of the full-texts (62 h) from human review across four different cancer-related SRs. In comparison, RobotAnalyst (1% of titles and abstracts, 1 h), EPPI Review (38% of titles and abstracts, 58 h; 59% of full-texts, 62 h), DistillerSR (42% of titles and abstracts, 22 h) also provided similar or lower work savings for single cancer-related SRs. AI-based automation tools exhibited promising but varying levels of accuracy and efficiency during the screening process of medical literature for conducting SRs in the cancer field. Until further progress is made and thorough evaluations are conducted, AI tools should be utilized as supplementary aids rather than complete substitutes for human reviewers.

Comparison of Ten Surrogate Insulin Resistance and Obesity Markers to Identify Metabolic Syndrome in Mexican Adults.

Metabolic syndrome (MetS) is a group of clinical traits directly linked to type 2 diabetes mellitus and cardiovascular diseases, whose prevalence has been rising nationally and internationally. We aimed to evaluate ten known and novel surrogate markers of insulin resistance and obesity to identify MetS in Mexican adults. The present cross-sectional study analyzed 10575 participants from ENSANUT-2018. The diagnosis of MetS was based on the Adult Treatment Panel III (ATP III) criteria and International Diabetes Federation (IDF) criteria, stratified by sex and age group. According to ATP III, the best biomarker was the metabolic score for insulin resistance (METS-IR) in men aged 20-39 and 40-59 years and lipid accumulation product (LAP) in those aged ≥60 years. The best biomarker was LAP in women aged 20-39 and triglyceride-glucose index (TyG) in those aged 40-59 and ≥60 years. Using the IDF criteria, the best biomarker was LAP in men of all ages. TyG gave the best results in women of all ages. The best biomarker for diagnosis of MetS in Mexican adults depends on the criteria, including sex and age group. LAP and TyG are easy to obtain, inexpensive, and especially useful at the primary care level.

Coccidioidomycosis in Immunocompromised at a Non-Endemic Referral Center in Mexico.

The incidence and distribution of coccidioidomycosis are increasing. Information scarcity is evident in Mexico, particularly in non-endemic zones and specific populations. We compared the treatment and outcomes for patients with isolated pulmonary infections and those with disseminated coccidioidomycosis, including mortality rates within six weeks of diagnosis. Of 31 CM cases, 71% were male and 55% were disseminated. For 42% of patients, there was no evidence of having lived in or visited an endemic region. All patients had at least one comorbidity, and 58% had pharmacologic immunosuppressants. The general mortality rate was 30%; without differences between disseminated and localized disease. In our research, we describe a CM with a high frequency of disseminated disease without specific risk factors and non-significant mortality. Exposure to endemic regions was not found in a considerable number of subjects. We consider diverse reasons for why this may be, such as climate change or migration.

An accessible method to standardize polyethylene microsphere (<100 µm) concentrations for zooplankton ingestion experiments.

The ubiquity of microplastics has caused alarm as to the impact of these materials on aquatic life, leading to experimental studies to understand these effects. In zooplankton bioassays, microspheres (Ms) are often used as a proxy to represent aquatic microplastic contamination due to their homogeneity and small sizes (<100 µm). The present study proposes an accessible protocol that does not require highly specialized equipment for the creation of Ms stock solutions and environmentally realistic experimental concentrations and describes some common issues. Adult females of the calanoid copepod Centropages furcatus underwent treatments of two Ms sizes at experimental concentrations of 10 Ms/mL. They consumed on average 0.9 ± 2.6 Ms/mL of 45-53 µm Ms, and 2.4 ± 1.1 Ms/mL of 38-45 µm Ms. The results are not directly comparable with other studies due to the wide variety of methods used but successfully demonstrate the reproducibility of the proposed protocol.

Rajids ovipositing on marine litter: A potential threat to their survival.

