Improved cognition after rifaximin treatment is associated with changes in intra- and inter-brain network functional connectivity.

BACKGROUND: Rifaximin is a non-reabsorbable antibiotic which acts at gut level, and improves cognition and inflammatory parameters in minimal hepatic encephalopathy (MHE) patients, but not all patients show the same level of response. This study aims to assess brain activity, both within and between brain networks, following rifaximin treatment, considering the differences between response groups as well. METHODS: Twenty-two healthy controls and 53 patients with cirrhosis (22 without and 31 with MHE, diagnosed by Psychometric Hepatic Encephalopathy Score, PHES) performed psychometric, attention and coordination tests, and blood inflammatory parameters were measured. Resting-state functional magnetic resonance imaging (fMRI) acquisitions were performed on controls and MHE patients. Eighteen MHE patients underwent a rifaximin treatment for 6 months, after which all measures were repeated. fMRI images were analysed and changes after treatment were assessed. RESULTS: After rifaximin treatment, 13 patients improved their PHES score (Responder patients) while 5 did not (Non-responder patients). No significant decrease in blood ammonia was observed after rifaximin treatment, but there was a decrease in plasma inflammatory cytokines in responder patients. A global effect of rifaximin was detected on the sensorimotor and fronto-parietal networks. Responder patients showed a relative increase of thalamic network connectivity in comparison to non-responder patients. Before treatment, responder and non-responder patients showed connectivity differences in basal ganglia network. The connection of the sensorimotor and thalamic networks between them and with other networks suffered changes after treatment. These connections between networks mostly decreased after treatment. All changes and differences showed a significant level of correlation with the performance of psychometric tests and the blood levels of inflammatory biomarkers. CONCLUSIONS: There was an improvement of the communication between executive, motor and attention-related brain areas, and their functional independence following rifaximin treatment. Patients who respond also show a less deteriorated connection involved in these functions before treatment. Results suggest that the improved inflammatory state of MHE patients, following rifaximin treatment would favour the observed changes in brain function and enhanced cognitive performance.

CAPTURE: a multinational, cross-sectional study of cardiovascular disease prevalence in adults with type 2 diabetes across 13 countries.

BACKGROUND: There is a paucity of global data on cardiovascular disease (CVD) prevalence in people with type 2 diabetes (T2D). The primary objective of the CAPTURE study was to estimate the prevalence of established CVD and its management in adults with T2D across 13 countries from five continents. Additional objectives were to further characterize the study sample regarding demographics, clinical parameters and medication usage, with particular reference to blood glucose-lowering agents (GLAs: glucagon-like peptide-1 receptor agonists and sodium-glucose co-transporter-2 inhibitors) with demonstrated cardiovascular benefit in randomized intervention trials. METHODS: Data were collected from adults with T2D managed in primary or specialist care in Australia, China, Japan, Czech Republic, France, Hungary, Italy, Argentina, Brazil, Mexico, Israel, Kingdom of Saudi Arabia, and Turkey in 2019, using standardized methodology. CVD prevalence, weighted by diabetes prevalence in each country, was estimated for the overall CAPTURE sample and participating countries. Country-specific odds ratios for CVD prevalence were further adjusted for relevant demographic and clinical parameters. RESULTS: The overall CAPTURE sample included 9823 adults with T2D (n = 4502 from primary care; n = 5321 from specialist care). The overall CAPTURE sample had median (interquartile range) diabetes duration 10.7 years (5.6-17.9 years) and glycated hemoglobin 7.3% (6.6-8.4%) [56 mmol/mol (49-68 mmol/mol)]. Overall weighted CVD and atherosclerotic CVD prevalence estimates were 34.8% (95% confidence interval [CI] 32.7-36.8) and 31.8% (95% CI 29.7-33.8%), respectively. Age, gender, and clinical parameters accounted for some of the between-country variation in CVD prevalence. GLAs with demonstrated cardiovascular benefit were used by 21.9% of participants, which was similar in participants with and without CVD: 21.5% and 22.2%, respectively. CONCLUSIONS: In 2019, approximately one in three adults with T2D in CAPTURE had diagnosed CVD. The low use of GLAs with demonstrated cardiovascular benefit even in participants with established CVD suggested that most were not managed according to contemporary diabetes and cardiology guidelines. Study registration NCT03786406 (registered on December 20, 2018), NCT03811288 (registered on January 18, 2019).

