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Embryonic exposure through maternally transferred pollutants can affect embryo vitality, survival, and health. Reptiles face global declines and are sensitive to embryonic pollutant exposure. Yet, they are often neglected in pollution risk assessment and conservation. We analyzed maternal transfer of organic pollutants in reptiles through a systematic extraction, homogenization, and integration of published data on organic pollutants measured in mother-egg pairs into a comprehensive database (DOI:10.5281/zenodo.10900226), complemented with molecular physical-chemical properties of the pollutants. Over four decades, 17 publications provided 19,955 data points shifting from legacy to emerging contaminants although research on newer contaminants lags regulatory and societal demands. Challenges including taxonomic bias, heterogeneity in sampled tissues, and 73% of censored data complicate comparative analyses. However, significant opportunities were identified including the use of the turtle Malachlemys terrapin and snake Enhydris chinensis as flagship species where a large amount of data is available across tissues (allowing investigation into physiological relations) and compounds (allowing insights into maternal transfer across the chemical universe). Data on other freshwater and marine turtles provide the possibility of exploring taxonomic patterns in this subgroup. The analysis, integrated database, and discussion present opportunities for research in an era where science needs to achieve more with limited wildlife data.
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Reptiles , Animales , Medición de Riesgo , Femenino , Monitoreo del Ambiente , Compuestos Orgánicos , TortugasRESUMEN
L-asparaginase (L-Asp) is an essential enzyme in the treatment of patients with Acute Lymphoblastic Leukemia (ALL), commonly associated with adverse events (AE). Knowing the pharmacokinetic and pharmacodynamic (PK/PD) parameters of L-Asp as well as its relationship with the development of AE is an important strategy in the search to improve the efficacy and safety of the treatment. Seventy-four children with ALL that were being treated with L-Asp, were included. One to three blood samples were randomly obtained from each patient, at times from 0 to 30 hours, until completing a total of 211 samples. The L-Asp activity and the Asparagine (Asp) concentration were quantified, in addition, the presence of anti-L-Asp antibodies (Anb) was determined. A population PK/PD model of L-Asp was developed to determine the association of covariates with PK/PD parameters. The presence of Anb was associated with the increase in L-Asp clearance (CL) and with the decrease of volume of distribution 1 (V1). On the other hand, female sex was significantly associated with the increase of V1, while the age from 1 to 6 years was significantly associated with the increase of V1. The presence of Anb as well as the female sex were related to the increase IC50 (concentration-needed to deplete-50% of Asp). Patients who presented Asp depletion before the first 24 hours after administration presented pancreatitis, this could be a risk marker. Significant results were found in this study, use of these results may contribute to the safe and effective use of L-Asp.
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PURPOSE OF REVIEW: Although advances in diabetes technology and pharmacology have significantly and positively impacted diabetes management and health outcomes for some, diabetes care remains burdensome and can be challenging to balance with other life priorities. The purpose of this article is to review the rationale for assessment of psychosocial domains in diabetes care settings and strategies for the implementation of psychosocial screening into routine practice. Survey data from the Type 1 Diabetes Exchange Quality Improvement Network is highlighted. RECENT FINDINGS: Implementation of psychosocial screening requires identifying the population; selecting validated tools to assess target domains; determining frequency of screening and mode of survey delivery; and scoring, interpreting, documenting, and facilitating referrals such that these processes are part of clinical workflows. Recognizing the influence of psychosocial factors for people with diabetes (PWD), professional society guidelines for comprehensive diabetes care recommend the integration of psychosocial screening into routine care.