Marine litter is a complex environmental issue threatening the well-being of multiple organisms. In the present study, we present an overlooked pathway by which marine litter interaction with certain ovigerous skates (Family: Rajidae) communities could compromise their survival. We propose that skates from the genus Sympterygia deposit their egg capsules on marine litter substrates by accident, which are then washed ashore still unhatched. We conducted 10 monitoring surveys on three beaches of La Libertad Region, on the north coast of Peru, looking for marine litter conglomerates to determine the presence of egg capsules. We registered a total of 75 marine litter conglomerates, containing 1595 egg capsules, out of which only 15.9 % were presumably hatched, and 15.8 % were still fresh. Fishing materials were identified as the main item in marine litter conglomerates. We conclude that this behavior could contribute to the decline of Sympterygia communities, although further research is needed.

Isolation and characterization of infectious Vibrio sinaloensis strains from the Pacific shrimp Litopenaeus vannamei (Decapoda: Penaeidae).

Infectious diseases especially those caused by bacterial and viral pathogens are serious loss factors in shrimp farming. In this study, bacteria were isolated from the gut and hepatopancreas of stressed shrimps obtained from a commercial farm. The isolates were screened on Thiosulfate citrate bile salt sucrose (TCBS) agar plates for the selection of Vibrio species. Presumptive vibrios were characterized through tests for hemolytic and enzymatic activity, hydrophobicity, growth and molecular identification. Three experimental infections were conducted in order to confirm the pathogenicity of selected bacterial strains VHPC18, VHPC23, VHPC24 and VIC30. In the third experimental challenge the LD50 was obtained, it lasted 10 days with 10 shrimp, weighing 6.9+1. Ig, per tank. The treatments in triplicate were: (1) saline solution (control group); (2) 2xl0(5)CFU/shrimp; (3) 4xl05CFU/shrimp; (4) 2x10(6)CFU/shrimp; (5) 4x10(6)CFU/shrimp, and (6) 8x10(6)CFU/shrimp. In all challenges, water parameters measured during the experimental period remained within optimum ranges. Pathogenicity tests confirmed that the mixture of four vibrio isolates, identified as Vibrio sinaloensis, was virulent for L. vannamei. The LD50 value was 1.178x10(5)CFU/g body weight. V sinaloensis may act as opportunistic pathogens for cultured L. vannamei.

Binational survey of personal protective equipment (PPE) pollution driven by the COVID-19 pandemic in coastal environments: Abundance, distribution, and analytical characterization.

In the present contribution, two nationwide surveys of personal protective equipment (PPE) pollution were conducted in Peru and Argentina aiming to provide valuable information regarding the abundance and distribution of PPE in coastal sites. Additionally, PPE items were recovered from the environment and analyzed by Fourier transformed infrared (FTIR) spectroscopy, Scanning electron microscopy (SEM) with Energy dispersive X-ray (EDX), and X-ray diffraction (XRD), and compared to brand-new PPE in order to investigate the chemical and structural degradation of PPE in the environment. PPE density (PPE m-2) found in both countries were comparable to previous studies. FTIR analysis revealed multiple polymer types comprising common PPE, mainly polypropylene, polyamide, polyethylene terephthalate, and polyester. SEM micrographs showed clear weathering signs, such as cracks, cavities, and rough surfaces in face masks and gloves. EDX elemental mapping revealed the presence of elemental additives, such as Ca in gloves and face masks and AgNPs as an antimicrobial agent. Other metals found on the surface of PPE were Mo, P, Ti, and Zn. XRD patterns displayed a notorious decrease in the crystallinity of polypropylene face masks, which could alter its interaction with external contaminants and stability. The next steps in this line of research were discussed.

[Comparison of climacteric syndrome symptoms among perimenopausal women from Mexico City and one Zapotec community of Oaxaca, Mexico]. / Comparación de los síntomas del climaterio entre mujeres perimenopáusicas de la Ciudad de México y las de una comunidad zapoteca del estado de Oaxaca.

