Active but not quiescent lupus nephritis during pregnancy is associated with a higher rate of adverse obstetric outcomes: Analysis of a prospective cohort.

OBJECTIVE: To compare the maternal-fetal/neonatal outcome in patients with systemic lupus erythematosus (SLE) with and without lupus nephritis (LN) in remission or with active disease. METHODS: A prospective cohort of pregnant patients with SLE (ACR 1997 criteria) was studied from January 2009 to December 2021. Demographic, clinical, biochemical, and immunological variables as well as the usual maternal-fetal/neonatal complications were recorded. We compared four groups according to the status of SLE during pregnancy: patients with quiescent SLE without lupus nephritis, patients with active SLE without lupus nephritis, patients with quiescent lupus nephritis, and patients with active lupus nephritis. Statistical analysis included descriptive statistics, bivariate analysis, and Cox regression analysis. RESULTS: A total of 439 pregnancies were studied, with a median age of 28 ± 6, SLE duration of 60 months (interquartile range 36-120). A higher frequency of maternal and fetal/neonatal complications was observed in patients with active SLE with or without lupus nephritis. Multivariate analysis showed that active LN was a risk factor for gestational hypertension (hazard ratios [HR] 1.95; 95% confidence intervals [CI]: 1.01-6.39), premature rupture of membranes (HR 3.56; 95% CI: 1.79-16.05) and more frequent cesarean section (HR 1.82; 95% CI: 1.13-2.94). CONCLUSION: LN is associated with a higher frequency of maternal complications, especially in those patients with active disease during pregnancy, and those maternal complications had an impact on poor fetal/neonatal outcomes. Strict control and timely care of LN could improve the obstetric prognosis.

An Integrated Process Analysis for Producing Glycerol Carbonate from CO2 and Glycerol.

Glycerol carbonate (GC) is one of the most attractive green chemicals involved in several applications such as polymer synthesis, e. g., the production of polyurethanes and polycarbonates. This relevant chemical can be produced, in a green way, using CO2 (from carbon capture) and glycerol (a byproduct from biodiesel manufacturing). Therefore, in this work, a comprehensive analysis of the GC production process is conducted based on the following synthesis route: urea-dimethyl carbonate-GC using carbon dioxide and glycerol as the main raw materials where the synthesis pathway was efficiently integrated using Aspen Plus. A techno-economic analysis was performed in order to estimate the required capital investment and operating cost for the whole GC process, providing insights on individual capital cost requirements for the urea, dimethyl carbonate, and GC production sections. A total capital cost of $192.1 MM, and a total operating cost of $225.7 MM/y were estimated for the process. The total annualized cost was estimated as $1,558 USD/t of GC produced, competitive with current market price.

Análisis de sentimientos y tópicos sobre las vacunas cubanas Soberana 02 y Abdala en Twitter

El análisis de sentimientos o minería de opiniones es una rama de la computación que permite analizar opiniones, sentimientos y emociones en ciertas áreas de interés social como productos, servicios, organizaciones, compañías, eventos y temas de interés actual. En tal sentido se propuso identificar los sentimientos y tópicos presentes en los tweets que hicieron mención a las vacunas cubanas Soberana 02 y Abdala en la red social Twitter. Se optó por los lenguajes de programación Python y R con sus librerías específicas para la ciencia de datos. La primera parte del estudio, que abarcó desde el web scraping hasta la cuantificación de las palabras más usadas, se realizó con Python y las siguientes librerías: tweepy, pandas, re, nltk y matplotlib. Mientras que la segunda, que fue la del análisis de sentimientos y detección de tópicos, se implementó con R y se utilizó: tokenizers, tm, syuzhet, topic modeling, tidyverse, barplot y wordcloud. Se obtuvo que entre los términos con que más se dialoga en Twitter están dosis, vacunas, eficacia, cubanos, candidatos, millones, país, personas, recibido y población. En los tweets las emociones predominantes fueron el miedo y, ligeramente por encima, la confianza; en la polaridad predominó la positiva, como expresión del contexto vivido en el cual se desarrolló la campaña de vacunación. A partir de los tópicos identificados y los términos que se relacionaron con las emociones predominantes, así como por la polaridad, se aprecia consenso en torno a las vacunas Soberana 02 y Abdala.

