You Cannot Function in "Overwhelm": Helping Primary Care Navigate the Slow End of the Pandemic.

GOAL: This study was developed to explicate underlying organizational factors contributing to the deterioration of primary care clinicians' mental health during the COVID-19 pandemic. METHODS: Using data from the Larry A. Green Center for the Advancement of Primary Health Care for the Public Good's national survey of primary care clinicians from March 2020 to March 2022, a multidisciplinary team analyzed more than 11,150 open-ended comments. Phase 1 of the analysis happened in real-time as surveys were returned, using deductive and inductive coding. Phase 2 used grounded theory to identify emergent themes. Qualitative findings were triangulated with the survey's quantitative data. PRINCIPAL FINDINGS: The clinicians shifted from feelings of anxiety and uncertainty at the start of the pandemic to isolation, lack of fulfillment, moral injury, and plans to leave the profession. The frequency with which they spoke of depression, burnout, and moral injury was striking. The contributors to this distress included crushing workloads, worsening staff shortages, and insufficient reimbursement. Consequences, both felt and anticipated, included fatigue and demoralization from the inability to manage escalating workloads. Survey findings identified responses that could alleviate the mental health crisis, namely: (1) measuring and customizing workloads based on work capacity; (2) quantifying resources needed to return to sufficient staffing levels; (3) promoting state and federal support for sustainable practice infrastructures with less administrative burden; and (4) creating patient visits of different lengths to rebuild relationships and trust and facilitate more accurate diagnoses. PRACTICAL APPLICATIONS: Attention to clinicians' mental health should be rapidly directed to on-demand, confidential mental health support so they can receive the care they need and not worry about any stigma or loss of license for accepting that help. Interventions that address work-life balance, workload, and resources can improve care, support retention of the critically important primary care workforce, and attract more trainees to primary care careers.

Play Nicely: Evaluation of a Brief Intervention to Reduce Physical Punishment and the Beliefs That Justify It.

The objective of this study was to assess the efficacy of the Play Nicely brief intervention in diminishing both the utilization of physical punishment and the beliefs that endorse such behavior among a sample of Colombian parents with children aged 2 to 6. Utilizing a quasi-experimental design, the research included pretest and posttest evaluations and involved both an intervention group (n = 37) and a control group (n = 29). The assessment tools used were a scale to measure beliefs about the positive impacts of physical punishment and the Physical Assault subscale of the Spanish version of the Conflict Tactics Scale Parent-Child (CTSPC). Parents participated in a single online session, which offered eight interactive options and lasted 10 min. The results highlighted a high prevalence of physical punishment within the sample (81.8%) and established statistically significant correlations between the justification of physical punishment and its actual use. Approximately one month following the intervention, there was a significant reduction in the employment of physical punishment among the intervention group (p = 0.009), and a notable decrease in the belief that "Punishment is the best alternative to control children's behavior" (p = 0.010) was observed. Consequently, the Play Nicely intervention proved effective in curtailing the use of physical punishment among parents of young children, demonstrating both efficacy and cost-effectiveness within a brief timeframe.

Cysteine Rich Intestinal Protein 2 is a copper-responsive regulator of skeletal muscle differentiation.

Copper (Cu) is an essential trace element required for respiration, neurotransmitter synthesis, oxidative stress response, and transcriptional regulation. Imbalance in Cu homeostasis can lead to several pathological conditions, affecting neuronal, cognitive, and muscular development. Mechanistically, Cu and Cu-binding proteins (Cu-BPs) have an important but underappreciated role in transcription regulation in mammalian cells. In this context, our lab investigates the contributions of novel Cu-BPs in skeletal muscle differentiation using murine primary myoblasts. Through an unbiased synchrotron X-ray fluorescence-mass spectrometry (XRF/MS) metalloproteomic approach, we identified the murine cysteine rich intestinal protein 2 (mCrip2) in a sample that showed enriched Cu signal, which was isolated from differentiating primary myoblasts derived from mouse satellite cells. Immunolocalization analyses showed that mCrip2 is abundant in both nuclear and cytosolic fractions. Thus, we hypothesized that mCrip2 might have differential roles depending on its cellular localization in the skeletal muscle lineage. mCrip2 is a LIM-family protein with 4 conserved Zn2+-binding sites. Homology and phylogenetic analyses showed that mammalian Crip2 possesses histidine residues near two of the Zn2+-binding sites (CX2C-HX2C) which are potentially implicated in Cu+-binding and competition with Zn2+. Biochemical characterization of recombinant human hsCRIP2 revealed a high Cu+-binding affinity for two and four Cu+ ions and limited redox potential. Functional characterization using CRISPR/Cas9-mediated deletion of mCrip2 in primary myoblasts did not impact proliferation, but impaired myogenesis by decreasing the expression of differentiation markers, possibly attributed to Cu accumulation. Transcriptome analyses of proliferating and differentiating mCrip2 KO myoblasts showed alterations in mRNA processing, protein translation, ribosome synthesis, and chromatin organization. CUT&RUN analyses showed that mCrip2 associates with a select set of gene promoters, including MyoD1 and metallothioneins, acting as a novel Cu-responsive or Cu-regulating protein. Our work demonstrates novel regulatory functions of mCrip2 that mediate skeletal muscle differentiation, presenting new features of the Cu-network in myoblasts.

The Impact of the Coronavirus Pandemic on Vaccination Coverage in Latin America and the Caribbean.

