Simultaneous Second Harmonic Generation and Multiphoton Excited Photoluminescence in Samarium-Doped BaTiO3 Nanoparticles Functionalized with Poly(ethylene glycol).

In this work, samarium-doped BaTiO3 (BT:Sm) nanoparticles (NPs) were prepared and coated with poly(ethylene glycol) (PEG) to investigate their optical characteristics and compatibility with biological systems. The structure, particle morphology, optical properties, and biological compatibility of the NPs were assessed. The results demonstrated the formation of BT:Sm and [(BT:Sm)-PEG]. The relative intensities and positions of peaks in the X-ray diffraction (XRD) are consistent with an average crystallite size of ∼75 nm. The Raman spectra showed that Sm doping produced the typical tetragonal peaks at around 306 and 715 cm-1, and Fourier transform infrared (FTIR) spectroscopy showed that the PEGylation process was effective. Also, our investigation demonstrates the potential of these NPs as very temperature-sensitive nanosensors with a resolution exceeding 0.5 °C, which is achievable through optical excitation. We also analyze their emission properties. Finally, we present a study related with the mitochondrial activity of naked and PEG-coated NPs. The results indicate that neither naked nor PEG-coated NPs exhibit changes in mitochondrial metabolism, as indicated by quantitative cell viability and morphological visualization. The PEG-coated NPs prevented the formation of aggregates in cell culture compared to naked NPs, demonstrating the significance of PEG as a stabilizing agent.

The ILux® compared to the mechanical meibomian gland expression for the treatment of moderate and severe meibomian gland dysfunction.

AIM: To compare the safety and effectiveness of eyelid treatment with the ILux®-MGD Treatment System in one session versus five sessions of mechanical meibomian gland expression (MMGE) in patients with moderate to severe meibomian gland dysfunction (MGD). METHODS: A prospective, randomized, open-label, and controlled clinical trial that compared one session of the ILux® MGD Treatment System versus five sessions of MMGE in both eyes of 130 patients aged ≥18y with Ocular Surface Disease Index (OSDI) scores ≥13, total meibomian gland scores (MGS) of <15 in the lower eyelid of each eye, and non-invasive tear break-up time (NI-TBUT) <10s, who were randomized 1:1 to ILux® or MMGE. RESULTS: The mean age was 58±17.49y. Baseline total MGS scores in both treatment groups were comparable. During follow-up, there were significant differences in total MGS and per sector with P<0.001. Multivariate analysis was performed using generalized estimating equations corresponding to the generalized linear model for repeated means to determine the treatment relationship with total MGS, NIBUT, and OSDI. There was a significant difference between ILux® and MMGE (P<0.001) at follow-up from the first to the twelfth month in MGS, NI-BUT, and OSDI scores. No adverse events were reported. CONCLUSION: ILux® treatment compared to MMGE significantly improves symptoms and signs in patients with moderate to severe MGD for one year without adverse events.

Characteristics and outcomes of people living with HIV hospitalised at tertiary healthcare institutions during the COVID-19 pandemic in Mexico City.

BACKGROUND: While existing research on people living with HIV (PWH) during the COVID-19 pandemic primarily focused on their clinical outcomes, a critical gap remains in understanding the implications of COVID-19 delivery of in-hospital care services to PWH. Our study aimed to describe the characteristics and outcomes of PWH hospitalised during 2020 in Mexico City, comparing patients admitted due to COVID-19 vs. patients admitted due to other causes. METHODS: All PWH hospitalised for ≥ 24 h at four institutions in Mexico City from January 1st to December 31st, 2020 were included. Patients were classified into two groups according to the leading cause of their first hospitalisation: COVID-19 or non-COVID-19. Characteristics among groups were compared using chi-square and Kruskal tests. A Cox model was used to describe the risk of death after hospitalisation and the characteristics associated with this outcome. Mortality and hospitalisation events were compared to data from 2019. RESULTS: Overall, we included 238 PWH hospitalised in 2020. Among them, 42 (18%) were hospitalised due to COVID-19 and 196 (82%) due to non-COVID-19 causes, mainly AIDS-defining events (ADE). PWH hospitalised due to COVID-19 had higher CD4 + cell counts (380 cells/mm3 [IQR: 184-580] vs. 97 cells/mm3 [IQR: 34-272], p < 0.01) and a higher proportion of virologic suppression (VS) compared to those hospitalised due to non-COVID-19 causes (92% vs. 55%, p < 0.01). The adjusted hazard ratio (aHR) for AIDS was 3.1 (95%CI: 1.3-7.2). COVID-19 was not associated with death (aHR 0.9 [95%CI: 0.3-2.9]). Compared to 2019, mortality was significantly higher in 2020 (19% vs. 9%, p < 0.01), while hospitalisations decreased by 57%. CONCLUSIONS: PWH with COVID-19 had higher VS and CD4 + cell counts and lower mortality compared to those hospitalised due to non-COVID-19-related causes, who more often were recently diagnosed with HIV and had ADEs. Most hospitalisations and deaths in 2020 in PWH were related to advanced HIV disease. The increased mortality and decreased hospitalisations of PWH during 2020 evidence the impact of the interruption of health services delivery for PWH with advanced disease due to the pandemic. Our findings highlight the challenges faced by PWH during 2020 in a country where advanced HIV remains a concern.

