A systematic review of biobanks in Latin America: Strengths and limitations for biomedical research.

Biobanks are valuable tools for developing and applying scientific research and international cooperation through the collection of biological materials and their associated data. Systematic research following the Preferred Reporting Items for Systematic Review and Meta-Analysis guidelines was conducted in late 2022 in PubMed and Scopus, and generated 17 articles to be reviewed in depth and critically assessed using the Critical Appraisal Skills Programme Checklist due to the limited available data; 12 relevant health organizations and government websites outside of peer-reviewed journals were also included. Our research identified 44 biobanks in Latin America. In general, there is a lack of regulation and legislation guaranteeing the stored materials' quality and institutional collaboration. We believe a consensus needs to be reached regarding the terminology and definitions used for biobanks. The design for informed consent should also be agreed upon to ensure the privacy of the data shared among institutions. In conclusion, in Latin America, there is a clear need for government support in creating specific procedures for biobanks and providing further support for existing biobanks.

Association of metabolic flexibility indexes after an oral glucose tolerance test with cardiometabolic risk factors.

BACKGROUND & AIMS: Metabolic flexibility (MetF) is considered a metabolic health biomarker, as excess body weight is associated with lower MetF. We aimed to identify whether MetF indexes were associated with cardiometabolic risk factors before and after adjustment for body size-related factors (body weight, fat-free mass, and resting metabolic rate). METHODS: We studied 51 participants (55% women; 33.6 ± 8.7 years; 26.3 ± 3.8 kg/m²) who consumed a 75-g glucose load. We measured gas exchange before (fasting) and for 3 h after glucose ingestion. MetF indexes were assessed, including the change after each hour and the 3-hour incremental area under the curve (iAUC) in respiratory exchange ratio (RER). These indexes were then related to cardiometabolic risk factors before and after adjusting for body size-related factors. RESULTS: MetF indexes correlated with each other (r ≥ 0.51; P < 0.001) and related to body weight (adjusted R2 ≥ 0.09; P < 0.03). A similar pattern was noted for fat-free mass and resting metabolic rate. MetF, regardless of the index, was not related to cardiometabolic risk factors except to BMI and high-density lipoprotein-cholesterol (HDL-C). The association between BMI and MetF disappeared after adjusting for body size-related factors. Similar adjustments did not modify the association between HDL-C and MetF, especially when approached by the change in RER after the first hour (adjusted R2 = 0.20-0.22; all P < 0.02). CONCLUSIONS: Inter-individual body size differences fully accounted for the associations between BMI and MetF. However, variability in body size-related factors appeared less relevant in affecting the associations of other cardiometabolic risk factors with MetF.

HDL abnormalities in type 2 diabetes: Clinical implications.

Atherosclerotic cardiovascular disease (ASCVD) represents the primary cause of mortality among patients with Type 2 Diabetes Mellitus (T2DM). In this population, High-Density Lipoprotein (HDL) particles exhibit abnormalities in number, composition, and function, culminating in diminished anti-atherosclerotic capabilities despite normal HDL cholesterol (HDL-C) concentrations. Hyperglycemic conditions contribute to these alterations in HDL kinetics, composition, and function, causing T2DM patients' HDL particles to exhibit decreased concentrations of diverse lipid species and proteins. Treatment of hyperglycemia has the potential to correct abnormal HDL particle attributes in T2DM; however, pharmacological interventions, including metformin and thiazolidinediones, yield inconsistent outcomes with respect to HDL-C concentrations and functionality. Despite numerous attempts with diverse drugs, pharmacologically augmenting HDL-C levels has not resulted in clinical benefits in mitigating ASCVD risk. In contrast, reducing Low Density Lipoprotein cholesterol (LDL-C) via statins and ezetimibe has demonstrated significant efficacy in curtailing CVD risk among T2DM individuals. Promising results have been observed in animal models and early-phase trials utilizing recombinant HDL and Lecitin Cholesterol Acyl Transferase (LCAT) -enhancing agents, but the evaluation of their efficacy and safety in large-scale clinical trials is ongoing. While aberrant HDL metabolism constitutes a prevalent aspect of dyslipidemia in T2DM, HDL cholesterol concentrations and composition no longer offer valuable insights for informing therapeutic decisions. Nevertheless, HDL metabolism remains a critical research area in T2DM, necessitating further investigation to elucidate the role of HDL particles in the development of diabetes-associated complications.