BACKGROUND: Routine vaccination coverage in Latin America and the Caribbean declined prior to and during the coronavirus pandemic. We assessed the pandemic's impact on national coverage levels and analyzed whether financial and inequality indicators, immunization policies, and pandemic policies were associated with changes in national and regional coverage levels. METHODOLOGY: We compared first- and third-dose coverage of diphtheria-pertussis-tetanus-containing vaccine (DTPcv) with predicted coverages using time series forecast modeling for 39 LAC countries and territories. Data were from the PAHO/WHO/UNICEF Joint Reporting Form. A secondary analysis of factors hypothesized to affect coverages during the pandemic was also performed. RESULTS: In total, 31 of 39 countries and territories (79%) had greater-than-predicted declines in DTPcv1 and DTPcv3 coverage during the pandemic, with 9 and 12 of these, respectively, falling outside the 95% confidence interval. Within-country income inequality (i.e., Gini coefficient) was associated with significant declines in DTPcv1 coverage, and cross-country income inequality was associated with declines in DTPcv1 and DTPcv3 coverages. Observed absolute and relative inequality gaps in DTPcv1 and DTPcv3 coverage between extreme country quintiles of income inequality (i.e., Q1 vs. Q5) were accentuated in 2021, as compared with the 2019 observed and 2021 predicted values. We also observed a trend between school closures and greater-than-predicted declines in DTPcv3 coverage that approached statistical significance (p = 0.06). CONCLUSION: The pandemic exposed vaccination inequities in LAC and significantly impacted coverage levels in many countries. New strategies are needed to reattain high coverage levels.

Examining the Moderating Role of Parental Stress in the Relationship between Parental Beliefs on Corporal Punishment and Its Utilization as a Behavior Correction Strategy among Colombian Parents.

Understanding beliefs about corporal punishment is crucial, as evidence suggests that positive beliefs in its effectiveness predict its use. High parental stress, especially in those valuing corporal punishment, increases the potential for child abuse. Factors such as having many children or low education and socioeconomic status contribute to parental tensions, leading to the use of corporal punishment for behavior correction. We posit that the accumulation of such variables results in heightened stress levels. Our focus aimed to determine the moderating role of stress levels among parental beliefs about corporal punishment and its reported use through quantitative research. In our study, 853 Colombian parents of low, middle, and high socioeconomic status, and from four different regions of Colombia, with children aged 0 to 17 participated. They provided information about their beliefs on corporal punishment, using the Beliefs and Punishment Scale. Correlations indicated that older parents with better socioeconomic status were less inclined to believe that strictness improves children. Regressions suggested that increased belief in corporal punishment modifying behavior, along with higher parental stress, increases corporal punishment use. Moderation models highlighted that when more stressors were present, corporal punishment was used due to stress rather than parental beliefs. Ultimately, stress emerged as a crucial factor influencing corporal punishment use among Colombian parents.

Maintaining the Region of the Americas free of polio: best practices for incident management support teams.

The Pan American Health Organization (PAHO) and its Member States have been leading the efforts to eradicate wild poliovirus in the Region of Americas since smallpox's successful elimination in 1971. The region became the first to be certified free of wild poliovirus in 1994. However, in July 2022, an unvaccinated patient with no recent travel history was diagnosed with poliomyelitis in the United States of America. In response to the emergence of a circulating vaccine-derived poliovirus in the United States, PAHO established the Polio Incident Management Support Team. This team has been coordinating response efforts, focusing on: coordination, planning, and monitoring; risk communication and community engagement; surveillance and case investigation; vaccination; and rapid response. In this paper, we identified and documented best practices observed following establishment of the Incident Management Support Team (September 2022-2023) through a comprehensive review and analysis of various data sources and country-specific data from the polio surveillance dashboard. The aim was to share these best practices, highlighting technical support and implementation of polio measures by Member States. Despite several challenges, the Americas region remains polio-free. Polio risk is declining, with a July 2023 assessment showing fewer countries at medium, high, and very high risk. This progress reflects improved immunization coverage, surveillance, containment, health determinants, and outbreak preparedness and response. The PAHO Polio Incident Management Support Team has played a key role in supporting these efforts.

La Organización Panamericana de la Salud (OPS) y sus Estados Miembros han liderado los esfuerzos para erradicar el poliovirus salvaje en la Región de las Américas desde la eliminación exitosa de la viruela en 1971. En 1994, la Región fue la primera en obtener la certificación de libre del poliovirus salvaje. Sin embargo, en julio del 2022, se diagnosticó poliomielitis a un paciente de Estados Unidos de América no vacunado y sin antecedentes de viajes recientes. Para responder a la aparición de un poliovirus circulante derivado de la vacuna en ese país, la OPS creó el equipo de apoyo a la gestión de incidentes de poliomielitis. Este equipo ha asumido la coordinación de los esfuerzos de respuesta y se ha centrado en la coordinación, la planificación y seguimiento; la comunicación de riesgos y la participación de la comunidad; la vigilancia e investigación de casos; la vacunación; y la respuesta rápida. En este artículo, se determinan y documentan las mejores prácticas observadas después de la creación del equipo de apoyo a la gestión de incidentes (septiembre del 2022-2023) mediante una revisión y un análisis pormenorizados de datos procedentes de diversas fuentes y de datos específicos de los países del panel de vigilancia de la poliomielitis. El objetivo fue poner en común estas mejores prácticas y resaltar el apoyo técnico y la aplicación de medidas contra la poliomielitis por parte de los Estados Miembros. A pesar de los diversos desafíos, la Región de las Américas se mantiene libre de poliomielitis. El riesgo de esta enfermedad es cada vez menor, y la evaluación de julio del 2023 muestra una disminución del número de países con un riesgo medio, alto o muy alto. Este progreso refleja la mejora de la cobertura de inmunización, la vigilancia, la contención, los determinantes de la salud y la preparación y respuesta ante brotes. El equipo de apoyo a la gestión de incidentes relacionados con la poliomielitis de la OPS ha desempeñado un papel fundamental para brindar apoyo a estas iniciativas.

