Surgical exploration for penetrating neck trauma - an audit of results in 145 patients.

BACKGROUND: Selective non-operative management (SNOM) is the current gold standard for the treatment of patients with penetrating neck trauma. The policy revolves around the liberal use of computed tomography angiography (CTA) in those patients who are haemodynamically stable, irrespective of the anatomical zone of injury, aiming at reducing the incidence of negative and non-therapeutic interventions and their potential complications. METHODS: A retrospective audit of results of patients who underwent immediate surgical exploration at the Chris Hani Baragwanath Academic Hospital in Soweto between January 2010 and December 2015 was performed. RESULTS: One-hundred and forty-five (145) patients, with a median age of 28 years (range 18-67 years), predominantly males (93.8%), underwent immediate exploration. Most injuries were caused by stab wounds (92.4%) and affected zone 2 (54.1%) on the left side of the neck (69.6%). The most common presentations were active haemorrhage (29.4%), shock (24.1%) and expanding haematoma (15.1%). A major vascular injury was found in 40%, and aero-digestive organ injury in 19.3%. The rate of negative-non-therapeutic exploration in this cohort was 4.1%. Complications were recorded in 7.6%, and the overall mortality was 9.6% secondary to early uncontrolled haemorrhage, sepsis and occlusive strokes. CONCLUSIONS: The utilisation of SNOM with strict criteria for selection of patients who require immediate surgical exploration versus investigations with CTA results in a low rate of non-therapeutic interventions.

Extensive extradural pneumorrhachis related to obstetric analgesia.

Iatrogenic extradural pneumorrhachis is a rare clinical entity, but anesthesiologists should be aware of this possibility when using the air technique for the identification of epidural space. Although in most published cases extradural pneumorrhachis is asymptomatic, relevant neurological consequences have been described, such as meningeal irritation, radicular pain, unilateral lower extremity weakness, cauda equina syndrome, paraplegia, and tetraplegia.We describe a very extensive extradural pneumorrachis (T9-S1), related to obstetric analgesia, in a patient with severe and atypical perineal pain after forceps-assisted delivery. Our aim is to synthesize and organize the available scientific evidence, analyzing preventive measures and summarizing the most appropriate diagnostic, follow-up and therapeutic techniques for symptomatic conditions, among which high concentrations of inspired oxygen, hyperbaric oxygen therapy and percutaneous or surgical decompression have been described.

Factors influencing initial implementation of an online community-based exercise intervention with adults living with HIV: a systems approach.

Introduction: Online community-based exercise (CBE) is a digital health intervention and rehabilitation strategy that promotes health among people living with HIV. Our aim was to describe the factors influencing initial implementation of a pilot online CBE intervention with adults living with HIV using a systems approach, as recommended by implementation science specialists. Methods: We piloted the implementation of a 6-month online CBE intervention and 6-month independent exercise follow up, in partnership with the YMCA in Toronto, Canada. We recruited adults living with HIV who identified themselves as safe to engage in exercise. The intervention phase included personalized exercise sessions online with a personal trainer; exercise equipment; access to online exercise classes; and a wireless physical activity monitor. Two researchers documented implementation factors articulated by participants and the implementation team during early implementation, defined as recruitment, screening, equipment distribution, technology orientation, and baseline assessments. Data sources included communication with participants; daily team communication; weekly team discussions; and in-person meetings. We documented implementation factors in meeting minutes, recruitment screening notes, and email communication; and analyzed the data using a qualitative descriptive approach using a systems engineering method called Cognitive Work Analysis. Results: Thirty-three adults living with HIV enrolled in the study (n = 33; median age: 52 years; cis-men: 22, cis-women: 10, non-binary: 1). Fifty-five factors influencing implementation, spanned five layers: (i) Natural, including weather and the COVID-19 virus; (ii) Societal, including COVID-19 impacts (e.g. public transit health risks impacting equipment pick-ups); (iii) Organizational, including information dissemination (e.g. tech support) and logistics (e.g. scheduling); (iv) Personal, including physical setting (e.g. space) and digital setting (e.g. device access); and (v) Human, including health (e.g. episodic illness) and disposition (e.g. motivation). The implementation team experienced heightened needs to respond rapidly; sustain engagement; and provide training and support. Additional organizational factors included a committed fitness training and research team with skills spanning administration and logistics, participant engagement, technology training, physical therapy, and research ethics. Conclusion: Fifty-five factors spanning multiple layers illustrate the complexities of online CBE with adults living with HIV. Initial implementation required a dedicated, rehabilitation-centred, multi-skilled, multi-stakeholder team to address a diverse set of factors.