Electroencephalography as a Non-Invasive Biomarker of Alzheimer's Disease: A Forgotten Candidate to Substitute CSF Molecules?

Biomarkers for disease diagnosis and prognosis are crucial in clinical practice. They should be objective and quantifiable and respond to specific therapeutic interventions. Optimal biomarkers should reflect the underlying process (pathological or not), be reproducible, widely available, and allow measurements repeatedly over time. Ideally, biomarkers should also be non-invasive and cost-effective. This review aims to focus on the usefulness and limitations of electroencephalography (EEG) in the search for Alzheimer's disease (AD) biomarkers. The main aim of this article is to review the evolution of the most used biomarkers in AD and the need for new peripheral and, ideally, non-invasive biomarkers. The characteristics of the EEG as a possible source for biomarkers will be revised, highlighting its advantages compared to the molecular markers available so far.

Is this the end for Cronbach's alpha? / ¿Es el final del alfa de Cronbach?

Letter to the editor.

Carta al editor.

Confidence Intervals for Omega Coefficient: Proposal for Calculus. / Intervalos de confianza para coeficiente Omega: Propuesta para el cálculo.

La confiabilidad es entendida como una propiedad métrica de las puntuaciones de un instrumento de medida. Recientemente se viene utilizando el coeficiente omega (ω) para la estimación de la confiabilidad. No obstante, la medición nunca es exacta por la influencia del error aleatorio, por esa razón es necesario calcular y reportar el intervalo de confianza (IC) que permite encontrar en valor verdadero en un rango de medida. En ese contexto, el artículo plantea una forma de estimar el IC mediante el método de bootstrap para facilitar este procedimiento se brindan códigos de R (un software de acceso libre) para que puedan realizarse los cálculos de una forma amigable. Se espera que el artículo sirva de ayuda a los investigadores de ámbito de salud.

La confiabilidad es entendida como una propiedad métrica de las puntuaciones de un instrumento de medida. Recientemente se viene utilizando el coeficiente omega (ω) para la estimación de la confiabilidad. No obstante, la medición nunca es exacta por la influencia del error aleatorio, por esa razón es necesario calcular y reportar el intervalo de confianza (IC) que permite encontrar en valor verdadero en un rango de medida. En ese contexto, el artículo plantea una forma de estimar el IC mediante el método de bootstrap para facilitar este procedimiento se brindan códigos de R (un software de acceso libre) para que puedan realizarse los cálculos de una forma amigable. Se espera que el artículo sirva de ayuda a los investigadores de ámbito de salud.

[Microbiological diagnosis of medical device-associated infections]. / Diagnóstico microbiológico de las infecciones asociadas a dispositivos biomédicos.

The use of surgically implanted medical devices has increased greatly over the last few years. Despite surgical advances and improvements in the materials and design of devices, infection continues to be a major complication of their use. Device-associated infections are produced mainly during their implantation and, are caused by microorganisms that are part of the skin flora. Biofilm development on device surfaces is the most important factor to explain the pathophysiological aspects of infection. Microbiological diagnosis is difficult and can often only be achieved after removal of the device. Sonication of the removed device may be a useful tool, since this procedure dislodges and disaggregates biofilm bacteria from the device. Molecular techniques, especially PCR, applied to the tissues and material obtained after sonication have shown to have a high sensitivity and specificity for the diagnosis of cardiovascular device infections.

Phylogeography of Cuban Rivulus: evidence for allopatric speciation and secondary dispersal across a marine barrier.