BACKGROUND: Climacteric syndrome accompanies the menopause and it has been studied in different cultures, with different results among them. OBJECTIVE: To compare the differences in the presentation of the climacteric syndrome among urban and rural women. MATERIAL AND METHOD: A transverse, study was carried out, in which climacteric symptoms were evaluated with the previously validated modified SUMEVA scale in two groups of perimenopausal women. Group 1, indigenous Zapotec spoken women from San Ildefonso Villa Alta, Oaxaca. Group 2, women from Mexico City that attended the gynecologic endocrinology consultation of the UMAE Hospital of Ginecobstetricia "Luis Castelazo Ayala". STATISTICAL ANALYSIS: Central tendency and dispersion measurements were done. The comparison among the groups for continuous variables was carried out by Student t-test and for those discontinuous chi2. RESULTS: The mean score of the SUMEVA scale was 42.3 +/- 31.2 for the rural women and 63.7 +/- 48.6 for Mexico's city women (p < 0.04). When symptoms were separately analyzed, they were significantly more intense in those women from Mexico City. CONCLUSION: Perimenopausal women from Mexico City have more intense climacteric symptoms than those rural. This can be influenced due to way of life in western culture.

Myocardial Inflammatory Changes Before and After Antiretroviral Therapy Initiation in People With Advanced Human Immunodeficiency Virus Disease.

Because of the high frequency of late presentation of human immunodeficiency virus (HIV) disease in our population, we decided to explore the presence of myocarditis among people with HIV infection and advanced immunosuppression (less than 200 CD4+ cells/µL) and to describe the inflammatory changes observed after combined antiretroviral therapy initiation in an observational, longitudinal, prospective cohort. We performed both cardiovascular magnetic resonance imaging and doppler transthoracic echocardiogram.

A novel histochemical method of simultaneous detection by a single- or double-immunofluorescence and Bielschowsky's silver staining in teased rat sciatic nerves.

BACKGROUND: The Golgi silver method has been widely used in neuroscience for the study of normal and pathological morphology of neurons. The method has been steadily improved and Bielschowsky's silver staining method (BSSM) is widely used in various pathological conditions, like Alzheimer's disease. NEW METHOD: In this work, teased sciatic nerves were silver impregnated using BSSM. We also developed simultaneous staining by silver impregnation and single- or double-immunofluorescence of the same section in teased nerve preparations. We immunostained against non-myelinating Schwann cells and different myelinating Schwann cell domains. RESULTS: BSSM teased nerves show a strong staining of axons (black) and a gold-brown staining of myelinating and non-myelinating Schwann cells. We were also able to stain by immunofluorescence these BSSM teased nerves with specific molecular markers against non-myelinating Schwann cells, also against non-compact myelin such as the Schmidt-Lanterman incisures or paranodal regions and compact myelin, but not axons. COMPARISON WITH EXISTING METHODS AND CONCLUSIONS: In peripheral nerves, several silver impregnation methods have been used to stain nerves in paraffin sections, but not in teased nerves to enable the assessment of isolated nerve fibers. In conclusion, BSSM gives accurate information of nerve morphology and combining the procedure with immunofluorescence it would be very useful to study the molecular nerve domain organization of the nerve fibers, and to study the molecular pathology of axon degeneration, or myelin disorders, or of any peripheral neuropathy, also to study demyelination diseases in the central nervous system.

Roads in India: safety and knowledge cross-sectional evaluation.

BACKGROUND: The World Health Organization estimates that more than 15% of the global burden of road traffic trauma is in India. We performed an image-based survey of 3 major roadways in New Delhi, India, to evaluate collision-prone vehicle and pedestrian behaviors. METHODS: We used a cross-sectional survey design with photograph- and video-based data collection. The study was performed at 3 purposively sampled high traffic volume roadways in New Delhi, India. The authors reviewed preliminary photographs and came to a consensus pertaining to the definition and criteria for dangerous and collision-prone behaviors. Analysis was descriptive and was based on frequency data. RESULTS: A total of 11,214 subjects were evaluated. Eighty-six percent were vehicles (n = 9624), whereas the remaining 14% were pedestrians (n = 1572). In 99% of the frames, 1 or more predefined behavioral infraction was identified, with a total of 21% (n = 2392) of subjects committing these infractions. Specifically, 15% of all vehicles (n = 1468) and 59% of all pedestrians (n = 924) displayed a risk-taking infraction. CONCLUSIONS: Road users in New Delhi, India, engage in unacceptably high rates of collision-prone behavior. There is a need for interventions that will improve the behaviors of road users.