Sentiment analysis or opinion mining is a branch of computing that allows analyzing opinions, feelings and emotions in certain areas of social interest such as products, services, organizations, companies, events and topics of current interest. In this sense, the objective of this paper was to identify the feelings and topics present in the tweets mentioning the Cuban vaccines Soberana 02 and Abdala on Twitter social network. The programming languages Python and R with their specific libraries for data science were chosen. The first part of the study, which ranged from web scraping to the quantification of the most used words, was carried out with Python and the libraries tweepy, pandas, re, nltk and matplotlib. While the second, which was the sentiment analysis and topic detection, was implemented with R and used tokenizers, tm, syuzhet, topic modeling, tidyverse, barplot, and wordcloud. It was obtained that among the terms with which there is more dialogue on Twitter are doses, vaccines, efficacy, Cubans, candidates, millions, country, people, received and population. In the tweets, the predominant emotions were fear and confidence, slightly above it; in the polarity, the positive one predominated, as an expression of the lived context in which the vaccination campaign was developed. A consensus can be perceived around the vaccines Soberana 02 and Abdala, from the identified topics and the terms that were related to the predominant emotions, as well as the polarity.

Acute pericarditis and pericardial effusion after Covid-19 infection

INTRODUCTION: COVID-19 infection has a wide spectrum of clinical presentations, including cardiovascular, including myocarditis and pericarditis. The prevalence and events associated with this condition still remain under analysis, as well as the repercussion of such complications after the viral infection. CASE DESCRIPTION: 74-year-old female patient, former smoker, bilateral carotid stenosis without hemodynamic repercussions, rheumatoid arthritis and diagnosis of viral pneumonia due to COVID-19 in January 2022. She was admitted, in March 2022, to a referral center in cardiovascular diseases, with a clinical picture of chest pain that worsened during inspiration with 2 months of evolution. Laboratory measurements of troponin and D-dimer within normal limits. Admission electrocardiogram suggestive of pericarditis. Transthoracic echocardiogram (TTECT) revealed preserved biventricular function and pericardial effusion with a greater depth of 11.0 mm. Despite the optimized clinical treatment for the pericarditis, the patient evolved with clinical worsening and rapid evolution of the pericardial effusion initially evident, with a 30.0 mm blade and signs of hemodynamic repercussion, requiring urgent drainage. On the 1st postoperative day in the intensive care unit, the patient evolved with severe acute biventricular dysfunction and need for vasoactive drugs, without response to the established clinical measures, progressing to death. CONCLUSION: The prevalence of underlying pericarditis and pericardial effusion in patients with COVID-19, as well as its clinical significance remains the subject of clinical research. Thus, knowing risk factors and the pathophysiology of cardiovascular complications related to COVID-19 are sine qua non conditions for understanding the clinical presentation, prognosis and therapeutic management.

Representación social de la muerte en un grupo de médicos / Social representation of death in a group of physicians

RESUMEN Introducción: En la relación de los médicos con la muerte en el escenario de lucha que es el hospital se manifiestan procesos psicológicos que legitiman sus conductas de rol. Objetivo: Caracterizar la representación social de la muerte en un grupo de médicos del Hospital Universitario "General Calixto García". Método: Investigación mixta, explicativa y de corte transversal realizada entre junio y septiembre del 2019 en una muestra de 35 médicos. En la etapa cuantitativa se aplicó el instrumento Asociación libre de palabras y para la etapa cualitativa la entrevista semiestructurada. Resultados: El núcleo central está integrado por la categoría Impacto afectivo (FR= 60; M= 3.5), en tanto que los contenidos del sistema periférico que se encuentra más próximos al núcleo en orden estructural son las categorías Concepción racional (FR=20; M= 2.8) y Estado postmorten (FR= 22; M= 4.4); esto en el contexto del Escenario del proceso morir donde ellos interactúan. Discusión: La representación social de la muerte se caracteriza por tener un núcleo central que refleja la diversidad de emociones que se vivencian. En tanto que el sistema periférico da cuenta de los aspectos cognoscitivos que se emplean para una Concepción de la Muerte y que se organizan en torno a la racionalidad biológica como parte del contexto de las características del Escenario del proceso de morir con el que se relacionan.

