Ballistic Facial Trauma Reconstruction: Incidence and Practice Patterns in the Civilian Population.

BACKGROUND: Management of nonfatal ballistic facial trauma is well described in the literature for wounds secondary to military combat. However, there is little literature describing such management in civilian practice. We aimed to describe nonmilitary patients with recent nonfatal facial injuries from ballistic trauma using the California Office of Statewide Health Planning and Development patient database. METHODS: A retrospective study was performed using the California Office of Statewide Health Planning and Development Ambulatory Surgery and Inpatient datasets. All adults with the International Classification of Diseases, 10th Revision codes of severe nonfatal facial trauma from firearms requiring emergent surgery during 2016-2018 were included. Outcomes assessed include number and type of facial procedures performed, hospital length of stay, number of admissions, timing of definitive management, and lifetime hospitalization costs. RESULTS: A total of 331 traceable patients were identified over this 3-year period. The average age was 35.4 years (SD, 15.2), and 87% were male. The median index admission length of stay was 8 days (interquartile range, 3-15 days). Subsequent readmission was required for 123 (37.2%) patients with 10% mortality in the index admission. Total median charges per patient for all admissions were $257,804 (interquartile range, $105,601-$531,916). A total of 215 patients (65%) had at least 1 facial repair performed. Of all 331 patients, 64.3% underwent musculoskeletal repair (n = 213), 31.4% underwent digestive system repair (n = 104), and 29.6% underwent respiratory system repair (n = 98). The average number of repairs per patient was 2.52 (SD, 3.38), with 35% not having any of the specified International Classification of Diseases, 10th Revision repair codes. A total of 27% of patients had 1 procedure performed, whereas 38% received 2 or more, for an average of 3.87 (SD, 3.5) repairs over the study duration. DISCUSSION: To our knowledge, this is the first assessment of civilian characteristics of nonfatal ballistic facial trauma in California. Nonfatal facial ballistic trauma results in complex injuries to multiple body systems, requiring long admissions, costly hospital stays, and coordination of care across several surgical specialties. Many patients require a variety of procedures over multiple admissions, highlighting the overall morbidity of these injuries. Future studies will look at how care for these patients differs between various hospitals and geographic regions and whether current civilian management aligns with well-defined military reconstructive protocols for facial ballistic injuries.

Embedded Bio-Mimetic System for Functional Electrical Stimulation Controlled by Event-Driven sEMG.

The analysis of the surface ElectroMyoGraphic (sEMG) signal for controlling the Functional Electrical Stimulation (FES) therapy is being widely accepted as an active rehabilitation technique for the restoration of neuro-muscular disorders. Portability and real-time functionalities are major concerns, and, among others, two correlated challenges are the development of an embedded system and the implementation of lightweight signal processing approaches. In this respect, the event-driven nature of the Average Threshold Crossing (ATC) technique, considering its high correlation with the muscle force and the sparsity of its representation, could be an optimal solution. In this paper we present an embedded ATC-FES control system equipped with a multi-platform software featuring an easy-to-use Graphical User Interface (GUI). The system has been first characterized and validated by analyzing CPU and memory usage in different operating conditions, as well as measuring the system latency (fulfilling the real-time requirements with a 140 ms FES definition process). We also confirmed system effectiveness, testing it on 11 healthy subjects: The similarity between the voluntary movement and the stimulate one has been evaluated, computing the cross-correlation coefficient between the angular signals acquired during the limbs motion. We obtained high correlation values of 0.87 ± 0.07 and 0.93 ± 0.02 for the elbow flexion and knee extension exercises, respectively, proving good stimulation application in real therapy-scenarios.

Simple dispersion estimate for single-section quantum-dash and quantum-dot mode-locked laser diodes.