Depuración de procalcitonina en pacientes con respuesta inflamatoria sistémica y su asociación con el desarrollo de delirium / Procalcitonin clearance in patients with systemic inflammatory response syndrome and its association with the development of delirium / Depuração da procalcitonina em pacientes com síndrome de resposta inflamatória sistemica e sua associação com o desenvolvimento de delirium

Resumen: El delirium es una entidad clínica caracterizada por una disfunción aguda en el estado de consciencia con alteraciones de la cognición, atención y curso fluctuante. Se trata de una enfermedad con alta prevalencia en pacientes críticamente enfermos con implicaciones pronósticas. La inflamación sistémica tiene un papel importante en la aparición del delirium y la disfunción cerebral aguda. El objetivo del estudio es buscar una relación entre marcadores clínicos de inflamación, principalmente la depuración de procalcitonina a las 72 horas y su asociación con el desarrollo de delirium en los pacientes de terapia intensiva con síndrome de respuesta inflamatoria sistémica (SIRS). Esto se refleja en los días libres de delirium o coma que el paciente cursa en la unidad de cuidados intensivos (UCI). Se trató de un estudio retrospectivo, en el cual se analizaron 126 pacientes, se observó una mortalidad hospitalaria de 23.01% y se detectó delirium por CAM-ICU en 69 (55.2%) de los pacientes. En los pacientes que presentaron delirium se encontraron mayores niveles séricos de procalcitonina al ingreso, a las 24, 48 y 72 horas frente a quienes no lo presentaron. No hubo diferencia entre los niveles de proteína C reactiva ni diferencias significativas en el porcentaje de depuración de procalcitonina entre los pacientes que presentaron delirium y aquéllos que no. Se detectó un cociente de riesgo de 0.97 (IC 0.96-0.99; p = 0.0154) por unidad de proteína C reactiva y un cociente de riesgo de 1.17 (IC 1.02-1.35; p = 0.0261) por unidad de aclaramiento de procalcitonina a las 48 horas. Se concluyó que, en pacientes con respuesta inflamatoria sistémica y delirium, algunos marcadores de inflamación están significativamente elevados y representan un factor de riesgo de tener menos días neurológicos normales.

Abstract: Delirium is a clinical entity characterized by an acute disfunction on patients' mental state, with altered cognition, inatention, and fluctuating course. Delirium has a high prevalence in critically ill patients, with important prognostic implications. Systemic inflammation plays an important role on the development of delirium and acute cerebral disfunction. The study's objective was to find a correlation between clinical markers of inflammation, specifically procalcitonin clearance, and its association with delirium on intensive care unit patients with Systemic Inflammatory Response Syndrome (SIRS). Studied as a reflection of delirium or coma free days by CAM-ICU that the patient experienced during it's intensive care unit stay. This retrospective study enrolled 126 patients, with a hospital mortality of 23.01% and a 55.2% prevalence of delirium as detected by CAM-ICU. Patients with delirium had higher levels of procalcitonin on enrollment, as well as at 24, 48 and 72 hours compared to those who did not develop delirium during their ICU stay. There was no difference between C reactive protein or procalcitonin clearance. Higher CRP levels were associated with an decrease in delirium and coma free days (OR 0.97, CI 0.96-0.99; p = 0.0154), a higher procalcitoin clearance at 48 hours was associated with an increase in delirium and coma free days (OR 1.17, IC 1.02-1.35; p = 0.0261). In conclusion, ICU patients with inflammatory response syndrome who develop delirium have a higher risk of developing delirium if inflammatory serum biomarker are elevated, and have a lower chance of having neurologically normal days.

