E-cigarettes and Youth: The Known, the Unknown, and Implications for Stakeholders.

ABSTRACT: Despite the decline in the prevalence of e-cigarette use among youth during the coronavirus disease 2019 pandemic, more than 2.5 million of US high and middle schoolers are still using e-cigarettes. Furthermore, those who use e-cigarettes are starting at a younger age and are using them more intensely, reflecting, at least in part, a high addiction liability of modern e-cigarettes. Beyond addiction, accumulating evidence suggests that, in the short-term, e-cigarettes are associated with cardiovascular and pulmonary effects, whereas the long-term effects of e-cigarette use are yet to be established. The aim of this review is to synthesize current knowledge on e-cigarette use among youth, including established and potential risks and efforts to date to curb youth exposure to e-cigarettes. In addition, we provide recommendations for health care providers, researchers, and other stakeholders to address this significant public health issue.

Cultivable Microbiome Approach Applied to Cervical Cancer Exploration.

Traditional microbiological methodology is valuable and essential for microbiota composition description and microbe role assignations at different anatomical sites, including cervical and vaginal tissues; that, combined with molecular biology strategies and modern identification approaches, could give a better perspective of the microbiome under different circumstances. This pilot work aimed to describe the differences in microbiota composition in non-cancer women and women with cervical cancer through a culturomics approach combining culture techniques with Vitek mass spectrometry and 16S rDNA sequencing. To determine the possible differences, diverse statistical, diversity, and multivariate analyses were applied; the results indicated a different microbiota composition between non-cancer women and cervical cancer patients. The Firmicutes phylum dominated the non-cancer (NC) group, whereas the cervical cancer (CC) group was characterized by the predominance of Firmicutes and Proteobacteria phyla; there was a depletion of lactic acid bacteria, an increase in the diversity of anaerobes, and opportunistic and non-typical human microbiota isolates were present. In this context, we hypothesize and propose a model in which microbial composition and dynamics may be essential for maintaining the balance in the cervical microenvironment or can be pro-oncogenesis microenvironmental mediators in a process called Ying-Yang or have a protagonist/antagonist microbiota role.

Three seasons of enhanced safety surveillance of a cell culture-based quadrivalent influenza vaccine.

The objective of this paper is to summarize annual enhanced safety surveillance activity across three seasons (2019/20-2021/22) for cell culture-based quadrivalent influenza vaccine (QIVc; Flucelvax® Tetra) in all age groups. This activity was conducted in primary care setting in Genoa (Italy) during the seasons 2019/20, 2020/21 and 2021/22. All adverse events registered within the first seven days following immunization were analyzed by season, type, age group and seriousness. Over three seasons, 3,603 QIVc exposures were recorded within the enhanced passive safety surveillance activity. No safety signals were identified. The overall reporting rates of individual case safety reports for the seasons 2019/20, 2020/21 and 2021/22 were 1.75%, 0.48% and 0.40%, respectively. The average number of adverse events per individual case safety report was similar (range 3.3-3.8 adverse events per case report) across the three seasons. Most adverse events were reactogenic in nature. The rate of adverse events was similarly low in all age groups. Enhanced passive safety surveillance activity is a feasible approach for the post-marketing monitoring of seasonal influenza vaccines. Within its limitations, results of this study support the favorable safety profile of QIVc. These safety data could further bolster public trust in influenza vaccines with the goal to increase vaccination uptake in all target groups.

Infections and risk factors for infection-related mortality after pediatric allogeneic hematopoietic stem cell transplantation in Mexico: A single center retrospective study.