The optical outputs of single-section quantum-dash and quantum-dot mode-locked lasers (MLLs) are well known to exhibit strong group velocity dispersion. Based on careful measurements of the spectral phase of the pulses from these MLLs, we confirm that the difference in group delay between the modes at either end of the MLL spectrum equals the cavity round-trip time. This observation allows us to deduce an empirical formula relating the accumulated dispersion of the output pulse to the spectral extent and free-spectral range of the MLL. We find excellent agreement with previously reported dispersion measurements of both quantum-dash and quantum-dot MLLs over a wide range of operating conditions.

Enablers and inhibitors of the implementation of the Casalud Model, a Mexican innovative healthcare model for non-communicable disease prevention and control.

BACKGROUND: The Mexican healthcare system is under increasing strain due to the rising prevalence of non-communicable diseases (especially type 2 diabetes), mounting costs, and a reactive curative approach focused on treating existing diseases and their complications rather than preventing them. Casalud is a comprehensive primary healthcare model that enables proactive prevention and disease management throughout the continuum of care, using innovative technologies and a patient-centred approach. METHODS: Data were collected over a 2-year period in eight primary health clinics (PHCs) in two states in central Mexico to identify and assess enablers and inhibitors of the implementation process of Casalud. We used mixed quantitative and qualitative data collection tools: surveys, in-depth interviews, and participant and non-participant observations. Transcripts and field notes were analyzed and coded using Framework Analysis, focusing on defining and describing enablers and inhibitors of the implementation process. RESULTS: We identified seven recurring topics in the analyzed textual data. Four topics were categorized as enablers: political support for the Casalud model, alignment with current healthcare trends, ongoing technical improvements (to ease adoption and support), and capacity building. Three topics were categorized as inhibitors: administrative practices, health clinic human resources, and the lack of a shared vision of the model. CONCLUSIONS: Enablers are located at PHCs and across all levels of government, and include political support for, and the technological validity of, the model. The main inhibitor is the persistence of obsolete administrative practices at both state and PHC levels, which puts the administrative feasibility of the model's implementation in jeopardy. Constructing a shared vision around the model could facilitate the implementation of Casalud as well as circumvent administrative inhibitors. In order to overcome PHC-level barriers, it is crucial to have an efficient and straightforward adaptation and updating process for technological tools. One of the key lessons learned from the implementation of the Casalud model is that a degree of uncertainty must be tolerated when quickly scaling up a healthcare intervention. Similar patient-centred technology-based models must remain open to change and be able to quickly adapt to changing circumstances.

Experimentally-guided in silico design of engineered heart tissues to improve cardiac electrical function after myocardial infarction.

Engineered heart tissues (EHTs) built from human induced pluripotent stem cell-derived cardiomyocytes (hiPSC-CMs) showed promising results for cardiac function restoration following myocardial infarction. Nevertheless, human iPSC-CMs have longer action potential and lower cell-to-cell coupling than adult-like CMs. These immature electrophysiological properties favor arrhythmias due to the generation of electrophysiological gradients when hiPSC-CMs are injected in the cardiac tissue. Culturing hiPSC-CMs on three-dimensional (3D) scaffolds can promote their maturation and influence their alignment. However, it is still uncertain how on-scaffold culturing influences the overall electrophysiology of the in vitro and implanted EHTs, as it requires expensive and time consuming experimentation. Here, we computationally investigated the impact of the scaffold design on the EHT electrical depolarization and repolarization before and after engraftment on infarcted tissue. We first acquired and processed electrical recordings from in vitro EHTs, which we used to calibrate the modeling and simulation of in silico EHTs to replicate experimental outcomes. Next, we built in silico EHT models for a range of scaffold pore sizes, shapes (square, rectangular, auxetic, hexagonal) and thicknesses. In this setup, we found that scaffolds made of small (0.2 mm2), elongated (30° half-angle) hexagons led to faster EHT activation and better mimicked the cardiac anisotropy. The scaffold thickness had a marginal role on the not engrafted EHT electrophysiology. Moreover, EHT engraftment on infarcted tissue showed that the EHT conductivity should be at least 5% of that in healthy tissue for bidirectional EHT-myocardium electrical propagation. For conductivities above such threshold, the scaffold made of small elongated hexagons led to the lowest activation time (AT) in the coupled EHT-myocardium. If the EHT conductivity was further increased and the hiPSC-CMs were uniformly oriented parallel to the epicardial cells, the total AT and the repolarization time gradient decreased substantially, thus minimizing the likelihood for arrhythmias after EHT transplantation.