Validation of the Health Index in the Postoperative Period: Use of the Nursing Outcome Classification to Determine the Health Level.

BACKGROUND: The postoperative period is the recovery time after surgery and is defined as an individual process whose purpose is to return the person to the state of normality and integrity that they had prior to surgery. AIM: Demonstrate the modification of the level of health of people in the early postoperative period through the development and validation of the Health Index Instrument, which is built from the Nursing Outcomes Classification (NOC) standardized language. DESIGN: The design used a mixed method, which involved a first phase of instrument development and a second phase of instrument validation. METHODS: The methods was based on focus group techniques with text analysis techniques, internal validation with a group of care language experts, external validation with a group of clinical nursing experts and a clinical validation with quantitative and qualitative analysis. A panel of experts in Language of Care evaluated the (NOC) labels and their correlation with the 11 Health Variables to construct the instrument. The instrument developed was subjected to external validation with a panel of clinical nurse experts in post-anesthesia care. The clinical validation included a cross-sectional descriptive study in a postoperative unit. The final sample of the cross-sectional descriptive study was 139 cases. RESULTS: Of the 89 NOCs proposed in the preliminary construction phase of the instrument, 36 passed through the first round. Of those 36 NOCs, 25 passed through to the second round with a review performance and 11 directly as approved. The total number of approved NOCs were 4. The results of the research show that there are changes in the global score of the health level and in each health variable. It is observed that there was a significant increase in the scores of the health variables at admission and discharge (p < 0.001). CONCLUSIONS: The results of the data analysis show that six groups present a similar pattern of evolution of the health variables. A correlation was found between the time of stay in the unit with the scores obtained in the health variables, the physical functioning, comfort status and the presence of symptoms being particularly significant.

The Evaluation of Menstrual Alterations in Mexican Women After Vaccination Against COVID-19.

Introduction Menstrual changes after COVID-19 vaccination suggest a secondary connection to the immune response to vaccination rather than a specific component of the vaccine. The evaluation of these alterations in women with the same and multiple vaccination schedules will provide valuable information. Methods An observational, cross-sectional study was carried out; data were collected through a survey of 164 vaccinated women at the American British Cowdray (ABC) Santa Fe Medical Center Hospital in Mexico City. The survey was validated by the Delphi method. Results The survey was applied from March 2023 to February 2024. Post-vaccination menstrual alterations occurred in 48.1%; the most frequent alteration was menorrhagia in 20.7% and pain accompanied by menstruation in 27.4%. Fifty-seven percent had a history of previous COVID-19 infection. There were no significant associations between changes in menstrual bleeding after vaccination, history of COVID-19 infection, and age group (p>0.9). However, women who received multiple doses of vaccines had a higher risk of suffering abnormalities in bleeding by 36.6%. Conclusion The incidence of menstrual disorders in this study post COVID-19 vaccination was 49%. Menstrual alterations in patients who received multiple doses and a single regimen were similar at 47% and 48%, where there is no statistical significance. The greatest number of menstrual alterations was seen in the first dose at 36%, probably due to the immunity they acquired after the different types of vaccination. Vaccination is a very effective way to prevent the severity of COVID-19 infection; it has an impact on menstrual bleeding in terms of menorrhagia and metrorrhagia. Vaccination against COVID-19 is associated with small changes in the menstrual cycle, without statistical significance. Women receiving the first dose of the vaccine had changes in the amount of bleeding specifically the amount.

Competencies in the Robotics of Care for Nursing Robotics: A Scoping Review.

