A mobile health intervention for emerging adults with regular cannabis use: A micro-randomized pilot trial design protocol.

BACKGROUND: Emerging adult (EA) cannabis use is associated with increased risk for health consequences. Just-in-time adaptive interventions (JITAIs) provide potential for preventing the escalation and consequences of cannabis use. Powered by mobile devices, JITAIs use decision rules that take the person's state and context as input, and output a recommended intervention (e.g., alternative activities, coping strategies). The mHealth literature on JITAIs is nascent, with additional research needed to identify what intervention content to deliver when and to whom. METHODS: Herein we describe the protocol for a pilot study testing the feasibility and acceptability of a micro-randomized trial for optimizing MiWaves mobile intervention app for EAs (ages 18-25; target N = 120) with regular cannabis use (≥3 times per week). Micro-randomizations will be determined by a reinforcement learning algorithm that continually learns and improves the decision rules as participants experience the intervention. MiWaves will prompt participants to complete an in-app twice-daily survey over 30 days and participants will be micro-randomized twice daily to either: no message or a message [1 of 6 types varying in length (short, long) and interaction type (acknowledge message, acknowledge message + click additional resources, acknowledge message + fill in the blank/select an option)]. Participants recruited via social media will download the MiWaves app, and complete screening, baseline, weekly, post-intervention, and 2-month follow-up assessments. Primary outcomes include feasibility and acceptability, with additional exploratory behavioral outcomes. CONCLUSION: This study represents a critical first step in developing an effective mHealth intervention for reducing cannabis use and associated harms in EAs.

Comparative study between the efficacy of prabotulinum toxin-A versus onabotulinum toxin-A for the treatment of upper facial expression lines.

BACKGROUND: Botulinum Toxin (BoNTA) is the most used nonsurgical aesthetic procedure to treat facial expression lines. AIMS: This study compared the efficacy of Prabotulinum toxin-A, a novel BoNTA that originates from Clostridium botulinum Hall-A, with onabotulinum toxin-A in treating facial expression lines using the Facial Wrinkle Scale (FWS) and FACE-Q questionnaires. METHODS: This was an experimental, comparative, longitudinal, open-label, and prospective study. Patients aged between 25 and 40 years with upper-third facial expression lines were included. Follow-ups were made at three, seven, 30, and 120 days. RESULTS: A total of 26 patients were included: 20 female, and six males, with a mean age of 28.26 years. An average of 31.00 IU and 31.38 IU were administered to the onabotulinum and prabotulinum groups, respectively. The prabotulinum group demonstrated superiority in FWS and Face-Q scores between the first and third days (p ≤ 0.001, p < 0.001, respectively), which continued on day 7. By day 30, there were no differences in the scores of the two questionnaires. CONCLUSIONS: Prabotulinum toxin-A is a safe and effective treatment for upper-third facial wrinkles. On day three and seven, the results suggest that prabotulinum toxin-A has a quicker onset of action than onabotulinum toxin-A. On days 30 and 120, both groups showed similar FWS and Face-Q scores.

Relationship between the polymerization distance of monowave and polywave light-curing units and the irradiance and physical properties of dental resin-based composites.

PURPOSE: To evaluate the influence of the polymerization distance of monowave and polywave light curing units (LCUs) on the measured irradiance relative to the value reported by the manufacturer in relation to the physical properties of resin-based composites (RBCs). METHODS: Four LCUs were used: one monowave and three polywave. The irradiance was measured with a digital radiometer. Depth of cure (DC) and flexural strength (FS) tests were performed according to ISO 4049:2019 at polymerization distances of 0 mm and 5 mm. RESULTS: The irradiance of all LCUs was higher than that reported by the manufacturer (>25-64%). The irradiance of the four LCUs was reduced when polymerization was performed at between 0 to 5 mm (paired t-test, P < 0.001). The DC at 0 mm was similar in all groups but was significantly decreased at 5 mm distance (ANOVA P < 0.001). FS showed differences among the LCUs at 0 mm (ANOVA P < 0.001) and was affected by the polymerization distance. The elastic modulus was unaffected by the LCU used or the distance (ANOVA P > 0.001). CONCLUSIONS: The LCU must be positioned as near as possible to RBCs during the polymerization process, as increased distance negatively affects the depth of cure and flexural strength.