Gestational Diabetes Mellitus Subtypes Classified by Oral Glucose Tolerance Test and Maternal and Perinatal Outcomes: Results of a Mexican Multicenter Prospective Cohort Study "Cuido Mi Embarazo".

Purpose: This study explores the impact of gestational diabetes mellitus (GDM) subtypes classified by oral glucose tolerance test (OGTT) values on maternal and perinatal outcomes. Patients and Methods: This multicenter prospective cohort study (May 2019-December 2022) included participants from the Mexican multicenter cohort study Cuido mi Embarazo (CME). Women were classified into four groups per 75-g 2-h OGTT: 1) normal glucose tolerance (normal OGTT), 2) GDM-Sensitivity (isolated abnormal fasting or abnormal fasting in combination with 1-h or 2-h abnormal results), 3) GDM-Secretion (isolated abnormal values at 1-h or 2-h or their combination), and 4) GDM-Mixed (three abnormal values). Cesarean delivery, neonates large for gestational age (LGA), and pre-term birth rates were among the outcomes compared. Between-group comparisons were analyzed using either the t-test, chi-square test, or Fisher's exact test. Results: Of 2,056 Mexican pregnant women in the CME cohort, 294 (14.3%) had GDM; 53.7%, 34.4%, and 11.9% were classified as GDM-Sensitivity, GDM-Secretion, and GDM-Mixed subtypes, respectively. Women with GDM were older (p = 0.0001) and more often multiparous (p = 0.119) vs without GDM. Cesarean delivery (63.3%; p = 0.02) and neonate LGA (10.7%; p = 0.078) were higher in the GDM-Mixed group than the overall GDM group (55.6% and 8.4%, respectively). Pre-term birth was more common in the GDM-Sensitivity group than in the overall GDM group (10.2% vs 8.5%, respectively; p=0.022). At 6 months postpartum, prediabetes was more frequent in the GDM-Sensitivity group than in the overall GDM group (31.6% vs 25.5%). Type 2 diabetes was more common in the GDM-Mixed group than in the overall GDM group (10.0% vs 3.3%). Conclusion: GDM subtypes effectively stratified maternal and perinatal risks. GDM-Mixed subtype increased the risk of cesarean delivery, LGA, and type 2 diabetes postpartum. GDM subtypes may help personalize clinical interventions and optimize maternal and perinatal outcomes.

MIDO GDM: an innovative artificial intelligence-based prediction model for the development of gestational diabetes in Mexican women.

Given the barriers to early detection of gestational diabetes mellitus (GDM), this study aimed to develop an artificial intelligence (AI)-based prediction model for GDM in pregnant Mexican women. Data were retrieved from 1709 pregnant women who participated in the multicenter prospective cohort study 'Cuido mi embarazo'. A machine-learning-driven method was used to select the best predictive variables for GDM risk: age, family history of type 2 diabetes, previous diagnosis of hypertension, pregestational body mass index, gestational week, parity, birth weight of last child, and random capillary glucose. An artificial neural network approach was then used to build the model, which achieved a high level of accuracy (70.3%) and sensitivity (83.3%) for identifying women at high risk of developing GDM. This AI-based model will be applied throughout Mexico to improve the timing and quality of GDM interventions. Given the ease of obtaining the model variables, this model is expected to be clinically strategic, allowing prioritization of preventative treatment and promising a paradigm shift in prevention and primary healthcare during pregnancy. This AI model uses variables that are easily collected to identify pregnant women at risk of developing GDM with a high level of accuracy and precision.