Impact of methods for data selection on the day-to-day reproducibility of resting metabolic rate assessed with four different metabolic carts.

BACKGROUND AND AIMS: Accomplishing a high day-to-day reproducibility is important to detect changes in resting metabolic rate (RMR) and respiratory exchange ratio (RER) that may be produced after an intervention or for monitoring patients' metabolism over time. We aimed to analyze: (i) the influence of different methods for selecting indirect calorimetry data on RMR and RER assessments; and, (ii) whether these methods influence RMR and RER day-to-day reproducibility. METHODS AND RESULTS: Twenty-eight young adults accomplished 4 consecutive RMR assessments (30-min each), using the Q-NRG (Cosmed, Rome, Italy), the Vyntus CPX (Jaeger-CareFusion, Höchberg, Germany), the Omnical (Maastricht Instruments, Maastricht, The Netherlands), and the Ultima CardiO2 (Medgraphics Corporation, St. Paul, Minnesota, USA) carts, on 2 consecutive mornings. Three types of methods were used: (i) short (periods of 5 consecutive minutes; 6-10, 11-15, 16-20, 21-25, and 26-30 min) and long time intervals (TI) methods (6-25 and 6-30 min); (ii) steady state (SSt methods); and, (iii) methods filtering the data by thresholding from the mean RMR (filtering methods). RMR and RER were similar when using different methods (except RMR for the Vyntus and RER for the Q-NRG). Conversely, using different methods impacted RMR (all P ≤ 0.037) and/or RER (P ≤ 0.009) day-to-day reproducibility in all carts. The 6-25 min and the 6-30 min long TI methods yielded more reproducible measurements for all metabolic carts. CONCLUSION: The 6-25 min and 6-30 min should be the preferred methods for selecting data, as they result in the highest day-to-day reproducibility of RMR and RER assessments.

Validity of four commercially available metabolic carts for assessing resting metabolic rate and respiratory exchange ratio in non-ventilated humans.

BACKGROUND & AIMS: The validity of most commercially available metabolic cart is mostly unknown. Thus, we aimed to determine the accuracy, precision, within-subject reproducibility, and concordance of RMR and RER measured by four commercially available metabolic carts [Cosmed Q-NRG, Vyaire Vyntus CPX, Maastricht Instruments Omnical, and Medgraphics Ultima CardiO2]. Further, we studied whether a previously proposed simulation-based post-calorimetric calibration of cart readouts [individual calibration control evaluation (ICcE)] modify the RMR and RER reproducibility and concordance. METHODS: Three experiments simulating different RMR and RER by controlled pure gas (N2 and CO2) infusions were conducted on 5 non-consecutive days. Moreover, 30-min methanol burns were performed on 3 non-consecutive days. Lastly, the RMR and RER of 29 young non-ventilated adults (11 women; 25 ± 4 years-old; BMI: 24.1 ± 3.2 kg/m2) were assessed twice using each instrument, 24 hours apart, under standardized conditions. RESULTS: The Omnical presented the lowest measurement error for RER (Omnical = 1.7 ± 0.9%; Vyntus = 4.5 ± 2.0%; Q-NRG = 6.6 ± 1.9%; Ultima = 6.8 ± 6.5%) and EE (Omnical = 1.5 ± 0.5%; Q-NRG = 2.5 ± 1.3%; Ultima = 10.7 ± 11.0%; Vyntus = 13.8 ± 5.0%) in all in vitro experiments (controlled pure gas infusions and methanol burns). In humans, the 4 metabolic carts provided discordant RMR and RER estimations (all P < 0.001). No differences were detected in RMR within-subject reproducibility (P = 0.058; Q-NRG inter-day coefficient of variance = 3.6 ± 2.5%; Omnical = 4.8 ± 3.5%; Vyntus = 5.0 ± 5.6%; Ultima = 5.7 ± 4.6%), although the Ultima CardiO2 provided larger RER inter-day differences (4.6 ± 3.5%) than the others carts (P = 0.001; Omnical = 1.9 ± 1.7%; Vyntus = 2.1 ± 1.3%; Q-NRG = 2.4 ± 2.1%). The ICcE procedure did not modify the RMR or RER concordance and did not reduce the inter-day differences in any of the carts. CONCLUSIONS: The 4 metabolic carts provided discordant measurements of RMR and RER. Overall, the Omnical provides more accurate and precise estimations of RMR and RER than the Q-NRG, Vyntus and Ultima CardiO2, and might be considered the best for assessing RMR and RER in non-ventilated humans. Finally, our results do not support the use of an ICcE procedure.