Neuropsychological profile of a patient with multiple sclerosis and psychiatric symptoms that masked and delayed the diagnosis. A case report using teleneuropsychology.

Objective: Multiple sclerosis (MS) may include not only severe neurological signs and symptoms, but also cognitive and psychiatric disturbances. When psychiatric symptoms precede or are comorbid with MS, it poses a clinical challenge, because it may lead to a mistaken diagnosis of MS as a psychiatric disorder, delaying proper treatment. We describe the neuropsychological profile of a female patient with MS whose diagnosis was delayed due to neuropsychiatric symptoms. Method: A comprehensive analysis of the medical history and the results of a teleneuropsychological assessment of a 36-year-old Mexican woman with a diagnosis of relapsing--remitting MS (RRMS) was performed. Results: The patient indicates a long history of psychotic, anxious, and depressive features years before the first neurological symptom that led to MS going unnoticed for several years. Language, attentional, perceptual, motor, and learning skills were found to be preserved. Short-term memory and spatial orientation problems were identified, with decreased processing speed and executive dysfunction, including working memory and planning deficits. Conclusions: The patient has a non-typical presentation of neuropsychological alterations with cognitive and behavioral symptoms that resemble dorsolateral frontal lobe syndrome. This case study highlights the importance of considering MS in differential diagnosis of patients with psychiatric symptoms, even in the absence of obvious neurological signs.

Mesialización del sector posterior por la ausencia del primer molar mediante el uso de microimplantes / Mesialization of the posterior sector due to the absence of the first molar through the use of micro-implants

Se presenta un caso clínico de paciente femenina de 16 años, la cual reportó haber perdido su primer molar superior izquierdo por caries dos años atrás. Es una paciente con maloclusión clase II esquelética, mesofacial, perfil recto, clase I molar derecho, ausencia del diente 26, clase I canina derecha y tendencia a clase II canina izquierda, con apiñamiento leve superior e inferior y línea media dental inferior desviada a la izquierda. Se trató mediante el uso de microimplante, con el objetivo de mesializar los dientes 27 y 28 así como mejorar el asentamiento de la clase canina izquierda. Se finalizó de manera exitosa la mesialización de los dientes posteriores superiores izquierdos, estableciendo una adecuada oclusión, eliminando el apiñamiento, logrando una buena guía anterior con líneas medias dentales coincidentes, proporcionando una sonrisa funcional y armoniosa. El propósito de este caso es demostrar que con las herramientas y mecánicas adecuadas además de una buena planificación, se puede lograr el control del anclaje en el movimiento de cierre posterior a falta de un molar ausente, y así lograr establecer una adecuada oclusión.

A clinical case of a 16-year-old female patient is presented, who reported having lost her upper left first molar due to caries two years ago is presented. She is a patient with class II skeletal, mesofacial malocclusion, straight profile, class I right molar, absence of tooth 26, class I right canine and tendency to class II left canine, with mild upper and lower crowding and lower dental midline deviated to the left. It was treated through the use of a microimplant, with the objective of mesializing teeth 27 and 28 as well as improving the settlement of the left canine class. The mesialization of the upper left posterior teeth was successfully completed, establishing adequate occlusion, eliminating crowding, achieving good anterior guidance with coincident dental midlines, providing a functional and harmonious smile. The purpose of this case is to demonstrate that with the appropriate tools and mechanics in addition to good planning, control of the anchorage in the posterior closing movement can be achieved in the absence of an absent molar, and thus achieve adequate occlusion.

Avoidance and fear day by day in social anxiety disorder.

OBJECTIVE: Theories assert that avoidance maintains maladaptive anxiety over time, yet a clear prospective test of this effect in the day-by-day lives of people with social anxiety disorder (SAD) is lacking. METHOD: We used intensive longitudinal data to test prospective relationships between social fear and social avoidance in 32 participants with SAD who reported on a total of 4256 time points. RESULTS: Results suggested that avoidance strongly predicted future anxiety, but only in a minority of people with SAD. Relationships between anxiety and avoidance varied considerably across individuals. Pre-registered tests found that the strength of autocorrelation for social fear is a good target for future testing of prediction of exposure response. Participants with lower autocorrelations were less likely to show between-session habituation. CONCLUSIONS: Overall, results suggest avoidance maintains fear in SAD for at least some individuals, but also indicates considerable variability. Further intensive longitudinal data is needed to examine individuals with SAD across varying time courses.

