The Inflammasome-Dependent Dysfunction and Death of Retinal Ganglion Cells after Repetitive Intraocular Pressure Spikes.

The dysfunction and selective loss of retinal ganglion cells (RGCs) is a known cause of vision loss in glaucoma and other neuropathies, where ocular hypertension (OHT) is the major risk factor. We investigated the impact of transient non-ischemic OHT spikes (spOHT) on RGC function and viability in vivo to identify cellular pathways linking low-grade repetitive mechanical stress to RGC pathology. We found that repetitive spOHT had an unexpectedly high impact on intraocular homeostasis and RGC viability, while exposure to steady OHT (stOHT) of a similar intensity and duration failed to induce pathology. The repetitive spOHT induced the rapid activation of the inflammasome, marked by the upregulation of NLRP1, NLRP3, AIM2, caspases -1, -3/7, -8, and Gasdermin D (GSDMD), and the release of interleukin-1ß (IL-1ß) and other cytokines into the vitreous. Similar effects were also detected after 5 weeks of exposure to chronic OHT in an induced glaucoma model. The onset of these immune responses in both spOHT and glaucoma models preceded a 50% deficit in pattern electroretinogram (PERG) amplitude and a significant loss of RGCs 7 days post-injury. The inactivation of inflammasome complexes in Nlrp1-/-, Casp1-/-, and GsdmD-/- knockout animals significantly suppressed the spOHT-induced inflammatory response and protected RGCs. Our results demonstrate that mechanical stress produced by acute repetitive spOHT or chronic OHT is mechanistically linked to inflammasome activation, which leads to RGC dysfunction and death.

4Ms for Early Learners: A Skills-Based Geriatrics Curriculum for Second-Year Medical Students.

Introduction: Given the growing population of older adults, it is of utmost importance for all future physicians to be trained in the core skills of conducting geriatric assessment. Methods: We designed an interactive, skills-based session introducing core competencies for geriatric assessment for second-year medical students (MS2s). We organized our curriculum for early learners based on the 4Ms framework: mind/memory, medications, mobility, and matters most. The session consisted of brief didactics with integration of real-time skills-based practice. Students completed pre- and postsession surveys to assess their confidence in their knowledge and skills. All students completed a geriatric assessment during a clinical skills encounter as part of a multistation, end-of-course, summative clinical skills examination (CSE). The session was conducted virtually over 2 academic years, and the CSE was conducted virtually in 2020 and in person in 2021. Results: One hundred ninety-nine MS2s participated in the session (100 in 2020, 99 in 2021). All students surveyed (33%) reported improved confidence in geriatric knowledge and skills by the end of the session (ps < .001). Students were more likely to use a cognitive screening tool, ask about advance care planning, and assess medication adherence on the CSE in 2021 compared to 2020 (ps < .001). Discussion: We provide an interactive curriculum for MS2s to develop geriatric assessment skills. The curriculum and assessment tools are versatile, can be easily integrated into any medical school curriculum, and can be effectively delivered in person or on a virtual platform.

Eating habits and mental health among rugby players of the Peruvian pre-selection during the second quarantine due to the COVID-19 pandemic.

OBJECTIVES: Social isolation during the COVID-19 pandemic impacts the mental health and diet of populations. AIM: The aim of the study was to evaluate whether the eating habits and mental health status of the rugby players of the Peruvian pre-selection were affected by the second quarantine of the COVID-19 pandemic. METHODS: A cross-sectional study was carried out through a pre-structured online survey in 74 players, 42 men (56.8%) and 32 women (43.2%). The mean age was 20.5 ± 4.4 years. Participants completed a validated food frequency questionnaire and depression, anxiety, and stress scale-21 (DASS-21). RESULTS: 58.1% of the respondents reported that their dietary intake remained the same or increased. 58.3% of the players experienced anxiety, among which 26.4% reported moderate and severe symptoms. A greater proportion of participants <20 years old reported depression compared to those ⩾20 years (68.6% vs 31.4%, p = 0.010). Those who reported inadequate food intake were more likely to report depressive symptoms (p = 0.006). CONCLUSION: These findings reaffirm the need to implement programs of psychological support and nutritional counseling among athletes to reduce negative symptoms and better face mental health and dietary challenges in these times of crisis.

Results of the implementation of a pilot model for the bidirectional screening and joint management of patients with pulmonary tuberculosis and diabetes mellitus in Mexico.