Ozone as an alternative decontamination process for N95 facemask and biosafety gowns.

COVID-19 pandemic created a global shortage of medical protective equipment. Here, we considered ozone (O3) a disinfectant alternative due to its potent oxidative activity against biological macromolecules. The O3 decontamination assays were done using SARS-CoV-2 obtained from patients to produce artificial contamination of N95 masks and biosecurity gowns. The quantification of SARS-CoV-2 was performed before and after exposing the samples to different ozone gas concentrations for times between 5 and 30 min. Viral loads as a function of the O3 exposure time were estimated from the data obtained by the RT-PCR technique. The genetic material of the virus was no longer detected for any tested concentrations after 15 min of O3 exposure, which means a disinfection Concentration-Time above 144 ppm min. Vibrational spectroscopies were used to follow the modifications of the polymeric fibers after the O3 treatment. The results indicate that the N95 masks could be safely reused after decontamination with treatments of 15 min at the established O3 doses for a maximum of 6 cycles.

Diurnal variations of cold-induced thermogenesis in young, healthy adults: A randomized crossover trial.

BACKGROUND: Harnessing cold-induced thermogenesis (CIT) and brown adipose tissue (BAT) activity has been proposed as a means of counteracting a positive energy balance, and thus of combating obesity and its related comorbidities. However, it has remained unclear whether CIT and BAT activity show diurnal variation in humans - knowledge that might allow treatments based on these factors to be time-optimized. METHODS: A randomized crossover experiment was designed to examine whether CIT shows morning/evening variation in young, healthy adults (n = 14, 5 women). On the first experimental day, subjects' shivering thresholds were determined following a cooling protocol. After ≈96 h had elapsed, the subjects then returned on two further days (approx. 48 h apart) at 08:00 h or 18:00 in random order. On both the latter days, the resting energy expenditure (REE) was measured before the subjects underwent personalized cold exposure (i.e., according to their shivering threshold). CIT was then assessed for 60 min by indirect calorimetry. In an independent cross-sectional study (n = 133, 88 women), subjects came to the laboratory between 8:00 and 18:00 h and their BAT 18F-fluordeoxyglucose (18F-FDG) uptake was assessed after personalized cold stimulation. RESULTS: Both the REE and CIT were similar in the morning and evening (all P > 0.05). Indeed, 60 min of personalized-mild cold exposure in the morning or evening elicited a similar change in energy expenditure (16.8 ± 12.8 vs. 15.7 ± 15.1% increase above REE, P = 0.72). BAT 18F-FDG uptake was also similar in the morning, evening and afternoon (all P > 0.05). CONCLUSION: CIT does not appear to show morning/evening variation in young healthy adults, with the current study design and methodology. BAT 18F-FDG uptake appears not to change across the day either, although experiments with a within-subject study design are needed to confirm these findings. Registered under ClinicalTrials.gov Identifier no. NCT02365129.