Comparison of radiographic scoring systems for assessment of bone healing after tibial plateau leveling osteotomy in dogs.

Introduction: Accurate radiographic assessment of bone healing is vital in determining both clinical treatment and for assessing interventions aimed at the promotion of bone healing. Several scoring systems have been used to evaluate osteotomy changes following tibial plateau leveling osteotomy (TPLO). The goal of this study was to compare the ability of five radiographic scoring systems to identify changes in bone healing following TPLO over time (Aim I), and to evaluate the influence of limb positioning on TPLO osteotomy scoring (Aim II). Materials and methods: Phase I-A randomized, blinded, prospective study was conducted using similarly positioned postoperative TPLO radiographs from seven dogs taken immediately postoperatively, 6-weeks, and 8-weeks postoperatively. Ten reviewers assessed the radiographs, and five different scoring systems were tested for each set including three previously published ones, a Visual Analog Score (VAS), and a subjective 11-point scale. For each system, responses for 6-week postoperative were compared to 8-week postoperative. Scores were judged as correct (=showing an increase in score), incorrect (=decrease in score), or unchanged (=same score). Phase II-An international group of 39 reviewers was asked to score radiographs from three dogs, taken in different positions, using the VAS grading system. Scores were averaged and comparisons were made for each set. Results: Phase I-The VAS system identified the greatest number of sets correctly (76%), with the least unchanged scores (15%), and 9% incorrect scores. Phase II-All three patients had an increase in the average difference between VAS-scores for differently positioned radiographs compared to similarly positioned radiographs. The magnitude of change between different positions far exceeded the magnitude of comparison of the similarly positioned radiographs from the 6- and 8-week time point. Discussion/Conclusion: The VAS system appears to be the most appropriate of the tested systems to identify small changes in bone healing. In addition, the positioning of postoperative TPLO radiographs makes a substantial difference in the healing score that is assigned. Care must be undertaken when performing postoperative radiographs in both the clinical and research setting to ensure accurate assessment of bone healing.

A potential role of hippocampus on impulsivity and alcohol consumption through CB1R.

There are a few studies suggesting that the hippocampus is involved in the regulation of impulsivity, and which attempt to explain drug seeking behavior in addiction. In addition, cannabinoid receptor 1 (CB1R) is highly expressed in the hippocampus (HPP). To further understand the potential role of the hippocampal CB1R in impulsive and drug seeking behaviors, we characterized impulsivity in adolescent and adult male rats, by means of a delay discounting task (DDT) by evaluating preference and seeking motivation for alcohol (10 % v/v) consumption, and analyzing CB1R expression in CA1, CA3 and the dentate gyrus (DG) of the HPP as well as in the medial prefrontal cortex (mPFC). Our results show that adolescent rats display more impulsive choices than adult rats in the DDT. The k value is statistically higher in adolescents, further supporting that they are more impulsive. Besides, adolescent rats have higher forced and voluntary alcohol consumption and display a higher alcohol conditioned place preference (CPP) vs. adult rats. In addition, CB1R expression in CA3 and the DG is higher in adolescent vs. adult rats. Our data further support the role of the hippocampus in impulsivity with the potential involvement of the endocannabinoid system, considering that CB1R in CA3 and DG is higher in adolescents, who display impulsivity and alcohol seeking and consumption.

External multicentre validation of pseudomyxoma peritonei PSOGI-Ki67 classification.

BACKGROUND: Pseudomyxoma peritonei (PMP) is a rare malignant disease. Adding of the Ki67 proliferation index to the PSOGI PMP classification provided two different subcategories of the extensive HG-PMP group (HG-PMP ≤15% and HG-PMP >15%) with different survival in a previous unicentric study. This study aims to carry out an external and multicentre validation of this new proposed classification. METHOD: It was a prospective analysis of samples from a historical and international cohort of patients. A representative area with higher cellular density was used to determine the Ki67%. The Ki67 proliferation index (%) was determined in all the HG-PMP patients. A Cox proportional hazard models and multivariable COX models were used. The Kaplan-Meier method and the two-tailed log-rank test were used to analyse the effect of different PSOGI-Ki67 categories on OS and DFS. Its predictive accuracy was analysed using Harrel's C-index and the ROC curve. The calibration was performed using the calibration plots matching. RESULTS: After exclusions, 349 patients were available for analysis. The 5-years OS were 86% for LG-PMP, 59% for HG-PMP≤15, 38% for HG-PMP>15 and 42% for SRC-PMP (p = 0.0001). The 5-years DFS were 49% for LG-PMP, 35% for HG-PMP≤15, 16% for HG-PMP>15 and 18% SRC-PMP (p = 0.0001). The discrimination capability of PSOGI-Ki67 was validated. CONCLUSION: the PSOGI-Ki67 classification discriminates and predicts the OS and DFS in patients with PMP dividing the HG-PMP category into two well-defined sub-categories. The Ki67 proliferation index should be incorporated routinely in the pathology report for these patients.