Timing jitter from the optical spectrum in semiconductor passively mode locked lasers.

An analysis of the passively mode locked regime in semiconductor lasers is presented, leading to an explicit expression relating the timing jitter diffusion constant to the optical linewidths in these devices. Experimental results for single section quantum-dash based lasers validating the theoretical analysis are presented for the first time. Timing jitter of mode locked lasers at rates of up to 130 GHz has been experimentally estimated from the optical spectra without requiring fast photodetection.

High performance mode locking characteristics of single section quantum dash lasers.

Mode locking features of single section quantum dash based lasers are investigated. Particular interest is given to the static spectral phase profile determining the shape of the mode locked pulses. The phase profile dependence on cavity length and injection current is experimentally evaluated, demonstrating the possibility of efficiently using the wide spectral bandwidth exhibited by these quantum dash structures for the generation of high peak power sub-picosecond pulses with low radio frequency linewidths.

Mode coherence measurements across a 1.5 THz spectral bandwidth of a passively mode-locked quantum dash laser.

The mode coherence of adjacent and non-adjacent spectral modes of a passively mode locked quantum dash (QDash) semiconductor laser are deduced through radio frequency beat-tone linewidth measurements. A wavelength conversion scheme that uses degenerate four wave mixing in a semiconductor optical amplifier is proposed which considerably extends the mode spacing beyond the limit imposed by conventional fast-photodetection and electrical spectrum analysis of around 100 GHz. Using this scheme, the mode coherence of the QDash laser was measured out to the thirty-first harmonic, or a mode separation of 1.5 THz.

Effects of Physical Exercise on Burnout Syndrome in University Students.

INTRODUCTION: Burnout syndrome has a negative impact on university students' health worldwide. Global prevalence of each dimension of the syndrome is estimated at 55.4% for emotional exhaustion, 31.6% for cynicism and 30.9% for academic inefficacy. OBJECTIVE: Evaluate the efficacy of physical exercise in reducing burnout levels in university students. METHODS: We carried out an investigation in students from the Technical University of Ambato, Ecuador. Students were in different career tracks, randomly selected, and were assigned to three different groups with pre-test and post-test measurements: two intervention groups (aerobic and strength exercise) and one control group (no exercise). The evaluation instrument was the Maslach Burnout Inventory-Student Survey, whose dimensions are exhaustion, cynicism and academic inefficacy. We also evaluated heart rate variability. RESULTS: The aerobic exercise group reduced cynicism by 21.1% (d = 0.252), inefficacy 13.1% (d = 0.397) and exhaustion by 31.0% (d = 0.532). The strength exercise group reduced cynicism by 27.4% (d = 0.315), inefficacy by 21.7% (d = 0.704) and exhaustion by 19.6% (d = 0.299). In the control group, exhaustion and inefficacy increased by 10.1% (d = 0.128) and 4.4% (d = 0.129) respectively; instead, cynicism was reduced by 7.3% (d = 0.062).The aerobic exercise group had the greatest increase in heart rate variability (at 16.8%), followed by the strength group (16.6%) and the control group (5.2%). CONCLUSIONS: Physical exercise (both aerobic and strength) was effective in reducing burnout levels in university students.

MIDO COVID: A digital public health strategy designed to tackle chronic disease and the COVID-19 pandemic in Mexico.