ABSTRACT Introduction: In the relationship of physicians with death in the scene of struggle that is the hospital, inter and intrasubjective processes are manifested that legimitize their role behaviors. Objective: Characterize the social representation of death in a group of physicians from a clinical-surgical hospital in Havana. Method: Mixed, explanatory and cross-sectional research carried out between June and September 2019 in a non-probabilistic simple of 35 physicians. In the quantitative stage, the Free association of words was applied and for the Qualitative stage, the semi-structured interview Results: The central nucleus is made up of the Affective Impact (FR= 60; M= 3.5) category; while the contents of the peripheral system that are closest to the nucleus in structural order are the categories Rational Conception (FR=20; M= 2.8) and Post-mortem State (FR= 22; M= 4.4). Discussion: The social representation of death is characterized by having a central nucleus that reflects the diversity of emotions that are experienced. While the peripheral system accounts for the cognitive aspects that are used for a conception of death and that are organized around biological rationality. This in the context of the characteristics of the Dying Process Scenario with which they related.

Vaginal Microbiota Is Stable and Mainly Dominated by Lactobacillus at Third Trimester of Pregnancy and Active Childbirth: A Longitudinal Study of Ten Mexican Women.

In healthy women at reproductive age, the vaginal microbiota is mainly dominated by Lactobacillus bacteria during pregnancy and non-pregnancy stages. However, little is known about longitudinal changes within the vaginal microbiota composition from the third trimester of pregnancy to childbirth in healthy women. Thus, we conducted an exploratory longitudinal study of vaginal microbiota composition of 10 Mexican pregnant women, sampling from the same volunteer at two-time points: third trimester of pregnancy and active childbirth. Vaginal bacterial microbiota was characterized by V3-16S rDNA libraries by high-throughput sequencing and bioinformatics methods. Out of ten, vaginal microbiota from eight women was dominated by the Lactobacillus genus at both time points, whereas the other two women showed vaginal microbiota composition with high abundance of genera Gardnerella, Prevotella, and members of the Atopobiaceae family, without any preterm birth correlation. Importantly, we found no statistically significant differences in relative abundances, absolute reads count, alpha and beta diversity between the third trimester of pregnancy, and active childbirth time points. However, compared to the third trimester of pregnancy, we observed a trend with higher absolute reads counts for Gardnerella, Faecalibaculum, Ileibacterium, and Lactococcus genus at active childbirth and lower absolute reads count of Lactobacillus genus. Our results suggest that the vaginal microbiota composition is stable, and Lactobacillus genus is the dominant taxa in Mexican women's vagina at the third trimester of pregnancy and childbirth.

Risk factors for equine trypanosomosis and hematological analysis of horses in Paraguay.

Animal trypanosomosis, caused by Trypanozoon trypanosomes (Trypanosoma evansi and T. equiperdum), and Trypanosoma vivax, is endemic to South American countries and has a negative impact on the livestock industry. However, the risk factors for trypanosomosis in Paraguay remain unknown. This study aimed to determine the risk factors for equine trypanosomosis in Paraguay based on a PCR-based molecular survey and individual horse sampling data. In this study, 739 blood samples were collected from horses in 16 departments of Paraguay between August 2019 and November 2020. To elucidate the risk factors for trypanosome infection, the relationship between trypanosome infection status detected by PCR and the location, sex, age, breed of horses, and season of sample collection was analyzed. There were no significant differences in trypanosome prevalence in horses between the eastern and western regions, ages, or breeds of horses in Paraguay. Sex and season were identified as risk factors for trypanosome infection in horses in Paraguay in the current study. These results suggest that the rainy-summer season, when vectors increase in number and their blood-sucking activity, could be the most important risk factor for trypanosome infection in Paraguay horses. Preventive measures and treatments should be developed to address these factors.