¿Han cambiado los conceptos de analgesia obstétrica en los últimos 100 años? / Have the concepts of obstetric analgesia changed in the last 100 years?

Objetivos: Comparar los conceptos y métodos de analgesia obstétrica actual con los existentes hace 100 años, cuando se publicaron por primera vez Anesthesia & Analgesia (1922) y British Journal of Anaesthesia (1923), que son las dos primeras revistas de anestesia publicadas de forma independiente.Material y métodos: Identificamos y analizamos todos los artículos relacionados con la analgesia obstétrica publicados en estas revistas durante los años 1922 y 1923, y los comparamos con la práctica clínica actual. También buscamos en estos números referencias indirectas a la atención prestada a la analgesia obstétrica en las reuniones científicas de la época.Resultados: En el primer número de Anesthesia & Analgesia que aparece en agosto de 1922, 3 de los 8 artículos publicados están relacionados exclusivamente con la anestesia y analgesia obstétrica, y entre 1922 y 1923 encontramos un alto número de artículos y referencias. El análisis de estos artículos publicados hace un siglo permite objetivar el interés de la época por los resultados, la comparación entre los diferentes métodos anestésicos, la seguridad y la divulgación del conocimiento científico. Son habituales las referencias a la mortalidad, a las complicaciones, al confort y la satisfacción de la paciente, a la influencia de la analgesia obstétrica en la duración del parto, así como al ahorro de tiempo y de gases anestésicos. Resulta obvio que la metodología de investigación actual no puede compararse con la de hace 100 años. Pero existen numerosos aspectos científicos que sentaron algunas de las bases de la investigación actual en obstetricia, entre los que destacan la recogida de amplias series de pacientes durante largos periodos de tiempo, la mención expresa a la publicación de resultados tanto favorables como desfavorables...(AU)

Objectives: To compare current obstetric analgesia concepts and methods with those existing 100 years ago, when Anesthesia & Analgesia (1922) and British Journal of Anaesthesia (1923), the first two independently published anesthesia journals, were first published.Methods: We identified and analyzed all articles related to obstetric analgesia published in these journals during the years 1922 and 1923 and compared them with current clinical practice. We also searched these issues for indirect references to the attention given to obstetric analgesia at scientific meetings of the time.Results: In the first issue of Anesthesia & Analgesia, appearing in August 1922, 3 of the 8 articles published are related exclusively to obstetric anesthesia and analgesia, and between 1922 and 1923 we found a high number of articles and references. The analysis of these articles published a century ago allows us to objectify the interest of the time in the results, the comparison between different anesthetic methods, safety and the dissemination of scientific knowledge. References to mortality, complications, patient comfort and satisfaction, the influence of obstetric analgesia on the duration of labor, as well as savings in time and anesthetic gases are common.It is obvious that today's research methodology cannot be compared with that of 100 years ago. But there are many scientific aspects that laid some of the foundations of current research in obstetrics, including the collection of large series of patients over long periods of time, the express mention of the publication of both favorable and unfavorable results, the references not only to cost but also to cost-effectiveness, as well as the use of specific parameters to measure not only results but also patient satisfaction.Conclusions: It is evident that over the years the outcomes in the practice of anesthesiology have improved, but also that many concepts remain the same 100 years later...(AU)

Pigmentary mosaicism as a recurrent clinical manifestation in three new patients with mosaic trisomy 12 diagnosed postnatally: cases report and literature review.