Synthesis, optical and thermoluminescence properties of thulium-doped KMgF3 fluoroperovskite.

KMgF3 fluoroperovskite doped with thulium at different concentrations were synthesized by the solid-state reaction method. The phase composition and the thermal stability up to 600 °C of the polycrystals were analyzed by X-ray diffraction and thermogravimetric analysis, respectively. The KMgF3 at 1.0 mol% of Tm polycrystals showed the best thermal stability and did not present another phase. The gamma radiation (0.1-10 kGy) effect in thulium-doped KMgF3 produced the F color centers, and their aggregates such as F2, and F3 centers. The F centers, and the potassium vacancies (VK-) in the fluoroperosvkites were analyzed by the optical absorption and emission measurements. Optical absorption at 275 nm and 443 nm were assigned to F and F2, respectively, in undoped KMgF3. Tm-doped fluoroperovskite shows the optical absorption bands at 277, 393, 432, and 577 nm, which were ascribed to the F, F3, F2 and VK- centers, respectively. When the F band for undoped polycrystals was excited at 275 nm, a clear emission associated with F2 and F3 centers was observed. In the case of Tm-doped, an enhancement of the blue emission at 457 nm occurred and a UV band (354 nm) was observed upon exciting the F band. The blue emission of thulium was overlapped with the F3 color center band. The emission bands at 457 and 354 nm were ascribed to 1D2 - 3F4 and 1D2 - 3H6 transitions of Tm in KMgF3. The optical absorption and glow curves were investigated too. The glow curves were assisted by the color centers, vacancies, and thulium impurity. Thermal bleaching shows that the F center was the main participant to give rise to the TL intensity of the glow curves. Thulium acts as a deep electron trap in the bandgap of the KMgF3 fluoroperovskites forming TL peak at the higher temperature, from 430 to 408 °C. The absorption, emission, and thermoluminescence glow peaks of the undoped and Tm-doped KMgF3 were compared.

Cardiovascular Risk Factors and Heart Rate Variability: Impact of the Level of the Threshold-Based Artefact Correction Used to Process the Heart Rate Variability Signal.

The associations between cardiovascular disease (CVD) risk factors and heart rate variability (HRV) have shown some inconsistencies. To examine the impact of the different Kubios threshold-based artefact correction levels on the associations between different CVD risk factors and a heart rate variability (HRV) score in three independent human cohorts. A total of 107 children with overweight/obesity, 132 young adults, and 73 middle-aged adults were included in the present study. Waist circumference and the HRV score were negatively associated using the medium and the strong Kubios filters in children (ß = -0.22 and - 0.24, P = 0.03 and 0.02 respectively) and the very strong Kubios filter in middle-aged adults (ß = -0.39, P = 0.01). HDL-C was positively associated with the HRV score across Kubios filters (ß ranged from 0.21 to 0.31, all P ≤ 0.04), while triglycerides were negatively associated with the HRV score using the very strong Kubios filter in young adults (ß = -0.22, P = 0.02). Glucose metabolism markers (glucose, insulin, and HOMA index) were inversely associated with the HRV score across Kubios filters in young adults (ß ranged from -0.29 to -0.22; all P ≤ 0.03). Importantly, most of these associations disappeared after including HR as a covariate, especially in children and young adults. It should be mandatory to report the Kubios filter used and to include the HR (as a confounder factor) to allow the comparability of the results across different studies.

Epidemiological behavior and current forecast of syphilis in Mexico: increase in male population.