Screening, prevention, and management of non-communicable diseases (NCDs, including obesity, hypertension, and type 2 diabetes) is the core function of Integrated Measurement for Early Detection (MIDO), a digital strategy developed by the Carlos Slim Foundation in Mexico. An extension of this strategy, MIDO COVID, was developed to address the need for an integrated plan in primary health care during the COVID-19 pandemic. MIDO COVID facilitates planning, surveillance, testing, and clinical management of SARS-CoV-2 infections and the major NCDs and their pre-disease states, to streamline the continuum of care. MIDO COVID screening was applied in 1063 Carso Group workplaces in 190 municipalities of the 32 Mexican states. Staff were trained to screen healthy workers for NCDs using a questionnaire, anthropomorphic measurements, and blood work; healthy individuals returning to work also received a SARS-CoV-2 antibody test. Between June 26 and December 31, 2020, 58,277 asymptomatic individuals underwent screening. The prevalence of obesity, hypertension, and type 2 diabetes was 32.1%, 25.7%, and 9.7% respectively. Only 2.2%, 8.8%, and 4.5% of individuals, respectively, were previously aware of their condition. Pre-obesity was identified in 38.6%, pre-hypertension in 17.4%, and prediabetes in 7.5% of the population. Risk of SARS-CoV-2 infection was highest for individuals with multiple NCDs. Many Mexicans are unaware of their health status and potentially increased risk of COVID-19 and serious complications. As a universal strategy implemented regardless of social factors, MIDO COVID promotes equity in access to health care prevention and early stage detection of NCDs; the information gained may help inform decisionmakers regarding prioritising vulnerable populations for immunisation.

Fabrication of human myocardium using multidimensional modelling of engineered tissues.

Biofabrication of human tissues has seen a meteoric growth triggered by recent technical advancements such as human induced pluripotent stem cells (hiPSCs) and additive manufacturing. However, generation of cardiac tissue is still hampered by lack of adequate mechanical properties and crucially by the often unpredictable post-fabrication evolution of biological components. In this study we employ melt electrowriting (MEW) and hiPSC-derived cardiac cells to generate fibre-reinforced human cardiac minitissues. These are thoroughly characterized in order to build computational models and simulations able to predict their post-fabrication evolution. Our results show that MEW-based human minitissues display advanced maturation 28 post-generation, with a significant increase in the expression of cardiac genes such as MYL2, GJA5, SCN5A and the MYH7/MYH6 and MYL2/MYL7 ratios. Human iPSC-cardiomyocytes are significantly more aligned within the MEW-based 3D tissues, as compared to conventional 2D controls, and also display greater expression of C×43. These are also correlated with a more mature functionality in the form of faster conduction velocity. We used these data to develop simulations capable of accurately reproducing the experimental performance. In-depth gauging of the structural disposition (cellular alignment) and intercellular connectivity (C×43) allowed us to develop an improved computational model able to predict the relationship between cardiac cell alignment and functional performance. This study lays down the path for advancing in the development ofin silicotools to predict cardiac biofabricated tissue evolution after generation, and maps the route towards more accurate and biomimetic tissue manufacture.

Diagnostic Accuracy of Capillary Blood Glucometer Testing for Gestational Diabetes.

Purpose: Few pregnant women in low-resource settings are screened for gestational diabetes mellitus (GDM) using the gold standard oral glucose tolerance test (OGTT). This study compared capillary blood glucose testing with 2-h plasma glucose measurements obtained using the 75-g OGTT to screen for GDM at primary healthcare clinics in Mexico. Patients and Methods: Pregnant women who participated in a previous prospective multicenter longitudinal cohort study and who had not been previously diagnosed with diabetes were included. Participants were evaluated using the plasmatic 2-h 75-g OGTT with simultaneous capillary blood glucose measurements using a glucometer. The study endpoint was the comparability of the glucometer results to the gold standard OGTT when collected simultaneously. Sensitivity, specificity, and area under the curve of the glucose measurements obtained for capillary blood compared with venous plasma (gold standard) were calculated to determine diagnostic accuracy. Results: The study included 947 pregnant women who had simultaneous glucose measurements available (blood capillary [glucometer] and venous blood OGTT). Overall, capillary blood glucose testing was very sensitive (89.47%); the specificity was 66.58% and the area under the curve (95% confidence interval) was 0.78 (0.74-0.81). The sensitivity, specificity and area under the curve of each capillary measurement were: 89.47%, 66.58% and 0.78 (0.74-0.82) for the fasting measurement, 91.53%, 93.24% and 0.92 (0.88-0.96) for the one-hour measurement, and 89.80%, 93.32%, 0.91 (0.87-0.95) for the second-hour measurement, respectively. No adverse events were reported. Conclusion: Capillary OGTT is a valid alternative to the gold standard OGTT for screening of GDM in low-resource situations or in situations where there are other limitations to performing the OGTT as part of primary healthcare services.