Evaluation of the Insecticidal Potential of Heterotheca inuloides Acetonic and Methanolic Extracts against Spodoptera frugiperda and Their Ecotoxicological Effect on Poecilia reticulata.

For the management of Spodoptera frugiperda, botanical extracts have been used to reduce the environmental impacts of synthetic chemical pesticides. In the present investigation, the insecticidal activity of the acetonic and methanolic extracts of Heterotheca inuloides (Asteraceae) and of the main compound 7-hydroxy-3,4-dihydrocadalene on this pest as well as its ecotoxicological effect on Poecilia reticulata were evaluated. A greater insecticidal response was obtained from the acetonic extracts than from the methanolic extracts, with LC50 values of 730.4 ppm and 711.7 ppm for samples 1 and 2, respectively. Similarly, there was a lethal effect on 50% of the P. reticulata population at low concentrations in the acetonic extract compared to the methanolic extract. The sesquiterpene 7-hydroxy-3,4-dihydrocadalene has greater insecticidal activity by presenting an LC50 of 44.36 ppm; however, it is classified as moderately toxic for guppy fish.

Marginalization and tooth loss in older Mexican adults.

OBJECTIVE: To examine the association between the level of marginalization and tooth loss in adults aged ≥50 years in Mexico. METHODS: A retrospective cross­sectional study was conducted on 2098 adults selected from communities presenting both high and medium levels of marginalization, with data obtained from the annual reports of the Epidemiological Surveillance System of Oral Pathologies 2019-2022. Analysis considered sociodemographic characteristics such as sex, age, and years of education. The prevalence of tooth loss was determined using the Decayed, Missing and Filled teeth (DMFT) index. Negative binomial regression was used to estimate rate ratio (RR) and 95% confidence intervals (CIs), using the presence of lost teeth as an outcome. RESULTS: Most (62.4%) participants had lost at least one tooth, of whom 60.3% had a medium level of marginalization, 28.8% a high level, and 10.9% a very high level. More adults who lived in high or very high marginalization communities had lost teeth [RR=1.19 (95% CI 1.08 - 1.30)] than those living in communities with a medium level of marginalization. More males [RR=1.19 (95% CI 1.09 - 1.31)], adults ≥70 years [RR=1.77 (95% CI 1.57 - 1.99)], people who were illiterate [RR=1.60 (95% CI 1.35 - 1.88)] or who had poor oral hygiene [RR=1.26 (95% CI 1.15 - 1.38)] had also lost teeth. CONCLUSION: High and very high marginalization was associated with tooth loss in adults ≥50 years in Mexico. Effective oral health strategies are required to prevent tooth loss, as are interventions to improve access to and quality of dental services for marginalized communities.

Acceptability of Cognitive Behavioral Therapy for Tinnitus: A Study With Veterans and Nonveterans.

PURPOSE: Cognitive behavioral therapy (CBT) is a gold standard yet underutilized treatment for tinnitus, and tinnitus is especially highly prevalent among veterans. The aims of this study were twofold: to determine (a) if CBT for tinnitus is underutilized because participants find it less acceptable than other behavioral treatments for tinnitus and (b) if veterans and nonveterans rate behavioral treatments for tinnitus differently. METHOD: This cross-sectional study was conducted online with a sample of 277 adults in the United States who self-reported at least some level of bothersome tinnitus in the past week. The sample for this study consisted of 129 veterans and 148 nonveterans. Participants read descriptions of CBT, tinnitus retraining therapy (TRT), and mindfulness-based stress reduction (MBSR). For each treatment, presented to them in random order, they provided credibility, expectancy, and acceptability ratings. RESULTS: Among 277 participants, 147 (53.07%) reporting gender were women, 216 (77.98%) reporting race/ethnicity were White, and 129 (46.57%) were veterans of any branch of the U.S. Armed Forces. Veteran ratings of credibility, expectancy, and acceptability were significantly lower than nonveteran ratings across treatments. There were differences in credibility, expectancy, and acceptability ratings across treatments, and post hoc testing revealed that TRT was consistently rated higher than CBT or MBSR. CONCLUSIONS: Despite strong research support, CBT was rated as less acceptable than a different, less widely empirically supported treatment. Veterans' ratings of acceptability were lower than those of nonveterans across all treatments.

