Neutrophil-to-Lymphocyte Ratio Dynamics From Pre-diagnosis to End-Stage Amyotrophic Lateral Sclerosis (ALS): A Case Study on Association With Progression and Clinical Events.

Amyotrophic lateral sclerosis (ALS) is a neurodegenerative condition characterized by the progressive degeneration of motor neurons, resulting in muscle weakness and paralysis. The neutrophil-to-lymphocyte ratio (NLR) has emerged as a potential marker for monitoring disease severity and progression in ALS, yet longitudinal analyses of NLR are limited. Our study conducts an in-depth examination of NLR dynamics from before diagnosis through the disease's progression to its end stage. We analyze the case of a 56-year-old Puerto Rican male with ALS, tracking his NLR over 13 years - six years before and seven years after his diagnosis - alongside assessments of clinical symptoms and lung function. Our findings indicate that NLR values were initially normal but significantly increased with the onset of symptoms. NLR remained elevated above the normal range, with a notable exception during a period of edaravone therapy when levels normalized. The study demonstrates a clear elevation in NLR associated with ALS progression and critical clinical events, such as symptom onset, diagnosis, and the initiation of respiratory support. This research is, to our knowledge, the first to provide a detailed characterization of NLR changes from the pre-diagnostic phase to end-stage ALS, showing its correlation with clinical deterioration, decreased pulmonary function, and key clinical events. Our results contribute to the body of evidence on NLR's role in ALS while enhancing our understanding of ALS's natural progression.

+Ciencia: a training program to increase evidence-based science communication and literacy for Hispanic high school and undergraduate students.

Science misinformation represents a significant challenge for the scientific community. Hispanic communities are particularly vulnerable due to language barriers and the lack of accessible information in Spanish. We identified that a key step toward enhancing the accessibility of information for non-native English-speaking communities involves imparting science communication education and training to Hispanic youth. Our goal was to provide them with the skills to become science ambassadors who can effectively engage with their communities and bridge communication gaps. To address this, we developed the first science communication training program in Spanish for Hispanic high school and undergraduate students in Puerto Rico. The program called +Ciencia aims to provide training and education on science communication for Hispanic minorities through experiential and collaborative learning. In the short term, our multifaceted approach works to counter misinformation and promote science literacy within the broader community. Over the long term, our grassroots efforts with students will evolve into a generation of professionals equipped with strong engagement skills and comprehensive training in science communication with a specific focus on Hispanic audiences. Herein, we describe the components of this educational program and provide open access to educational materials and articles developed by three cohorts.

Synthesis and In Vitro Studies of Photoactivatable Semisquaraine-type Pt(II) Complexes.

The synthesis, full characterization, photochemical properties, and cytotoxic activity toward cisplatin-resistant cancer cell lines of new semisquaraine-type Pt(II) complexes are presented. The synthesis of eight semisquaraine-type ligands has been carried out by means of an innovative, straightforward methodology. A thorough structural NMR and X-ray diffraction analysis of the new ligands and complexes has been done. Density functional theory calculations have allowed to assign the trans configuration of the platinum center. Through the structural modification of the ligands, it has been possible to synthesize some complexes, which have turned out to be photoactive at wavelengths that allow their activation in cell cultures and, importantly, two of them show remarkable solubility in biological media. Photodegradation processes have been studied in depth, including the structural identification of photoproducts, thus justifying the changes observed after irradiation. From biological assessment, complexes C7 and C8 have been demonstrated to behave as promising photoactivatable compounds in the assayed cancer cell lines. Upon photoactivation, both complexes are capable of inducing a higher cytotoxic effect on the tested cells compared with nonphotoactivated compounds. Among the observed results, it is remarkable to note that C7 showed a PI > 50 in HeLa cells, and C8 showed a PI > 40 in A2780 cells, being also effective over cisplatin-resistant A2780cis cells (PI = 7 and PI = 4, respectively). The mechanism of action of these complexes has been studied, revealing that these photoactivated platinum complexes would actually present a combined mode of action, a therapeutically potential advantage.

Delayed left main coronary obstruction following transfemoral inovare transcatheter aortic valve replacement: A challenging case.