In parallel with the development and design of different technological advances, competencies in nursing have advanced. With the development of robotics, it is expected that nursing robotic competencies will also increase. The aim of this study is to review the competencies in nursing robotics. A review was conducted between January 2017 and December 2023. The search strategy was carried out in the MEDLINE database (through PubMed). This review explores the developmental competencies in nursing robotics and informatics. The data extraction in this review included an intentional search for competencies and learning outcomes in engineering and robotic programs. A total of 340 competencies and program outcomes were reviewed. The synthesis of the data established a total of 17 developmental competencies in nursing robotics based on this knowledge extraction, which we organized into five categories: assessment, diagnosis, planning, intervention (implementation) and evaluation. This review suggests that nursing robotic competencies for the development of care robotics are still scarce, and there is an opportunity for the development of competencies and the definition of new roles in the area of nursing informatics in order to adapt to the new health care demands of society.

Risk of adverse perinatal outcomes among women with clinical and subclinical histopathological chorioamnionitis.

Introduction: Histologic chorioamnionitis (HCA) is a placental inflammatory condition associated with adverse perinatal outcomes (APOs). This historical cohort study explores the risk of APOs in pregnant women with HCA and compares the impact of clinical chorioamnionitis (CCA) with subclinical chorioamnionitis (SCCA). Methodology: Placentas were evaluated by a perinatal pathologist tand all women with HCA were included. Two groups were integrated: (1) women with clinical chorioamnionitis (CCA) and (2) women with subclinical chorioamnionitis (SCCA). Additionally, we conducted a secondary analysis to compare the prevalence of APOs among stage 1, 2 and 3 of HCA and the risk of APOs between grades 1 and 2 of HCA. The APOs analyzed were preterm birth, stillbirth, neonatal weight < 1,500 g, neonatal sepsis. Relative risk with 95% confidence interval was calculated. Results: The study included 41 cases of CCA and 270 cases of SCCA. The mean gestational age at diagnosis and birth was 30.2 ± 5.4 weeks and 32.5 ± 5.1 weeks, for group 1 and 2, respectively. The study also found that women with HCA stage 3 and grade 2 had a higher prevalence and risk of adverse perinatal outcomes. Discussion: The findings of this study suggest the importance of placental histological study to excluded SCCA, which represents a significant risk to both maternal and neonatal health, contributing to high morbidity and mortality.

Active and Healthy Confinement: Care Recommendations on Activity, Sleep and Relationships.

Persons that lived through periods of confinement suffered an impact on their physical and mental health. The adaptation of the lifestyle in relation to activity, sleep and social relationships is key to facing these periods of confinement. The aim is to validate a series of care recommendations aimed at being able to maintain an active and healthy confinement, which serves to prepare the population for future health crises. This study is part of a general strategy based on a care recommendation guide for COVID-19. The validation was carried out by a group of experts using the Delphi technique through a questionnaire that uses the Content Validity Index (CVI) and considers high validation those with a score >0.80. A total of 75 care recommendations are proposed: 30 on activity-exercise (CVI = 0.82), 14 on sleep-rest (CVI = 0.83) and 31 on roles-relationships (CVI = 0.83). Additionally, 49 recommendations achieve high validation. The care recommendations integrate a person-centred model, which addresses individual characteristics (age, health status, professional role). An active and healthy confinement requires respecting social distance measures, maintaining a balance between physical activity and sleep, and using technologies to promote social contact, which promote well-being and avoid depression and anxiety.

TRUSformer: improving prostate cancer detection from micro-ultrasound using attention and self-supervision.

PURPOSE: A large body of previous machine learning methods for ultrasound-based prostate cancer detection classify small regions of interest (ROIs) of ultrasound signals that lie within a larger needle trace corresponding to a prostate tissue biopsy (called biopsy core). These ROI-scale models suffer from weak labeling as histopathology results available for biopsy cores only approximate the distribution of cancer in the ROIs. ROI-scale models do not take advantage of contextual information that are normally considered by pathologists, i.e., they do not consider information about surrounding tissue and larger-scale trends when identifying cancer. We aim to improve cancer detection by taking a multi-scale, i.e., ROI-scale and biopsy core-scale, approach. METHODS: Our multi-scale approach combines (i) an "ROI-scale" model trained using self-supervised learning to extract features from small ROIs and (ii) a "core-scale" transformer model that processes a collection of extracted features from multiple ROIs in the needle trace region to predict the tissue type of the corresponding core. Attention maps, as a by-product, allow us to localize cancer at the ROI scale. RESULTS: We analyze this method using a dataset of micro-ultrasound acquired from 578 patients who underwent prostate biopsy, and compare our model to baseline models and other large-scale studies in the literature. Our model shows consistent and substantial performance improvements compared to ROI-scale-only models. It achieves [Formula: see text] AUROC, a statistically significant improvement over ROI-scale classification. We also compare our method to large studies on prostate cancer detection, using other imaging modalities. CONCLUSIONS: Taking a multi-scale approach that leverages contextual information improves prostate cancer detection compared to ROI-scale-only models. The proposed model achieves a statistically significant improvement in performance and outperforms other large-scale studies in the literature. Our code is publicly available at www.github.com/med-i-lab/TRUSFormer .