OBJECTIVES: Even when new cases of syphilis are notifiable since 1944, the Mexican National Epidemiological Surveillance System lacks information on the changes of the rate of case reports considering the geographic and demographic variables. Therefore, it is necessary to have evidence, with particular attention to the study of the epidemiological behavior by the identification of risk factors and groups. The objective of this study was to analyze the epidemiology, geographical distribution, and forecast of syphilis in Mexico. STUDY DESIGN: The design of the study was a secondary research of epidemiological databases. METHODS: A retrospective analysis of the national surveillance data (2007-2017) of acquired and congenital syphilis (CS) issued by the General Directorate of Epidemiology was performed. RESULTS: Of all cases, 34,998 and 1030 cases were reported for acquired syphilis (AS) and CS , respectively, reflecting an increasing trend in the whole country for both diseases. Cases and incidence of AS per year showed that, male gender presented an increase in reproductive age. Distribution of the rate of case reports is mostly commanded by the states in the extreme north (Gulf of California and northern Gulf of Mexico) and south (Gulf of southern Mexico and the Caribbean Sea). Likewise, the Seasonal Autoregressive Integrated Moving Average model was selected as the best-fit model for the forecast analysis. This model was used to forecast AS cases during 2018-2019. AS may have a slight fluctuation (on the rise) during the following 24 months. CONCLUSIONS: These findings underscore the importance of intensifying, as well as expanding screening and treatment in adult population, including men, who are not routinely benefiting from maternal and reproductive service-based syphilis screening and treatment.

Inter- and intra-researcher reproducibility of heart rate variability parameters in three human cohorts.

Heart rate variability (HRV) is a valid and non-invasive indicator of cardiac autonomic nervous system functioning. Short-term HRV recordings (e.g., 10 min long) produce data that usually is manually processed. Researcher subjective decision-making on data processing could produce inter- or intra-researcher differences whose magnitude has not been previously quantified in three independent human cohorts. This study examines the inter- and intra-researcher reproducibility of HRV parameters (i.e., the influence of R-R interval selection by different researchers and by the same researcher in different moments on the quantification of HRV parameters, respectively) derived from short-term recordings in a cohort of children with overweight/obesity, young adults and middle-age adults. Participants were recruited from 3 different studies: 107 children (10.03 ± 1.13 years, 58% male), 132 young adults (22.22 ± 2.20 years, 33% males) and 73 middle-aged adults (53.62 ± 5.18 years, 48% males). HRV was measured using a Polar RS800CX heart rate monitor. The intraclass correlation coefficient (ICC) ranged from 0.703 to 0.989 and from 0.950 to 0.998 for inter-and intra-researcher reproducibility, respectively. Limits of agreement for HRV parameters were higher for the inter-researcher processing compared with the intra-researcher processing. On average, the intra-researcher differences were 31%, 62%, and 80% smaller than the inter-researchers differences based on Coefficient of Variation in children, young and middle-aged adults, respectively. Our study provides the quantification of the inter-researcher and intra-researcher differences in three independent human cohorts, which could elicit some clinical relevant differences for HRV parameters. Based on our findings, we recommend the HRV data signal processing to be performed always by the same trained researcher and we postulate a development of algorithms for an automatic ECG selection.

[Utilisation of first-line antibiotics six years after a multifaceted intervention]. / Uso de antibióticos de primera línea 6 años después de una intervención multifacética.

OBJECTIVE: No study has evaluated the impact of a multifaceted intervention on the quality of the antibiotics prescribed more than 5 years later. METHODS: A total of 210 general practitioners (GP) from eight different regions of Spain were asked to participate in two registrations of respiratory tract infections (RTI) in 2008, before, and in 2009, just after a multifaceted intervention including prescriber feedback, clinical guidelines, training sessions focused on appropriate antibiotic prescribing, workshop on rapid tests and provision of these tests in the GP consultation. They were all again invited to participate in a similar registration in 2015. A new group of clinicians from the same areas who had never participated in antimicrobial stewardship courses were also invited to participate and acted as controls. RESULTS: The 121 GPs who continued the study (57.6%) and the 117 control GPs registered 22,407 RTIs. The antibiotic most commonly prescribed was amoxicillin and clavulanic acid, prescribed in 1,801 cases (8.1% of the total), followed by amoxicillin (1,372 prescriptions, 6.2%), being lower among GPs just after the intervention. The third leading antibiotic among GPs just after the intervention was penicillin V (127 cases, 3.3%) whereas macrolides ranked third in the other three groups of GPs. CONCLUSIONS: The use of first-line antibiotic for RTIs wanes over time after an intervention, but their utilisation is still significantly greater among intervened clinicians six years later compared to GPs who have never been exposed to any antimicrobial stewardship programmes.