SEOM-GECOD clinical guideline for unknown primary cancer (2021).

Cancer of unknown primary site (CUP) is defined as a heterogeneous group of tumors that appear as metastases, and of which standard diagnostic work-up fails to identify the origin. It is considered a separate entity with a specific biology, and nowadays molecular characteristics and the determination of actionable mutations may be important in a significant group of patients. In this guide, we summarize the diagnostic, therapeutic, and possible new developments in molecular medicine that may help us in the management of this unique disease entity.

Manejo con cirugía conservadora de tumor mucinoso infiltrante ovárico coexistente con tumor mucinoso borderline contralateral en gestante de 8 semanas / Conservative surgery for management of invasive mucinous ovarian tumor with concurrent borderline mucinous tumor on contralateral ovary in a woman in 8th week of pregnancy

INTRODUCCIÓN: Aproximadamente un 4% de mujeres embarazadas presentan tumoraciones anexiales en el primer trimestre de gestación, siendo la mayoría quistes anexiales simples. Solo el 1,5% persisten tras el primer trimestre y en torno al 0,9% son malignos. CASO CLÍNICO: Paciente de 31 años que consultó en urgencias por sangrado y amenorrea de 5 semanas. La ecografía transvaginal evidenció un saco gestacional intraútero y una tumoración anexial izquierda compleja de 68 mm, multilocular, sólida, de ecogenicidad mixta, con septos gruesos y un área sólida vascularizada de 40 mm, sospechosa de neoplasia de ovario. Se realizó manejo quirúrgico conservador mediante anexectomía bilateral laparoscópica en la octava semana de gestación. El diagnóstico fue de adenocarcinoma mucinoso infiltrante bien diferenciado en ovario derecho, coexistente con tumor mucinoso borderline en ovario izquierdo (etapa IC FIGO). El embarazo cursó con normalidad, a excepción de feto pequeño para la edad gestacional en la semana 39. Se finalizó la gestación en la semana 40 mediante parto vaginal. Debido al deseo de la paciente, la cirugía se realizó en el primer trimestre de embarazo en lugar de en el segundo como se recomienda. La cirugía se completó meses después del parto, con histerectomía y apendicectomía laparoscópica. DISCUSIÓN: El cáncer de ovario es el segundo tumor ginecológico más diagnosticado durante el embarazo. Suele diagnosticarse en el primer trimestre debido al cribado ecográfico gestacional. Ocurre en mujeres con baja paridad y en sus últimos años de edad reproductiva. Esto podría verse reflejado en un aumento de su incidencia debido al retraso de la edad materna al primer embarazo. Normalmente se diagnostica en etapa I, siendo entonces la supervivencia superior al 90% a los 5 años. En etapas iniciales en mujeres embarazadas, la laparoscopia es tan válida como la laparotomía.

INTRODUCTION: Approximately 4% of pregnant women present adnexal tumors in the first trimester of gestation, the majority being simple adnexal cysts. Only 1.5% persist after the first trimester and around 0.9% are malignant. CASE REPORT: 31-year-old patient who came to the emergency room because of spotting and 5-week amenorrhea. A transvaginal ultrasound revealed an intrauterine gestational sac and a 69 mm complex multiocular-solid left adnexal tumor, with thick septa and a solid vascularized area of 40 mm, with suspicion of ovarian neoplasia. Conservative surgical management was performed through laparoscopic bilateral salpingo-oophorectomy in eighth week of gestation. The diagnosis was a well-differentiated infiltrating mucinous adenocarcinoma in the right ovary, and a coexisting borderline mucinous tumor in the left ovary (FIGO stage IC). The pregnancy proceeded normally except for a small for gestational age fetus at week 39 and pregnancy was completed at week 40 by vaginal delivery. Due to the patients wishes, the surgery was performed in the 1st trimester of pregnancy instead in the 2nd as is recommended. Final surgery was completed after giving birth, with laparoscopic hysterectomy and appendectomy. DISCUSSION: Ovarian cancer is the second most diagnosed gynecological tumor during pregnancy. It is usually diagnosed during the first trimester with gestational ultrasound screening. It occurs in women with low parity and in their later years of reproductive age. This could be reflected in an increase in its incidence due to the delay in the age of first pregnancy. Normally it is diagnosed in stage I, when the survival rate is superior to 90% after 5 years. In early stages, laparoscopic surgery in pregnant women is as valid as laparotomy.