Coronary obstruction is an uncommon and severe complication after a transcatheter aortic valve replacement (TAVR), that occurs during the procedure in the vast majority of patients. In the present case even in the absence of classic risk factors, an acute coronary syndrome occurred one day after TAVR. Selective angiography revealed a severe left main ostium obstruction by the bulky native leaflet calcification. This is the first case of delayed presentation of coronary obstruction with a transfemoral balloon-expandable valve using the Inovare bioprosthesis (Braile Biomedica, Brazil). In addition, after drug-eluting stent placement in the left main coronary, intravascular ultrasound revealed severe stent underexpansion, so that a second layer of a bare-metal stent and high-pressure balloon post-dilatation was necessary to improve the final result. The patient was discharged after 7 days, and at the 6-month follow-up remained asymptomatic. .

Metas internacionales de seguridad del paciente en centro de salud: un artículo de revisión bibliográfica / International goals of patient safety in health centers: a bibliographic review article

Las metas internacionales de seguridad del paciente fueron implementadas por la Joint Commision International (JCI), a nivel mundial, con la finalidad de reducir los eventos adversos en los centros de salud. El objetivo de esta revisión bibliográfica fue identificar las metas internacionales de seguridad del paciente (MISP) incorporadas en centros de salud en el marco de la cultura de seguridad y calidad de la atención. Se realizó una revisión bibliográfica narrativa sistematizada utilizando las bases de datos de PubMed y EBSCO Host, utilizando criterios de inclusión y exclusión para la selección de los artículos para análisis. Los ámbitos evaluados relacionados a las metas internacionales de seguridad, identificados en los artículos seleccionados fueron: i) cultura de seguridad, ii) calidad de la atención, iii) comunicación efectiva, iv) cirugía de alto riesgo, v) medicamentos de alto riesgo. Las metas internacionales de calidad están incorporadas en los diferentes centros de salud, algunos de ellos definidos explícitamente en los sistemas de evaluación de calidad y otros de manera implícita en ámbitos generales en los sistemas de evaluación.

The Joint Commission International (JCI) implemented international patient safety goals worldwide to reduce adverse events in health centers. The objective of this literature review was to identify the international patient safety goals (MISP) incorporated in healthcare facilities within the framework of safety culture and quality of care. A systematized narrative literature review was carried out using PubMed and EBSCO Host databases, using inclusion and exclusion criteria to select articles for analysis. The areas evaluated related to the international safety goals identified in the selected articles were: i) safety culture, ii) quality of care, iii) effective communication, iv) high-risk surgery, v) high-risk drugs. International quality goals are incorporated in the different health centers, explicitly defined in the quality evaluation systems and others in general areas in the evaluation systems.

Perfil de farmacorresistencia microbiana en adultos con infección del tracto urinario en una población de Pichincha-Ecuador / Microbial drug resistance profile in adults with urinary tract infection in a population of Pichincha-Ecuador

INTRODUCCIÓN. Las infecciones del tracto urinario son causa de mayor morbilidad en la población adulta y afectan con frecuencia a la mujer. Al ser un problema prevalente, fue fundamental realizar estudios sobre perfiles de susceptibilidad locales para establecer medidas de vigilancia y control de uso de antibióticos. OBJETIVO. Determinar el perfil de farmacorresistencia microbiana en adultos con infección del tracto urinario. MATERIALES Y MÉTODOS. Estudio descriptivo, transversal. La población fue de 437 urocultivos y una muestra de 176 positivos con su antibiograma, realizados en el laboratorio del Hospital Básico de Sangolquí entre enero de 2017 hasta abril de 2018. Los criterios de inclusión fueron: pacientes mayores de 15 años de edad de ambos sexos, ambulatorios y hospitalizados, que presentaron urocultivos positivos definidos por una cuenta mayor a 100 000 Unidades Formadoras de Colonia. RESULTADOS. Del 40,27% (176; 437) de urocultivos positivos, la bacteria aislada con frecuencia fue Escherichia coli. 69,31% (122; 176), con resistencia a ampicilina 77,97% (92; 118), trimetropim-sulfametoxazole 62,26% (66; 106), norfloxacino 37,50% (42; 112), ciprofloxacino 35,65 % (41; 115), ampicilina/sulbactam 32,20% (38; 118) y con susceptibilidad a: fosfomicina, ceftriaxona, amikacina y nitrofurantoina. CONCLUSIÓN. Se determinó el perfil de farmacorresistencia microbiana en adultos con infección del tracto urinario; donde Escherichia coli. fue aislada con frecuencia, con susceptibilidad favorable para nitrofurantoína y fosfomicina.