OBJECTIVE: To identify the type of infections and risk factors for infection-related mortality (IRM) after allogeneic hematopoietic stem cell transplantation (HSCT). METHODS: Retrospective cohort study of patients <16 years of age treated in 2010-2019 was conducted. Unadjusted hazard ratios (HR) and adjusted hazard ratios (aHR) with 95% confidence intervals (95% CIs) were estimated using Cox regression. Cumulative incidence was calculated. RESULTS: Data for 99 pediatric patients were analyzed. The myeloablative conditioning was the most used regimen (78.8%) and the hematopoietic stem cell source was predominantly peripheral blood (80.8%). Primary graft failure occurred in 19.2% of patients. Frequency of acute graft-versus-host disease was 46.5%. Total of 136 infectious events was recorded, the most common of which were bacterial (76.4%) followed by viral infection (15.5%) and then fungal infection (8.1%). The best predictors for infection subtypes where the following: a) for bacterial infection (the age groups of 10.1-15 years: aHR = 3.33; 95% CI: 1.62-6.85 and. >15 years: aHR = 3.34; 95% CI: 1.18-9.45); b) for viral infection (graft versus host disease: aHR = 5.36; 95% CI: 1.62-17.68), however, for fungal infection statistically significant predictors were not identified. Related mortality was 30% (n = 12). Increased risk for infection-related mortality was observed in patients with unrelated donor and umbilical cord stem cells recipients (HR = 3.12; 95% CI: 1.00-9.85). CONCLUSIONS: Frequencies of infections and infection-related mortality appear to be similar to those reported. Unrelated donors and stem cells from umbilical cord recipients were associated with a high risk of mortality.

Clinical Studies on the Supplementation of Manufactured Human Milk Oligosaccharides: A Systematic Review.

Human milk oligosaccharides (HMOs) are a major component of human milk. They are associated with multiple health benefits and are manufactured on a large scale for their addition to different food products. In this systematic review, we evaluate the health outcomes of published clinical trials involving the supplementation of manufactured HMOs. We screened the PubMed database and Cochrane Library, identifying 26 relevant clinical trials and five publications describing follow-up studies. The clinical trials varied in study populations, including healthy term infants, infants with medical indications, children, and adults. They tested eight different HMO structures individually or as blends in varying doses. All trials included safety and tolerance assessments, and some also assessed growth, stool characteristics, infections, gut microbiome composition, microbial metabolites, and biomarkers. The studies consistently found that HMO supplementation was safe and well tolerated. Infant studies reported a shift in outcomes towards those observed in breastfed infants, including stool characteristics, gut microbiome composition, and intestinal immune markers. Beneficial gut health and immune system effects have also been observed in other populations following HMO supplementation. Further clinical trials are needed to substantiate the effects of HMO supplementation on human health and to understand their structure and dose dependency.

Clinical considerations for sarcopenia in older Colombian Afro-descendant and mestizo women.

OBJECTIVES: To identify the frequencies of clinical suspicion of sarcopenia (CSS) and probable sarcopenia (PS) and their association with ethnic groups. METHODS: This cross-sectional study categorized 700 women into Afro-descendant and mestizo ethnic groups. Calf circumference, muscle strength, and gait speed were measured. CSS was assessed using a sarcopenia risk scale and the measurement of calf circumference; the muscle strength of the dominant hand was used to establish PS. Unadjusted logistic regressions assessed associations between CSS/PS and ethnicity. Two adjusted logistic regression models included relevant covariates. RESULTS: CSS and PS were identified in 10.4% to 20.7% and 7.8% to 14.1% of study participants, respectively. Compared with mestizos, Afro-descendants had a more favorable sarcopenia risk score, greater calf circumference, and greater muscle strength and were associated with a lower risk for CSS (odds ratio [OR]: 0.13, 95% confidence interval [CI]: 0.06-0.28 and OR: 0.12, 95% CI: 0.07-0.21) and PS (OR: 0.12, 95% CI: 0.05-0.30 and OR: 0.11, 95% CI: 0.06-0.21). CONCLUSION: Compared with mestizos, CSS and PS were less frequent among Afro-descendants, who had 87% to 88% lower probability of CSS and 88% to 89% lower probability of PS.