The genus Rivulus is currently comprised of two species, R. cylindraceus and R. insulaepinorum, which are endemic to Cuba. However, the taxonomic status of the latter species remains dubious because of the poor quality of the original description. In addition, a recent barcoding survey suggests that the two species may be conspecific. The aim of this study was to test the hypothesis that the two species represent a single evolutionary clade. To delimit the species and their evolutionary history, we used a combination of molecular phylogenetic analyses, with both mitochondrial and nuclear sequences, tests of phylogeographic hypotheses, combined with morphological measurements and information on known dispersal barriers and species distribution. None of the data sets support R. insulaepinorum and R. cylindraceus as separate taxa. However, a new species, restricted to the northwestern part of the main island, was identified by phylogenetic analyses, body colour pattern and geographical distribution. The evolutionary distance between the two lineages (cytb, d=15%; CAM-4, d=2.5%) indicates a long period of divergence. Phylogeographic analyses shed light on the dispersal history of R. cylindraceus, which probably originated on the Isla de la Juventud. They also suggest that each lineage had contrasting histories; Rivulus sp. is restricted to a relatively small geographic area whereas R. cylindraceus has dispersed considerably and more than once from its centre of origin, probably facilitated by sea level fluctuations. These results strengthen previous findings, i.e. that the diversity of Cuban freshwater fishes is far from well-known and deserves more in-depth studies, and that vicariance and dispersal events have resulted in a complex biogeographical landscape which has had a significant impact on the freshwater fishes of the Caribbean islands.

3D-Printed Organic Conjugated Trimer for Visible-Light-Driven Photocatalytic Applications.

Small molecule organic semiconductors (SMOSs) have emerged as a new class of photocatalysts that exhibit visible light absorption, tunable bandgap, good dispersion, and solubility. However, the recovery and reusability of such SMOSs in consecutive photocatalytic reactions is challenging. This work concerns a 3D-printed hierarchical porous structure based on an organic conjugated trimer, named EBE. Upon manufacturing, the photophysical and chemical properties of the organic semiconductor are maintained. The 3D-printed EBE photocatalyst shows a longer lifetime (11.7 ns) compared to the powder-state EBE (1.4 ns). This result indicates a microenvironment effect of the solvent (acetone), a better dispersion of the catalyst in the sample, and reduced intermolecular π-π stacking, which results in improved separation of the photogenerated charge carriers. As a proof-of-concept, the photocatalytic activity of the 3D-printed EBE catalyst is evaluated for water treatment and hydrogen production under sun-like irradiation. The resulting degradation efficiencies and hydrogen generation rates are higher than those reported for the state-of-the-art 3D-printed photocatalytic structures based on inorganic semiconductors. The photocatalytic mechanism is further investigated, and the results suggest that hydroxyl radicals (HO⋅) are the main reactive radicals responsible for the degradation of organic pollutants. Moreover, the recyclability of the EBE-3D photocatalyst is demonstrated in up to 5 uses. Overall, these results indicate the great potential of this 3D-printed organic conjugated trimer for photocatalytic applications.

Multifactorial Causation of Alzheimer's Disease Due to COVID-19.

There are several implications of the surge in the incidence of pandemics and epidemics in the last decades. COVID-19 being the most remarkable one, showed the vulnerability of patients with neurodegenerative diseases like Alzheimer's disease (AD). This review studies the pathological interlinks and triggering factors between the two illnesses and proposes a multifactorial pathway of AD causation due to COVID-19. The article evaluates and describes all the postulated hypotheses which explain the etiology and possible pathogenesis of the disease in four domains: Inflammation & Neurobiochemical interactions, Oxidative Stress, Genetic Factors, and Social Isolation. We believe that a probable hypothesis of an underlying cause of AD after COVID-19 infection could be the interplay of all these factors.

Management of patients with suspected or confirmed antibiotic allergy. Executive summary of guidance from the Spanish Society of Infectious Diseases and Clinical Microbiology (SEIMC), the Spanish Society of Allergy and Clinical Immunology (SEAIC), the Spanish Society of Hospital Pharmacy (SEFH) and the Spanish Society of Intensive Medicine and Coronary Care Units (SEMICYUC).