Desde a eliminação bem-sucedida da varíola em 1971, a Organização Pan-Americana da Saúde (OPAS) e seus Estados Membros têm estado à frente de iniciativas para erradicar o poliovírus selvagem na Região das Américas. Em 1994, a região foi a primeira do mundo a ser certificada como livre do poliovírus selvagem. Entretanto, em julho de 2022, um paciente não vacinado e sem histórico de viagens recentes foi diagnosticado com poliomielite nos Estados Unidos da América. Em resposta ao surgimento de um poliovírus derivado de vacina circulante nos Estados Unidos, a OPAS criou a Equipe de Apoio à Gestão de Incidentes de Poliomielite. A equipe vem administrando os esforços de resposta, concentrando-se em: coordenação, planejamento e monitoramento; comunicação de risco e envolvimento da comunidade; vigilância e investigação de casos; vacinação; e resposta rápida. Neste documento, identificamos e documentamos as melhores práticas observadas após a criação da Equipe de Apoio à Gestão de Incidentes (setembro de 2022 a 2023) por meio de uma revisão e análise abrangentes de diversas fontes de dados e dados específicos de cada país fornecidos por meio do painel de vigilância da poliomielite. O objetivo foi compartilhar essas melhores práticas, destacando o apoio técnico e a implementação de medidas contra a poliomielite pelos Estados Membros. Apesar de vários desafios, a Região das Américas continua livre da poliomielite. Um levantamento de julho de 2023 demonstrou que o risco da poliomielite vem diminuindo, com menos países com risco médio, alto ou muito alto. Essa evolução é resultado de melhoras na cobertura vacinal, vigilância, contenção, preparação, determinantes de saúde e resposta a surtos. A Equipe de Apoio à Gestão de Incidentes de Poliomielite da OPAS foi fundamental para apoiar esses esforços.

Association of the polymorphisms rs179008 (TLR7), rs2004640 (IRF5), rs1800795 (IL-6) and rs2280788 (CCL5) with systemic lupus erythematosus in women of Mayan ethnicity from Yucatan.

Introduction: IFN-α is the main cytokine in SLE, and single nucleotide polymorphisms (SNP) in different genes could induce it. Aim: To determine the association of rs2004640 (IRF5), rs179008 (TLR7), rs1800795 (IL-6) and rs2280788 (CCL5) with SLE in Mexican women with Mayan ethnicity. Methods: DNA and RNA were isolated from the peripheral blood of 110 patients and 200 healthy control subjects. SNP genotyping and gene expression analysis of IRF5, TLR7, IL-6 and IFN-α were determined by real-time PCR and analyzed with SNP Stat, Stata 10.1 and Graph Pad Prism v5. Results: rs2004640, rs179008, and rs1800795 in both groups were according to Hardy-Weinberg equilibrium. Risk alleles rs179008T and rs2004640T frequencies were higher in controls (p = 0.015 and p = 0.028, respectively), whereas rs179008A frequency was higher in patients (p = 0.015). Allelic combination AGT frequency was higher in patients (p = 0.001). IL-6 rs1800795C > G and CCL5 rs2280788G > C frequencies did not show significant differences (p > 0.05), being rs2280788G (CCL5) monomorphic in controls. SLE patients showed higher TLR7, IRF5, IL6, and IFN-α mRNA levels. IRF5 expression was higher in SLE patients homozygous for rs2004640T (IRF5). Conclusion: This work showed the contribution of TLR7 and IRF5 in SLE pathogenesis in Mayan females from Yucatan.

High-Dimensional Feature Selection for Automatic Classification of Coronary Stenosis Using an Evolutionary Algorithm.

In this paper, a novel strategy to perform high-dimensional feature selection using an evolutionary algorithm for the automatic classification of coronary stenosis is introduced. The method involves a feature extraction stage to form a bank of 473 features considering different types such as intensity, texture and shape. The feature selection task is carried out on a high-dimensional feature bank, where the search space is denoted by O(2n) and n=473. The proposed evolutionary search strategy was compared in terms of the Jaccard coefficient and accuracy classification with different state-of-the-art methods. The highest feature selection rate, along with the best classification performance, was obtained with a subset of four features, representing a 99% discrimination rate. In the last stage, the feature subset was used as input to train a support vector machine using an independent testing set. The classification of coronary stenosis cases involves a binary classification type by considering positive and negative classes. The highest classification performance was obtained with the four-feature subset in terms of accuracy (0.86) and Jaccard coefficient (0.75) metrics. In addition, a second dataset containing 2788 instances was formed from a public image database, obtaining an accuracy of 0.89 and a Jaccard Coefficient of 0.80. Finally, based on the performance achieved with the four-feature subset, they can be suitable for use in a clinical decision support system.

Is primary care ready for a potential new public health emergency in the wake of the COVID-19 pandemic, now subsided?

INTRODUCTION: The lingering burden of the COVID-19 pandemic on primary care clinicians and practices poses a public health emergency for the United States. This study uses clinician-reported data to examine changes in primary care demand and capacity. METHODS: From March 2020 to March 2022, 36 electronic surveys were fielded among primary care clinicians responding to survey invitations as posted on listservs and identified through social media and crowd sourcing. Quantitative and qualitative analyses were performed on both closed- and open-ended survey questions. RESULTS: An average of 937 respondents per survey represented family medicine, pediatrics, internal medicine, geriatrics, and other specialties. Responses reported increases in patient health burden, including worsening chronic care management and increasing volume and complexity. A higher frequency of dental- and eyesight-related issues was noted by respondents, as was a substantial increase in mental or emotional health needs. Respondents also noted increased demand, "record high" wait times, and struggles to keep up with patient needs and the higher volume of patient questions. Frequent qualitative statements highlighted the mismatch of patient needs with practice capacity. Staffing shortages and the inability to fill open clinical positions impaired clinicians' ability to meet patient needs and a substantial proportion of respondents indicated an intention to leave the profession or knew someone who had. CONCLUSION: These data signal an urgent need to take action to support the ability of primary care to meet ongoing patient and population health care needs.

Description of maternal and neonatal adverse events in pregnant people immunised with COVID-19 vaccines during pregnancy in the CLAP NETWORK of sentinel sites. Nested case-control analysis of the immunization-associated risk: A study protocol.