Política pública en cuidados paliativos y sus implicaciones sobre servicios, opioides y educación en Colombia / Public policy on palliative care and its implications for services, opioids, and education in Colombia

Introducción: El desarrollo de cuidados paliativos exige la intervención de múltiples dimensiones de salud pública, incluyendo la disponibilidad de servicios de salud, medicamentos esenciales y programas educativos. En Colombia se han realizado diversos cambios en las políticas públicas para promover la atención de personas con necesidades paliativas. Objetivo: Evaluar empíricamente las políticas públicas, existentes en cuidados paliativos y sus implicaciones sobre disponibilidad de servicios, opioides y programas educativos en los años 2010 ­ 2019 en Colombia. Materiales y métodos: Se diseñó un estudio mixto exploratorio secuencial en tres fases: identificación de indicadores empíricos de políticas nacionales, diagnostico situacional de cuidados paliativos y evaluación cualitativa de los resultados de la implementación de políticas en siete nodos territoriales de Colombia. Resultados: Se revisaron siete normas obteniendo 12 indicadores empíricos para la evaluación, seis de ellos no contaban con fuentes de información. El diagnostico nacional evidencia un aumento gradual de servicios y consumo de opioides en los años hito del desarrollo de políticas. 44 profesionales de cuidados paliativos perciben un efecto positivo de las políticas públicas en el consumo de opioides y bajos resultados para el dominio de servicios y educación Conclusiones: Existe una relación positiva entre políticas públicas y consumo de opioides, una relación cuantitativa positiva para servicios de cuidados paliativos y una relación cuanticualitativa negativa para programas educativos, lo que denota un bajo estatus operativo de las políticas construidas para mejorar el dolor y sufrimiento asociado a la enfermedad crónica avanzada.

Introduction: Palliative care development requires the intervention of multiple dimensions of public health, including the availability of health services, essential medicines, and educational programs. In Colombia, several changes have been made in public policy to promote the care of people with palliative needs. Objective: To empirically evaluate existing public policies on palliative care and their implications for the availability of services, opioids, and educational programs during the years 2010 to 2019 in Colombia. Materials and methods: A mixed sequential exploratory study was designed in three phases: identification of empirical indicators of national policies, palliative care situational diagnosis, and qualitative assessment of the results of policy implementation in seven regional nodes in Colombia. Results: Seven standards were reviewed, yielding 12 empirical indicators for assessment, six of which had no sources of information. The national diagnosis shows a gradual increase in services and opioid use during the landmark years of policy development. Forty-four palliative care professionals perceive a positive effect of public policy on opioid use and low outcomes for service and education domains. Conclusions: There is a positive relationship between public policy and opioid use, a positive quantitative relationship with palliative care services, and a negative quantitative-qualitative relationship with educational programs. This indicates a low operational status of policies designed to alleviate the pain and suffering associated with advanced chronic diseases.

Introdução: O desenvolvimento dos cuidados paliativos requer a intervenção de múltiplas dimensões da saúde pública, incluindo a disponibilidade de serviços de saúde, medicamentos essenciais e programas educativos. Na Colômbia, várias mudanças foram feitas nas políticas públicas para promover o cuidado de pessoas com necessidades paliativas. Objetivo: Avaliar empiricamente as políticas públicas existentes em cuidados paliativos e suas implicações na disponibilidade de serviços, opioides e programas educacionais nos anos 2010 - 2019 na Colômbia. Materiais e métodos: Desenhou-se um estudo misto exploratório sequencial em três fases: identificação de indicadores empíricos de políticas nacionais, diagnóstico situacional de cuidados paliativos e avaliação qualitativa dos resultados da implementação de políticas em sete nodos territoriais da Colômbia. Resultados: Sete normas foram revisadas, obtendo-se 12 indicadores empíricos para avaliação, seis delas não possuíam fontes de informação. O diagnóstico nacional mostra um aumento gradual nos serviços e consumo de opioides nos anos marcantes do desenvolvimento de políticas. 44 profissionais de cuidados paliativos percebem efeito positivo das políticas públicas sobre o consumo de opioides e resultados baixos para o domínio serviços e educação Conclusões: Existe relação positiva entre políticas públicas e consumo de opioides, relação quantitativa positiva para serviços de cuidados paliativos e negativa relação quantitativo-qualitativa para programas educativos, o que denota um baixo status operacional das políticas destinadas a melhorar a dor e o sofrimento associados à doença crônica avançada.