Resumo: O delirium é uma entidade clínica caracterizada por disfunção aguda no estado de consciência, com alterações na cognição, atenção e curso flutuante. É uma doença com alta prevalência em pacientes em estado crítico com implicações prognósticas. A inflamação sistêmica desempenha um papel importante no aparecimento de delirium e disfunção cerebral aguda. O objetivo deste estudo é buscar uma relação entre os marcadores clínicos de inflamação, principalmente a depuração de procalcitonina às 72 horas, e sua associação com o desenvolvimento de delirium em pacientes em terapia intensiva com síndrome da resposta inflamatória sistêmica (SIRS). Isso é refletido pelos dias sem delirium ou coma que o paciente apresenta na unidade de terapia intensiva. Tratou-se de um estudo retrospectivo em que foram analisados 126 pacientes, encontrando-se uma mortalidade hospitalar de 23.01% e o delirium detectado pelo CAM-ICU em 69 (55.2%) dos pacientes. Nos pacientes que apresentaram delirium foram encontrados níveis séricos de procalcitonina mais altos na admissão, às 24, 48 e 72 horas em comparação com aqueles que não a apresentaram. Não houve diferença entre os níveis de proteína C-reativa, nem diferenças significativas na porcentagem de depuração de procalcitonina entre os pacientes que apresentaram delirium e aqueles que não. Foi encontrada uma fator de risco de 0.97 (IC 0.96-0.99, p = 0.0154) por unidade de proteína C reativa e uma fator de risco de 1.17 (IC 1.02-1.35; p = 0.0261) por unidade de depuração da procalcitonina às 48 horas. Concluiu-se que nos pacientes com resposta inflamatória sistêmica e delirium, alguns marcadores de inflamação são significativamente elevados e apresentam um fator de risco para apresentar um número menor de dias neurológicos normais.

Frequency and genotype distribution of multiple human papillomavirus infections in cancer of the head and neck in a Mexican population.

OBJECTIVE: The aim of this study was to determine the frequency and genotype distribution of single and multiple human papillomavirus (HPV) infections in head and neck squamous cell carcinomas (HNSCCs) in a Mexican population and to assess their associations with smoking and drinking habits and clinicopathologic characteristics. STUDY DESIGN: A cross-sectional study was performed on a sample of patients diagnosed with HNSCCs. Tumor DNA was amplified using polymerase chain reaction with HPV consensus and multiplex primers. The associations among HPV status, survival, and clinical characteristics were analyzed. RESULTS: Sixteen of the 43 HNSCCs were HPV positive. HPV16 was the most prevalent type, with single infections present in 5 cases, whereas another 5 cases were combined with HPV56 infection. There was a significant association between HPV infection and oropharyngeal cancers. HPV positivity was associated with overall survival at a nearly significant P level of 0.06. CONCLUSIONS: Our data support the importance of HPV infection in oropharyngeal cancer, with a trend toward higher survival in HPV-positive cases.

Effect of consecutive matches on heart rate variability in elite volleyball players / Efecto de partidos consecutivos sobre la variabilidad de la frecuencia cardíaca en jugadores elite de voleibol / Efeito de jogos consecutivos na variabilidade da frequência cardíaca em jogadores de vôlei de elite

The objective of this study was to observe and determine changes in HRV parameters in volleyball players during the Mexican national professional volleyball league. Heart rate was monitored in 12 athletes (age 22.60 ± 3.4) for four months during weekends (Saturdays and Sundays). Three measures were taken during each match-day: the first at rest (REST), the second in the afternoon after the matches of the first day (R2), and the third after the matches of the second day (R4). Data were analyzed with ANOVA and the Bonferroni method. We found a difference between REST and R2 and R4 in SDNN (98.66 ± 62.50 vs. 50.35 ± 26.33 ms, p < .001; 59.24 ± 22.11, p < .001 for R2 and R4 respectively), rMSSD (43.49 ± 34.60 vs. 24.33 ± 18.89, p < .05; 28.44 ± 16.70, p < .05 for R2 and R4, respectively), pNN50 (30.37 ± 21.47% vs. 12.09 ± 16.56, p < .001; 13.30 ± 13.64, p < .001 for R2 and R4 respectively), SD1 (45.84 ± 30.17 ms vs. 22.83 ± 17.30, p < .001; 28.01 ± 14.94, p <.01 for R2 and R4, respectively) and SD2 (123.18 ± 53.67 ms vs. 65.58 ± 32.42, p < .001; 79.06 ± 28.33, p < .001 for R2 and R4, respectively). There were no significant differences between R2 and R4. These results show that heart rate variability helps determine changes after several matches in sympathetic and parasympathetic modulation in volleyball players, and that this provides information on athletes’ physical performance (AU)