Profiling the Physical Performance of Young Boxers with Unsupervised Machine Learning: A Cross-Sectional Study.

Mexico City is the location with the largest number of boxers in Mexico; in fact, it is the first city in the country to open a Technological Baccalaureate in Education and Sports Promotion with a pugilism orientation. This cross-sectional study aimed to determine the physical-functional profile of applicants for admission to the baccalaureate in sports. A total of 227 young athletes (44F; 183M; 15.65 (1.79) years; 63.66 (14.98) kg; >3 years of boxing experience) participated in this study. Body mass (BM), maximal isometric handgrip (HG) strength, the height of the countermovement jump (CMJ), the velocity of straight boxing punches (PV), and the rear hand punch impact force (PIF) were measured. The young boxers were profiled using unsupervised machine learning algorithms, and the probability of superiority (ρ) was calculated as the effect size of the differences. K-Medoids clustering resulted in two sex-independent significantly different groups: Profile 1 (n = 118) and Profile 2 (n = 109). Except for BM, Profile 2 was statistically higher (p < 0.001) with a clear distinction in terms of superiority on PIF (ρ = 0.118), the PIF-to-BM ratio (ρ = 0.017), the PIF-to-HG ratio (ρ = 0.079) and the PIF-to-BM+HG ratio (ρ = 0.008). In general, strength levels explained most of the data variation; therefore, it is reasonable to recommend the implementation of tests aimed at assessing the levels of isometric and applied strength in boxing gestures. The identification of these physical-functional profiles might help to differentiate training programs during sports specialization of young boxing athletes.

New Onset Autoimmune Diseases after the Sputnik Vaccine.

The vertiginous advance for identifying the genomic sequence of SARS-CoV-2 allowed the development of a vaccine including mRNA-based vaccines, inactivated viruses, protein subunits, and adenoviral vaccines such as Sputnik. This study aims to report on autoimmune disease manifestations that occurred following COVID-19 Sputnik vaccination. Patients and Methods: A retrospective study was conducted on patients with new-onset autoimmune diseases induced by a post-COVID-19 vaccine between March 2021 and December 2022, in two referral hospitals in Mexico City and Argentina. The study evaluated patients who received the Sputnik vaccine and developed recent-onset autoimmune diseases. Results: Twenty-eight patients developed recent-onset autoimmune diseases after Sputnik vaccine. The median age was 56.9 ± 21.7 years, with 14 females and 14 males. The autoimmune diseases observed were neurological in 13 patients (46%), hematological autoimmune manifestations occurred in 12 patients (42%), with thrombotic disease observed in 10 patients (28%), and autoimmune hemolytic anemia in two patients (7.1%). Rheumatological disorders were present in two patients (7.1%), and endocrine disorders in one patient (3.5%). Principio del formulario Conclusion: Although the COVID-19 Sputnik vaccine is generally safe, it can lead to adverse effects. Thrombosis and Guillain-Barre were the most frequent manifestations observed in our group of patients.

Prolactin reduces the kainic acid-induced increase in intracellular Ca2+ concentration, leading to neuroprotection of hippocampal neurons.