Suspected or confirmed antibiotic allergy is a frequently encountered clinical circumstance that influences antimicrobial prescribing and often leads to the avoidable use of less efficacious and/or more toxic or costly drugs than first-line antimicrobials. Optimizing antimicrobial therapy in patients with antibiotic allergy labels has become one of the priorities of antimicrobial stewardship programs (ASP) in several countries. This guidance document aims to make recommendations for the systematic approach to patients with suspected or confirmed antibiotic allergy based on current evidence. A panel of eleven members of involved Scientific Societies with expertise in the management of patients with suspected or confirmed antibiotic allergy formulated questions about the management of patients with suspected or confirmed antibiotic allergy. A systematic literature review was performed by a medical librarian. The questions were distributed among panel members who selected the most relevant references, summarized the evidence and formulated graded recommendations when possible. The answers to all questions were finally reviewed by all panel members. A systematic approach to patients with suspected or confirmed antibiotic allergy is recommended to improve antibiotic selection and, consequently clinical outcomes. A clinically oriented, 3-category risk-stratification strategy was recommended for patients with suspected antibiotic allergy. Complementary assessments should consider both clinical risk category and preferred antibiotic agent. Empirical therapy recommendations for the most relevant clinical syndromes in patients with suspected or confirmed ß-lactam allergy were formulated. Recommendations on the implementation and monitoring of the impact of the guidelines were formulated. ASP and allergists should design and implement activities that facilitate the most adequate antibiotic use in these patients.

Morphology of yolk and pericardial sacs in lecithotrophic and matrotrophic nutrition in poeciliid fishes.

We used histological techniques to describe the morphology of the yolk and pericardial sacs in developing embryos of the lecithotrophic species Girardinus creolus, Gambusia puncticulata, Limia vittata, and Quintana atrizona, in comparison with the extreme matrotrophic Heterandria formosa. In lecithotrophic species, the yolk sac was enlarged and lasted until the final stages of development, while in H. formosa it was completely absorbed soon after fertilization. Lecithotrophic poeciliids showed a pericardial sac with a single layer of blood vessels covering the dorsal surface of the cephalic region only, while H. formosa showed a more complex largely vascularized pericardial sac covering the entire dorsal surface, except the caudal region. In advanced gestation of G. creolus, a vascular plexus of the yolk sac reaches the pharyngeal region, behind the gills, suggesting that the pharynx may play a role in embryonic nutrition in lecithotrophic species. These morphological evidences suggest that matrotrophy derives from lecithotrophy.

Is Oxidative Stress the Link Between Cerebral Small Vessel Disease, Sleep Disruption, and Oligodendrocyte Dysfunction in the Onset of Alzheimer's Disease?

Oxidative stress is an early occurrence in the development of Alzheimer's disease (AD) and one of its proposed etiologic hypotheses. There is sufficient experimental evidence supporting the theory that impaired antioxidant enzymatic activity and increased formation of reactive oxygen species (ROS) take place in this disease. However, the antioxidant treatments fail to stop its advancement. Its multifactorial condition and the diverse toxicological cascades that can be initiated by ROS could possibly explain this failure. Recently, it has been suggested that cerebral small vessel disease (CSVD) contributes to the onset of AD. Oxidative stress is a central hallmark of CSVD and is depicted as an early causative factor. Moreover, data from various epidemiological and clinicopathological studies have indicated a relationship between CSVD and AD where endothelial cells are a source of oxidative stress. These cells are also closely related to oligodendrocytes, which are, in particular, sensitive to oxidation and lead to myelination being compromised. The sleep/wake cycle is another important control in the proliferation, migration, and differentiation of oligodendrocytes, and sleep loss reduces myelin thickness. Moreover, sleep plays a crucial role in resistance against CSVD, and poor sleep quality increases the silent markers of this vascular disease. Sleep disruption is another early occurrence in AD and is related to an increase in oxidative stress. In this study, the relationship between CSVD, oligodendrocyte dysfunction, and sleep disorders is discussed while focusing on oxidative stress as a common occurrence and its possible role in the onset of AD.

Total hip arthroplasty in heart transplant patients.