Factores socioculturales que influyen en las usuarias de 50 años para la toma de Papanicolaou de un Hospital Nasca

Objetivo: El objetivo del presente estudio fue determinar los factores socioculturales en usuarias de 50 años para la toma de Papanicolaou en el hospital Ricardo Cruzado Rivarola de Nasca durante el periodo Diciembre 2021 - Febrero 2022. Materiales y métodos : Realizamos un estudio observacional, analítica, y prospectivo. La población de estudio está constituida por 80 usuarias de 50 años que acuden al hospital Ricardo Cruzado Rivarola para controles de Papanicolaou al consultorio de Ginecología-Obstetricia. La muestra estuvo conformada por 67 usuarias, seleccionadas por muestreo no probabilístico por conveniencia. Resultados: Para el primer análisis, en la regresión simple, se encontró que las mujeres con nivel de conocimientos altos tenían 153% mayor frecuencia de haberse realizado alguna vez un pap y las mujeres con nivel de conocimientos altos tenían 384% mayor frecuencia de haberse realizado alguna vez un PAP, en comparación a quienes tenían un nivel de conocimientos bajo. Luego, en la regresión múltiple se observó que las mujeres con nivel de conocimientos altos tenían 382% mayor frecuencia de haberse realizado alguna vez un PAP, en comparación a quienes tenían un nivel de conocimientos bajo. Conclusiones: El nivel de conocimiento sobre el PAP influye de una manera relevante al haberse realizado un PAP; pero además las mujeres que tuvieron mayor educación fueron las que tuvieron mayor frecuencia de haberlo realizado. Esto sumado a la cantidad de hijos; posiblemente porque en los círculos de mujeres con hijos uno de los temas a tratar es sobre la salud materna y dentro ellos el PAP.

Objective: The objective of this study was to determine the sociocultural factors in 50-year-old users for pap smears at the Ricardo Cruzado Rivarola de Nasca Hospital during the period December 2021 - February 2022. Material and methods: Observational, analytical, and prospective study. The study population is made up of 80 50-year-old users who attend the Ricardo Cruzado Rivarola Hospital for PAP tests at the gynecology-obstetrics office and the sample is 67 users, selected by non-probabilistic sampling for convenience. Results: For the first analysis, in simple and multiple regression, it was found that women with high levels of knowledge had a 384% and 382% higher frequency of having ever undergone a PAP test compared to those with low levels of knowledge. Conclusions: The level of knowledge about the PAP has a relevant influence on having carried out a PAP; but also the women who had a high level were the ones who had the highest frequency of having done it. This added to the number of children; possibly because in the circles of women with children one of the topics to be discussed is about maternal health and within them the PAP.

Factores que favorecen el tamizaje de cáncer de cuello uterino en mujeres de 12 a 49 años: Sub-análisis de la Encuesta Demográfica y de Salud Familiar 2019, Perú

Introducción: La prueba de Papanicolau ayuda a detectar de manera oportuna en la intervención de rutina el cáncer de cuello uterino. Objetivo: Analizar factores asociados al tamizaje para cáncer de cuello uterino en mujeres de 12 a 49 años en Perú durante el año 2019. Metodología: Se realizó un estudio observacional, analítico-transversal de un análisis secundario de datos de la Encuesta Demográfica y de Salud Familiar del 2019. Muestreo bietápico, probabilístico, equilibrado y estratificado. Se utilizó estadística descriptiva y analítica (nivel de inferencia p<0.05). Para el análisis bivariado y multivariado se utilizaron razones de prevalencia con intervalo de confianza de 95% y p<0.05. Resultados: La frecuencia de tamizaje de cáncer de cuello uterino en las regiones políticas con menores valores de prevalencia fueron Pasco (0,52%) y Tumbes (0,55%). Discusión: Los factores asociados al tamizaje de cáncer de cuello uterino son la edad, tener pareja, nivel educación superior, nivel socioeconómico pobre, residir en área rural, tener seguro de salud, edad de inicio de relaciones sexuales y haber escuchado del cáncer de cuello uterino.