Integrated Measurement for Early Detection (MIDO) as a digital strategy for timely assessment of non-communicable disease profiles and factors associated with unawareness and control: a retrospective observational study in primary healthcare facilities in Mexico.

OBJECTIVES: The Carlos Slim Foundation implemented the Integrated Measurement for Early Detection (MIDO), a screening strategy for non-communicable diseases (NCDs) in Mexico as part of CASALUD, a portfolio of digital health services focusing on healthcare delivery and prevention/management of NCDs. We investigated the disease profile of the screened population and evaluated MIDO's contribution to the continuum of care of the main NCDs. DESIGN: Using data from MIDO and the chronic diseases information system, we quantified the proportion of the population screened and diagnosed with NCDs, and measured care linkage/retention and level of control achieved. We analysed comorbidity patterns and estimated prevalence of predisease stages. Finally, we estimated characteristics associated with unawareness and control of NCDs, and examined efficacy of the CASALUD model in improving NCD control. SETTING: Public primary health centres in 27/32 Mexican states. PARTICIPANTS: Individuals aged ≥20 years lacking healthcare access. RESULTS: From 2014 to 2018, 743 000 individuals were screened using MIDO. A predisease or disease condition was detected in ≥70% of the population who were unaware of their NCD status. The screening identified 38 417 new cases of type 2 diabetes, 53 133 new cases of hypertension and 208 627 individuals with obesity. Dyslipidaemia was found in 77.3% of individuals with available blood samples. Comorbidities were highly prevalent, especially in people with obesity. Only 5.47% (n=17 774) of individuals were linked with their corresponding primary health centre. Factors associated with unawareness of and uncontrolled NCDs were sex, age, and social determinants, for example, rural/urban environment, access to healthcare service, and education level. Patients with type 2 diabetes treated at clinics under the CASALUD model were more likely to achieve disease control (OR: 1.32, 95% CI: 1.09 to 1.61). CONCLUSION: Patient-centred screening strategies such as MIDO are urgently needed to improve screening, access, retention and control for patients with NCDs.

[Maternal mortality in the Hospital General de Matamoros Dr. Alfredo Pumarejo Lafaurie for a period of 10 years]. / Mortalidad materna en el Hospital General de Matamoros Dr. Alfredo Pumarejo Lafaurie durante un periodo de 10 años.

BACKGROUND: In Mexico, maternal mortality has fallen substantially in recent decades. Although according to the Secretaria de Salud, in Tamaulipas the maternal mortality rate has increased in recent years. Despite these facts, Tamaulipas ranks among the ten institutions with the lowest level of maternal mortality. OBJECTIVE: To describe the basic elements of epidemiologic behavior of maternal mortality during a period of ten years at the Gynecology and Obstetrics department of the Hospital General de Matamoros Dr. Alfredo Pumarejo Lafaurie in Tamaulipas, Mexico. MATERIAL AND METHOD: A descriptive, transverse, retrospective and a cases series research was carried out at the Gynecology and Obstetrics department of the Hospital General de Matamoros Dr. Alfredo Pumarejo Lafaurie in Tamaulipas, Mexico. There was a revision of the expedients of direct and indirect obstetric maternal deaths occurred from January 1, 1998 to December 31, 2007. We used descriptive statistics with central trend measurements and standard deviation. RESULTS: 30 obstetric maternal deaths were registered. Maternal death ratio was 87.2 x 100,000 live births during the 10 years. The average age of patients was 25.1 +/- 7.8 years old. 54% were in their first pregnancy. Only 20% had adequate prenatal control. Direct obstetric causes were 60% and indirect obstetric causes 40%. The main causes of maternal deaths were preeclampsia/eclampsia (27%), obstetric hemorrhage (20%) and gravid-puerperal sepsis (13%). 83% was foreseeable. CONCLUSIONS: It was noted a clear trend towards the reduction in the maternal mortality ratio in the decade from 1998 to 2007. Preeclampsia-eclampsia and obstetric hemorrhage remain the main causes of maternal death. The maternal mortality ratio tended to invest when comparing the first five years with the last five years of the study, which talks about improvements in management and direct obstetric causes prevention.