Avascular necrosis of the femoral head (AVNFH) is a known complication after heart transplantation. In order to assess the efficacy and complications of cementless total hip arthroplasty (THA) in this population, the authors analysed 24 cementless THAs in 18 patients with advanced AVNFH (stage II affecting more than 15% of the articular surface, stage III and IV according to the Ficat-Arlet classification) after a heart transplant procedure. Average duration of follow-up was 35.4 months (range: 16 to 66). Pain and function scores (Harris Hip Score and WOMAC arthritis index) showed significant improvement from the preoperative levels. There was no evidence of component loosening, heart-related complications or infection following the THA. Cementless THA is a reasonable treatment option for advanced avascular necrosis of the femoral head following heart transplant procedures.

[Central venous pressure. Variations in patients with intolerance to supine decubitus]. / Presión venosa central. Variaciones en pacientes con intolerancia al decúbito supino.

An accurate measure of central venous pressure has great clinical value; although at times due to causes inherent in the pathology of a patient this cannot be measured be the utmost conditions. The position a patient has in bed invariably affects the final measurement of central venous pressure in that patient. It is important to bear this in mind for patients who do not tolerate a supine position, such as those with polytraumatic injuries. The authors studied the variations in central venous pressure values taken on the same patient when he was in a supine position and when he had his bed inclined 45; the authors opted for an analytical study using 1061 measurements on patients checked into the intensive care ward at the Nuestra Señora de Fatima Clinic in Seville. The correct placement of the central catheter, either clavicle, jugular or "DRUM" placement, was confirmed by means of radiological testing in each of these patients. After obtaining these central venous pressure measurement values, the authors related these to the patient's corporal mass index, a comparison of weight in kilograms to height en square meters; they observed that when a patient's corporal volume is greater, greater is the difference between the measurements in a supine position and with bed inclined 45 degrees, in favor of the first measurement.

[How to reduce the incidence of traumatic phlebitis]. / Flebitis traumáticas. Cómo disminuir su incidencia.

The authors carried out an analytic study on 2572 patients to reduce the occurrence of phlebitis having a traumatic cause. The authors conclude that the use of extensions after three way valves, or infusion systems and a venous catheter, considerably reduces the risk of traumatic phlebitis occurring. Furthermore, their use reduces 1. the bother patients incur, 2. the amount of work nursing professionals have derived by the appearance of traumatic phlebitis and 3. the cost of health care.

Acciones para la superación de los maestros sobre la postura corporal correcta en los niños de la Educación Primaria / Actions for the overcoming of the teachers on the correct corporal posture in the children of the Primary Education

RESUMEN La postura corporal correcta es un aspecto importante para la salud y la calidad de vida de los niños desde las primeras edades y se incluye como parte del eje temático de Higiene en el Programa Director de Salud que se desarrolla en las escuelas cubanas. Teniendo en cuenta la existencia de esta problemática en la Educación Primaria, se partió de un diagnóstico sobre la situación actual referente a la postura corporal en una muestra de 184 niños de ambos sexos pertenecientes al semi-internado «Isidro de Armas¼ de Pinar del Río. Durante el estudio se empleó la observación científica y el examen somatoscópico, además se aplicó una encuesta a 27 maestros trabajadores en ese centro. A partir de las deficiencias y debilidades encontradas se elaboró un conjunto de acciones encaminadas a la capacitación de los maestros del referido centro, para un desarrollo eficiente de la educación corporal en los niños comprendidos entre 6 a 12 años. La implementación de dichas acciones en la práctica pedagógica permitió a los maestros profundizar en los aspectos teóricos, prácticos y metodológicos indispensables para el logro de un desarrollo adecuado de la postura corporal en los infantes.

ABSTRACT The correct corporal posture is an important aspect for the health and the quality of children's life since the early years and it is included as part of the hygiene thematic axis in the Health Principal Program which is developed in our schools. Taking into account the existence of the problematic situation in the Elementary Education, the authors of this investigation elaborated and validated an up-grading strategic for the primary teachers of the school «Isidoro Garcia¼ from Las Minas de Matahambres municipality, gaining outstanding results after applying the corresponding methods such as the observation, the survey and a Somatoscopical test. Besides, other samples of groups were included in the investigation, like the family, supervisors and principals.