BACKGROUND: To date, only twenty-one cases diagnosed postnatally with mosaic trisomy 12 have been reported. The most frequent phenotypic manifestations are developmental delay, dysmorphic facial features, congenital heart defects, digital alterations, and pigmentary disorders. In the present report, detailed clinical and genetic profiles of three unrelated new patients with mosaic trisomy 12 are described and compared with previously reported cases. CASE PRESENTATION: In the present report, we include the clinical, cytogenetic, and molecular description of three Mexican patients diagnosed postnatally with mosaic trisomy 12. At phenotypic level, the three patients present with developmental delay, dysmorphic facial features, congenital heart defects and skin pigmentary anomalies. Particularly, patient 1 showed unique eye alterations as bilateral distichiasis, triple rows of upper lashes, and digital abnormalities. In patient 2 redundant skin, severe hearing loss, and hypotonia were observed, and patient 3 presented with hypertelorism and telecanthus. Hyperpigmentation with disseminated pigmentary anomalies is a common trait in all of them. The cytogenetic study was carried out under the strict criteria of analysis, screening 50-100 metaphases from three different tissues, showing trisomy 12 mosaicism in at least one of the three different tissues analyzed. With SNParray, the presence of low-level mosaic copy number variants not previously detected by cytogenetics, and uniparental disomy of chromosome 12, was excluded. STR markers allowed to confirm the absence of uniparental disomy as well as to know the parental origin of supernumerary chromosome 12. CONCLUSIONS: The detailed clinical, cytogenetic, and molecular description of these three new patients, contributes with relevant information to delineate more accurately a group of patients that show a heterogeneous phenotype, although sharing the same chromosomal alteration. The possibility of detecting mosaic trisomy 12 is directly associated with the sensitivity of the methodology applied to reveal the low-level chromosomal mosaicism, as well as with the possibility to perform the analysis in a suitable tissue.

Utilidad del índice kappa en el diagnóstico de esclerosis múltiple y validación de valores de referencia en la Comunidad de Aragón / Usefulness of the kappa index in the diagnosis of multiple sclerosis and validation of reference values in the Community of Aragon

Introducción: La determinación de bandas oligoclonales (BOC) en el líquido cefalorraquídeo es esencial para el diagnóstico de esclerosis múltiple (EM). El índice kappa es un biomarcador con una sensibilidad y una especificidad comparables a las de las BOC. El objetivo de este trabajo fue estudiar su utilidad y calcular el punto de corte óptimo. Material y métodos. Estudio observacional de muestras recibidas en el servicio de inmunología de referencia para Aragón entre enero de 2019 y junio de 2020. Se determinó el valor del índice kappa y el índice IgG. Se trazaron y compararon curvas ROC frente a la detección de BOC y el diagnóstico de EM. Se calcularon valores de sensibilidad y especificidad y el punto de corte óptimo. Resultados: Se analizaron 181 pacientes (59,7%, mujeres; edad media, 47,62 ± 17,8 años). El grupo de EM demostró valores estadísticamente superiores de índice kappa (66,62 frente a 0,02; p < 0,001). En el análisis de curvas ROC, el índice kappa demostró un área bajo la curva superior al índice IgG en la detección de BOC+ (0,93 frente a 0,83; p < 0,002) y el diagnóstico de EM (0,91 frente a 0,83; p < 0,021). El punto de corte óptimo del índice kappa para la detección de BOC fue 5,02 (sensibilidad y especificidad, 0,92) y 7,58 para el diagnóstico de EM (sensibilidad, 0,85; especificidad, 0,94). Conclusiones: El índice kappa es un biomarcador útil en el diagnóstico de la EM. Su determinación es un proceso automático y rápido, con valores de sensibilidad y especificidad superiores al índice IgG. Todavía se debe llegar a un consenso sobre el punto de corte óptimo para su positividad, si bien, en nuestro medio, un punto de corte de 5,02 parece razonable.(AU)

INTRODUCTION: Detection of oligoclonal bands (OCB) in CSF is essential in the diagnosis of multiple sclerosis (MS). Kappa-index is a promising biomarker, with sensitivity and sensibility values comparable to those of OCB. Our objective was to investigate kappa-index utility in the diagnosis work-up for MS and to determine the optimal cut-off point for our population. Material and methods. Observational study of consecutive samples received in the Immunology lab department in a third level hospital between January 2019 to June 2020. Kappa-index and IgG index were measured. ROC analysis for screening of OCB and for diagnosis of MS was conducted. Sensibility, specificity and the optimal cut-off points were determined. RESULTS: 181 samples were included (59.7% females; age, 47.62 ± 17.8 years). Patients in the EM group presented significantly higher kappa-index level than patients without an EM diagnosis (66.62 versus 0.02; p < 0.001). ROC analysis reported a better area under the curve for the kappa-index than the IgG index for the detection of BOC (0.93 versus 0.83; p < 0.002) and the diagnosis of EM (0.91 versus 0.83; p < 0.021). An optimal cut-off point of 5.02 was determined for the detection of BOC (sensibility and specificity, 0.92) and of 7.58 for the diagnosis of EM (sensibility, 0.85; specificity, 0.94). CONCLUSIONS: Kappa-index is an useful biomarker in the diagnosis of MS. Its specificity and sensibility are superior to the IgG index. The optimal cut-off point has yet to be determined, but for our population a cut-off of 5.02 seems reasonable.(AU)