INTRODUCTION. Urinary tract infections are the cause of greater morbidity in the adult population and it often affects women. As it is a prevalent problem, it was essential to carry out studies on local susceptibility profiles to establish surveillance measures and control of antibiotic use. OBJECTIVE. To determine the microbial drug resistance profile in adults with urinary tract infection. MATERIALS AND METHODS. Descriptive, cross-sectional study. The population was 437 urine cultures and a sample of 176 positive with their antibiogram, carried out in the laboratory of the Hospital Básico de Sangolquí between january 2017 and april 2018. Inclusion criteria were: patients older than 15 years of age of both sexes, ambulatory and hospitalized, who presented positive urine cultures defined by a count greater than 100 000 Colony Forming Units. RESULTS. Of the 40,27% (176; 437) of positive urine cultures, the bacterium frequently isolated was Escherichia coli. 69,31% (122; 176), with resistance to ampicillin 77,97% (92; 118), trimethoprim-sulfamethoxazole 62,26% (66; 106), norfloxacin 37,50% (42; 112), ciprofloxacin 35,65% (41; 115), ampicillin / sulbactam 32,20% (38; 118) and with susceptibility to: fosfomycin, ceftriaxone, amikacin and nitrofurantoin. CONCLUSION. The microbial drug resistance profile was determined in adults with urinary tract infection; where Escherichia coli. was frequently isolated, with favorable susceptibility to nitrofurantoin and fosfomycin.

Resident Indentified Violations of Usability Heuristic Principles in Local Electronic Health Records.

INTRODUCTION: Difficulties with the electronic health record (EHR) are known to be associated with high physician burnout. Usability studies can evaluate and identify usability issues with the EHR at the end user level. This study was conducted to determine physician perspectives and usability issues of local EHR systems. METHODS: Survey and focus group methodology were employed. Participants were resident physicians who were members of a resident council in the Midwest. Survey data collected included demographics and perceptions. Focus group data included participants identification of usability principle violations and potential impact to end user. RESULTS: There were 15 survey respondents (across 11 residency programs) who reported use of three different EHR systems: Cerner®, Meditech, and Computerized Patient Record System (CPRS). Satisfaction was greatest with Cerner® as well as most reported level of experience. Focus group respondents reported a variety of usability violations which lead to provider confusion, increased time, alert fatigue, and potential patient safety issues. CONCLUSION: Violations of usability principles can result in disruption of physician workflow processes and lead to increased documentation time as well as fatigue. These issues have been associated with increased provider burnout. Continuous usability assessments should be conducted at the end user level to promote the development of more effective and efficient EHR interface designs.

Squaramide-Based Pt(II) Complexes as Potential Oxygen-Regulated Light-Triggered Photocages.

Two new squaramide-based platinum(II) complexes C1 and C2 have been synthesized and fully characterized. Their photoresponse has been assessed and is discussed. A remarkable enhancement in the DNA binding activity has been observed for both complexes, up on irradiation. For C2, the release of Pt(II) provoked by its irradiation has been studied. The response of C2 has been found to be regulated by the presence of oxygen. In vitro cytotoxicity tests show an enhancement in the activity of complex C2 after selective irradiation under hypoxic conditions. Resulting Pt(II) species have been isolated and characterized by various analytical methods establishing this type of squaramido-based complexes as a proof of concept for new Pt(II) photocages.

The metagenome of Caracolus marginella gut microbiome using culture independent approaches and shotgun sequencing.

Studies underestimate the microbial diversity and genotypic traits in the snails' microbiome. Caracolus marginella, a land snail native to Caribbean islands, can adapt to different environments. Our research focused on the generation of a metagenomic library from C. marginella gut, to further explore the diversity and functional traits. Thirty specimens of C. marginella were collected from the four regions of Puerto Rico. High molecular weight (40 kb) metagenomic libraries were generated using a direct DNA isolation method. DNA was end-repaired and ligated into a pCCFOS1 fosmid vector; then, the cloned DNA was transduced into Escherichia coli EPI300. The master pool library contains approximately 60,200 clones and restriction enzyme digestion showed that 90% of the library contains insert. After removing the fosmid and host genome sequences, 567,015 sequences were analyzed using the MG-RAST online server. The Bacteria domain was the most abundant (82.15%), followed by viruses (16.49%), eukaryotes (0.83%) and archaea (0.31%). The Proteobacteria (51.47%) was predominant in the gut environment, followed by unidentified virus (16.28%), and Actinobacteria (8.52%). Escherichia coli, Streptomyces avermitilis, and Burkholderia sp. were the most abundant species present. Subsystem functional analysis showed that 35.00% of genes belong to transposable elements, 10.00% of genes belong to clustering-based subsystems, 4.00% of genes belong to the production of cofactors and secondary metabolites, and 2.00% resistance to antibiotics and toxic compounds. The data generated in this research is the first metagenomic examination of a snail gut in Puerto Rico, and will serve as a baseline to start understanding of C. marginella gut microbiome.