Characterization of the Polar Profile of Bacon and Fuerte Avocado Fruits by Hydrophilic Interaction Liquid Chromatography-Mass Spectrometry: Distribution of Non-structural Carbohydrates, Quinic Acid, and Chlorogenic Acid between Seed, Mesocarp, and Exocarp at Different Ripening Stages.

Avocado fruit growth and development, unlike that of other fruits, is characterized by the accumulation of oil and C7 sugars (in most fruits, the carbohydrates that prevail are C6). There are five essential carbohydrates which constitute 98% of the total content of soluble sugars in this fruit; these are fructose, glucose, sucrose, d-mannoheptulose, and perseitol, which together with quinic acid and chlorogenic acid have been the analytes under study in this work. After applying an efficient extraction procedure, a novel methodology based on hydrophilic interaction liquid chromatography coupled to mass spectrometry was applied to determine the levels of these seven substances in tissues─exocarp, seed, and mesocarp─from avocado fruits of two different varieties scarcely studied, Bacon and Fuerte, at three different ripening stages. Quantitative characterization of the selected tissues was performed, and the inter-tissue distribution of metabolites was described. For both varieties, d-mannoheptulose was the major component in the mesocarp and exocarp, whereas perseitol was predominant in the seed, followed by sucrose and d-mannoheptulose. Sucrose was found to be more abundant in seed tissues, with much lower concentrations in avocado mesocarp and exocarp. Quinic acid showed a predominance in the exocarp, and chlorogenic acid was exclusively determined in exocarp samples.

Study on the insecticidal activity of entomopathogenic fungi for the control of the fruit fly (Anastrepha obliqua), the main pest in mango crop in Colombia.

The aim of this study was to evaluate and select entomopathogenic fungi that produces insecticidal compounds for the control of adults of Anastrepha obliqua Macquart (Diptera: tephritidae) that are the main pest of mango (Mangifera indica L. Bark) in Colombia. Nine entomopathogenic fungi isolates were evaluated, five belonging to the genus Metarhizium and four belonging to the genus Beauveria. One strain of the species Metarhizium robertsii with insecticidal activity was selected. By column fractionation, an active fraction was obtained, which caused mortalities higher than 90% after 48 h of exposure. Through HPLC it was determined that the active fraction is composed of more than 22 metabolites. Identification of the metabolites by UHPLC MS/MS revealed the presence of destruxin in E, D, A and B groups (destruxin E-diol, destruxin D, destruxin D1, destruxin D2, destruxin A2, destruxin A, destruxin A3, dihydrodestruxin A, desmB, destruxin B2, destruxin B and destruxin B1). The evaluation of the insecticidal capacity of the organic fractions obtained by HPLC indicated that the extract obtained from the isolate M. robertsii had a compound with high activity on adults of A. obliqua (destruxin A) causing massive mortality of up to 100%, after 48 h of the treatment administration. Furthermore, two other compounds with medium activity were found (destruxin A2 and destruxin B), showing mortalities between 60.0 and 81.3%, respectively. The extract of the isolate MT008 of M. robertsii showed higher insecticidal activity and a potential source for the control of A. obliqua.

Effect of microencapsulated inoculum of Pichia kudriavzevii on the fermentation and sensory quality of cacao CCN51 genotype.