[Usefulness of the kappa index in the diagnosis of multiple sclerosis and validation of reference values in the Community of Aragon]. / Utilidad del índice kappa en el diagnóstico de esclerosis múltiple y validación de valores de referencia en la Comunidad de Aragón.

INTRODUCTION: Detection of oligoclonal bands (OCB) in CSF is essential in the diagnosis of multiple sclerosis (MS). Kappa-index is a promising biomarker, with sensitivity and sensibility values comparable to those of OCB. Our objective was to investigate kappa-index utility in the diagnosis work-up for MS and to determine the optimal cut-off point for our population. MATERIAL AND METHODS: Observational study of consecutive samples received in the Immunology lab department in a third level hospital between January 2019 to June 2020. Kappa-index and IgG index were measured. ROC analysis for screening of OCB and for diagnosis of MS was conducted. Sensibility, specificity and the optimal cut-off points were determined. RESULTS: 181 samples were included (59.7% females; age, 47.62 ± 17.8 years). Patients in the EM group presented significantly higher kappa-index level than patients without an EM diagnosis (66.62 versus 0.02; p < 0.001). ROC analysis reported a better area under the curve for the kappa-index than the IgG index for the detection of BOC (0.93 versus 0.83; p < 0.002) and the diagnosis of EM (0.91 versus 0.83; p < 0.021). An optimal cut-off point of 5.02 was determined for the detection of BOC (sensibility and specificity, 0.92) and of 7.58 for the diagnosis of EM (sensibility, 0.85; specificity, 0.94). CONCLUSIONS: Kappa-index is an useful biomarker in the diagnosis of MS. Its specificity and sensibility are superior to the IgG index. The optimal cut-off point has yet to be determined, but for our population a cut-off of 5.02 seems reasonable.

TITLE: Utilidad del índice kappa en el diagnóstico de esclerosis múltiple y validación de valores de referencia en la Comunidad de Aragón.Introducción. La determinación de bandas oligoclonales (BOC) en el líquido cefalorraquídeo es esencial para el diagnóstico de esclerosis múltiple (EM). El índice kappa es un biomarcador con una sensibilidad y una especificidad comparables a las de las BOC. El objetivo de este trabajo fue estudiar su utilidad y calcular el punto de corte óptimo. Material y métodos. Estudio observacional de muestras recibidas en el servicio de inmunología de referencia para Aragón entre enero de 2019 y junio de 2020. Se determinó el valor del índice kappa y el índice IgG. Se trazaron y compararon curvas ROC frente a la detección de BOC y el diagnóstico de EM. Se calcularon valores de sensibilidad y especificidad y el punto de corte óptimo. Resultados. Se analizaron 181 pacientes (59,7%, mujeres; edad media, 47,62 ± 17,8 años). El grupo de EM demostró valores estadísticamente superiores de índice kappa (66,62 frente a 0,02; p menor de 0,001). En el análisis de curvas ROC, el índice kappa demostró un área bajo la curva superior al índice IgG en la detección de BOC+ (0,93 frente a 0,83; p menor de 0,002) y el diagnóstico de EM (0,91 frente a 0,83; p menor de 0,021). El punto de corte óptimo del índice kappa para la detección de BOC fue 5,02 (sensibilidad y especificidad, 0,92) y 7,58 para el diagnóstico de EM (sensibilidad, 0,85; especificidad, 0,94). Conclusiones. El índice kappa es un biomarcador útil en el diagnóstico de la EM. Su determinación es un proceso automático y rápido, con valores de sensibilidad y especificidad superiores al índice IgG. Todavía se debe llegar a un consenso sobre el punto de corte óptimo para su positividad, si bien, en nuestro medio, un punto de corte de 5,02 parece razonable.