BACKGROUND: Recently, the World Health Organisation and the International Union Against Tuberculosis and Lung Disease published a Collaborative Framework for the Care and Control of Tuberculosis (TB) and Diabetes (DM) (CFTB/DM) proposing bidirectional screening and joint management. OBJECTIVE: To evaluate the feasibility and effectiveness of the CFTB/DM in Mexico. DESIGN: Prospective observational cohort. SETTING: 15 primary care units in 5 states in Mexico. PARTICIPANTS: Patients aged ≥20 years diagnosed with DM or pulmonary TB who sought care at participating clinics. INTERVENTION: The WHO/Union CFTB/DM was adapted and implemented according to official Mexican guidelines. We recruited participants from July 2012 to April 2013 and followed up until March 2014. Bidirectional screening was performed. Patients diagnosed with TB and DM were invited to receive TB treatment under joint management. MAIN OUTCOME MEASURES: Diagnoses of TB among DM, of DM among TB, and treatment outcomes among patients with DM and TB. RESULTS: Of 783 DM patients, 11 (1.4%) were unaware of their TB. Of 361 TB patients, 16 (4.4%) were unaware of their DM. 95 TB/DM patients accepted to be treated under joint management, of whom 85 (89.5%) successfully completed treatment. Multiple linear regression analysis with change in HbA1c and random capillary glucose as dependent variables revealed significant decrease with time (regression coefficients (ß)  = -0.660, (95% confidence interval (CI), -0.96 to -0.35); and ß = -1.889 (95% CI, -2.77 to -1.01, respectively)) adjusting by sex, age and having been treated for a previous TB episode. Patients treated under joint management were more likely to experience treatment success than patients treated under routine DM and TB programs as compared to historical (adjusted OR (aOR), 2.8, 95%CI 1.28-6.13) and same period (aOR 2.37, 95% CI 1.13-4.96) comparison groups. CONCLUSIONS: Joint management of TB and DM is feasible and appears to improve clinical outcomes.

Susceptibility of Arcobacter butzleri to heavy metals

Arcobacter butzleri é um bacilo Gram negativo de caráter zoonótico, pertencente à Família Campylobacteraceae, que tem sido associado a diarréia e septicemia no ser humano. A susceptibilidade de 50 amostras de A. butzleri isoladas de fígados de frango [12], mariscos [18], água de rio [6] e fezes de bovinos [5], patos [2] e pelicanos [7] aos metais pesados mercúrio (Hg), cromo (Cr), prata (Ag), níquel (Ni), cobalto Co), ferro (Fe), manganês (Mn), molibdênio (Mo) e chumbo (Pb) foi determinada.Todas as amostras foram resistentes a Mo, Mn, Ni, Co, Pb e Fe, sendo susceptíveis a Hg, Ag e Cr. Os valores das CIM apresentaram alta variabilidade indicando um comportamento não homogêneo entre as amostras.

Micetomas en el cuello: informe de dos minimicetomas pediátricos por nocardia sp / Mycetomas on the neck: report tof two pediatric minimycetomas due to nocardia sp

Se presentan dos pacientes pediátricos con minimicetomas en el cuello por Nocardia sp. El diagnóstico representó un reto y ambos pacientes se manejaron con sulfonas con respuesta favorable. El informe de estos casos es por lo singular de la localización, presentación en el sexo femenino y en niños

Leptospirosis: una enfermadad rara en México. Revisión de un caso / Leptospirosis:a rare disease in Mexico: A review of a case

Se comunica el caso de un enfermo diagnosticado inicialmente como dengue hemorrágico, en quien los estudios de laboratorio confirmaron infección por Leptospira. Dada la elevada frecuencia del dengue hemorrágico y la confluencia de factores de riesgo para su aparición en amplias zonas del país, además de la similitud de su cuadro clínico con las formas icterohemorrágicas de la infección por Leptospira, se hace obligatorio establecer en forma rutinaria el diagnóstico diferencial entre ambos padecimientos. Hasta hace algunos años estos padecimientos se consideraban raros en Latinoamérica; no obstante, existen demostraciones de brotes importantes en diversas área. Hay varios estudios que indican que la frecuencia de infección por Leptospira es alta y que su espectro clínico es amplio. En este trabajo se hace hincapié en la importancia de considerar ambos diagnósticos en pacientes de cualquier edad con manifestaciones hemorrágicas y se abren las puertas para la investigación aplicada sobre su frecuencia y distribución; asimismo, se contemplan los factores de riesgo más importantes para su aparición y se establece la necesidad de reforzar la vigilancia del padecimiento y la capacidad diagnóstica en el laboratorio, incluyendo las pruebas para Leptospira como parte de los estudios rutinarios en pacientes febriles