El objetivo del estudio fue realizar observar y determinar los cambios en la variabilidad de la frecuencia cardiaca (VFC) de un equipo de voleibol masculino durante su participación en la liga profesional nacional de México. Se registró a 12 atletas (Edad 22.60 ± 3.4) por cuatro meses durante el fin de semana (sábado y domingo). En cada jornada se realizaron tres mediciones, la primera por la mañana en reposo (REST); la segunda por la tarde al finalizar los partidos del primer día (R2) y la tercera al finalizar los partido del segundo día (R4). Los datos se analizaron con el test ANOVA y el test de Bonferroni. Se encontró diferencia entre REST con respecto a la R2 y con la R4 en SDNN (98.66±62.50 ms vs. 50.35±26.33, p < .001; 59.24±22.11, p < .001 para R2 y R4 respectivamente), en la rMSSD (43.49±34.60 ms vs. 24.33±18.89, p < .05; 28.44±16.70, p < .05 para R2 y R4 respectivamente), en el pNN50 (30.37±21.47 % vs. 12.09±16.56, p < .001; 13.30±13.64, p < .001 para R2 y R4 respectivamente), en SD1 (45.84±30.17 ms vs. 22.83±17.30, p < .001; 28.01±14.94, p < .01 para R2 y R4 respectivamente) y en SD2 (123.18±53.67 ms vs. 65.58±32.42, p < .001; 79.06±28.33, p < .001 para R2 y R4 respectivamente), entre la R2 y la R4 no hay diferencias significativas. Los resultados indican que en jugadores de voleibol posterior a varios partidos permite determinar los cambios en la modulación simpática y parasimpática a través de la VFC brindando información sobre el estado de rendimiento físico de los atletas (AU)

O objetivo do estudo foi realizar, observar e determinar mudanças na variabilidade da frequência cardíaca (VFC) da equipe de voleibol dos homens, enquanto participavam na nacional liga profissional México. Foram registrados 12 atletas (entre 22,60 ± 3,4 anos de idade) por quatro meses durante o fim de semana (sábado e domingo). Cada dia se realizaram três medições, a primeira de manhã em repouso (REST); a segunda pela tarde no final das primeiros jogos do dia (R2) e a terceira na parte final das jogos do segundo dia (R4). Os dados foram analisados com o teste ANOVA e teste de Bonferroni. Uma diferença foi encontrada entre o REST no que diz respeito a R2 e R4 em SDNN (98,66 ± 62,50 ms vs 50,35 ± 26,33 ms, p < 0,001; 59,24 ± 22,11, p < 0,001 para R2 e R4, respectivamente), em rMSSD (43,49 ± 34,60 ms vs 24,33 ± 18,89, p < 0,05; 28,44 ± 16,70, p < 0,05, para R2 e R4, respectivamente), no pNN50 (30,37 ± 21,47% vs 12,09 ± 16,56%, p < 0,001; 13,30 ± 13,64, p < 0,001 para R2 e R4, respectivamente), SD1 (45,84 ± 30.17 ms vs. 22,83 ± 17,30, p < 0,001; 28,01 ± 14,94, p < 0,01 para R2 e R4, respectivamente) e no SD2 (123,18 ± 53,67 ms vs 65,58 ± 32,42 ms, p < 0,001; 79,06 ± 28,33, p < 0,001 para R2 e R4, respectivamente), entre R2 e R4 não há diferenças significativas. Os resultados indicam que, nos jogadores de vôlei trás várias jogos, permite determinar alterações na modulação simpático e parassimpático através do VFC fornecendo informações sobre o estado de desempenho físico dos atletas (AU)