INTRODUCTION: COVID-19 is associated with higher morbimortality in pregnant people compared with non-pregnant people. At present, the benefits of maternal immunisation are considered to outweigh the risks, and therefore, vaccination is recommended during pregnancy. However, additional information is needed on the safety of the vaccines in this population. METHODS AND ANALYSIS: This a retrospective cohort nested case-control study in pregnant people who attended maternity hospitals from eight Latin American and Caribbean countries. A perinatal electronic clinical history database with neonatal and obstetric information will be used. The proportion of pregnant people immunised with COVID-19 vaccines of the following maternal and neonatal events will be described: preterm infant, small for gestational age, low birth weight, stillbirth, neonatal death, congenital malformations, maternal near miss and maternal death. Moreover, the risk of prematurity, small for gestational age and low birth weight associated with exposure to COVID-19 vaccines will be estimated. Each case will be matched with two groups of three randomly selected controls. Controls will be matched by hospital and mother's age (±3 years) with an additional matching by delivery date and conception time in the first and second control groups, respectively. The estimated required sample size for the main analysis (exposure to any vaccine) concerning 'non-use' is at least 1009 cases (3027 controls) to detect an increased probability of vaccine-associated event risk of 30% and at least 650 cases (1950 controls) to detect 30% protection. Sensitivity and secondary analyses considering country, type of vaccine, exposure windows and completeness of immunisation will be reported. ETHICS: The study protocol was reviewed by the Ethical Review Committee on Research of the Pan American Health Organization. Patient informed consent was waived due to the retrospective design and the utilisation of anonymised data (Ref. No: PAHOERC.0546.01). Results will be disseminated in open access journals.

Synergic association of the consortium Arthrospira maxima with the microalga growth-promoting bacterium Azospirillum cultured under the stressful biogas composition.

The present study evaluates the association of the blue-green microalga Arthrospira maxima (Spirulina), which is known for its CO2 fixation, biomass, and high-value metabolite production, with the microalga growth-promoting bacterium Azospirillum brasilense under the stressful composition of biogas. The results demonstrated that A. maxima co-cultured with A. brasilense under the high CO2 (25%) and methane (CH4; 75%) concentrations of biogas recorded a CO2 fixation rate of 0.24 ± 0.03 g L-1 days-1, thereby attaining a biomass production of 1.8 ± 0.03 g L-1. Similarly, the biochemical composition quality of this microalga enhanced the attainment of higher contents of carbohydrates, proteins, and phycocyanin than cultured alone. However, metabolites other than tryptophan (Trp) and indole-3-acetic acid could have supported this beneficial interaction. Overall, the results demonstrate that this prokaryotic consortium of A. maxima-A. brasilense established a synergic association under biogas, which represents a sustainable strategy to improve the bio-refinery capacity of this microalga and increase the usefulness of A. brasilense in multiple economic sectors.

Maintaining the Region of the Americas free of polio: best practices for incident management support teams / Mantener a la Región de las Américas libre de poliomielitis: mejores prácticas para los equipos de apoyo a la gestión de incidentes / Mantendo a Região das Américas livre da poliomielite: melhores práticas para as equipes de apoio à gestão de incidentes

[ABSTRACT]. The Pan American Health Organization (PAHO) and its Member States have been leading the efforts to erad- icate wild poliovirus in the Region of Americas since smallpox's successful elimination in 1971. The region became the first to be certified free of wild poliovirus in 1994. However, in July 2022, an unvaccinated patient with no recent travel history was diagnosed with poliomyelitis in the United States of America. In response to the emergence of a circulating vaccine-derived poliovirus in the United States, PAHO established the Polio Inci- dent Management Support Team. This team has been coordinating response efforts, focusing on: coordination, planning, and monitoring; risk communication and community engagement; surveillance and case investiga- tion; vaccination; and rapid response. In this paper, we identified and documented best practices observed following establishment of the Incident Management Support Team (September 2022–2023) through a com- prehensive review and analysis of various data sources and country-specific data from the polio surveillance dashboard. The aim was to share these best practices, highlighting technical support and implementation of polio measures by Member States. Despite several challenges, the Americas region remains polio-free. Polio risk is declining, with a July 2023 assessment showing fewer countries at medium, high, and very high risk. This progress reflects improved immunization coverage, surveillance, containment, health determinants, and outbreak preparedness and response. The PAHO Polio Incident Management Support Team has played a key role in supporting these efforts.

[RESUMEN]. La Organización Panamericana de la Salud (OPS) y sus Estados Miembros han liderado los esfuerzos para erradicar el poliovirus salvaje en la Región de las Américas desde la eliminación exitosa de la viruela en 1971. En 1994, la Región fue la primera en obtener la certificación de libre del poliovirus salvaje. Sin embargo, en julio del 2022, se diagnosticó poliomielitis a un paciente de Estados Unidos de América no vacunado y sin antecedentes de viajes recientes. Para responder a la aparición de un poliovirus circulante derivado de la vacuna en ese país, la OPS creó el equipo de apoyo a la gestión de incidentes de poliomielitis. Este equipo ha asumido la coordinación de los esfuerzos de respuesta y se ha centrado en la coordinación, la planificación y seguimiento; la comunicación de riesgos y la participación de la comunidad; la vigilancia e investigación de casos; la vacunación; y la respuesta rápida. En este artículo, se determinan y documentan las mejores prácticas observadas después de la creación del equipo de apoyo a la gestión de incidentes (septiembre del 2022-2023) mediante una revisión y un análisis pormenorizados de datos procedentes de diversas fuentes y de datos específicos de los países del panel de vigilancia de la poliomielitis. El objetivo fue poner en común estas mejores prácticas y resaltar el apoyo técnico y la aplicación de medidas contra la poliomielitis por parte de los Estados Miembros. A pesar de los diversos desafíos, la Región de las Américas se mantiene libre de poliomielitis. El riesgo de esta enfermedad es cada vez menor, y la evaluación de julio del 2023 muestra una disminución del número de países con un riesgo medio, alto o muy alto. Este progreso refleja la mejora de la cobertura de inmunización, la vigilancia, la contención, los determinantes de la salud y la preparación y respuesta ante brotes. El equipo de apoyo a la gestión de incidentes relacionados con la poliomielitis de la OPS ha desempeñado un papel fundamental para brindar apoyo a estas iniciativas.