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Diabetes Mellitus Tipo 1 , Humanos , Diabetes Mellitus Tipo 1/diagnóstico , Diabetes Mellitus Tipo 1/terapia , Diabetes Mellitus Tipo 1/psicología , Mejoramiento de la Calidad , Tamizaje MasivoRESUMEN
BACKGROUND: Self-care is a central element in the training of health students. The lack of effective strategies to develop it is associated with a 50% prevalence of burnout in this population. AIM: Identify and analyze effective strategies for self-care assessment and intervention in health students. METHODOLOGY: We developed a systematized scoping review using standardized methods to assess quality using the Scale for the Assessment of Narrative Review Articles. The Critical Appraisal Skills Programme was used for the thematic analysis. Four sources of information were explored including Pubmed, Google Scholar, Epistemónikos and Lilacs as well as gray literature. Two independent reviewers reviewed each publication and one expert defined controversies. RESULTS: A total of 1682 articles were identified, of which 33 were selected. The average quality of the reviewed articles was 13 points [6-14]. The thematic analysis identified two groups. First, self-care assessment studies (N = 12) highlighting the World Health Organization Quality-of-Life Scale (WHOQOL-BREF) and the Health Promoting Lifestyle Profile II (HPLP-II); and second effective intervention study highlighting four strategies: mindfulness (N = 14); group interventions (N = 8); mentoring (N = 2); and curricular interventions (N = 4). CONCLUSION: There are a variety of effective strategies to assess and promote self-care in health students. The studies we found stand out for being of good quality and applicable to the different study plans.
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Autocuidado , Humanos , Calidad de Vida , Agotamiento Profesional/prevención & control , Agotamiento Profesional/psicología , Estudiantes del Área de la Salud/psicologíaRESUMEN
The luteinizing hormone receptor (LHR) is a glycoprotein member of the G protein-coupled receptors superfamily. It participates in corpus luteum formation and ovulation in females and acts in testosterone synthesis and spermatogenesis in males. In this study, we extracted RNA from sheep testicles and synthetized the cDNA to amplify the gene lhr-bed. This gene consists of 762 bp and encodes 273 amino acids of the extracellular domain of LHR. The lhr-bed was cloned into pJET1.2/blunt, then subcloned into pCOLD II, and finally, transformed in E. coli BL21 (DE3) cells. Because the induced rLHR-Bed protein was found in the insoluble fraction, we followed a modified purification protocol involving induction at 25 °C, subjection to denaturing conditions, and on-column refolding to increase solubility. We confirmed rLHR-Bed expression by means of Western blot and mass spectrometry analysis. It is currently known that the structure stem-loop 5'UTR on pCOLD II vector is stable at 15 °C. We predicted and obtained RNAfold stability at 25 °C. We successfully obtained the recombinant LHR extracellular domain, with protein yields of 0.2 mg/L, and purity levels of approximately 90%, by means of a single chromatographic purification step. The method described here may be used to obtain large quantities of rLHR-Bed in the future.
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Editor's Note: This article is adapted from a speech Dr. Muñoz delivered in June 2021 as President, Health Care & Education of the American Diabetes Association. She delivered her address at the Association's 81st Scientific Sessions, which was held online as a result of the coronavirus disease 2019 pandemic. A webcast of this speech is available for viewing at https://bit.ly/3rk3Esp.
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We aimed to identify patterns in the internal distribution of persistent organic pollutants (POPs) and assess contributing factors using sea turtles and their offspring as a case study of a long-lived wildlife species. We systematically synthesized 40 years of data and developed a lipid database to test whether lipid-normalized POP concentrations are equal among tissues as expected under steady state for lipophilic compounds. Results supported equal partitioning among tissues with high blood flow or perfusion including the heart, kidney, muscle, and lung. Observed differences in the brain, fat, and blood plasma, however, suggest the physiological influence of the blood-brain barrier, limited perfusion, and protein content, respectively. Polybrominated diphenyl ethers partitioned comparably to legacy POPs. Polycyclic aromatic hydrocarbons, meanwhile, partitioned more into the lung, colon, and muscle compared to the liver under chronic and acute field exposure. Partitioning ratios of individual POPs among tissues were significantly related to the lipophilicity of compounds (as estimated by Kow) in half of the observed cases, and significant differences between juveniles and adults underscore physiological differences across life stages. The comprehensive tissue partitioning patterns presented here provide a quantitative basis to support comparative assessments of POP pollution derived from biomonitoring among multiple tissues.