BACKGROUND: Microencapsulated yeasts are a novel alternative as a delivery matrix for microbiological starters. This technology aims to protect the active compounds from adverse environmental conditions and prolong their useful life and could also improve the conditions of the starters for cocoa fermentation. The present study established the effective dose to apply the microencapsulated yeast Pichia kudriavzevii as a microbiological starter of fermentation and biotechnological strategy for promoting the biochemical dynamics and sensory expression of the cocoa variety CCN-51. For this, 0.5%, 1%, 2%, and 3% of microencapsulated P. kudriavzevii yeast insolated from the artisanal fermentation process of cocoa was added to the cocoa mass to be fermented and studied on a laboratory scale. RESULTS: The partial least squares regression of fermentation was related in four quartiles, comprising the hedonic judgments of the sensory evaluation with the biochemical traits of the cocoa liquor, finding a high correlation between the physicochemical variables total phenols, percentage of insufficiently fermented grains, and percentage of total acidity, with a level of bitterness and defects found in liquors with the addition of 0.5% of microencapsulated starter. The treatments with the addition of 2% and 3% of the inoculum showed a high correlation between the variables pH, total anthocyanins, cocoa, fruity and floral aromas, sweet taste, and general aroma perception. CONCLUSION: The higher presence of volatile compounds such as 2,3-butanediol associated with cocoa aroma and 1-phenyl-2-ethanol and acetophenone associated with aromatic descriptors of fruity and floral series allowed establishment in 2% of microencapsulated P. kudriavzevii yeast, comprising the effective dose for promoting the biochemical dynamics of laboratory-scale fermentation and the development of cocoa, as well as the fruity and floral aromas of cocoa CCN-51 liquor. The microencapsulation is suitable for cocoa starters. © 2023 Society of Chemical Industry.

Enfermedad ósea metabólica del prematuro: revisión de tema / Metabolic bone disease of prematurity: topic review

Resumen La enfermedad ósea metabólica del prematuro es una patología multifactorial que representa una importante causa de morbilidad, cuya prevalencia ha aumentado. Su diagnóstico requiere criterios bioquímicos, radiológicos y, en etapas avanzadas, clínicos; por lo cual, muchos autores recomiendan estrategias de tamizaje y prevención. El objetivo del presente artículo es realizar una revisión de los aspectos más relevantes respecto a la enfermedad ósea metabólica del prematuro, con énfasis en la prevención y tratamiento precoz. Se realizó una revisión bibliográfica con términos MeSH, en las bases de datos de Pubmed, ClinicalKey, ScienceDirect, SciELO y LILACS. Aunque no hay consenso en las pautas de tamizaje, diagnóstico y tratamiento, la principal estrategia usada en la actualidad es el soporte nutricional individualizado que cubra las demandas de calcio, fósforo y vitamina D, asociado a métodos de intervención clínica y seguimiento de bebés de alto riesgo. La comprensión de esta patología permitirá mejorar las estrategias de tamización, diagnóstico precoz, y de esta forma evitará complicaciones.

Abstract Metabolic bone disease of prematurity is a multifactorial pathology that represents a significant cause of morbidity and has increased in prevalence. Its diagnosis requires biochemical, radiological, and, in advanced stages, clinical criteria; therefore, many authors recommend screening and prevention strategies. This article aims to review the most relevant aspects of the metabolic bone disease of prematurity, with emphasis on prevention and early treatment. A bibliographic review was carried out with MeSH terms in the Pubmed, ClinicalKey, ScienceDirect, SciELO, and LILACS databases. Although there is no consensus on screening, diagnosis and treatment guidelines, the main strategy currently used is to provide individualized nutritional support that covers the demands of calcium, phosphorus and vitamin D associated with clinical intervention methods and monitoring of high-risk babies. Understanding this pathology will improve screening strategies and early diagnosis and thus avoid complications.

Using the articularis genu to test peri-articular muscle health during knee osteoarthritis.

Knee osteoarthritis (OA) involves peri-articular sarcopenia. The infrapatellar articularis genu (AG) links to the quadriceps femoris (QF) and can be sampled from discarded tissue during arthroplasty. We predict disuse-mediated changes in AG myofiber type ratio and atrophy similar to reports on the QF during OA. OA AGs (n = 40) were preserved and grouped by poor (≤ 85°; n = 11), fair (90°-110°; n = 19), and good (≥ 115°; n = 10) range of motion (ROM). Immunolabeling of slow and fast myosin heavy chains in AG sections allowed comparing distribution and cross-sectional area (CSA) of type-I (T1) and type-II (T2) myofibers between groups and associating to ROM. T1/T2 ratios in fair and poor ROM groups was consistent with those published in OA QF. Increasing mean ± SD T2 percentages from good (43.31 ± 11.76), to fair (50.96 ± 5.85), and poor (60.02 ± 8.29) ROM groups was significant between poor versus fair (p = 0.018) and good (p < 0.0001) in association with ROM deficits (r = - 0.729; p < 0.0001). T1 and T2 CSA decreased with worsening ROM, which associates with lower symptom scores (r = 0.3198; p = 0.0472). In-depth evaluation of the OA AG as a surrogate for the OA QF relative to serum and/or synovial fluid biomarkers of sarcopenia could refine diagnostics of peri-articular muscle health to guide individualized strength rehabilitation after surgery.