Life History Data of Dipetalogaster maxima (Hemiptera: Reduviidae).

Dipetalogaster maxima (Uhler) is a triatomine species that has been found to be infected by Trypanosoma cruzi Chagas in the habitats of the most important tourist areas of Mexico. Its behavior and vectorial capacity have been scarcely studied, although such information is necessary to reliably estimate the importance of this species as a vector of T. cruzi in its distribution area. This study reports biological parameters related to the vectorial capacity of D. maxima. In particular, the egg-to-adult development time, number of blood meals required to molt, accumulative mortality, time to beginning of feeding, feeding and defecation times, fecundity, and fertility were examined. D. maxima took a median of 211 d to develop from egg to adult, requiring 11 meals in total. Almost two-thirds (63%) of specimens died during the cycle. The time to beginning of feeding was 1 min in all instars. Feeding times varied from 14 to 27 min. Most nymphs (except first-instar) defecated when feeding or immediately thereafter. A mean of 0.7 eggs/♀/day was recorded, with an eclosion rate of 27.3%. Five of the eight studied parameters (mainly defecation delay) suggest the remarkable potential vectorial capacity of D. maxima, so it is necessary to maintain permanent surveillance of domiciliary populations of D. maxima, because they may be infected with T. cruzi.

Estudio en vida real para evaluar la adherencia y el sabor de un suplemento oral Nutricional hipercalórico e hiperproteico en pacientes con desnutrición en un hospital / A real-world study to evaluate adherence and flavor of a high-protein hypercaloric oral nutritional supplement in patients with malnutrition in a hospital

Objetivo: el objetivo de nuestro estudio en vida real fue evaluar en pacientes ingresados desnutridos la adherencia y las preferencias de sabor de un suplemento oral Nutricional (SON) hipercalórico e hiperproteico. Métodos: se incluyeron en este estudio en vida real un total de 34 pacientes ingresados con pérdida de peso reciente. Se administró un sabor (café, vainilla o fresa) cada día de forma aleatoria a cada paciente durante tres días consecutivos. En los primeros tres días se pidió a los pacientes que completaran dos cuestionarios destinados a reflejar la tolerancia y aceptación del SON (Renutryl®). La adherencia del SON fue evaluada durante el ingreso hospitalario. Resultados: el sabor dulce fue más elevado para el sabor fresa (4,54 ± 0,2 puntos) que para el sabor vainilla (3,13 ± 0,1 puntos; p < 0,03) y el sabor café (3,03 ± 0,1 puntos; p < 0,02). Al analizar a los pacientes que tomaron suplementos después de elegir el sabor, los pacientes que eligieron café tomaron un total de 13,3 ± 1,1 envases de promedio durante la hospitalización (0,91 ± 0,2 por día), los pacientes que eligieron fresa tomaron 13,4 ± 1,3 envases (0,92 ± 0,1 por día) y, finalmente, los pacientes que eligieron envases de vainilla tomaron 8,3 ± 0,9 envases durante el ingreso (0,61 ± 0,1 por día), con diferencias significativas a favor de los sabores de fresa y café frente al sabor de vainilla. Por otra parte, el SON elegido mayoritariamente por los pacientes al alta hospitalaria fue el pack multisabor (n = 20; 50 %).Conclusiones: las preferencias de sabor de los SON de tres sabores son similares, aunque la adherencia fue más elevada durante el ingreso con respecto a los SON con sabor a café y fresa. La dulzura puede haber influido en este hallazgo, sobre todo con el sabor fresa, con una buena tolerancia de los 3 sabores (AU)

Aim: the objective of our real-life study was to evaluate adherence and taste preferences of a hypercaloric and hyperprotein oral nutritional supplement (ONS) in malnourished hospitalized patients. Methods: a total of 34 in patients with recent weight loss were included in this study. One flavor (coffe, vanilla or strawberry) was administered each day in a random way to each patient during three consecutive days. In the first three days, patients were asked to fulfill two questionnaires intended to reflect ONS (Renutryl®) tolerance and acceptance. Adherence to the ONS was measured during hospital stay. Results: the sweet flavor was higher for strawberry (4.54 ± 0.2 points) than for the vanilla flavor (3.13 ± 0.1 points; p < 0.03) and coffee flavor (3.03 ± 0.1 points; p <0.02). When analyzing the total number of patients who took supplements after choosing the flavor, the patients who chose coffee took a total of 13.3 ± 1.1 packages on average during hospitalization (0.91 ± 0.2 per day), the patients who chose strawberry took 13.4 ± 1.3 packages (0.92 ± 0.1 per day), and finally the patients who chose vanilla packages took 8.3 ± 0, 9 packages during admission (0.61 ± 0.1 per day), with significant differences in favor of the strawberry and coffee flavors versus vanilla. The ONS chosen mostly by the patients at hospital discharge was the multiflavor pack (n = 20; 50 %). Conclusions: taste preferences for the three flavored ONSs are similar, although adherence was higher during admission to the coffee- and strawberry-flavored ONS. Sweetness may have influenced this finding, especially with the strawberry flavor, with a good tolerance of all three flavors (AU)