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Contaminantes Ambientales , Bifenilos Policlorados , Tortugas , Contaminantes Químicos del Agua , Animales , Monitoreo del Ambiente , Contaminantes Ambientales/análisis , Éteres Difenilos Halogenados/análisis , Contaminantes Orgánicos PersistentesRESUMEN
IN BRIEF Diabetic ketoacidosis (DKA) is a life-threatening complication that frequently occurs at diagnosis of type 1 diabetes, occurs more commonly when a patient is misdiagnosed, is the leading cause of death in children with type 1 diabetes, and is associated with worse long-term outcomes. Our retrospective online survey found that 25% of all participants were misdiagnosed and that misdiagnosis was associated with an 18% increased risk for DKA compared to those correctly diagnosed. Adult providers should consider type 1 diabetes when diagnosing type 2 diabetes, and pediatric providers should rule out type 1 diabetes when a patient reports nonspecific viral symptoms.
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BACKGROUND: Stroke survivors have high rates of subsequent cardiovascular and recurrent cerebrovascular events, and mortality. While healthy lifestyle practices - including a diet rich in fruits and vegetables, limited alcohol intake, and regular physical activity - can mitigate these outcomes, few stroke survivors adhere to them. Minorities from socioeconomically disadvantaged communities who obtain care in safety-net health systems experience the most barriers to implementing healthy lifestyle changes after stroke. PURPOSE: To report the design of Healthy Eating and Lifestyle After Stroke (HEALS), a randomized controlled trial (RCT) was designed to test the feasibility of using a manualized, lifestyle management intervention in a safety-net setting to improve lifestyle practices among ethnically diverse individuals with stroke or transient ischemic attack (TIA). METHODS: Design: Pilot RCT. PARTICIPANTS: Inclusion criteria: 1) Adults (≥40 years) with ischemic stroke or TIA (≥ 90 days prior); 2) English- or Spanish-speaking. SETTING: Outpatient clinic, safety-net setting. INTERVENTION: Weekly two-hour small group sessions led by an occupational therapist for six weeks. The sessions focused on implementing nutrition, physical activity, and self-management strategies tailored to each participant's goals. MAIN OUTCOME MEASURES: Body mass index, diet, and physical activity. CONCLUSIONS: Recruitment for this study is complete. If the HEALS intervention study is feasible and effective, it will serve as a platform for a large-scale RCT that will investigate the efficacy and cost-effectiveness of life management interventions for racially and ethnically diverse, low-income individuals with a history of stroke or TIA who seek healthcare in the safety-net system.
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Dieta Saludable , Ataque Isquémico Transitorio/terapia , Conducta de Reducción del Riesgo , Autocuidado , Rehabilitación de Accidente Cerebrovascular/métodos , Accidente Cerebrovascular/terapia , Anciano , Consejo , Dieta Saludable/etnología , Estudios de Factibilidad , Femenino , Conocimientos, Actitudes y Práctica en Salud , Humanos , Ataque Isquémico Transitorio/etnología , Ataque Isquémico Transitorio/mortalidad , Ataque Isquémico Transitorio/fisiopatología , Los Angeles/epidemiología , Masculino , Persona de Mediana Edad , Cooperación del Paciente , Educación del Paciente como Asunto , Proyectos Piloto , Factores Protectores , Recurrencia , Proyectos de Investigación , Factores de Riesgo , Proveedores de Redes de Seguridad , Accidente Cerebrovascular/etnología , Accidente Cerebrovascular/mortalidad , Accidente Cerebrovascular/fisiopatología , Rehabilitación de Accidente Cerebrovascular/efectos adversos , Rehabilitación de Accidente Cerebrovascular/mortalidad , Factores de Tiempo , Resultado del TratamientoRESUMEN
IC50 values were obtained for two series of isoindolines derived from α-amino acids over cyclooxygenase 1 and 2 (COX-1 and COX-2). In order to explain the biological activity observed, a structure-activity relationship (SAR) model was achieved for the tested compounds and 19 reference compounds with known selective inhibitory activity, through the correlation of the binding energies calculated from rigid docking of the best conformations into the catalytic sites of COX-1 and COX-2, as well as their molecular descriptors: Log P, molecular weight (MW), volume (V), and solvation energy (Esol) versus their experimental IC50 values by MLR and LS-SVM methods. The model probed whether the COX-1 and COX-2 inhibitory activities of the isoindolines correlate with steric, hydrophobic, and thermodynamic parameters. The correlation values with MLR for COX-1 and COX-2 (r(2) = 0.4193 and r(2) = 0.5929) were optimized with LS-SVM until r(2) = 0.6818 for COX-1 and r(2) = 0.8985 for COX-2, resulting in a good predictive ability for COX-1 and -2 inhibition with this model. In conclusion, the data suggests that the physicochemical descriptors evaluated have an impact on the inhibitory activity and selectivity of isoindolines over COX-1 and COX-2.