The aim of this study was to determine the effect of prolactin (PRL) on intracellular calcium (Ca2+) concentration and its neuroprotective role in a model of kainic acid (KA) excitotoxicity in primary cultures of hippocampal neurons. Cell viability and intracellular Ca2+ concentrations were determined by MTT and Fura-2 assays, respectively, either after induction by KA as an agonist or after treatment with NBQX antagonist alone or in combination with PRL administration. Expression of ionotropic glutamatergic receptors (iGluRs) subunits in neuronal cells was determined by RT-qPCR. Dose-response treatments with KA or glutamate (Glu), the latter used as endogenous agonist control, induced a significant increase in neuronal intracellular Ca2+ concentration followed by a significant decrease in hippocampal neuronal viability. Administration of PRL induced a significant increase in neuronal viability after treatment with KA. Furthermore, administration of PRL decreased intracellular Ca2+ concentrations induced by KA treatment. Independent administration of the AMPAR-KAR antagonist reversed cell death and reduced intracellular Ca2+ concentration in a similar manner as PRL. Additionally, mRNA expression of AMPAR, KAR and NMDAR subtypes were detected in hippocampal neurons; however, no significant changes in iGluRs subunit expression were observed due to excitotoxicity or PRL treatment. The results suggest that PRL inhibits the increase in intracellular Ca2+ concentration induced by KA, leading to neuroprotection.

The cytotoxicity effect of 7-hydroxy-3,4-dihydrocadalene from Heterotheca inuloides and semisynthetic cadalenes derivates towards breast cancer cells: involvement of oxidative stress-mediated apoptosis.

Background: Heterotheca inuloides, traditionally employed in Mexico, has demonstrated anticancer activities. Although it has been proven that the cytotoxic effect is attributed to cadinane-type sesquiterpenes such as 7-hydroxy-3,4-dihydrocadalene, the mechanism of action by which these agents act in tumor lines and their regulation remain unknown. This study was undertaken to investigate for first time the cytotoxic activity and mechanism of action of 7-hydroxy-3,4-dihydrocadalene and two semi-synthetic cadinanes derivatives towards breast cancer cells. Methods: Cell viability and proliferation were assayed by thiazolyl blue tetrazolium bromide (MTT) assay and Trypan blue dye exclusion assay. Cell migration measure was tested by wound-healing assay. Moreover, the reactive oxygen species (ROS) and lipid peroxidation generation were measured by 2',7'-dichlorofluorescein diacetate (DCFH-DA) assay and thiobarbituric acid reactive substance (TBARS) assay, respectively. Furthermore, expression of caspase-3, Bcl-2 and GAPDH were analyzed by western blot. Results: The results showed that 7-hydroxy-3,4-dihydrocadalene inhibited MCF7 cell viability in a concentration and time dependent manner. The cytotoxic potency of semisynthetic derivatives 7-(phenylcarbamate)-3,4-dihydrocadalene and 7-(phenylcarbamate)-cadalene was remarkably lower. Moreover, in silico studies showed that 7-hydroxy-3,4-dihydrocadalene, and not so the semi-synthetic derivatives, has optimal physical-chemical properties to lead a promising cytotoxic agent. Further examination on the action mechanism of 7-hydroxy-3,4-dihydrocadalene suggested that this natural product exerted cytotoxicity via oxidative stress as evidenced in a significantly increase of intracellular ROS levels and in an induction of lipid peroxidation. Furthermore, the compound increased caspase-3 and caspase-9 activities and slightly inhibited Bcl-2 levels. Interestingly, it also reduced mitochondrial ATP synthesis and induced mitochondrial uncoupling. Conclusion: Taken together, 7-hydroxy-3,4-dihydrocadalene is a promising cytotoxic compound against breast cancer via oxidative stress-induction.

Unreported ent-rosane diterpenes from Croton niveus Jacq. (Euphorbiaceae). Cytotoxic activity and docking studies.

From the bioactive extract of the euphorbiaceous Croton niveus Jacq., three previously unreported ent-rosane diterpenes have been isolated and characterized by conventional methods, in addition to the known compounds lupeol, cajucarinolide and some phytosterols. Two of the ent-rosane diterpenes displayed activity against HCT-15 and PC-3 cancer cell lines, and the results of docking calculations of these compounds with NF-κB and STAT3 receptors agreed with the proposed mode of action of diterpenes against PC-3 cells.

Prolactin-induced neuroprotection against excitotoxicity is mediated via PI3K/AKT and GSK3ß/NF-κB in primary cultures of hippocampal neurons.