Regeneration of a keystone semiarid shrub over its range in Spain: habitat degradation overrides the positive effects of plant-animal mutualisms.

Global change drivers are currently affecting semiarid ecosystems. Because these ecosystems differ from others in biotic and abiotic filters, cues for plant regeneration and management derived from elsewhere may not be applicable to semiarid ecosystems. We sought to determine the extent to which regional variation in regeneration prospects of a long-lived semiarid keystone shrub depends on anthropogenic habitat degradation, plant-animal interactions and climate determinants. We investigated the regeneration ability (via population size structure, juvenile density and juvenile/adult ratio), fruit set and seed dispersal of Ziziphus lotus in 25 localities spanning the range of its threatened habitats in Spain. We dissected the relative contribution of different regeneration determinants using multiple regression and structural equation modelling. Population regeneration was extremely poor, and size structures were biased towards large classes and low juvenile densities and juvenile/adult ratios. Poor regeneration was often coincident with seed dispersal collapse. However, the positive effect of seed dispersal on population regeneration disappeared after considering its relationship with habitat degradation. Protected areas did have juveniles. Together, these data suggest that habitat degradation directly impacts juvenile establishment. Our results provide insights into habitat and species management at the regional level. Z. lotus populations are currently driven by persistence-based dynamics through the longevity of the species. Nonetheless, collapsed seed dispersal, poor regeneration and the removal of adults from their habitats forecast extinction of Z. lotus in many remnants. The extreme longevity of Z. lotus provides opportunities for recovery of its populations and habitats through effective enforcement of regulations.

Congruent validity and inter-day reliability of two breath by breath metabolic carts to measure resting metabolic rate in young adults.

BACKGROUND & AIMS: Achieving high inter-day reliability is a key factor to analyze the magnitude of change in RMR, for instance after an intervention. The aims of this study were: i) to determine the congruent validity of RMR and respiratory quotient (RQ) with two breath by breath commercially available metabolic carts [CCM Express (CCM) and Ultima CardiO2 (MGU)]; and ii) to analyze the inter-day reliability of RMR and RQ measurements. METHODS & RESULTS: Seventeen young adults participated in the study. RMR measurements were performed during two consecutive 30-min periods, on two consecutive days with both metabolic carts. The 5-min period that met the steady state criteria [Coefficient of variance (CV) < 10% for VO2, VCO2, and VE, and CV<5% for RQ] and with the lowest CV average was included in further analysis. RMR values were higher with the MGU than with the CCM on both days (two-way ANOVA, P = 0.021), however, no differences were found on RQ values obtained by both metabolic carts (P = 0.642). Absolute inter-day RMR differences obtained with the MGU were higher than those obtained with the CCM (219 ± 185 vs. 158 ± 154 kcal/day, respectively, P = 0.002; 18.3 ± 17.2% vs. 13.5 ± 15.3%, respectively, P = 0.046). We observed a significant positive association of absolute inter-day differences in RMR obtained with both metabolic carts (ß = 0.717; R2 = 0.743; P < 0.001). CONCLUSIONS: The CCM metabolic cart provides lower RMR values and seems more reliable than the MGU in our sample of young adults. Our findings also suggest that a great part of inter-day variability is explained by the individuals.