Introduction: The Papanicolaou test smear helps detect cervical cancer in a timely manner in routine intervention. Objective: To analyze factors associated with screening for cervical cancer in women aged 12 to 49 years in Peru in 2019. Methods: An observational, analytical-cross-sectional study of a secondary analysis of data from 2019 Demographic and Family Health Survey was carried out. Two-stage, probabilistic, balanced, and stratified sampling. Descriptive and analytical statistics were used (level of inference p<0.05). For the bivariate and multivariate analysis, prevalence ratios were used with a 95% confidence interval and p<0.05. Results: The frequency of cervical cancer screening in the political regions with the lowest prevalence values were Pasco (0.52%) and Tumbes (0.55%). Discussion: The factors associated with cervical cancer screening are age, having a partner, higher education level, poor socioeconomic level, residing in a rural area, having health insurance, age at the start of sexual relations, and having heard of cervical cancer.

Extrarenal rhabdoid tumor of anterior mediastinal location.

BACKGROUND: Rhabdoid tumors are malignant neoplasms of low prevalence, aggressive behavior, and high mortality. They were initially described as renal tumors, although tumors with the same histopathological and immunohistochemical characteristics have been discovered in other locations, mainly in the central nervous system. Few cases of mediastinal location have been reported internationally. This work aimed to describe the case of a mediastinal rhabdoid tumor. CASE REPORT: We describe the case of an 8-month-old male patient admitted to the pediatric department with dysphonia and laryngeal stridor progressing to severe respiratory distress. Contrast-enhanced computed tomography of the thorax showed a large mass with homogeneous soft tissue density, and smooth and well-defined borders, with suspicion of malignant neoplasm. Due to the oncological emergency compressing the airway, empirical chemotherapy was initiated. Subsequently, the patient underwent incomplete tumor resection due to its invasive nature. The pathology report showed morphology compatible with a rhabdoid tumor, which immunohistochemical and genetic studies corroborated. Chemotherapy and radiotherapy to the mediastinum were administered. However, the patient died three months after the initial treatment due to the aggressive behavior of the tumor. CONCLUSIONS: Rhabdoid tumors are aggressive and malignant entities difficult to control and have poor survival. Early diagnosis and aggressive treatment are required, although the 5-year survival does not exceed 40%. It is necessary to analyze and report more similar cases to establish specific treatment guidelines.

INTRODUCCIÓN: Los tumores rabdoides son neoplasias malignas de baja prevalencia, con comportamiento agresivo y alta mortalidad. Inicialmente fueron descritos como renales, aunque posteriormente se han descrito tumores con las mismas características histopatológicas e inmunohistoquímicas en otros sitios, principalmente en el sistema nervioso central. Internacionalmente se han descrito pocos casos de localización mediastinal. El objetivo del presente trabajo fue describir el caso de un tumor rabdoide de localización mediastinal. CASO CLÍNICO: Se presenta el caso de un paciente de sexo masculino de 8 meses de edad que ingresó al servicio de pediatría con disfonía y estridor laríngeo que progresó a dificultad respiratoria severa. En la tomografía computarizada contrastada de tórax se observó una gran masa homogénea con densidad de tejidos blandos, de bordes lisos y bien definidos, por lo que se sospechó una neoplasia maligna. Debido a la urgencia oncológica compresiva de la vía aérea se inició con un esquema empírico de quimioterapia. Posteriormente se sometió a resección tumoral incompleta por carácter invasor. El reporte de patología mostró morfología compatible con un tumor rabdoide, el cual se corroboró con estudios de inmunohistoquímica y genética. Se administró un esquema de quimioterapia y radioterapia al mediastino. Sin embargo, el paciente falleció a los 3 meses del inicio de tratamiento debido al comportamiento agresivo del tumor. CONCLUSIONES: Los tumores rabdoides son entidades agresivas y malignas de difícil control y con pobre supervivencia. A pesar de que se requiere un diagnóstico precoz y un tratamiento agresivo, no se ha logrado la supervivencia a 5 años mayor al 40%. Es necesario analizar una mayor cantidad de casos para establecer guías específicas de tratamiento.

Effects of chronic exposure to cold stress on ovarian functions in prepubertal rats.

Ovarian functions are modulated by the hypothalamus-pituitary-ovary axis and neural signals. Stress modifies the activity of the sympathetic nervous system. In adult female rats, cold stress results in higher noradrenergic and steroidogenic activity of the ovary, anovulation and the presence of ovarian cysts; however, it is unknown whether this response occurs in prepubertal rats. The purpose of this study was to analyse the effects of cold stress initiated in the prepubertal stage of female rats on ovarian function. Female rats 24 days old were exposed to three, five or eight weeks of cold stress. Autopsies were performed at the end of each stress period. The parameters analysed were the number of ova shed by ovulating animals; the number of ovulating animals; the serum concentrations of progesterone, testosterone, and oestradiol; and the ovarian concentrations of norepinephrine and 3-methoxy-4-hydroxyphenyl-glycol. Our results show that chronic cold stress applied to prepubertal rats did not modify the number of ovulating animals, the total number of ova shed, or progesterone and testosterone concentrations in any of the periods analysed. Oestradiol concentration was lower in the animals exposed to five or eight weeks of stress. The ovarian norepinephrine concentration was higher in the animals exposed to three weeks of stress and was lower at eight weeks of stress. No changes in ovarian morphology were observed. Our data suggest that the changes in noradrenergic activity resulting from chronic cold stress experienced in the prepubertal stage do not modify ovarian architecture or affect the ovulatory response in adulthood.