Prolactin (PRL) is a polypeptide hormone that has been reported to play a significant role in neuroprotection against neuronal excitotoxicity produced by glutamate (Glu) or kainic acid (KA) in both, in vitro and in vivo models. However, the molecular mechanisms involved in PRL's neuroprotective effects in the hippocampus have not been completely elucidated. The aim of the present study was to assess the signaling pathways involved in PRL neuroprotection against excitotoxicity. Primary rat hippocampal neuronal cell cultures were used to assess PRL-induced signaling pathway activation. The effects of PRL on neuronal viability, as well as its effects on activation of key regulatory pathways, phosphoinositide 3-kinases/Protein Kinase B (PI3K/AKT) and glycogen synthase kinase 3ß / nuclear factor kappa B (GSK3ß/NF-κB), were evaluated under conditions of Glutamate-induced excitotoxicity. Additionally, the effect on downstream regulated genes such as Bcl-2 and Nrf2, was assessed. Here, we show that the PI3K/AKT signaling pathway is activated by PRL treatment during excitotoxicity, promoting neuronal survival through upregulation of active AKT and GSK3ß/NF-κB, resulting in induction of Bcl-2 and Nrf2 gene expression. Inhibition of the PI3K/AKT signaling pathway abrogated the protective effect of PRL against Glu-induced neuronal death. Overall, results indicate that the neuroprotective actions of PRL are mediated in part, by the activation of the AKT pathway and survival genes. Our data support the idea that PRL could be useful as a potential neuroprotective agent in different neurological and neurodegenerative diseases.

Panorama de la ectasia coronaria en el Instituto Nacional de Cardiología Ignacio Chávez: un estudio transversal / Outlook of coronary ectasia at the National Institute of Cardiology Ignacio Chávez: a cross-sectional study

Resumen Introducción: La ectasia coronaria (EC) es una remodelación patológica con una prevalencia mundial baja. Se define como una dilatación difusa mayor a 1.5 veces el diámetro de los segmentos adyacentes de esta o diferentes arterias coronarias. Objetivo: Documentar las características clínicas y angiográficas, y el tratamiento médico que reciben los pacientes con diagnóstico de EC en el Instituto Nacional de Cardiología (INC). Métodos: Estudio de tipo transversal con diseño no experimental descriptivo, con un muestreo por conveniencia no probabilístico. Resultados: De 69 pacientes que asistieron al INC con diagnóstico de EC la mayor parte eran hombres, con una media de edad de 56 ± 11 años, el factor de riesgo coronario más común en los pacientes con EC fue el tabaquismo, en 40 (58%); se asoció un infarto agudo de miocardio con elevación del segmento ST (IAMCEST) en 45 (65.2%), de localización frecuente en la cara inferior 18 (40%), relacionado con la arteria más afectada, la coronaria derecha 48 (69.6%), seguida de la circunfleja 39 (56.5%). Destaca el uso preferente de la terapia antiplaquetaria dual con anticoagulante (APD+ACO) en 40 (58%) al egreso de cada paciente del INC. Conclusión: La EC es una remodelación patológica no infrecuente en el INC. En este estudio se evidenció que el SCA-IAMCEST es la manifestación más típica de la EC, la coronariografía diagnóstica identificó un Markis tipo 3, por lo que se esperaría una tasa baja de mortalidad y recurrencia de eventos cardiovasculares y a pesar de no existir un consenso sobre la terapia ideal, en el INC se prefiere el tratamiento individualizado, recomendando modificación en el estilo de vida y empleando como tratamiento médico el uso de la triple terapia (APD+ACO) solo al momento de egreso del paciente.