First molecular survey of animal trypanosomes in Paraguayan horses.

Despite the epidemic situation of animal trypanosomosis caused by Trypanosoma evansi, Trypanosoma equiperdum and Trypanosoma vivax in South American countries, there are no reports for the prevalence of animal trypanosomes in Paraguay. In this study, 408 blood samples were obtained from apparently healthy horses from sixteen departments of Paraguay, for routine medical check-up from August to September 2019, and a polymerase chain reaction (PCR)-based cross-sectional study was carried out to identify trypanosome prevalence. The prevalence of Trypanozoon (T. evansi and T. equiperdum) and T. vivax was 7.11% (29/408) and 26.23% (107/408), respectively. Mixed infections were detected in 4.90% (20/408) of the samples. Some of the selected trypanosome positive samples were confirmed as T. vivax and T. evansi Type A by sequence analysis of the internal transcribe spacer region and RoTat1.2 variant surface glycoprotein gene, respectively. In conclusion, we found higher prevalence of T. vivax than Trypanozoon in Paraguayan horses. However, the genotypic variation should be verified in further studies.

Synthesis, Fungitoxic Activity against Botrytis cinerea and Phytotoxicity of Alkoxyclovanols and Alkoxyisocaryolanols.

Clovane and isocaryolane derivatives have been proven to show several levels of activity against the phytopathogenic fungus Botrytis cinerea. Both classes of sesquiterpenes are reminiscent of biosynthetic intermediates of botrydial, a virulence factor of B. cinerea. Further development of both classes of antifungal agent requires exploration of the structure-activity relationships for the antifungal effects on B. cinerea and phytotoxic effects on a model crop. In this paper, we report on the preparation of a series of alkoxy-clovane and -isocaryolane derivatives, some of them described here for the first time (2b, 2d, 2f-2h, and 4c-4e); the evaluation of their antifungal properties against B. cinerea, and their phytotoxic activites on the germination of seeds and the growth of radicles and shoots of Lactuca sativa (lettuce). Both classes of compound show a correlation of antifungal activity with the nature of side chains, with the best activity against B. cinerea for 2d, 2h, 4c and 4d. In general terms, while 2-alkoxyclovan-9-ols (2a-2e) exert a general phytotoxic effect, this is not the case for 2-arylalkoxyclovan-9-ols (2f-2i) and 8-alkoxyisocaryolan-9-ols (4a-4d), where stimulating effects would make them suitable candidates for application to plants.

Actitudes ante la muerte en cirujanos e internistas

RESUMEN Introducción: La muerte en el contexto hospitalario, es un estresor crítico que para el médico en su asistencia es parte del rol profesional, lo cual produce diferentes actitudes de afrontamiento. Objetivo: Comparar las actitudes ante la muerte en médicos cirujanos e internistas de un hospital clínico quirúrgico. Método: Investigación cuantitativa, descriptiva y transversal, realizada en agosto del 2019, en una muestra intencional de 30 cirujanos y 33 internistas. Se empleó el Cuestionario de Actitudes ante la Muerte - 2, compuesto por 32 ítems distribuidos en 6 subescalas. Resultados: Hubo desacuerdos con tener actitudes religiosas tanto en cirujanos como en internistas. No se manifestaron actitudes de ansiedad ante la muerte ni actitudes proeutanasia. Se identificaron posiciones no definidas con relación a las actitudes de distanciamiento profesional. Se mostró ambigüedad con respecto a las actitudes de vulnerabilidad afectiva y de evasión ante la muerte. No hubo asociación entre la edad y la experiencia profesional con respecto a las actitudes caracterizadas. Conclusiones: Las actitudes ante la muerte entre internistas y cirujanos se caracterizaron por ser predominantemente homogéneas. No se halla ningún tipo de relación entre las variables sociodemográficas edad y experiencia laboral, con respecto a las actitudes ante la muerte.