Association study of functional polymorphisms of dopaminergic pathway in epilepsy-related factors of temporal lobe epilepsy in Brazilian population.

BACKGROUND AND PURPOSE: There are few data about the role of neurotransmission modulated by dopamine in epilepsy, especially temporal lobe epilepsy (TLE). This is the first study that aimed to analyze the dopaminergic polymorphisms in an etiologically homogeneous group of patients with TLE with hippocampal sclerosis. Selected polymorphisms were: (i) the most expressed D2-like receptors in the limbic system (DRD2/ANKK1 TAQ-1A, D4_VNTR and D4_rs1800955); (ii) the dopamine transporter (DAT) 3'-untranslated region and intron 8; and (iii) two degrading enzymes regulating the synaptic activity, i.e. the main metabolizer of dopamine, catechol-O-methyltransferase, and monoamine oxidase A. METHODS: We assessed 119 patients with unequivocal TLE with hippocampal sclerosis and 112 healthy volunteers. Individuals were genotyped for the polymorphisms of the gene encoding dopaminergic pathway transporter DAT haplotype, dopaminergic receptors, catechol-O-methyltransferase and monoamine oxidase A. We also evaluated epilepsy-related factors (e.g. seizure frequency, age of onset, duration and status epilepticus). RESULTS: There was no difference between the groups for the studied polymorphisms. The polymorphism DRD4_VNTR was associated with family history of epilepsy (P = 0.003), DRD2_rs1800497 was related to status epilepticus (P = 0.022), and intron 8 VNTR DAT was related to higher seizure frequency (P = 0.019) and family history of epilepsy (P = 0.011). CONCLUSIONS: Our findings demonstrated that polymorphisms of the dopaminergic pathway are associated with significant clinical features of this form of epilepsy, such as seizure frequency, family history of epilepsy and status epilepticus.

Amputación bilateral en paciente diabética con ceguera, el uso de prótesis inadecuadas. Reporte de caso / Bilateral amputation in diabetic patient with blindness, the use of inadequate prosthesis. Case report

Resumen: Las complicaciones más frecuentes asociadas con la diabetes incluyen al pie diabético y al glaucoma, que suelen llevar a la amputación y a la pérdida de la visión, respectivamente. El desarrollo científico y tecnológico actual ha permitido el diseño e implementación de sistemas protésicos óptimos para estos pacientes, asegurando una reincorporación a las actividades de la vida diaria, así como una correcta adaptación al uso de las mismas. La falta de recursos económicos compromete la adquisición de las prótesis ideales, recurriendo al uso de sistemas «artesanales¼ o «rústicos¼ que afectan la adaptación. Se presenta el caso de un paciente femenino de 47 años de edad, ama de casa, quien presenta parestesias bilaterales y sensación de miembro fantasma asociado a neuromas de amputación por diabetes mellitus tipo II de ocho años de evolución. La paciente, con bajos recursos económicos, es evaluada postamputación con diagnóstico de dependencia grave en la ejecución de las actividades de la vida diaria, con desplazamiento en silla de ruedas asistido; esta presentación es una variante frecuente como consecuencia de la pérdida bilateral de miembros inferiores, concomitante a la ausencia total de la visión. Se presenta el tratamiento de rehabilitación en etapa preprotésica y protésica, acompañados por los resultados de las evaluaciones para mostrar la efectividad del proceso terapéutico, sin olvidar la participación del cuidador como ente coterapéutico fundamental en el proceso.