Extrarenal rhabdoid tumor of anterior mediastinal location / Tumor rabdoide extrarrenal de localización mediastinal anterior

Abstract Background: Rhabdoid tumors are malignant neoplasms of low prevalence, aggressive behavior, and high mortality. They were initially described as renal tumors, although tumors with the same histopathological and immunohistochemical characteristics have been discovered in other locations, mainly in the central nervous system. Few cases of mediastinal location have been reported internationally. This work aimed to describe the case of a mediastinal rhabdoid tumor. Case report: We describe the case of an 8-month-old male patient admitted to the pediatric department with dysphonia and laryngeal stridor progressing to severe respiratory distress. Contrast-enhanced computed tomography of the thorax showed a large mass with homogeneous soft tissue density, and smooth and well-defined borders, with suspicion of malignant neoplasm. Due to the oncological emergency compressing the airway, empirical chemotherapy was initiated. Subsequently, the patient underwent incomplete tumor resection due to its invasive nature. The pathology report showed morphology compatible with a rhabdoid tumor, which immunohistochemical and genetic studies corroborated. Chemotherapy and radiotherapy to the mediastinum were administered. However, the patient died three months after the initial treatment due to the aggressive behavior of the tumor. Conclusions: Rhabdoid tumors are aggressive and malignant entities difficult to control and have poor survival. Early diagnosis and aggressive treatment are required, although the 5-year survival does not exceed 40%. It is necessary to analyze and report more similar cases to establish specific treatment guidelines.

Resumen Introducción: Los tumores rabdoides son neoplasias malignas de baja prevalencia, con comportamiento agresivo y alta mortalidad. Inicialmente fueron descritos como renales, aunque posteriormente se han descrito tumores con las mismas características histopatológicas e inmunohistoquímicas en otros sitios, principalmente en el sistema nervioso central. Internacionalmente se han descrito pocos casos de localización mediastinal. El objetivo del presente trabajo fue describir el caso de un tumor rabdoide de localización mediastinal. Caso clínico: Se presenta el caso de un paciente de sexo masculino de 8 meses de edad que ingresó al servicio de pediatría con disfonía y estridor laríngeo que progresó a dificultad respiratoria severa. En la tomografía computarizada contrastada de tórax se observó una gran masa homogénea con densidad de tejidos blandos, de bordes lisos y bien definidos, por lo que se sospechó una neoplasia maligna. Debido a la urgencia oncológica compresiva de la vía aérea se inició con un esquema empírico de quimioterapia. Posteriormente se sometió a resección tumoral incompleta por carácter invasor. El reporte de patología mostró morfología compatible con un tumor rabdoide, el cual se corroboró con estudios de inmunohistoquímica y genética. Se administró un esquema de quimioterapia y radioterapia al mediastino. Sin embargo, el paciente falleció a los 3 meses del inicio de tratamiento debido al comportamiento agresivo del tumor. Conclusiones: Los tumores rabdoides son entidades agresivas y malignas de difícil control y con pobre supervivencia. A pesar de que se requiere un diagnóstico precoz y un tratamiento agresivo, no se ha logrado la supervivencia a 5 años mayor al 40%. Es necesario analizar una mayor cantidad de casos para establecer guías específicas de tratamiento.

Emotional dysregulation in women with endometriosis with cyclical and non-cyclical chronic pelvic pain.