HIV prevention technology transfer: challenges and strategies in the real world.

OBJECTIVES: We examined implementation of evidence-based interventions for HIV prevention at community-based organizations in Los Angeles County, CA. METHODS: We conducted 2 waves of interviews with 34 organization staff members. We analyzed activities reported by staff in the phases (preimplementation, implementation, and maintenance and evolution) and activities defined by the technology transfer model for evidence-based HIV prevention interventions. RESULTS: Staff members were able to select, adapt, and implement evidence-based HIV prevention interventions despite challenges in each phase of technology transfer. Preimplementation challenges included lack of information and poor fit between the interventions and organizations' clients. Implementation challenges included retention of participants across intervention sessions and staff turnover. A challenge in the maintenance and evolution phase was enhancing staff skills in outcome monitoring and cost analyses. CONCLUSIONS: Technical assistance must be matched to the specific challenges found in each phase of technology transfer. Successful transfer of evidence-based HIV prevention interventions will depend on their continued uptake and use by organization staff. This study highlights directions for improving communications regarding appropriate modifications to these interventions and for organizational planning to continue adapted interventions.

Therapeutic Effect of Recombinant Adenovirus Encoding Interferon-γ in a Murine Model of Progressive Pulmonary Tuberculosis.

We constructed recombinant adenoviruses encoding murine interferon-γ (AdIFNγ) and tested its therapeutic efficiency in a well characterized model of progressive pulmonary tuberculosis (TB) in Balb/c mice, infected through the trachea with the laboratory drug-susceptible H37Rv strain or multidrug-resistant (MDR) clinical isolate. When the disease was in a late phase, 2 months after infection, we administered by intratracheal cannulation a single dose [1.7 × 109 plaque forming units (pfu)] of AdIFNγ or the control adenovirus. Groups of mice were killed at different time-points and the lungs were examined to determine bacilli colony forming units (CFU), cytokine/chemokine gene expression, and CD4/CD8 subpopulations, and also subjected to automated histomorphometry. In comparison with the control group, after 2 weeks of treatment and during the next 6 months, AdIFNγ-treated animals infected with either the H37Rv strain or the MDR strain showed significantly lower bacilli loads and tissue damage (pneumonia), higher expressions of IFN-γ, tumor necrosis factor (TNF), and inducible nitric oxide synthase (iNOS), and bigger granulomas. When compared with the results from conventional chemotherapy or AdIFNγ treatment alone, the combined treatment with AdIFNγ plus conventional chemotherapy shortened the time taken for reduction of bacillary load. This shows that gene therapy with AdIFNγ efficiently reconstituted the protective immune response and controlled the progress of pulmonary TB produced by MDR or non-MDR strains.

Therapeutic effect of recombinant adenovirus encoding interferon-gamma in a murine model of progressive pulmonary tuberculosis.