ABSTRACT Introduction: Death in the hospital context is a critical stressor; for the doctor in his care, is part of the professional role, producing different coping attitudes. Objective: To compare the attitudes to death in surgeons and internists of clinical-surgical hospital. Methods: Quantitative, descriptive and cross-sectional research conducted in August 2019, in an intentional sample of 30 surgeons and 33 internists. The Attitudes to Death Questionnare-2 was used, composed of 32 items distributed in 6 subscales. Results: There were disagreements with having religious attitudes both surgeons and internists. There were no anxiety attitudes towards death as well as pro-euthanasia attitudes. Undefined positions were identified in relation to professional distancing attitudes. There was ambiguity regarding attitudes of affective vulnerability and evasion before death. There was no association between age and professional experience with respect to the attitudes characterized. Conclusions: The attitudes to death between surgeons and internists were characterized by being predominantly homogeneous. No type of relationship was found between the sociodemographic variables age and work experience with respect to attitudes towards death.

Analytic approach for the number statistics of non-Hermitian random matrices.

We introduce a powerful analytic method to study the statistics of the number N_{A}(γ) of eigenvalues inside any smooth Jordan curve γ∈C for infinitely large non-Hermitian random matrices A. Our generic approach can be applied to different random matrix ensembles of a mean-field type, even when the analytic expression for the joint distribution of eigenvalues is not known. We illustrate the method on the adjacency matrices of weighted random graphs with asymmetric couplings, for which standard random-matrix tools are inapplicable, and obtain explicit results for the diluted real Ginibre ensemble. The main outcome is an effective theory that determines the cumulant generating function of N_{A} via a path integral along γ, with the path probability distribution following from the numerical solution of a nonlinear self-consistent equation. We derive expressions for the mean and the variance of N_{A} as well as for the rate function governing rare fluctuations of N_{A}(γ). All theoretical results are compared with direct diagonalization of finite random matrices, exhibiting an excellent agreement.

Spatial distribution and level of contamination of potentially toxic elements in sediments and soils of a biological reserve wetland, northern Amazon region of Ecuador.

This study quantifies the degree of pollution and assess the ecological risk of As, Ba, Cd, Co, Cr, Cu, Mo, Ni, Pb, V and Zn in sediments and soils of the Limoncocha Biological Reserve (Ecuador), identified as a Ramsar site with high ecological and socioeconomic value. The hydrologic system of the Reserve is mainly formed by two rivers that drain into the Limoncocha lagoon, which occupies only five percent of the protected area but support a high anthropic influence. Local statistical baseline of studied potentially toxic elements is established using cumulative frequency method, and Al is selected as reference element due to the good correlation with the studied elements. The grade of pollution and the potential ecological risk are evaluated applying three individual (Contamination Factor, Geo-accumulation Index and Enrichment Factor) and six integrated (Degree and modified degree of contamination, Pollution Load Index, Nemerow and modified Nemerow pollution indexes and potential ecological risk index) indices. Results analysis are based on the combined application of traditional statistics, multivariate data analysis and self organizing maps. Outcomes suggest to classify sediments and soils as "moderate contamination and enrichment" due mainly to the concentrations of Cu (66.4-110 mg/kg) and Cd (0.0262-0.808 mg/kg), derived from domestic wastewaters and agricultural activities, and in a lesser extent due to Mo (0.822-4.37 mg/kg), Ni (10.3-25.8 mg/kg), Co (7.27-24.8 mg/kg) and V (60.3-178 mg/kg), derived from oil field drilling activities. The distributions of As (0.328-8.83 mg/kg), Ba (143-1100 mg/kg), Pb (7.20-26.5 mg/kg), Zn (60.1-276 mg/kg) and Cr (10.1-48.6 mg/kg) are heterogeneous in the studied sampling sites. Sediments located next to the pier and at the central area of the Limoncocha lagoon, show moderate potential risk and according to sediment quality guidelines, the calculated mean Effect Range Median quotient (mERMq) classify the sites as medium-low priority risk level. A three-level classification of a mean quotient based on soil quality and soil potential uses is proposed. Soil sites with high anthropogenic activities show low to moderate potential ecological risk being classified as poor soil quality sites but with all potential soil uses allowed according to the legal limits for land uses in Ecuador.