BACKGROUND: Endometriosis is a pathophysiological condition characterized by glands and stroma outside the uterus in regions such as the bladder, ureter, fallopian tubes, peritoneum, ovaries, and even in extra pelvic sites. One of the main clinical problems of endometriosis is chronic pelvic pain (CPP), which considerably affects the patients' quality of life. Patients with endometriosis may, cyclically or non-cyclically (80% of cases) experience CPP. High levels of anxiety and depression have been described in patients with endometriosis related to CPP; however, this has not been evaluated in endometriosis women with different types of CPP. Therefore, the research question of this study was whether there is a difference in the emotional dysregulation due to the type of pain experienced by women with endometriosis? METHODS: This work was performed in the National Institute of Perinatology (INPer) in Mexico City from January 2019 to March 2020 and aimed to determine if there are differences in emotional dysregulation in patients with cyclical and non-cyclical CPP. 49 women from 18 to 52 years-old diagnosed with endometriosis presenting cyclical and non-cyclical CPP answered several batteries made up of Mini-Mental State Examination, Visual Analog Scale, Beck's Depression Inventory, State Trait-Anxiety Inventory, and Generalized Anxiety Inventory. Mann-Whitney U and Student's t-test for independent samples to compare the difference between groups was used. Relative risk estimation was performed to determine the association between non-cyclical and cyclical CPP with probability of presenting emotional dysregulation. RESULTS: We observed that patients with non-cyclical CPP exhibited higher levels of depression and anxiety (trait-state and generalized anxiety) than patients with cyclical pain, p < 0.05 was considered significant. No differences were observed in pain intensity, but there was a higher probability of developing emotional dysregulation (anxiety or depression) in patients with non-cyclical CPP. No differences were observed in cognitive impairment. CONCLUSIONS: Our data suggest that patients with non-cyclical (persistent) CPP present a higher emotional dysregulation than those with cyclical pain.

Management of neonates with 35 weeks of gestational age or more with infectious risk factors at birth: opportunities for improvement.

OBJECTIVES: The Northern California Kaiser-Permanente Neonatal Sepsis Risk Calculator (SRC) has proved to be safe and effective in reducing laboratory tests, hospital admissions, and administration of antibiotics to patients at risk of early-onset neonatal sepsis (EONS). Many studies have focused on maternal chorioamnionitis as the principal risk factor for EONS. We wanted to know if the use of the SRC could be equally efficient in the context of several other infectious risk factors (IRF), in addition to chorioamnionitis, such as intrapartum maternal fever, GBS colonization and/or prolonged rupture of membranes (PROM). METHODS: Systematic study of neonates with ≥35 weeks gestational age (GA), born in our tertiary university hospital during a period of 18 months. Patients were retrospectively assessed with the SRC and its recommendations were compared with the actual management. A bivariate analysis of perinatal interventions, and outcomes was performed. RESULTS: A total of 5,885 newborns were born during the study period and 1783 mothers (31%) had at least one IRF. The incidence of culture-proven EONS was 0.5‰. The use of the SRC would have reduced laboratory evaluations (CBC and CRP) from 56.2 to 23.3%, and blood cultures, hospital admissions and antibiotic therapy from 22.9 to 15.5%, 17.8 and 7.6%, respectively. The management based on patients' symptoms would have shown a reduction to 7.5% in all the outcomes of interest. CONCLUSIONS: Both, the SRC and the management based on clinical findings, are safe and efficient to reduce the number of analytical studies, hospital admissions and administration of antibiotics to neonates with IRF.

Non-parametric combination of multimodal MRI for lesion detection in focal epilepsy.

One third of patients with medically refractory focal epilepsy have normal-appearing MRI scans. This poses a problem as identification of the epileptogenic region is required for surgical treatment. This study performs a multimodal voxel-based analysis (VBA) to identify brain abnormalities in MRI-negative focal epilepsy. Data was collected from 69 focal epilepsy patients (42 with discrete lesions on MRI scans, 27 with no visible findings on scans), and 62 healthy controls. MR images comprised T1-weighted, fluid-attenuated inversion recovery (FLAIR), fractional anisotropy (FA) and mean diffusivity (MD) from diffusion tensor imaging, and neurite density index (NDI) from neurite orientation dispersion and density imaging. These multimodal images were coregistered to T1-weighted scans, normalized to a standard space, and smoothed with 8 mm FWHM. Initial analysis performed voxel-wise one-tailed t-tests separately on grey matter concentration (GMC), FLAIR, FA, MD, and NDI, comparing patients with epilepsy to controls. A multimodal non-parametric combination (NPC) analysis was also performed simultaneously on FLAIR, FA, MD, and NDI. Resulting p-maps were family-wise error rate corrected, threshold-free cluster enhanced, and thresholded at p < 0.05. Sensitivity was established through visual comparison of results to manually drawn lesion masks or seizure onset zone (SOZ) from stereoelectroencephalography. A leave-one-out cross-validation with the same analysis protocols was performed on controls to determine specificity. NDI was the best performing individual modality, detecting focal abnormalities in 38% of patients with normal MRI and conclusive SOZ. GMC demonstrated the lowest sensitivity at 19%. NPC provided superior performance to univariate analyses with 50% sensitivity. Specificity in controls ranged between 96 and 100% for all analyses. This study demonstrated the utility of a multimodal VBA utilizing NPC for detecting epileptogenic lesions in MRI-negative focal epilepsy. Future work will apply this approach to datasets from other centres and will experiment with different combinations of MR sequences.