[RESUMO]. Desde a eliminação bem-sucedida da varíola em 1971, a Organização Pan-Americana da Saúde (OPAS) e seus Estados Membros têm estado à frente de iniciativas para erradicar o poliovírus selvagem na Região das Américas. Em 1994, a região foi a primeira do mundo a ser certificada como livre do poliovírus sel- vagem. Entretanto, em julho de 2022, um paciente não vacinado e sem histórico de viagens recentes foi diagnosticado com poliomielite nos Estados Unidos da América. Em resposta ao surgimento de um poliovírus derivado de vacina circulante nos Estados Unidos, a OPAS criou a Equipe de Apoio à Gestão de Incidentes de Poliomielite. A equipe vem administrando os esforços de resposta, concentrando-se em: coordenação, plane- jamento e monitoramento; comunicação de risco e envolvimento da comunidade; vigilância e investigação de casos; vacinação; e resposta rápida. Neste documento, identificamos e documentamos as melhores práticas observadas após a criação da Equipe de Apoio à Gestão de Incidentes (setembro de 2022 a 2023) por meio de uma revisão e análise abrangentes de diversas fontes de dados e dados específicos de cada país forne- cidos por meio do painel de vigilância da poliomielite. O objetivo foi compartilhar essas melhores práticas, destacando o apoio técnico e a implementação de medidas contra a poliomielite pelos Estados Membros. Apesar de vários desafios, a Região das Américas continua livre da poliomielite. Um levantamento de julho de 2023 demonstrou que o risco da poliomielite vem diminuindo, com menos países com risco médio, alto ou muito alto. Essa evolução é resultado de melhoras na cobertura vacinal, vigilância, contenção, preparação, determinantes de saúde e resposta a surtos. A Equipe de Apoio à Gestão de Incidentes de Poliomielite da OPAS foi fundamental para apoiar esses esforços.

[Subtle and subclinical neurological findings in patients with SARS-CoV-2]. / Hallazgos sutiles y subclínicos neurológicos en pacientes con SARS-CoV-2.

Background: There are severe neurological conditions in patients with COVID-19, such as: cerebrovascular disease, Guillain-Barré syndrome, encephalitis, acute hemorrhagic necrotizing encephalopathy and myelitis. Objective: We describe that the patient with SARS-CoV 2 with respiratory symptoms has subtle or subclinical neurological manifestations. Material and methods: Observational, cross-sectional, analytical study, which included patients aged 18-65 years with respiratory symptoms and a confirmed diagnosis of COVID-19. Intubated patients with chronic neurodegenerative diseases or pre-existing neurological compromise were excluded. Semiology of the headache and neurological examination were performed; Serum levels of glucose, protein, electrolytes, lactate, C-reactive protein, lactic dehydrogenase, and D-dimer were measured. Cerebrospinal fluid (CSF) analysis and electroencephalogram (EEG) were also performed in patients who accepted the risks. Results: A high prevalence of subtle neurological manifestations was found in patients with COVID-19 with only a respiratory clinical picture. Headache, anosmia, dysgeusia, and hypopalesthesia predominated in the early stages, with frequent abnormal findings in the CSF (>70%) and less frequently in the EEG (<20%). Conclusions: Headache, anosmia, dysgeusia and hypoesthesia were frequent at the beginning of the infection, together with abnormal findings in CSF and EEG, without other neurological symptoms or neurological disease.

Introducción: existen condiciones neurológicas severas en pacientes con COVID-19, como: enfermedad cerebrovascular, síndrome de Guillain-Barré, encefalitis, encefalopatía necrotizante hemorrágica aguda y mielitis. Objetivo: describimos que el paciente con SARS-CoV-2 con síntomas respiratorios tiene manifestaciones neurológicas sutiles o subclínicas. Material y métodos: estudio observacional, transversal, analítico, que incluyó pacientes de 18-65 años con síntomas respiratorios y diagnóstico de COVID-19 confirmado. Se excluyeron pacientes intubados, con enfermedades neurodegenerativas crónicas o compromiso neurológico preexistente. Se realizó semiología de la cefalea y exploración neurológica; Se midieron los niveles séricos de glucosa, proteínas, electrolitos, lactato, proteína C reactiva, deshidrogenasa láctica y dímero D. También se realizaron análisis de líquido cefalorraquídeo (LCR) y un electroencefalograma (EEG) en los pacientes que aceptaron los riesgos. Resultados: se encontró alta prevalencia de manifestaciones neurológicas sutiles en pacientes con COVID-19 con solo cuadro clínico respiratorio. Cefalea, anosmia, disgeusia e hipopalestesia predominaron en las primeras etapas, con hallazgos anormales frecuentes en el LCR (>70%) y con menos frecuencia en el EEG (<20%). Conclusiones: la cefalea, anosmia, disgeusia e hipoestesia fueron frecuentes al inicio de la infección, junto con hallazgos anormales en LCR y EEG, sin otros síntomas neurológicos ni enfermedad neurológica.

[Ultrasound-guided insertion and the proportion of catheter-associated thrombosis]. / Inserción con técnica ecoguiada y la proporción de trombosis asociada a catéter.

Background: Central venous accesses are of great importance in daily medical practice. Insertion into the jugular vein is common due to its accessibility. Catheter-associated venous thrombosis is a relatively common medium-term complication. The use of ultrasound to guide catheterization offers multiple advantages and promises to make vascular access installation a safer technique. Objective: To compare the proportion of catheter-associated jugular thrombosis when an anatomical landmark technique is used with respect to the ultrasound-guided technique. Material and methods: An observational, cross-sectional, and analytical study that compares the frequency of thrombosis when the ultrasound-guided technique was used concerning anatomical reference technique in patients in an intensive care unit. Results: A total of 91 patients were studied: in 44 an ultrasound-guided technique was used, and in 47 anatomical references. A single case of mural thrombosis (2.7%) was observed in the ultrasound-guided insertion group vs. 11 cases (23.4%) in the other group, resulting in a significant association between the anatomical reference insertion technique and thrombosis. Chi squared (1, n = 91) = 8.86, p = 0.004. Conclusion: The proportion of catheter-associated jugular thrombosis is greater when an anatomical reference technique is used compared to the ultrasound-guided technique.