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Aminoácidos/química , Inhibidores de la Ciclooxigenasa/química , Isoindoles/química , Aminoácidos/síntesis química , Ciclooxigenasa 1/química , Inhibidores de la Ciclooxigenasa 2/síntesis química , Inhibidores de la Ciclooxigenasa 2/química , Inhibidores de la Ciclooxigenasa/síntesis química , Interacciones Hidrofóbicas e Hidrofílicas , Isoindoles/síntesis química , Simulación del Acoplamiento Molecular , Estereoisomerismo , Relación Estructura-Actividad , TermodinámicaRESUMEN
The integration of stakeholder engagement (SE) in research, quality improvement (QI), and clinical care has gained significant traction. Type 1 diabetes is a chronic disease that requires complex daily management and care from a multidisciplinary team across the lifespan. Inclusion of key stakeholder voices, including patients, caregivers, health care providers and community advocates, in the research process and implementation of clinical care is critical to ensure representation of perspectives that match the values and goals of the patient population. This review describes the current framework for SE and its application to research, QI, and clinical care across the lifespan.
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Diabetes Mellitus Tipo 1 , Humanos , Diabetes Mellitus Tipo 1/terapia , Participación de los Interesados , Mejoramiento de la Calidad , Personal de SaludRESUMEN
BACKGROUND: Motivation for the study. There are few studies describing the variation of COVID-19-associated multisystem inflammatory syndrome (MIS-C) in Peru across pandemic waves. BACKGROUND: Main findings. Cases of MIS-C decreased during the first three years of the pandemic, with higher frequency in the second wave with clinical features similar to Kawasaki disease. BACKGROUND: Implications. MIS-C is a post-infectious complication of SARS-CoV-2. Its diagnostic suspicion is important weeks after peak infections, especially in children who have not yet received COVID-19 vaccines. BACKGROUND: This study aimed to describe the characteristics of multisystemic inflammatory syndrome associated with COVID-19 (MIS-C) in the first three years of the pandemic in children in a pediatric hospital in Peru. We conducted an observational, descriptive study with data from 73 patients and described the clinical and laboratory characteristics, treatment and complications according to the wave of the pandemic and whether they had shock. The median age was 6 years, gastrointestinal and mucocutaneous manifestations were frequent in the three waves. Kawasaki disease-like phenotype was present in 34 (46.6%) patients and 21 (28.8%) patients developed shock. The most commonly used treatment was immunoglobulin (95.9%), followed by acetylsalicylic acid (94.5%) and corticosteroid (86.3%). Five (7%) patients had coronary aneurysm and 17 (23.3%) were admitted to the intensive care unit (ICU). Patients with shock had greater laboratorial alteration and need for mechanical ventilation. In conclusion, MIS-C has decreased in the first three years of the pandemic, possibly due to COVID-19 vaccination in children.
BACKGROUND: El propósito del estudio fue describir las características del síndrome inflamatorio multisistémico asociado a COVID-19 (SIM-C) en los primeros tres años de pandemia en niños de un hospital pediátrico del Perú. Se realizó un estudio observacional, descriptivo con datos de 73 pacientes y se describieron las características clínicas, laboratoriales, tratamiento y complicaciones según la ola de la pandemia y si tuvieron shock. La mediana de edad fue 6 años, las manifestaciones gastrointestinales y mucocutáneas fueron frecuentes en las tres olas. El fenotipo similar a enfermedad de Kawasaki se presentó en 34 (46,6%) pacientes y 21 (28,8%) pacientes desarrollaron shock. El tratamiento más usado fue la inmunoglobulina (95,9%), ácido acetil salicílico (94,5%) y corticoide (86,3%). Cinco (7%) pacientes tuvieron aneurisma coronario y 17 (23,3%) ingresaron a la unidad de cuidados intensivos (UCI). Los pacientes con shock tuvieron mayor alteración laboratorial y necesidad de ventilación mecánica. En conclusión, el SIM-C ha disminuido en los primeros tres años de pandemia posiblemente por la vacunación de COVID-19 en niños. BACKGROUND: Motivación para realizar el estudio. Existen limitados estudios que describan la variación del síndrome inflamatorio multisistémico asociado a COVID-19 (SIM-C) en Perú a través de las olas de la pandemia. BACKGROUND: Principales hallazgos. En los primeros tres años de pandemia los casos de SIM-C disminuyeron, con mayor la frecuencia en la segunda ola con características clínicas similares a la enfermedad de Kawasaki. BACKGROUND: Implicancias. El SIM-C es una complicación posinfecciosa del SARS-CoV-2. Es importante su sospecha diagnóstica semanas posteriores a los picos de contagios, especialmente en los niños que aún no han recibido vacunas contra la COVID-19.