Health Through a Human Right Lens at the US-Mexico Border: Increasing Access to Healthcare for Central American Immigrants.

The number of immigrants seeking entry into the U.S. through asylum requests or through irregular means is increasing, and most come from the Northern Triangle of El Salvador, Guatemala, and Honduras. Immigrants come fleeing extreme poverty, violence, health and social inequities, and drastic climate changes. Most had limited access to healthcare at home, and even more limited care along the journey. Those that are allowed entry into the U.S., are confronted with feeling unwelcome in many communities, having to navigate an array of local, state, and federal laws that regulate access to healthcare. We need immigration policies that preserve the health, dignity with a multinational policy for provision of healthcare through a human rights lens from point of origin to point of destination.

Artificial neural networks model: Neuropsychological variables and their relationship with body fat percentage in adults / Modelo de redes neuronales artificiales: Variables neuropsicológicas y su relación con el porcentaje de grasa corporal en adultos

Abstract There is a growing interest to understand the neural functions and substrates of complex cognitive processes related to Obesity (OB). Artificial Intelligence (AI) is being applied, specifically the perceptron model of Artificial Neural Networks (ANN) in non-communicable chronic diseases, to identify with greater certainty the connective factors (synaptic networks) between the input variables and the output variables associated. Objective Identify the synaptic weights of the ANN whose input variables are the executive functions (EF) and healthy lifestyles as predictors of Body Fat Percentage (BFP) in a group of adult subjects with different levels of BFP. Methods It was an exploratory, quantitative, cross-sectional, comparative, convenience, and explanatory research. The Neuropsychological Battery (BANFE-2) and the Overeating Questionnaire (OQ) were administered to 40 participants aged between 18-38 years. BFP was measured using a RENPHO ES-24M Smart Body Composition Scale. The perceptron ANN model with ten trials was applied with a multilayer-perceptron. Results The ANN showed that the sensory variables with greater synaptic weight for BFP were Stroop A and B Errors and Successes of BANFE-2, and OQ scales Rationalizations and Healthy Habits. Conclusions ANN proved to be important in the simultaneous analysis of neuropsychological and healthy lifestyle data for the analysis of OB prevention and treatment by identifying the variables that are closely related. These findings open the door for the use of non-linear analysis models, which allow the identification of relationships of different weights, between input and output variables, to more effectively direct interventions to modify obesity habits.

Resumen Existe un interés creciente por comprender las funciones neuronales y sustratos cognitivos complejos relacionados con la obesidad. Se está aplicando Inteligencia Artificial, en concreto el modelo perceptrón de Redes Neuronales Artificiales en enfermedades crónicas no transmisibles, para identificar con mayor certeza los factores de conexión (redes sinápticas) entre las variables de entrada y las variables de salida. Objetivo Identificar pesos sinápticos de la RNA cuyas variables de entrada fueron las funciones ejecutivas y los estilos de vida saludable, como predictores del Porcentaje de Grasa Corporal en un grupo de sujetos adultos con diferentes niveles del Porcentaje de Grasa. Métodos se trató de una investigación exploratoria, cuantitativa, transversal, comparativa, de conveniencia y explicativa. Se administró la Batería Neuropsicológica (BANFE-2) y el Cuestionario de Sobreingesta (OQ), a 40 participantes con edades comprendidas entre los 18-38 años. El porcentaje de grasa se midió con una báscula de composición corporal (RENPHO ES-24M). El modelo redes neuronales de perceptrón, se ejecutó con diez ensayos. Resultados El modelo de Red Neuronal mostró que las variables sensoriales con mayor peso sináptico para el porcentaje de grasa, fueron Errores Stroop A y B y Aciertos de BANFE-2, y Racionalizaciones de las escalas OQ y Hábitos Saludables. Conclusiones las redes neuronales artificiales demostró ser importante en el análisis simultáneo de datos neuropsicológicos y de estilo de vida saludable para el análisis de prevención y tratamiento de la obesidad, al identificar las variables que están estrechamente relacionadas. Estos hallazgos abren la puerta al uso de modelos de análisis no lineales, que permiten identificar relaciones de diferente peso, entre variables de entrada y salida, más eficientes que los modelos lineales.