We constructed recombinant adenoviruses encoding murine interferon-gamma (AdIFNgamma) and tested its therapeutic efficiency in a well characterized model of progressive pulmonary tuberculosis (TB) in Balb/c mice, infected through the trachea with the laboratory drug-susceptible H37Rv strain or multidrug-resistant (MDR) clinical isolate. When the disease was in a late phase, 2 months after infection, we administered by intratracheal cannulation a single dose [1.7 x 10(9) plaque forming units (pfu)] of AdIFNgamma or the control adenovirus. Groups of mice were killed at different time-points and the lungs were examined to determine bacilli colony forming units (CFU), cytokine/chemokine gene expression, and CD4/CD8 subpopulations, and also subjected to automated histomorphometry. In comparison with the control group, after 2 weeks of treatment and during the next 6 months, AdIFNgamma-treated animals infected with either the H37Rv strain or the MDR strain showed significantly lower bacilli loads and tissue damage (pneumonia), higher expressions of IFN-gamma, tumor necrosis factor (TNF), and inducible nitric oxide synthase (iNOS), and bigger granulomas. When compared with the results from conventional chemotherapy or AdIFNgamma treatment alone, the combined treatment with AdIFNgamma plus conventional chemotherapy shortened the time taken for reduction of bacillary load. This shows that gene therapy with AdIFNgamma efficiently reconstituted the protective immune response and controlled the progress of pulmonary TB produced by MDR or non-MDR strains.

Estado nutricional en estudiantes de medicina de la Universidad San Gregorio de Portoviejo, Ecuador / Nutritional status in medical students of the University San Gregorio of Portoviejo, Ecuador

Fundamentos: Los estudiantes de medicina pueden ser vulnerables al desarrollo de alteraciones en su estado nutricional por las características propias de su formación, que pueden comprometer su estado saludable. El objetivo fue determinar el estado nutricional de los estudiantes de medicina de la Universidad San Gregorio de Portoviejo, Ecuador. Material y métodos: Se realizó un estudio descriptivo de corte transversal en 117 estudiantes de medicina (69 mujeres y 48 hombres) de la Universidad San Gregorio de Portoviejo, Ecuador. Las mediciones realizadas fueron: peso corporal, estatura, circunferencia de cintura, circunferencia de cadera y edad. Luego se calcularon: índice de masa corporal, porcentaje de grasa corporal, índice cintura cadera e índice cintura estatura. Resultados: Se observaron elevados niveles de sobrepeso según el IMC (más del 30%), teniendo la obesidad una prevalencia superior al 10% en ambos sexos. El índice de %GC y la circunferencia de cinturas mostraron niveles de obesidad abdominal superiores que los determinados por el IMC. Así, el %GC arrojo una ligera mayor prevalencia de obesidad en mujeres que en hombres, mientras que alrededor del 15% de los participantes masculinos y femeninos presentó obesidad abdominal. Finalmente, las mujeres presentaron una mayor prevalencia de riesgo cardiovascular alto, y casi el 45,8% de los hombres fueron considerados con un riesgo metabólico elevado. Conclusiones: Se encontraron preocupantes niveles de sobrepeso en ambos sexos. El sexo masculino tuvo mayor riesgo de sufrir síndrome metabólico, mientras que las mujeres presentaron en general mayor riesgo cardiovascular. (AU)

Background: Medical students may be vulnerable to the development of alterations in their nutritional status due to the characteristics of their process. The objective was to identify the nutritional status of medical students at the Universidad San Gregorio de Portoviejo, Ecuador. Material and methods: A descriptive cross-sectional study was carried out in 117 medical students (69 women and 48 men) of the Universidad San Gregorio de Portoviejo, Ecuador. The measurements taken were: body weight, height, waist circumference, hip circumference and age. Results: High levels of overweight were observed according to BMI (more than 30%), with obesity having a prevalence greater than 10% in both sexes. The %BF index and waist circumference showed higher levels of abdominal obesity than those determined by BMI. Thus, the %BF showed a slightly higher prevalence of obesity in women than in men, while around 15% of male and female participants presented abdominal obesity. Finally, women had a higher prevalence of high cardiovascular risk, and almost 45.8% of men were considered to have a high metabolic risk. (AU)