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COVID-19 , Síndrome de Respuesta Inflamatoria Sistémica , Humanos , Perú/epidemiología , COVID-19/complicaciones , COVID-19/epidemiología , Síndrome de Respuesta Inflamatoria Sistémica/epidemiología , Niño , Masculino , Femenino , Preescolar , Adolescente , Lactante , Hospitales Pediátricos , Síndrome Mucocutáneo Linfonodular/epidemiologíaRESUMEN
Clinicians and researchers need tools for accurate early assessment of children's acute stress reactions and acute stress disorder (ASD). There is a particular need for independently validated Spanish-language measures. The current study reports on 2 measures of child acute stress (a self-report checklist and a semistructured interview), describing the development of the Spanish version of each measure and psychometric evaluation of both the Spanish and English versions. Children between the ages of 8 to 17 years who had experienced a recent traumatic event completed study measures in Spanish (n = 225) or in English (n = 254). Results provide support for reliability (internal consistency of the measures in both languages ranged from .83 to .89; cross-language reliability of the checklist was .93) and for convergent validity (with later PTSD symptoms, and with concurrent anxiety symptoms). Comparing checklist and interview results revealed a strong association between severity scores within the Spanish and English samples. Differences between the checklist and interview in evaluating the presence of ASD appear to be linked to different content coverage for dissociation symptoms. Future studies should further assess the impact of differing assessment modes, content coverage, and the use of these measures in children with diverse types of acute trauma exposure in English- and Spanish-speaking children.
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Comparación Transcultural , Hispánicos o Latinos/psicología , Acontecimientos que Cambian la Vida , Determinación de la Personalidad/estadística & datos numéricos , Psicometría/estadística & datos numéricos , Trastornos de Estrés Traumático Agudo/diagnóstico , Trastornos de Estrés Traumático Agudo/etnología , Encuestas y Cuestionarios , Población Blanca/psicología , Adolescente , Trastornos de Ansiedad/diagnóstico , Trastornos de Ansiedad/psicología , Niño , Comorbilidad , Trastornos Disociativos/diagnóstico , Trastornos Disociativos/psicología , Femenino , Humanos , Entrevista Psicológica , Masculino , Multilingüismo , Trastornos por Estrés Postraumático/diagnóstico , Trastornos por Estrés Postraumático/psicología , Trastornos de Estrés Traumático Agudo/psicología , Traducción , Estados UnidosRESUMEN
To establish the use of eggs as biomonitoring tools for maternal body burdens, we investigated the mother-to-egg ratio of 56 PCB, 12 OCP and 34 PBDE unique compounds from maternal plasma into replicate egg yolk and albumen samples in the loggerhead turtle (Caretta caretta) as a case study of a threatened migratory marine species. We applied robust Regression on Order Statistics to fully account for the information in both censored and uncensored data. Our results added new insights into the use of yolk as a suitable biomonitoring matrix; the difference between yolk and albumen which were previously analysed as a homogeneous mixture; and the value of accounting for censored data. Overall, compound-specific mother-to-egg ratios need to be considered when translating yolk levels back to maternal pollution burdens, and when assessing the risk to the subsequent generations of turtle embryos.