Variables psicológicas asociadas al estrés Postraumático en desmovilizados de las Fuerzas Armadas Revolucionarias de Colombia (FARC-EP) / Psychological variables associated with post-traumatic stress in demobilized members of the Revolutionary Armed Forces of Colombia (FARC-EP)

Resumen: Objetivo: Evaluar la relación entre el estrés post traumático y variables psicológicas asociadas, en guerrilleros desmovilizados las Fuerzas Armadas Revolucionarias de Colombia (FARC-EP) en el departamento de Córdoba, Colombia. Método: Estudio cuantitativo, transversal, de alcance correlacional. Participaron 48 guerrilleros mayores de edad (34 hombres y 14 mujeres) pertenecientes al Frente 58 de esta agrupación, a quienes se les aplicó los cuestionarios Lista de chequeo de estrés post traumático (PCL-5), la escala de distrés psicológica de Kessler, el cuestionario de creencias básicas (CBI), la escala de la esperanza de Herth y la escala de bienestar compuesto (WBC). Resultados: Los participantes no presentaban síntomas de estrés post traumático, tenían bajos niveles de estrés y de cambios en las creencias básicas, igualmente presentaban altos niveles de esperanza y de bienestar físico y psicológico. Para detectar posibles predictores del TEPT se desarrolló un análisis de regresión múltiple en el cual el 48% de la varianza total fue explicado por el distrés psicológico y las creencias básicas. Conclusión: Se evidencia la necesidad de desarrollar estudios que profundicen en las características del estado psicológico de los ex guerrilleros de la FARC-EP, con el fin de aclarar las variables involucradas que favorecen los procesos de reintegración a la vida civil.

Abstract: Objective: To evaluate the relationship between post-traumatic stress and associated psychological variables in demobilized guerrillas from the Revolutionary Armed Forces of Colombia (FARC-EP) in the department of Córdoba, Colombia. Method: We carried out a quantitative, cross-sectional study of correlational scope, in which 48 guerrillas of legal age participated (34 men and 14 women) belonging to the 58th Front of this group. The Post Traumatic Stress Checklist (PCL-5), the Kessler psychological distress scale, the basic beliefs questionnaire (CBI), the Herth hope scale and the composite well-being scale (WBC) were applied. Results: The participants did not present symptoms of post traumatic stress, they had low levels of stress and changes in basic beliefs, they also presented high levels of hope and physical and psychological well-being. To detect possible predictors of PTSD, a multiple regression analysis was developed in which 48% of the total variance was explained by psychological distress and basic beliefs. Conclusion: There is evidence of the need to develop studies that delve into the characteristics of the psychological state of former FARC-EP guerrillas, in order to clarify the variables involved that favor the processes of reintegration into civilian life.

Wilson disease: revision of diagnostic criteria in a clinical series with great genetic homogeneity.

BACKGROUND: Wilson disease is an autosomal recessive disorder of copper metabolism caused by mutations in the ATP7B gene. An early diagnosis is crucial to prevent evolution of the disease, as implantation of early therapeutic measures fully prevents its symptoms. As population genetics data predict a higher than initially expected prevalence, it was important to define the basic diagnostic tools to approach population screening. METHODS: A highly genetically homogeneous cohort of 70 patients, belonging to 50 unrelated families, has been selected as a framework to analyze all their clinical, biochemical and genetic characteristics, to define the disease in our population, with an estimated prevalence of 1 in 12,369, and determine the most useful features that reach diagnostic value. RESULTS: Serum ceruloplasmin below 11.5 mg/dL and cupremia below 60 µg/mL, were the best analytical predictors of the disease in asymptomatic individuals, while cupruria or hepatic copper determination were less powerful. Genetic analysis reached a conclusive diagnosis in all 65 patients available for complete testing. Of them, 48 were carriers of at least one p.Leu708Pro mutant allele, with 24 homozygotes. Nine patients carried a promoter deletion mutation, revealing that extended sequencing beyond the ATP7B gene-coding region is essential. All mutations caused hepatic damage since early ages, increasing its severity as diagnosis was delayed, and neurological symptoms appear. CONCLUSION: Serum ceruloplasmin determination followed by genetic screening would reduce costs and favor the prioritization of non-invasive procedures to reach a definitive diagnosis, even for asymptomatic cases.