Abstract Introduction: Coronary Ectasia (CE) is a pathological remodeling with a low worldwide prevalence. It is defined as a diffuse dilatation greater than 1.5 times the diameter of the adjacent segments of the same or different coronary arteries. Objective: To document the clinical and angiographic characteristics, and medical treatment at the discharge of patients diagnosed with coronary ectasia who attended the National Institute of Cardiology (INC). Methods: Cross-sectional study with a non-experimental descriptive design, with a non-probabilistic convenience sampling. Results: Of 69 patients who attended the INC with a diagnosis of CD, most were men, with a mean age of 56 + 11 years, the most common coronary risk factor in patients with CE was smoking 58% (40); it was associated mostly with an acute myocardial infarction ST-segment elevation (STEMI) 65.2% (45), of frequent location in the lower face 40% (18), correlated with the most affected artery is the Right Coronary Artery (CD) 69.6% (48), followed by the circumflex (Cx) 56.5% (39). A mean LVEF of 47 + 9.72 was evident within the ventricular function. As well as the preferential use of dual antiplatelet therapy with anticoagulant (DAP + OAC) in 58% (40) at the discharge of each patient from the INC. Conclusion: CE is a not uncommon pathological remodeling in INC. This study showed that STEMI is the most typical manifestation of CE, diagnostic coronary angiography identified a type 3 Markis, so a low rate of mortality and recurrence of cardiovascular events would be expected, and despite the lack of consensus on the ideal therapy, at the INC individualized treatment is preferred, recommending lifestyle changes, and using triple therapy (DAP + OAC) as a medical treatment only at the time of patient discharge.

Rigorous and rapid evidence assessment in digital health with the evidence DEFINED framework.

Dozens of frameworks have been proposed to assess evidence for digital health interventions (DHIs), but existing frameworks may not facilitate DHI evidence reviews that meet the needs of stakeholder organizations including payers, health systems, trade organizations, and others. These organizations may benefit from a DHI assessment framework that is both rigorous and rapid. Here we propose a framework to assess Evidence in Digital health for EFfectiveness of INterventions with Evaluative Depth (Evidence DEFINED). Designed for real-world use, the Evidence DEFINED Quick Start Guide may help streamline DHI assessment. A checklist is provided summarizing high-priority evidence considerations in digital health. Evidence-to-recommendation guidelines are proposed, specifying degrees of adoption that may be appropriate for a range of evidence quality levels. Evidence DEFINED differs from prior frameworks in its inclusion of unique elements designed for rigor and speed. Rigor is increased by addressing three gaps in prior frameworks. First, prior frameworks are not adapted adequately to address evidence considerations that are unique to digital health. Second, prior frameworks do not specify evidence quality criteria requiring increased vigilance for DHIs in the current regulatory context. Third, extant frameworks rarely leverage established, robust methodologies that were developed for non-digital interventions. Speed is achieved in the Evidence DEFINED Framework through screening optimization and deprioritization of steps that may have limited value. The primary goals of Evidence DEFINED are to a) facilitate standardized, rapid, rigorous DHI evidence assessment in organizations and b) guide digital health solutions providers who wish to generate evidence that drives DHI adoption.

Women with Acute Myocardial Infarction: Clinical Characteristics, Treatment, and In-Hospital Outcomes from a Latin American Country.

Background: Women are underrepresented in acute myocardial infarction (AMI) studies. Furthermore, there is scarce information regarding women with AMI in Latin America. Aims: To describe the presentation, clinical characteristics, risk factor burden, evidence-based care, and in-hospital outcome in a population of women with AMI admitted to a coronary care unit (CCU) in Mexico. Methods: Retrospective cohort study including patients with AMI admitted from January 2006 to December 2021 in a CCU. We identified patients with ST-segment elevation myocardial infarction (STEMI) and non-ST-segment elevation myocardial infarction (NSTEMI). We described demographic characteristics, clinical variables, treatment, and in-hospital outcomes according to gender. Cox regression analysis was used to identify predictors of mortality. Results: Our study included 12,069 patients with AMI, of whom 7,599 had STEMI and 4,470 had NSTEMI. Women represented 19.6% of the population. Women had higher rates of hypertension, diabetes, stroke, and atrial fibrillation than men. For STEMI, women were less likely to receive reperfusion therapy (fibrinolysis; 23.7 vs. 28.5%, p < 0.001 and primary percutaneous coronary intervention (PCI); 31.2 vs. 35.1%, p = 0.001) and had more major adverse events than men: heart failure (4.2 vs. 2.5%, p = 0.002), pulmonary edema (3.4% vs. 1.7%, p < 0.001), major bleeding (2.1% vs. 1%, p = 0.002), stroke (1.3% vs. 0.6%, p = 0.008), and mortality (15.1% vs. 8.1%, p < 0.001). For NSTEMI, women were less likely to undergo coronary angiography or PCI and had more major bleeding and mortality. Multivariate Cox regression analysis revealed that females had an increase in mortality in STEMI and NSTEMI (HR 1.21, CI 1.01-1.47, p = 0.05 and HR 1.39, CI 1.06-1.81, p = 0.01). Conclusion: Real-world evidence from a hospital in a Latin American low- to middle-income country (LMIC) showed that women with AMI had more comorbidities, received less reperfusion treatment or invasive strategies, and had worse outcomes. In STEMI and NSTEMI, female gender represented an independent predictor of in-hospital mortality.