Culprit Lesion Detection in Patients Presenting With Non-ST Elevation Acute Coronary Syndrome and Multivessel Disease.

BACKGROUND/PURPOSE: Identification of the culprit lesion in patients with non-ST elevation acute coronary syndrome (NSTE-ACS) allows appropriate coronary revascularization but may be unclear in patients with multivessel coronary disease (MVD). Therefore, we investigated the rate of culprit lesion identification during coronary angiography in NSTE-ACS and multivessel disease. METHODS/MATERIALS: Consecutive patients presenting with NSTE-ACS and MVD, between January 2012 and December 2016 were evaluated. Coronary angiograms, intravascular imaging, and ECGs were analyzed for culprit lesion identification. Long-term clinical outcomes in terms of major adverse cardiac events (MACE) and mortality were reported in patients with or without culprit identification. RESULTS: A total of 1107 patients with NSTE-ACS and MVD were included in the analysis, 310 (28.0%) with unstable angina and 797 (72.0%) with non-ST elevation myocardial infarction. The culprit lesion was angiographically identified in 952 (86.0%) patients, while no clear culprit lesion was found in 155 (14.0%) patients. ECG analysis allowed to predict the location of the culprit vessel with low sensitivity (range 28.4%-36.7%) and high specificity (range 90.6%-96.5%). Higher lesion complexity was associated with inability to identify the culprit. Intravascular imaging was applied in 55 patients and helped to identify the culprit lesion in 53 patients (96.4%). There was no difference in all-cause mortality (21.4% vs. 25.8%, p = 0.24) and MACE (39.2% vs. 47.6%, p = 0.07) between the cohorts with or without culprit lesion identification by angiography. CONCLUSIONS: The culprit lesion appeared unclear by coronary angiography in >10% of patients with NSTE-ACS and MVD. Complementary invasive imaging substantially enhanced the diagnostic accuracy of culprit lesion detection.

Síndrome de dolor miofascial en la musculatura del suelo pélvico femenino. Revisión narrativa de la literatura / Myofascial pain syndrome in the female pelvic floor musculature. Narrative review of the literature

Introducción: El síndrome de dolor miofascial del suelo pélvico en la mujer es una causa frecuente de dolor agudo y crónico, en ocasiones superpuesto a otras entidades patológicas. Es secundario a la sobrecarga mecánica muscular que favorece la aparición de puntos gatillo.Objetivo: Describir una entidad dolorosa frecuente, su fisiopatología y posibilidades de tratamiento.Metodología: Se realizó una revisión de la literatura con términos Mesh en inglés y español en las bases de datos Embase, Pubmed, Lilacs, Sage, Google Acedemics y Scielo desde el año 1983 hasta el año 2021. Se encontraron 240 artículos y fueron seleccionados 50, basados en su impacto clínico.Resultados: El dolor pélvico afecta a más del 50 % de las mujeres mayores de 35 años. Existen diferentes condiciones clínicas que favorecen la sobrecarga mecánica muscular y la formación de puntos miofasciales dolorosos. El diagnóstico es clínico, pero se pueden solicitar estudios imagenológicos. El tratamiento incluye varias modalidades: terapia física, psicoterapia, farmacoterapia e intervencionismo con aguja seca, estimulación eléctrica y toxina botulínica.Conclusión: El síndrome miofascial en la musculatura pélvica femenina es una condición prevalente que debe ser considerada dentro del diagnóstico de dolor pélvico y abordada de manera multidisciplinaria.(AU)

