Empagliflozin and Dapagliflozin Improve Endothelial Function in Mexican Patients with Type 2 Diabetes Mellitus: A Double-Blind Clinical Trial.

AIM: To assess the acute effect of empagliflozin versus dapagliflozin administration on flow-mediated vasodilation in patients with type 2 diabetes mellitus. DESIGN: A double-blind clinical trial, at the Experimental and Clinical Therapeutics Institute, University Health Sciences Center, at the Universidad de Guadalajara, in inpatients with T2D according to the 2023 ADA criteria. METHODS: Thirty patients (15 males and 15 females), aged between 35 and 65 years, were included in this study, according to the 2023 ADA criteria. The eligible patients were randomly assigned to three groups: empagliflozin 25 mg once daily, dapagliflozin 10 mg once daily, or placebo once daily. Anthropometric parameters were taken using validated techniques. FMD was measured using a high-resolution semiautomatic ultrasound UNEX-EF 38G (UNEX Co., Ltd., Nagoya, Japan). Arterial tension was determined with the OMRON electronic digital sphygmomanometer (HEM 907 XL, Kyoto, Japan). RESULTS: The group of patients who received empagliflozin had a significantly lower baseline flow-mediated dilation (FMD) compared to the group receiving dapagliflozin (p = 0.017); at the end of this study, the empagliflozin group achieved a comparable FMD to the dapagliflozin group (p = 0.88). CONCLUSION: After the treatment period, the empagliflozin and dapagliflozin groups achieved similar FMD, suggesting a class effect.

Clinical Course and Outcomes of Autoimmune Versus Non-Autoimmune Surgically Induced Scleral Necrosis: A Multicentric Comparative Study.

BACKGROUND: To analyze the clinical course and outcomes of autoimmune vs. non-autoimmune surgically induced scleral necrosis (SISN). METHODS: Multicentric, retrospective, comparative cohort study. Eighty-two eyes of 70 patients with SISN were classified according to pathogenic mechanism into autoimmune vs. non-autoimmune. Main outcome measures included necrosis onset, type of surgery, associated systemic disease, visual acuity, and treatment were analysed in patients followed for ≥ 6 months. RESULTS: Forty-six (65.7%) patients were women, and the median age was 66 (range: 24-90) years. Most patients (82.9%) had unilateral disease. The median time between surgery and SISN onset was 58 (1-480) months. Thirty-one (37.8%) eyes were classified as autoimmune, and 51 (62.2%) as non-autoimmune SISN. Autoimmune SISN was associated with a shorter time between the surgical procedure and SISN onset than non-autoimmune cases (median of 26 vs. 60 months, p = 0.024). Also, autoimmune SISN was associated with cataract extraction (93.5% vs. 25.5%, p < 0.001), severe scleral inflammation (58.1% vs. 17.6%, p < 0.001), and higher incidence of ocular complications (67.7% vs. 33.3%, p = 0.002) than non-autoimmune cases. Remission was achieved with medical management alone in 44 (86.3%) eyes from the non-autoimmune and in 27 (87.1%) from the autoimmune group (p = 0.916). Surgical management was required in 11 (13.4%) eyes, including two requiring enucleations due to scleral perforation and phthisis bulbi. CONCLUSIONS: Eyes with autoimmune SISN had a higher rate of cataract surgery, severe scleral inflammation, and ocular complications. Early SISN diagnosis and appropriate management, based on clinical features and pathogenic mechanisms, are critical to avoid sight-threatening complications.

Leukemic infiltration of the ciliary body in a child with T-cell acute lymphoblastic leukemia.

A 14-year-old boy presented after 2 months of vision loss, redness, and pain in the right eye, initially treated as anterior uveitis with topical corticosteroids. He had a 1-year history of T-cell acute lymphoblastic leukemia, which had been in remission for 6 months. On examination, visual acuity in the right eye was light perception, with 4+ anterior chamber cells, pupillary membrane, and an intumescent cataract. Ultrasound biomicroscopy (UBM) revealed a ciliary body mass and capsular bag rupture. After consultation with his oncologist, he received 10 radiotherapy sessions. At 1 month, UBM showed resolution of the mass. After 1 year of remission, the patient underwent pars plana vitrectomy, pupillary membranectomy, and placement of a scleral-fixated intraocular lens. Thirty months after surgery, visual acuity was 20/25. Leukemic infiltration of the ciliary body is a rare manifestation of the disease that is often misdiagnosed as uveitis.