Closed Financial Loops: When They Happen in Government, They're Called Corruption; in Medicine, They're Just a Footnote.

Many physicians are involved in relationships that create tension between a physician's duty to work in her patients' best interest at all times and her financial arrangement with a third party, most often a pharmaceutical manufacturer, whose primary goal is maximizing sales or profit. Despite the prevalence of this threat, in the United States and globally, the most common reaction to conflicts of interest in medicine is timid acceptance. There are few calls for conflicts of interest to be banned, and, to our knowledge, no one calls for conflicted practitioners to be reprimanded. Contrast our attitudes in medicine with public attitudes toward financial conflicts among government employees. When enforcement of rules against conflict of interest slackens in the public sector, news organizations investigate and publish their criticism. Yet even when doctors are quoted in the media promoting specific drugs, their personal financial ties to the drug maker are rarely mentioned. Policies for governmental employees are strict, condemnation is strong, and criminal statutes exist (allowing for corruption charges). Yet the evidence that conflict is problematic is, if anything, stronger in medicine than in the public sector. Policies against conflicts of interest in medicine should be at least as strong as those already existing in the public sector.

Prevalencia de síndrome metabólico y factores de riesgo asociados en jóvenes universitarios ecuatorianos / Prevalence of metabolic syndrome and associated risk factors in ecuadorian university students

Antecedentes y Objetivo: En México, el 64% de los pacientes hospitalizados sufren de desnutrición hospitalaria y hasta un 100% en adultos mayores, se han estudiado las causas, entre ellas se destacan: la sub-alimentación, el tiempo de hospitalización, el catabolismo presente en diversas patologías, falta de interés o tiempo del personal que labora en los hospitales entre otras. El objetivo del presente trabajo fue obtener la prevalencia de sub-alimentación en los pacientes hospitalizados con soporte enteral, en el Centro Médico 'Lic. Adolfo López Mateos' (CMLALM) durante el periodo Agosto-Octubre 2014. Metodología: Se diseñó un estudio observacional, transversal, descriptivo; con una población de 52 pacientes con soporte enteral en el que se analizó la prevalencia de pacientes con sub-alimentación a partir de la ministración de la dieta enteral y la prescripción nutricional calórica establecida, durante el periodo de Agosto-Octubre 2014. Resultados: Se realizaron medidas de tendencia central para obtener el porcentaje de pacientes con sub-alimentación calórica. La prevalencia de pacientes con sub-alimentación fue del 71%, con mayor predominio el sexo masculino (70%) y en un rango de edad entre 51 años y 61 años (43%). El servicio médico de hospitalización donde se encontró la mayor prevalencia de pacientes con sub-alimentación fue medicina interna afectando a 14 pacientes (38%), seguido de neurocirugía con 7 pacientes (19%) y unidad de cuidados intensivos (UCI) con 7 pacientes (19%); siendo el turno nocturno donde se presentó en mayor predominio la sub-alimentación. Conclusiones: La sub-alimentación afectó a 37 pacientes con soporte enteral los cuales representan el 71% de la población estudiada, esta cifra coincide con otros estudios similares. La causa principal de la sub-alimentación fue el incumplimiento en la ministración de la dieta enteral (AU)

Introduction: Overweight and obesity in in young people especially in children and adolescents is considered as public health problem in the world. Obesity could be the most important cause of insulin resistance. For this reason obese children and adolescents become in a risky group for developing metabolic syndrome (MS). In Ecuador is shocking the low following that is given to the diagnosis of MS for predicting the risk of cardio and cerebral vascular disease and diabetes mellitus. Objective: To determine the prevalence of metabolic syndrome and its risk factors in a sample of students from the 'Universidad Central del Ecuador' (UCE) in Quito. Methods: Students form first, second and third semester of Medicine College in UCE were included in the study. The age range was between 17 and 25 years old. All students were measured weight, height, body mass index (BMI, blood pressure, waist circumference and serum levels of total cholesterol, HDL, LDL, triglycerides and glucose. Results: The study shows that the prevalence of MS was 7.58% (IDF). It means that 1 of 13 students had MS. 22.24% has pre obesity and 3.14% has obesity. We found that waist circumference was mainly higher in women than men (53.39% vs. 25.85) of low values of HDLc, the 38.84% occurred among women and 19.73% among men, the values of total cholesterol, LDL cholesterol and glucose were normal. Conclusion: In the tested sample was found that 1 out of 13 students had MS and 1 out of 2 had at least one risk factor for MS. According with the pre-obesity and obesity result, 1 out of 4 students shows one of these symptoms. In addition, these results show the direct relationship between risk factors and TA. Finally, Healthy lifestyles promotion (includes non-pharmacological treatments such diet and exercise) could be the first goal to prevent metabolic disease, because the large amount of persons with at least one risk factor for MS (AU)

[Prevalence of metabolic syndrome and associated risk factors in ecuadorian university students]. / Prevalencia de síndrome metabólico y factores de riesgo asociados en jóvenes universitarios ecuatorianos.