Outlook of coronary ectasia at the National Institute of Cardiology Ignacio Chávez: a cross-sectional study.

INTRODUCTION: Coronary Ectasia (CE) is a pathological remodeling with a low worldwide prevalence. It is defined as a diffuse dilatation greater than 1.5 times the diameter of the adjacent segments of the same or different coronary arteries. OBJECTIVE: To document the clinical and angiographic characteristics, and medical treatment at the discharge of patients diagnosed with coronary ectasia who attended the National Institute of Cardiology (INC). METHODS: Cross-sectional study with a non-experimental descriptive design, with a non-probabilistic convenience sampling. RESULTS: Of 69 patients who attended the INC with a diagnosis of CD, most were men, with a mean age of 56 + 11 years, the most common coronary risk factor in patients with CE was smoking 58% (40); it was associated mostly with an acute myocardial infarction ST-segment elevation (STEMI) 65.2% (45), of frequent location in the lower face 40% (18), correlated with the most affected artery is the Right Coronary Artery (CD) 69.6% (48), followed by the circumflex (Cx) 56.5% (39). A mean LVEF of 47 + 9.72 was evident within the ventricular function. As well as the preferential use of dual antiplatelet therapy with anticoagulant (DAP + OAC) in 58% (40) at the discharge of each patient from the INC. CONCLUSION: CE is a not uncommon pathological remodeling in INC. This study showed that STEMI is the most typical manifestation of CE, diagnostic coronary angiography identified a type 3 Markis, so a low rate of mortality and recurrence of cardiovascular events would be expected, and despite the lack of consensus on the ideal therapy, at the INC individualized treatment is preferred, recommending lifestyle changes, and using triple therapy (DAP + OAC) as a medical treatment only at the time of patient discharge.

INTRODUCCIÓN: La ectasia coronaria (EC) es una remodelación patológica con una prevalencia mundial baja. Se define como una dilatación difusa mayor a 1.5 veces el diámetro de los segmentos adyacentes de esta o diferentes arterias coronarias. OBJETIVO: Documentar las características clínicas y angiográficas, y el tratamiento médico que reciben los pacientes con diagnóstico de EC en el Instituto Nacional de Cardiología (INC). MÉTODOS: Estudio de tipo transversal con diseño no experimental descriptivo, con un muestreo por conveniencia no probabilístico. RESULTADOS: De 69 pacientes que asistieron al INC con diagnóstico de EC la mayor parte eran hombres, con una media de edad de 56 ± 11 años, el factor de riesgo coronario más común en los pacientes con EC fue el tabaquismo, en 40 (58%); se asoció un infarto agudo de miocardio con elevación del segmento ST (IAMCEST) en 45 (65.2%), de localización frecuente en la cara inferior 18 (40%), relacionado con la arteria más afectada, la coronaria derecha 48 (69.6%), seguida de la circunfleja 39 (56.5%). Destaca el uso preferente de la terapia antiplaquetaria dual con anticoagulante (APD+ACO) en 40 (58%) al egreso de cada paciente del INC. CONCLUSIÓN: La EC es una remodelación patológica no infrecuente en el INC. En este estudio se evidenció que el SCA-IAMCEST es la manifestación más típica de la EC, la coronariografía diagnóstica identificó un Markis tipo 3, por lo que se esperaría una tasa baja de mortalidad y recurrencia de eventos cardiovasculares y a pesar de no existir un consenso sobre la terapia ideal, en el INC se prefiere el tratamiento individualizado, recomendando modificación en el estilo de vida y empleando como tratamiento médico el uso de la triple terapia (APD+ACO) solo al momento de egreso del paciente.