Introducción: los accesos venosos centrales tienen mucha importancia en la práctica médica diaria. La inserción en la vena yugular es habitual debido a su accesibilidad. La trombosis venosa asociada a catéter es una complicación relativamente común y de mediano plazo. El empleo de la ecografía para guiar la inserción y la evaluación posterior del vaso sanguíneo ofrece múltiples ventajas y promete hacer de la instalación de accesos vasculares una técnica más segura. Objetivo: comparar la proporción de trombosis yugular asociada a catéter cuando se emplea una técnica de referencias anatómicas con respecto a la técnica de guía ecográfica. Material y métodos: estudio observacional, transversal y analítico que compara la frecuencia de trombosis yugular según la técnica de inserción utilizada en pacientes de una unidad de cuidados intensivos. Resultados: se estudiaron un total de 91 pacientes: en 44 se utilizó una técnica de guía ecográfica y en 47 se empleó referencia anatómica. Se observó un solo caso de trombosis mural (2.7 %) en el grupo de inserción por guía ecográfica frente a 11 casos (23.4%) del grupo por referencias anatómicas, con lo cual se obtuvo como resultado una asociación significativa entre la técnica de inserción por referencia anatómica y trombosis. Chi cuadrada (1, n = 91) = 8.86, p = 0.004. Conclusión: la proporción de trombosis yugular asociada a catéter es mayor cuando se emplea una técnica de referencias anatómicas con respecto a la técnica de guía ecográfica.

[Results and complications of knee arthroplasty in patients with obesity]. / Resultados y complicaciones de la artroplastía de rodilla en pacientes con obesidad.

Introduction: In México, many patients undergoing total knee arthroplasty (TKA) are obese, which has medical and financial consequences. The functional outcomes and the incidence of complications of these patients remain uncertain due to the inconsistency between studies. Objective: To determine the association between obesity, complications and functional results of patients undergoing TKA. Material and methods: Descriptive, cross-sectional, prospective, observational, cohort study in which patients who underwent TKA between September 1, 2021, and August 30, 2022, were studied. Patients were divided by their body mass index (BMI) in < 30kg/m2 and > 30kg/m2 and their demographic characteristics, Oxford Knee Score (OKS), and incidence of complications were compared. Results: Out of the 102 patients, 59 presented a BMI < 30 kg/m2 and 43 a BMI > 30 kg/m2. No difference was found in their postoperative OKS (p = 0.12) and delta OKS (p = 0.07). A significant increase in trans-surgical (p = 0.02) and post-surgical (p = 0.04) complications was found in the group with BMI > 30 kg/m2, presenting a risk 5.03 times higher. Conclusion: A BMI > 30kg/m2 does not affect the functional results after a TKA; however, it is associated with a risk 5.03 times higher of suffering complications during and after surgical intervention.

Introducción: en México un gran número de pacientes sometidos a artroplastía total de rodilla (ATR) padecen obesidad, situación que genera grandes implicaciones médicas y financieras. Los resultados funcionales y la incidencia de complicaciones de estos pacientes permanecen inciertos debido a la gran incongruencia entre los diferentes estudios. Objetivos: determinar la asociación entre obesidad, complicaciones y resultados funcionales de los pacientes sometidos a una ATR. Material y métodos: estudio descriptivo, transversal, prospectivo, observacional, de cohorte en el que se estudiaron los pacientes a los que se les realizó una ATR primaria entre el 1 de septiembre de 2021 y el 30 de agosto de 2022. Se dividió a los pacientes con base en su índice de masa corporal (IMC) en < 30kg/m2 y > 30 kg/m2 y se compararon según sus características demográficas, el Oxford Knee Score (OKS) y la incidencia de complicaciones. Resultados: de los 102 pacientes, 59 presentaron un IMC < 30 kg/m2 y 43 un IMC>30kg/m2. No se encontró diferencia significativa en el OKS postquirúrgico (p = 0.12) y el OKS delta (p = 0.07); sin embargo, sí se encontró un aumento significativo en las complicaciones transquirúrgicas (p = 0.02) y postquirúrgicas (p = 0.04) en el grupo de IMC > 30 kg/m2, pues presentó un riesgo 5.03 veces mayor. Conclusión: un IMC > 30 kg/m2 no afecta los resultados funcionales posteriores a una ATR; sin embargo, sí se asocia con un riesgo 5.03 veces mayor de sufrir complicaciones durante y después de la intervención quirúrgica.

[Relationship between the systolic-diastolic shock index and mortality in myocardial infarction]. / Relación del índice de choque sistólico-diastólico con mortalidad en el infarto miocárdico.

Background: In the emergency room, the shock index was applied to determine the prognosis in various pathologies, such as acute infarction. The shock index is the re-sult of dividing heart rate by the systolic blood pressure. Objective: To determine the relationship between the systolic shock index and the di-astolic shock index as prognostic factors for mortality in acute myocardial infarction with ST segment elevation prior to admission to the Hemodynamics Room. Material and methods: A prolective analytical cross-sectional study was carried out in patients who were admitted to the Hemodynamics Room for cardiac catheterization within a period of 5 months in 2022. The systolic shock index and diastolic shock index were included as independent variables and mortality was the dependent variable. SPSS, version 25, was used and Pearson's chi-square test was used as statistical test, with a p value < 0.05 being significant. Results: 162 patients were analyzed and showed a diastolic shock index > 1.2143 with a sensitivity of 62.5% and a specificity of 77.4% with a p < 0.05. Their systolic shock in-dex was > 0.8908 with a sensitivity of 45.8% and specificity of 91.2%, with a p < 0.05. Conclusion: It was determined that both shock indices are related as mortality prognos-tic factors in acute myocardial infarction with ST elevation prior to admission to the He-modynamic Room.