Biological Parameters of Two Triatoma protracta Subspecies (Hemiptera: Reduviidae).

In recent years, concerns about Chagas disease in the United States have increased. Triatomine bug (Hemiptera: Reduviidae) populations are the vectors of the parasite Trypanosoma cruzi Chagas (Trypanosomatida: Trypanosomatidae), which causes Chagas disease, although the route of transmission is considered inefficient in United States. However, more studies on triatomine feeding and defecation behavior are needed. In this study, six related biological parameters from two populations of Triatoma protracta protracta (Uhler) and T. p. woodi (Uhler) from Mexican locations near the U.S. border were evaluated. The four population life cycles were less than 6 mo (161-171 d), with 9-10 blood meals needed to molt. Mortality rates were similar (31-38%) among the four populations. Triatoma p. woodi from Hidalgo, Coahuila was the most aggressive one. Feeding times were over 10 min, increasing with instar in all populations. Defecation behaviors varied among populations. High percentages of male and female fourth- and fifth-instar nymphs of T. p. protracta from Imuris and both populations of T. p. woodi defecated immediately after or <1 min of feeding. Lower percentages were observed for T. p. protracta from Jacumé. Because most parameters were similar among the four populations, independent of their subspecies and their geographic origin, we considered that T. p. protracta and T. p. woodi are efficient vectors of T. cruzi. In contrast, defecation patterns were noticeably different among some of the four triatomine populations studied. Our results highlight the importance of studying the biological parameters of local triatomine populations. They also contribute to increasing the knowledge of North American triatomine behavior and defecation patterns.

Ozone as an alternative decontamination process for N95 facemask and biosafety gowns.

COVID-19 pandemic created a global shortage of medical protective equipment. Here, we considered ozone (O3) a disinfectant alternative due to its potent oxidative activity against biological macromolecules. The O3 decontamination assays were done using SARS-CoV-2 obtained from patients to produce artificial contamination of N95 masks and biosecurity gowns. The quantification of SARS-CoV-2 was performed before and after exposing the samples to different ozone gas concentrations for times between 5 and 30 min. Viral loads as a function of the O3 exposure time were estimated from the data obtained by the RT-PCR technique. The genetic material of the virus was no longer detected for any tested concentrations after 15 min of O3 exposure, which means a disinfection Concentration-Time above 144 ppm min. Vibrational spectroscopies were used to follow the modifications of the polymeric fibers after the O3 treatment. The results indicate that the N95 masks could be safely reused after decontamination with treatments of 15 min at the established O3 doses for a maximum of 6 cycles.

Fuerza muscular como predictora de fragilidad ósea en pacientes con diabetes mellitus tipo 2 / Muscle strength as a predictor of bone fragility in patients with type 2 diabetes mellitus

Objetivo: Identificación de biomarcadores que relacionan la osteoporosis con enfermedades pulmonares ocupacionales y ambientales. Material y métodos:: Mediante bases de datos de terminología médica unificada se obtuvieron enfermedades relacionadas con enfermedades pulmonares que, junto con la osteoporosis, fueron analizadas en DisGeNET para obtener los genes asociados a cada enfermedad y formar una red de interacción proteína-proteína (PPI) mediante el uso de STRING dentro de Cytoscape. A través de la aplicación de diferentes algoritmos de centralidad utilizando CythoHubba en Cytoscape, se seleccionaron las 5 proteínas de la red con el mayor grado de centralidad. Resultados: 9 enfermedades fueron incluidas en el grupo de enfermedades pulmonares. Se obtuvieron 2.698 genes asociados a enfermedades pulmonares y a osteoporosis. Los genes vinculados con osteoporosis y con al menos dos de las enfermedades pulmonares incluidas dieron lugar a una red PPI con 152 nodos y 1.378 ejes. Las proteínas con mayor grado de centralidad de la red fueron AKT1, ALB, IL6, TP53 y VEGFA. Conclusiones: Existe una elevada relación entre la osteoporosis y las enfermedades pulmonares ambientales estudiadas, a través de genes con una implicación dual. Nosotros proponemos cinco genes importantes que vinculan estas enfermedades y que podrían constituir una base coherente para investigaciones más profundas en este campo. (AU)