INTRODUCTION: Overweight and obesity in in young people especially in children and adolescents is considered as public health problem in the world. Obesity could be the most important cause of insulin resistance. For this reason obese children and adolescents become in a risky group for developing metabolic syndrome (MS). In Ecuador is shocking the low following that is given to the diagnosis of MS for predicting the risk of cardio and cerebral vascular disease and diabetes mellitus. OBJECTIVE: To determine the prevalence of metabolic syndrome and its risk factors in a sample of students from the "Universidad Central del Ecuador" (UCE) in Quito. METHODS: Students form first, second and third semester of Medicine College in UCE were included in the study. The age range was between 17 and 25 years old. All students were measured weight, height, body mass index (BMI, blood pressure, waist circumference and serum levels of total cholesterol, HDL, LDL, triglycerides and glucose. RESULTS: The study shows that the prevalence of MS was 7.58% (IDF). It means that 1 of 13 students had MS. 22.24% has pre obesity and 3.14% has obesity. We found that waist circumference was mainly higher in women than men (33.67% vs. 9.55) of the 31.79% of low values of HDLc, the 24.50% occurred among women and 7.29% among men. , the values of total cholesterol, LDL cholesterol and glucose were normal. CONCLUSION: In the tested sample was found that 1 out of 13 students had MS and 1 out of 2 had at least one risk factor for MS. According with the pre-obesity and obesity result, 1 out of 4 students shows one of these symptoms. In addition, these results show the direct relationship between risk factors and TA. Finally, Healthy lifestyles promotion (includes non-pharmacological treatments such diet and exercise) could be the first goal to prevent metabolic disease, because the large amount of persons with at least one risk factor for MS.

Introducción: El sobrepeso y la obesidad en niños y adolescentes se consideran un problema de salud pública en el mundo. La obesidad parece ser el desencadenante más importante de la resistencia a la insulina, lo que convierte a los niños y adolescentes obesos en un grupo de riesgo para desarrollar Síndrome Metabólico. En el Ecuador, el seguimiento que se le da al diagnóstico de Síndrome Metabólico para la predicción del riesgo de enfermedad cardio y cerebro vascular y Diabetes Mellitus, es limitado. Objetivo: Determinar la prevalencia de Síndrome Metabólico y sus factores riesgo en una muestra de estudiantes de la Universidad Central del Ecuador de la ciudad de Quito. Métodos: Fueron incluidos estudiantes de los tres primeros semestres de la carrera de Medicina de la UCE, comprendidos entre 17 y 25 años. A todos los estudiantes se midió peso, talla, se calculó índice de masa corporalIMC, tensión arterial, perímetro abdominal, y niveles séricos de colesterol total, cHDL, cLDL, triglicéridos y glucosa. Resultados: En el presente estudio se encontró que la prevalencia de Síndrome Metabólico fue de 7.58% (IDF). El 22,24% presentó pre obesidad y 3.14% obesidad. Se encontró que el perímetro abdominal estuvo alterado preferentemente en mujeres en relación con los hombres (33.67% vs 9.55%). En el 31.79% se encontró niveles de cHDL bajo los valores normales, siendo más significativo en mujeres (24.50% mujeres, 7.29% hombres), los valores de colesterol total, colesterol LDL y glucosa estuvieron dentro de parámetros normales. Conclusión: En la muestra estudiada se encontró que 1 de cada 13 estudiantes presentaron Síndrome Metabólico y 1 de cada 2, al menos un factor de riesgo. En relación a pre obesidad y obesidad, 1 de cada 4 estudiantes presento algún grado de sobrepeso u obesidad. Se evidencio una relación directamente proporcional entre la presencia de factores de riesgo y un aumento de TA. Dada la gran cantidad de personas que presentan al menos un factor de riesgo es indispensable promover estilos de vida saludable que incluyan medidas no farmacológicas como dieta y ejercicio.