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Contaminantes Ambientales , Bifenilos Policlorados , Tortugas , Animales , Contaminantes Ambientales/análisis , Yema de Huevo , Bifenilos Policlorados/análisis , Monitoreo BiológicoRESUMEN
The high accumulation potential of estuaries for plastics, particularly microplastics, poses a threat to the high societal value and biodiversity they provide. To support a spatially refined evaluation of the risk that microplastic pollution poses to fauna utilizing estuarine sedimentary habitats, we investigated the distribution of microplastics (lower limit of quantification, LOQ = 62 µm) at the sediment surface of two dominant habitats, and subsequently compared microplastic burdens between two crabs species utilizing these habitats. Microplastics were dominated by low density polyolefins (45-50 %), comparable to the polymer composition of macroplastics. The vast majority (99 %) of microplastics were ≤1 mm, and increased exponentially (with an exponent of 2.7) in abundance at smaller sizes, hinting at three-dimensional fragmentation. Our results suggest that the presence of vegetation needs to be accounted for in risk assessments with small microplastics (≥62 µm and ≤1 mm) on average 2.6 times more prevalent within reed beds compared to mudflats. Additionally, sediment properties also play a role with an exponential decrease in small microplastic abundance at coarser sediments, increased organic matter content, and decreased water content. These results suggest that at specific locations, such as the study area, local sources can provide a substantial contribution to microplastic contamination. To translate these habitat- and site-specific differences into a risk assessment relevant for macroinvertebrates, ecological traits such as differences in feeding modes should be accounted for, as we found substantial differences in both size and abundance of microplastics in gastrointestinal tracts of two crab species, Chiromantes dehaani and Chasmagnathus convexus, with different feeding modes.
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Braquiuros , Contaminantes Químicos del Agua , Animales , Microplásticos , Plásticos , Contaminantes Químicos del Agua/análisis , Monitoreo del Ambiente , Sedimentos Geológicos , Ecosistema , BiodiversidadRESUMEN
The inability to quantitatively integrate scattered data regarding potential threats posed by the increasing total amount and diversity of chemical substances in our environment limits our ability to understand whether existing regulations and management actions sufficiently protect wildlife. Systematic literature reviews and meta-analyses are great scientific tools to build upon the current push for accessibility under the Open Science and FAIR movements. Despite the potential of such integrative analyses, the emergence of innovative findings in wildlife ecology and ecotoxicology is still too rare relative to the potential that is hidden within the entirety of the available scattered data. To promote the reuse of wildlife ecotoxicology data, we propose the ATTAC workflow which comprises five key steps (Access, Transparency, Transferability, Add-ons, and Conservation sensitivity) along the chain of collecting, homogenizing, and integrating data for subsequent meta-analyses. The ATTAC workflow brings together guidelines supporting both the data prime movers and re-users. As such, the ATTAC workflow could promote an open and collaborative wildlife ecotoxicology able to reach a major objective in this applied field, namely, providing strong scientific support for regulations and management actions to protect and preserve wildlife species.
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Introduction: Restrictions during the COVID-19 pandemic necessitated remote administration of neuropsychological testing. We assessed the test-retest reliability for a telephone-administered cognitive battery, recommended for use in the National Institute on Aging Alzheimer's Disease Research Center (ADRC). Methods: 64 participants in the University of Southern California ADRC clinical core underwent repeat telephone evaluation using the T-cog Neuropsychological Battery. Reliability was measured by intraclass correlation coefficient (ICC) for continuous variables and weighted Kappa coefficient for categorical variables. Mean scores for Montreal Cognitive Assessment (MoCA) total and Craft Story 21 Immediate and Delayed Recall were compared using paired t tests. Results: Mean age was 74.8 (8.3 standard deviation); 73.4% were female. ICCs ranged from 0.52 to 0.84, indicating moderate test-retest reliability except for number span backward, which showed poor reliability. Weighted Kappa for MoCA items ranged from -0.016 to 0.734; however, relatively good observed agreement was seen across all items (70.3% to 98.4%). Although MoCA total scores did not significantly change, Craft Story 21 Immediate and Delayed Recall mean scores increased between first and second administrations (P < 0.0001). Discussion: Test-retest reliability for the T-cog Neuropsychological Battery is adequate. The variation seen in testing is similar to results seen from face-to-face testing, with Craft Story 21 recall showing modest and expected practice effects. Highlights: Moderate test-retest reliability is seen in most measures of the National Alzheimer's Coordinating Center Neuropsychological Test Battery and the Montreal Cognitive Assessment (MoCA).Intraclass correlation coefficients ranged from 0.52 to 0.84, except for number Span backward.Weighted Kappa for MoCA items varied, but good observed agreement was seen.MoCA total mean score did not change significantly between administrations.Craft Story 21 Immediate and Delayed Recall means increased on repeat testing (P < 0.0001).