Abstract: The most frequent diabetes-related complications are diabetic foot and glaucoma, which lead to amputation and loss of vision, respectively. Current scientific and technologic developments have permitted the design and implementation of prosthetic systems that are optimal for these patients, as the latter adapt themselves to them and can resume activities of daily living. The lack of economic resources compromises the quality of the prostheses patients can afford, as they resort to «artisanal¼ or «rustic¼ systems that hamper their adaptation process. We present herein the case of a 47 year-old female patient, housewife, with bilateral paresthesias and phantom limb sensation associated with amputation neuromas resulting from type II diabetes mellitus that had affected the patient for eight years. This patient of a low socioeconomic stratum underwent a post-amputation assessment and was diagnosed as being heavily dependent when performing activities of daily living and required assisted wheelchair for ambulation. This is a frequent variant resulting from bilateral loss of lower limbs together with complete loss of vision. We describe the rehabilitation therapy during the pre- and post-prosthetic stages, together with the results of the assessments to show the effectiveness of the treatment process, without forgetting the participation of the caregiver as a fundamental co-therapeutic element in this process.

[Bilateral amputation in diabetic patient with blindness, the use of inadequate prosthesis. Case report]. / Amputación bilateral en paciente diabética con ceguera, el uso de prótesis inadecuadas. Reporte de caso.

The most frequent diabetes-related complications are diabetic foot and glaucoma, which lead to amputation and loss of vision, respectively. Current scientific and technologic developments have permitted the design and implementation of prosthetic systems that are optimal for these patients, as the latter adapt themselves to them and can resume activities of daily living. The lack of economic resources compromises the quality of the prostheses patients can afford, as they resort to «artisanal¼ or «rustic¼ systems that hamper their adaptation process. We present herein the case of a 47 year-old female patient, housewife, with bilateral paresthesias and phantom limb sensation associated with amputation neuromas resulting from type II diabetes mellitus that had affected the patient for eight years. This patient of a low socioeconomic stratum underwent a post-amputation assessment and was diagnosed as being heavily dependent when performing activities of daily living and required assisted wheelchair for ambulation. This is a frequent variant resulting from bilateral loss of lower limbs together with complete loss of vision. We describe the rehabilitation therapy during the pre- and post-prosthetic stages, together with the results of the assessments to show the effectiveness of the treatment process, without forgetting the participation of the caregiver as a fundamental co-therapeutic element in this process.

Las complicaciones más frecuentes asociadas con la diabetes incluyen al pie diabético y al glaucoma, que suelen llevar a la amputación y a la pérdida de la visión, respectivamente. El desarrollo científico y tecnológico actual ha permitido el diseño e implementación de sistemas protésicos óptimos para estos pacientes, asegurando una reincorporación a las actividades de la vida diaria, así como una correcta adaptación al uso de las mismas. La falta de recursos económicos compromete la adquisición de las prótesis ideales, recurriendo al uso de sistemas «artesanales¼ o «rústicos¼ que afectan la adaptación. Se presenta el caso de un paciente femenino de 47 años de edad, ama de casa, quien presenta parestesias bilaterales y sensación de miembro fantasma asociado a neuromas de amputación por diabetes mellitus tipo II de ocho años de evolución. La paciente, con bajos recursos económicos, es evaluada postamputación con diagnóstico de dependencia grave en la ejecución de las actividades de la vida diaria, con desplazamiento en silla de ruedas asistido; esta presentación es una variante frecuente como consecuencia de la pérdida bilateral de miembros inferiores, concomitante a la ausencia total de la visión. Se presenta el tratamiento de rehabilitación en etapa preprotésica y protésica, acompañados por los resultados de las evaluaciones para mostrar la efectividad del proceso terapéutico, sin olvidar la participación del cuidador como ente coterapéutico fundamental en el proceso.

Complete Genome Sequence of Human Respiratory Syncytial Virus Isolated in Mexico.

Human respiratory syncytial virus (HRSV) is a member of the Paramyxoviridae family, which causes lower respiratory tract infections in neonates and children younger than 5 years. Here, we report the complete genome sequence of HRSV, isolated from a nasopharyngeal swab of a pregnant woman with cardiac complications.

Escaldadura estafilocócica recurrente. ¿Existe algo más? / Recurrent staphylococcal scalded skin syndrome. Is there something else?

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