Introducción: en el Servicio de Urgencias, se implementó el índice de choque para determinar el pronóstico de forma rápida en diversas patologías, como en el infarto agudo al miocardio. El índice de choque es el resultado de dividir la frecuencia cardia-ca entre la presión arterial. Objetivo: determinar la relación entre el índice de choque sistólico y el índice de choque diastólico como factores pronósticos de mortalidad en el infarto agudo al mio-cardio con elevación del segmento ST previo al ingreso al Área de Hemodinamia. Material y métodos: estudio transversal analítico prolectivo en pacientes que ingresa-ron al Área de Hemodinamia para cateterismo cardiaco en un plazo de cinco meses en el 2022. Tuvo como variables independientes el índice de choque sistólico y el índice de choque diastólico y como variable dependiente la mortalidad. Se utilizó el paquete estadístico SPSS, versión 25, y como prueba estadística la prueba chi cuadrada de Pearson, con una p < 0.05 como estadísticamente significativa. Resultados: se analizaron 162 pacientes que tuvieron un índice de choque diastólico > 1.2143, con una sensibilidad de 62.5% y una especificidad de 77.4%, con una p < 0.05. Y presentaron un índice de choque sistólico > 0.8908, con una sensibilidad de 45.8% y una especificidad de 91.2%, con una p < 0.05. Conclusión: se determinó que ambos índices de choque tienen relación como factores pronósticos de mortalidad en el infarto agudo al miocardio con elevación del segmento ST antes de su ingreso al Área de Hemodinamia.

[Electrocardiographic interval as a predictor of life-threatening arrhythmias in dilated cardiomyopathy patients]. / Intervalo electrocardiográfico como predictor de arritmias graves en pacientes con miocardiopatía dilatada.

Background: The Tpe interval (Tp-e) in the surface electrocardiogram represents ventricular repolarization, a key phase in the pathogenesis of severe ventricular arrhythmias. However, there are few studies evaluating changes in this electrocardiographic interval as a risk factor for serious arrhythmias in patients with dilated cardiomyopathy. Objective: To determine whether the Tp-e interval prolongation predicts the presence of life-threatening arrhythmias in patients with dilated cardiomyopathy (DCM) with implantable cardioverter-defibrillator (ICD). Material and methods: Analytical, cross-sectional study in patients with DCM with ICDs. The Tp-e interval was measured in the V2 electrocardiographic lead and correlated with the incidence of life-threatening arrhythmias identified by the ICD. Results: 53 patients were recruited, 10 (18.8%) presented life-threatening arrhythmias. Prolongation of Tp-e interval was related to an increase in the incidence of ventricular tachycardia/fibrillation tachycardia (VT/FT) with a mean of 93 ± 20.5 ms (p = 0.003), using ROC curves to determine the thereshold of 90 ms for increased risk of VT/VF with sensitivity of 70% and specificity of 84%, with an area under the curve of 0.798. Conclusion: The prolongation of the ITp-e interval greater than 90 ms in a population with dilated cardiomyopathy predicts the presence of arrhythmic episodes, such as VT and/or VT/FT.

Introducción: el intervalo Tpe (ITp-e) en el electrocardiograma de superficie representa la repolarización ventricular, fase clave en la patogénesis de arritmias ventriculares graves. Sin embargo, existen pocos estudios que evalúen la alteración de este intervalo electrocardiográfico como factor de riesgo de arritmias graves en pacientes con miocardiopatía dilatada. Objetivo: determinar si la prolongación del ITp-e predice la presencia de arritmias potencialmente mortales en pacientes con miocardiopatía dilatada (MCD) portadores de desfibrilador automático implantable (DAI). Material y métodos: estudio, transversal analítico en pacientes con MCD portadores de DAI. Se midió el ITp-e en la derivación electrocardiográfica V2 y se correlacionó con la incidencia de arritmias potencialmente letales identificadas por el DAI. Resultados: se incluyeron 53 pacientes, 10 (18.8%) presentaron arritmias potencialmente mortales. La prolongación del ITp-e se relacionó con aumento de incidencia de taquicardia ventricular/fibrilación ventricular (TV/FV) con media de 93 ± 20.5 ms (p = 0.003), por lo que se determinó mediante curvas ROC el punto de corte de 90 ms para el aumento de riesgo de TV/FV con sensibilidad de 70% y especificidad de 84%, con área bajo la curva de 0.798. Conclusión: la prolongación del intervalo ITp-e > 90 ms en población con miocardiopatía dilatada predice la presencia de episodios arrítmicos como TV o FV.

[Mortality associated with myocardial damage by troponin I in patients with COVID 19]. / Mortalidad asociada a daño miocárdico mediante troponina I en pacientes con COVID-19.

Background: Coronavirus disease 2019 (COVID-19) can cause cardiac injury, probably associated with myocarditis and ischemia induced by the infection. Myocardial damage leads to the liberation of proinflammatory cytokines and to the activation of autoimmune adaptive mechanisms through molecular limitation. Objective: To assess mortality associated with myocardial damage in hospitalized patients with COVID-19 confirmed by troponin I measurement. Material and methods: Case-control study nested in a cohort of patients of a third-level hospital. Descriptive statistics were used to characterize the population. Qualitative variables were expressed as proportions and ranges, quantitative variables as means and standard deviation. Fisher's exact test was used to compare mortality between patients with and without myocardial damage. A p value < 0.05 was considered significant. Results: From June 2020 to August 2020, 28 patients who met the selection criteria were enrolled, out of which 15 had no myocardial damage and 13 had myocardial damage assessed by serum troponin measurement. A strong association was found between mortality and the presence of myocardial damage, since mortality was 20% (3/15) among patients without myocardial damage and 92.3% (12/13) among those with myocardial damage (Fisher's exact test, p < 0.005). Conclusion: Mortality in patients with COVID-19 is associated with myocardial damage assessed by troponin I measurement.