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BACKGROUND: Pulmonary embolism (PE) is a complication reported in the adult population with coronavirus disease 2019 (COVID-19); however, its documentation in the pediatric population is limiteda. CASE REPORT: We report the case of a 15-year-old male with obesity and Down syndrome who was admitted for severe COVID-19 pneumonia. On day 7 of admission, he presented with chest pain, hemoptysis, respiratory distress, and marked elevation of D-dimer. Pulmonary CT angiography found an extensive thrombus in the right lower lobar artery. He received treatment with enoxaparin and rivaroxaban and had a favorable clinical outcome. In the tomographic control 1 month after treatment, thrombus was not evidenced and was successfully resolved. CONCLUSIONS: There are few reports of PE in children with COVID-19. Prompt diagnosis and early anticoagulant treatment are important to avoid life-threatening complications.
INTRODUCCIÓN: El tromboembolismo pulmonar es una complicación reportada en la población adulta con COVID-19; sin embargo, en la población pediátrica, su descripción es limitada. CASO CLÍNICO: Se reporta el caso de un varón de 15 años con antecedente de obesidad y síndrome de Down que fue hospitalizado por neumonía COVID-19 severa. En el séptimo día de hospitalización presentó dolor torácico, hemoptisis, dificultad respiratoria y elevación del dímero D. En la angiotomografía pulmonar se encontró un extenso trombo en la arteria lobar inferior derecha. Recibió tratamiento con enoxaparina y rivaroxabán evolucionando favorablemente. La resolución al mes de tratamiento fue existosa, ya que el control tomográfico no evidenció más el trombo. CONCLUSIONES: El tromboembolismo pulmonar es una complicación poco reportada en niños con neumonía COVID-19. El diagnóstico oportuno y tratamiento anticoagulante es importante para evitar complicaciones mortales.
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COVID-19 , Embolia Pulmonar , Trombosis , Niño , Masculino , Adulto , Humanos , Adolescente , COVID-19/complicaciones , SARS-CoV-2 , Embolia Pulmonar/diagnóstico , Embolia Pulmonar/tratamiento farmacológico , Embolia Pulmonar/etiología , Pulmón/diagnóstico por imagen , Arteria PulmonarRESUMEN
Despite the global occurrence of microplastic contamination on sandy beaches, evidence of microplastic distribution within beaches remains contradictory. When conflicting evidence is used to inform sampling surveys, it increases uncertainty in resulting data. Moreover, it hampers spatially explicit risk characterization of microplastic pollution to intertidal fauna. We aimed to guide sampling designs for microplastic monitoring on beaches, and to quantify macroinfauna exposure to microplastics. Microplastic abundance, quantified between 5 mm-66 µm, lacked a significant zonation across the top sediment layer of sub-terrestrial, upper and lower midlittoral, and swash zones at two sites with varying anthropogenic influence on a microtidal dissipative beach in Uruguay. Microplastic abundance decreased exponentially with increasing grain size, as revealed by Bayesian Poisson regression, although the decrease was less steep compared to prior knowledge regarding sediment - plastic interactions obtained for large (millimeter-sized) industrial pellets. Significant differences in microplastic contamination between the two sites with varying anthropogenic influence likely related to their proximity to a freshwater canal. Corresponding field measurements of body burdens of fibers and irregular particles were significantly lower for the polychaete Euzonus (Thoracophelia) furcifera, despite its preference for finer sediments with higher microplastic loads, compared to the isopods Excirolana braziliensis and Excirolana armata. Results provide critical insights toward representative sampling of microplastics within beach sites. Specifically, we caution against sampling limited to the drift line, and instead recommend: 1) reporting beach morphodynamic characteristics; 2) using clearly defined, ecologically-informed zonation schemes; and 3) accounting for sediment grain size as a covariate to normalize among reported contamination levels. The results contribute valuable baseline data toward realistic exposure landscapes relative to the sediment grain size preferences of macroinfauna, needed to inform laboratory experiments.