Introduction: Pelvic floor myofascial pain syndrome in women is a frequent cause of acute and chronic pain, sometimes superimposed on other pathological entities. It is secondary to mechanical muscle overload that favors the appearance of trigger points.Objective: To describe a frequent painful entity, its pathophysiology, and treatment possibilities.Methodology: A literature review was carried out with Mesh terms in English and Spanish in the databases Embase, Pubmed, Lilacs, Sage, Google Academics, Scielo from 1983 to 2021. 240 articles were found and 50 were selected based on their clinical impact.Results: Pelvic pain affects more than 50 % of women over 35 years of age. There are different clinical conditions that favor mechanical muscle overload and the formation of painful myofascial points. Diagnosis is clinical, but imaging studies may be requested. Treatment includes several modalities: physical therapy, psychotherapy, pharmacotherapy, and dry needling, electrical stimulation, and botulinum toxin.Conclusion: Myofascial syndrome in the female pelvic musculature is a prevalent condition that should be considered within the diagnosis of pelvic pain and approached in a multidisciplinary manner.(AU)

[Relationship between gestational obesity and adverse perinatal outcomes: A multicenter study]. / Relación entre obesidad gestacional y desenlaces perinatales adversos: Estudio multicéntrico.

INTRODUCTION: To identify the association between maternal obesity and perinatal adverse outcomes in a population from the Colombian northeast. PATIENTS AND METHOD: Multicenter, prospective, transverse study with patients who consulted and completed their pregnancy at the Clinica Materno Infantil San Luis and Hospital Universitario de Santander, between January 2019 and March 2020. The nutritional status of the patients was classified according to the Rosso-Mardones curve and obese and normal- weight pregnant women were included. The main outcome was prematurity, and the secondary ones were intrauterine growth restriction, large for gestational age, and early neonatal hypoglycemia. The analysis was made in subgroups of pregnant women without comorbidities. The strength of associa tion was estimated through binomial regression (RR), and a confidence interval of 95%, adjusted by maternal age as a confounding variable according to a counterfactual model. A p- < 0.05 value was considered statistically significant. RESULTS: 283 obese pregnant women and 276 normal body mass index pregnant women were included. There was a significant association between maternal obesity and prematurity (RR 2.5; CI95% 1.4-4.2), early neonatal hypoglycemia (RR 7.1; CI95% 2.1-23.7), and large for gestational age (RR 6.6; CI95% 3,3-13,1). These findings were similar in pregnant wo men without maternal hypertension or diabetes. CONCLUSION: Maternal obesity is associated with prematurity, large for gestational age, and early neonatal hypoglycemia; even in patients without maternal hypertension and diabetes.

Human prion disease surveillance in Spain, 1993-2018: an overview.

In Spain, human transmissible spongiform encephalopathies (TSEs) have been undergoing continuous surveillance for over 25 years. In 1995, the system was launched as an EU Concerted Action, with EU surveillance network procedures being incorporated from 2002 onwards. The aim of this report was to describe performance and outcomes of this surveillance system across the period 1993-2018. Neurology and public health specialists from every region reported cases to a central hub at the Carlos III Health Institute, Madrid. In all, eight accidentally transmitted cases and five definite variant Creutzfeldt-Jakob disease (vCJD) patients were reported. All vCJD cases were diagnosed between 2005 and 2008. Two of these were family/dietary-related and spatially linked to a third. Yearly incidence of sporadic CJD per million was 1.25 across the period 1998-2018, and displayed a north-south gradient with the highest incidence in La Rioja, Navarre and the Basque Country. Genetic TSEs were observed to be clustered in the Basque Country, with a 4-fold incidence over the national rate. A total of 120 (5.6%) non-TSE sporadic, conformational, rapidly progressing neurodegenerative and vascular brain disorders were reported as suspect CJD. We conclude that TSEs in Spain displayed geographically uneven, stable medium incidences for the sporadic and genetic forms, a temporal and spatial family cluster for vCJD, and decreasing numbers for dura-mater-associated forms. The vCJD surveillance, framed within the EU network, might require continuing to cover all prion disorders. There is need for further strategic surveillance research focusing on case definition of rapid-course, conformational encephalopathies and surgical risk.