Impact of Systemic Lupus Erythematosus on Pregnancy: Analysis of a Large 10-Year Longitudinal Mexican Cohort.

BACKGROUND: Pregnancy in patients with systemic lupus erythematosus is considered a high risk one since it is associated with a higher rate of maternal-fetal complications compared with the pregnancies in healthy women. OBJECTIVES: The aim of this study was to describe the maternal-fetal outcomes in a cohort of Mexican patients with systemic lupus erythematosus and to identify risk factors associated with adverse maternal and fetal outcomes. PATIENTS AND METHODS: A cohort of pregnant lupus patients was analyzed. Maternal-fetal complications were described, and clinical, biochemical, and immunological variables associated with obstetric adverse outcomes were studied. Descriptive statistics, comparison of variables using appropriate tests, and finally logistic regression analysis were performed to identify potential risk factors for adverse maternal and fetal outcomes. RESULTS: A total of 351 pregnancies were included in a 10-year period. The most frequently observed maternal adverse outcomes were lupus flare (35%) and preeclampsia (14.5%). Active lupus before pregnancy (hazards ratio [HR], 3.7; 95% confidence interval [CI], 1.1-12.5; p = 0.003) was a predictor for these complications, whereas the use of antimalarial drugs (HR, 0.4; 95% CI, 0.2-0.7; p = 0.007) was a protective factor. The most frequent fetal adverse outcomes were preterm birth (38.1%), miscarriages (10%), and low birth weight babies (28%), and very low birth weight newborns (11%). Proteinuria in early pregnancy (HR, 7.1; 95% CI, 1.01-50.3; p = 0.04) and preeclampsia (HR, 9.3; 95% CI, 1.7-49.7; p = 0.009) were risk factors associated with these complications. CONCLUSIONS: Variables related to systemic lupus erythematosus activity predict an adverse maternal outcome, whereas proteinuria in early pregnancy and preeclampsia are associated with an adverse fetal outcome.

IoT-Based Electricity Bill for Domestic Applications.

This work proposes a real-time electricity bill for quantifying the energy used in domestic facilities in Mexico. This bill is a low-cost tool that takes advantage of the IoT technology for generating an easy reading real-time bill allowing the customers to constantly review and administrate their energy consumption. Using low-cost sensors and the electronic board Particle® Photon, an energy meter is proposed. The presented prototype is extremely compact and satisfies safety measures to be used by anyone in a domestic installation. The measurement data is displayed and processed in real-time, and an appropriate algorithm determines the accumulated kWh. The energy consumed is displayed using an Html interface of easy interpretation for the customers, given recommendations about their consumption habits and some alarms in case of abnormal or high consumption. As a reinforcement measure for avoiding large consumption bills, the system is programmed to send messages to the user, remembering if the estimated consumption is large.

Bond reactivity indices approach analysis of the [2+2] cycloaddition of jatrophane skeleton diterpenoids from Euphorbia gaditana Coss to tetracyclic gaditanone.

The reaction mechanism of the intramolecular [2 + 2] cycloaddition from a jatrophane precursor to the gaditanane skeleton, an unprecedented 5/6/4/6-fused tetracyclic ring framework recently isolated from Euphorbia spp., was studied using the bond reactivity indices approach. Furthermore, six diterpenoids, including three undescribed jatrophanes isolated from E. gaditana Coss, were described. The structures of these compounds were deduced by a combination of 2D NMR spectroscopy and ECD data analysis.

New Mesoporous Silica-Supported Organocatalysts Based on (2S)-(1,2,4-Triazol-3-yl)-Proline: Efficient, Reusable, and Heterogeneous Catalysts for the Asymmetric Aldol Reaction.