Introducción: la enfermedad por coronavirus del 2019 (COVID-19) puede causar lesión cardiaca, probablemente asociada con miocarditis e isquemias inducidas por la infección. El daño miocárdico conduce a la liberación de citocinas proinflamatorias y a la activación de mecanismos adaptativos de tipo autoinmune por medio de la limitación molecular. Objetivo: evaluar la mortalidad asociada a daño miocárdico en pacientes hospitalizados con COVID-19 confirmado mediante la medición de troponina I. Material y métodos: estudio de casos y controles anidado en una cohorte de los pacientes de un hospital de tercer nivel. Se utilizó estadística descriptiva para caracterizar a la población. Las variables cualitativas se expresaron como proporciones y rangos, las cuantitativas como medias y desviación estándar. Para comparar la mortalidad entre pacientes con y sin daño miocárdico se utilizó la prueba exacta de Fisher. Valores de p < 0.05 fueron significativos. Resultados: de junio del 2020 a agosto del 2020 se enrolaron 28 pacientes que cumplieron los criterios de selección, de los cuales 15 no tuvieron daño miocárdico y 13 tuvieron daño miocárdico evaluado con la medición de troponina sérica. Se encontró fuerte asociación entre la mortalidad y la presencia de daño miocárdico, ya que se registró mortalidad del 20% (3/15) entre los pacientes sin daño miocárdico y de 92.3% (12/13) entre los que tuvieron daño miocárdico (prueba exacta de Fisher: p < 0.005). Conclusiones: la mortalidad en pacientes con COVID-19 se asocia a daño miocárdico evaluado a través de la medición de troponina I.

[Systolic blood pressure reduction in patients with intracranial hemorrhage and functional prognosis]. / Reducción de la presión arterial sistólica en pacientes con hemorragia intracraneal y pronóstico funcional.

Background: Acute intracerebral hemorrhage affects annually more than 1 million people worldwide. Chronic systemic arterial hypertension is the most important modifiable risk factor for spontaneous intracerebral hemorrhage. Objective: To determine the relationship between the decrease in systolic blood pressure (SBP) in patients with intracranial hemorrhage and their short-term functional prognosis. Material and methods: Observational, longitudinal, prospective study in patients with intraparenchymal hemorrhage secondary to hypertensive dyscontrol, older than 18 years, of both sexes. Blood pressure was recorded at admission, every hour during the first 6 hours and every two hours from 8 to 24 hours after admission. Functionality was assessed using the modified Rankin scale at admission, at 6 and 24 hours after admission. Results: 58 patients were included, in whom the reduction of systolic blood pressure at admission was 17.04% and at 24 hours was 31.3 mm Hg; the mean systolic blood pressure was 183.62 mm Hg as opposed to 152.3 mm Hg at discharge (p < 0.001). Conclusions: In the first 6 hours, reduction in ASR is significantly associated with hospital outcome in patients with intracranial hemorrhage. A linear association was observed with improvement and favorable functional prognosis as measured by the modified Rankin scale.

Introducción: la hemorragia intracerebral aguda afecta anualmente a más de un millón de personas en todo el mundo. La hipertensión arterial sistémica crónica es el factor de riesgo modificable más importante para la hemorragia intracerebral espontánea. Objetivo: determinar la relación entre la disminución de la presión arterial sistólica (TAS) en pacientes con hemorragia intracraneal y su pronóstico funcional a corto plazo. Métodos: estudio observacional, longitudinal, prospectivo, en pacientes con hemorragia intraparenquimatosa secundaria a descontrol hipertensivo, mayores de 18 años, de ambos sexos. Se realizaron registros de presión arterial al ingreso, cada hora durante las primeras seis horas y cada dos horas desde las ocho a las 24 horas posterior al ingreso. Se evaluó funcionalidad mediante escala de Rankin modificada al ingreso, a las seis y a las 24 horas después del ingreso. Resultados: se incluyeron 58 pacientes, en quienes la reducción de la TAS al ingreso fue de 17.04% y a las 24 horas fue de 31.3 mm Hg de la presión arterial sistólica; la media de la TAS fue de 183.62 mm Hg a diferencia de la registrada al egreso, que fue de 152.3 mm Hg (p < 0.001). Conclusiones: en las primeras seis horas, la reducción de la TAS está significativamente asociada con el resultado hospitalario en pacientes con hemorragia intracraneal. Se observó una asociación lineal con la mejoría y un pronóstico funcional favorable, medido por la escala de Rankin modificada.

In Silico Analysis of the Dextransucrase Obtained From Leuconostoc mesenteroides Strain IBUN 91.2.98.

The DSR-IBUN dextransucrase produced by Leuconostoc mesenteroides strain IBUN 91.2.98 has a short production time (4.5 hours), an enzymatic activity of 24.8 U/mL, and a specific activity of purified enzyme 2 times higher (331.6 U/mg) than that reported for similar enzymes. The aim of this study was to generate a structural model that, from an in silico approach, allows a better understanding, from the structural point of view, of the activity obtained by the enzyme of interest, which is key to continue with its study and industry application. For this, we translated the nucleotide sequence of the dsr_IBUN gene. With the primary structure of DSR-IBUN, the in silico prediction of physicochemical parameters, the possible subcellular localization, the presence of signal peptide, and the location of domains and functional and structural motifs of the protein were established. Subsequently, its secondary and tertiary structure were predicted and a homology model of the dextransucrase under study was constructed using Swiss-Model, performing careful template selection. The values obtained for the model, Global Model Quality Estimation (0.63), Quality Mean (-1.49), and root-mean-square deviation (0.09), allow us to affirm that the model for the enzyme dextransucrase DSR-IBUN is of adequate quality and can be used as a source of information for this protein.