Objetives: The objective of this study was to analyze the relationship between muscle strength and bone fragility in patients with DM2. Methods: This observational cross-sectional study included 60 patients with DM2 (60% men and 40% postmenopausal women) ranging in age from 49 to 85 years. Demographic, anthropometric, clinical and biochemical variables were studied. Bone mineral density (BMD) in the lumbar spine (LS), femoral neck and total hip was determined using DXA (Hologic QDR 4500), and TBS values (TBS iNsight Software, version 3.0.2.0, Medimaps, Merignac, France). Hand grip (kg/cm2) was measured with a Jamar® manual hydraulic dynamometer (5030j1; Jackson, MI). To assess the level of mobility and the risk of falls, the Time Up and Go test was carried out. Statistical analysis was performed using the SPSS program (SPSS, inc, v 25.0). Results: The mean age of the patients was 66.3±8.3 years. The mean HbA1c was 7.7±1.1%, with inadequate glycemic control (HbA1c >7.5%) observed in 73.3% of the patients. 91.7% of the women and 77.8% of the men had low muscle strength. 41.7% of women and 25% of men presented a high risk of falls. Subjects with low hand grip strength and those with high risk of falls had significantly lower TBS values than those with greater hand grip strength (0.99±0.17 vs 1.12±0.15; p=0.03) and low risk of falls (0.94±0.13 vs 1.04±0.19; p=0.02). Patients with normal and partially degraded TBS had greater hand grip strength than subjects with degraded TBS (p=0.031). Hand grip strength was positively associated with TBS (p<0.05) regardless of age, waist circumference, 25OH vitamin D levels, and BMD in LS. There were no significant differences in hand grip strength as a function of BMD values. Conclusions: Our study shows that the reduction in muscle strength may be related to bone microarchitecture deterioration determined by TBS in patients with DM2. (AU)

Impact of switching to raltegravir and/or adding losartan in lymphoid tissue fibrosis and inflammation in people living with HIV. A randomized clinical trial.

BACKGROUND: Persistent inflammation and immune activation are associated with lymph node fibrosis and end-organ diseases in treatment-suppressed people living with HIV (PLWH). We investigated the effect of switching to raltegravir and/or adding losartan on lymphoid tissue fibrosis and on the inflammatory/immune-activation mediators in treated HIV patients. METHODS: Chronic HIV-infected patients treated with two nucleoside reverse transcriptase inhibitors (2NRTI) and one non-NRTI (NNRTI) or protease inhibitor (PI) during at least 48 weeks were randomized to four groups (n = 48): 2NRTI + efavirenz (EFV), 2NRTI + EFV + losartan, 2NRTI + raltegravir and 2NRTI + raltegravir + losartan for 48 weeks. Tonsillar biopsy and peripheral blood markers of CD4 and CD8 T-lymphocyte activation and senescence, monocyte activation and soluble markers of inflammation were determined at baseline and at week 48 and compared between groups. RESULTS: No changes in lymphoid tissue architecture were observed. Adding losartan had no impact on lymphocyte subsets. Conversely, patients who switched to raltegravir showed a higher decrease in all activated [CD4+CD38+HLA-DR+, -0.3 vs. 0.48 (P = 0.033); CD8+CD38+ HLA-DR+, -1.6 vs. 1.3 (P = 0.02)] and senescent [CD4+CD28-CD57+, -0.3 vs. 0.26 (P = 0.04); CD8+CD28-CD57+, -6.1 vs. 3.8 (P = 0.002)] T lymphocytes. In addition, the median CD4/CD8 ratio increased by 0.35 in patients in the raltegravir group vs. 0.03 in the other arms (P = 0.002). Differences between groups in monocyte subpopulations or soluble inflammation markers were not observed. CONCLUSIONS: Losartan had no effect on lymphoid fibrosis or immune activation/inflammation. Conversely, switching to a regimen with raltegravir significantly decreased activated and senescent T-lymphocyte subpopulations and increased CD4/CD8 ratio in successfully treated PLWH.