Novel organocatalytic systems based on the recently developed (S)-proline derivative (2S)-[5-(benzylthio)-4-phenyl-(1,2,4-triazol)-3-yl]-pyrrolidine supported on mesoporous silica were prepared and their efficiency was assessed in the asymmetric aldol reaction. These materials were fully characterized by FT-IR, MS, XRD, and SEM microscopy, gathering relevant information regarding composition, morphology, and organocatalyst distribution in the doped silica. Careful optimization of the reaction conditions required for their application as catalysts in asymmetric aldol reactions between ketones and aldehydes afforded the anticipated aldol products with excellent yields and moderate diastereo- and enantioselectivities. The recommended experimental protocol is simple, fast, and efficient providing the enantioenriched aldol product, usually without the need of a special work-up or purification protocol. This approach constitutes a remarkable improvement in the field of heterogeneous (S)-proline-based organocatalysis; in particular, the solid-phase silica-bonded catalytic systems described herein allow for a substantial reduction in solvent usage. Furthermore, the supported system described here can be recovered, reactivated, and reused several times with limited loss in catalytic efficiency relative to freshly synthesized organocatalysts.

Desgarro perineal con mucosa vaginal íntegra tras primera relación sexual / Perineal tear with intact vaginal mucosa after first sexual intercourse

RESUMEN Las lesiones del tracto genital femenino tras relaciones sexuales son un problema frecuente en las urgencias de ginecología, pero poco estudiado salvo su aspecto médico-legal. Su incidencia es desconocida ya que muchas mujeres no llegan a consultar por miedo o pudor. El reconocimiento precoz de estas lesiones y su correcto tratamiento puede evitar la parición de secuelas que acompañarán a nuestra paciente durante el resto de su vida. Presentamos el caso de una paciente de 18 años con un desgarro perineal con mucosa vaginal íntegra tras su primera relación sexual.

ABSTRACT Injuries to the female genital tract after sexual intercourse are a frequent problem in gynecological emergencies, but little studied except for their medico-legal aspect. Its incidence is unknown since many women do not go to their specialist out of fear or embarrassment. Early recognition of these injuries and their correct treatment may prevent the appearance of sequelae that will accompany our patient for the rest of her life. We present the case of an 18-year-old patient with a perineal tear with intact vaginal mucosa after her first sexual intercourse.

Use of antimalarial drugs is associated with a lower risk of preeclampsia in lupus pregnancy: A prospective cohort study.

INTRODUCTION: Several factors have been associated with the development of preeclampsia in women with systemic lupus erythematosus (SLE). OBJECTIVE: To identify risk factors associated with preeclampsia in patients with SLE and its impact on fetal outcomes. PATIENTS AND METHODS: We studied a prospective cohort of pregnancies in women with SLE from January 2009 to December 2018. Demographic, clinical, serological and drug use characteristics were compared between patients who developed preeclampsia and those who did not, as well as the main neonatal outcomes. An adjusted logistic regression analysis was performed to identify factors potentially associated with preeclampsia. RESULTS: We studied 316 pregnancies of 20 or more weeks of gestation. A total of 46 pregnancies (14.5%) were complicated by preeclampsia. A higher frequency of active disease before pregnancy (24.4% vs 11.3%, P = .01) and history of lupus nephritis (56.5% vs 30.1%, P < .001) were found in those patients who developed preeclampsia compared to those who did not. Preeclampsia was associated with a higher rate of prematurity, births of very low birth weight, stillbirth, and neonatal death. The multivariate analysis showed that the activity of the disease before (relative risk [RR] 2.7, 95% CI 1.04-7.4, P = .04) and during pregnancy (RR 3.0, 95% CI 1.0-9.1, P = .04) was associated with the development of preeclampsia. The use of antimalarial drugs during pregnancy was associated with a lower risk of preeclampsia (RR 0.21, 95% CI 0.08-0.53, P < .001). CONCLUSIONS: Our study suggests that the use of antimalarial drugs during pregnancy reduces the risk of preeclampsia in lupus pregnancies.