Efectos de Cinnamomum zeylanicum en niveles glucémicos en pacientes con diabetes tipo 2: ensayo clínico aleatorizado / Effects of Cinnamomum zeylanicum on glycemic levels in patients with type 2 diabetes: Randomized clinical trial

Objetivo: Evaluar el efecto del consumo de suplemento de Cinnamomum zeylanicum (canela) en los niveles glucémicos de adultos mexicanos con diabetes tipo 2. Métodos: Se realizó un ensayo clínico aleatorizado simple ciego con 30 pacientes >18 años con diabetes tipo 2, se aleatorizaron en los grupos: intervención y control; donde consumieron cápsulas con 2 gramos de C. zeylanicum o harina de trigo (placebo) diario por 12 semanas y se midieron variables antropométricas y bioquímicas (HbA1c, GPa, triglicéridos, colesterol total, HDL y LDL). Se utilizó el software IBM SPSS versión 23 y se aplicó la prueba T-Student y U-Mann Withney para muestras independientes (según el comportamiento de la variable) para las diferencias entre grupos, valores p<0.05 fueron considerados estadísticamente significativos. Resultados: No se observaron cambios significativos en HbA1c entre grupos (p>0.05). Sin embargo, post-tratamiento el grupo intervención disminuyó significativamente HbA1c al compararlo con su línea base (-0.41%, p=0.01) mientras que no se encontraron diferencias en el grupo control (+0.03%, p=0.64). No hubo diferencias significativas en variables antropométricas ni bioquímicas. Conclusiones: El consumo de 2 g de C. zeylanicum en mexicanos con diabetes tipo 2 no produjo cambios significativos entre grupos. Se sugieren nuevos estudios donde se evalúe el suplemento de canela con una muestra mayor. ClinicalTrials.gov; NCT04023539. (AU)

Objective: To evaluate the effect of Cinnamomum zeylanicum (cinnamon) supplement use on the glycemic levels of Mexican adults with type 2 diabetes. Methods: A single-blind randomized clinical trial was conducted with 30 patients over 18 years of age with type 2 diabetes. They were randomized into intervention and control groups where they took 2-gram capsules of Cinnamomum zeylanicum or wheat flour (placebo) daily for 12 weeks; then the anthropometric and biochemical variables HbA1c, FPG, triglycerides, total cholesterol, HDL and LDL were measured. IBM SPSS version 23 software was used and the Student's t-test and Mann-Whitney U test for independent samples (according to the behavior of the variable) were applied for differences between groups, p-values <0.05 were considered statistically significant. Results: No significant changes in HbA1c were seen between the two groups (p>0.05). However, post-treatment, the HbA1c value in the intervention group decreased significantly when compared to their baseline (-0.41%, p=0.01), while no differences were found in the control group (+0.03%, p=0.64). There were no significant differences in the anthropometric or biochemical variables. Conclusions: The consumption of 2 g of Cinnamomum zeylanicum in Mexican people with type 2 diabetes did not produce significant changes between the groups. New studies evaluating cinnamon supplementation on a larger sample size are suggested. ClinicalTrials.gov; NCT04023539. (AU)

Creencias sobre prácticas de alimentación y obesidad de madres con hijos menores de 5 años del noroeste de México / Crenças sobre práticas de alimentação e obesidade entre mães com filhos menores de 5 anos de idade no noroeste do México / Beliefs about feeding practices and obesity among mothers with children under 5 years of age in northwestern Mexico

Introducción: Existe una tendencia mundial de incrementoen los índices de sobrepeso y obesidad en niños menoresde 5 años. Las creencias, percepciones y actitudes de lasmadres hacia las prácticas de alimentación y la obesidadtienen implicaciones directas sobre la salud del hijo.Objetivo: Explorar creencias sobre prácticas de alimentacióny obesidad infantil entre madres con hijos menores de cincoaños del noroeste de México.Metodología: Estudio cualitativo de aproximación etnográfica.Mediante un muestreo propositivo se realizaron nueve entrevistassemiestructuradas a mujeres que contaban con un promediode 12 años de educación.Resultados: Las creencias incluyeron inseguridad para asumirel rol de madre, una baja percepción de apoyo familiar ycreencias que no se alineaban con las recomendaciones dela lactancia materna exclusiva e introducción de alimentoscomplementarios. Además, estas tenían la creencia de que laobesidad no es un problema debido a la corta edad de sus hijos.Conclusiones: Existe una ambivalencia entre las creencias delas participantes y sus prácticas con relación a la alimentacióny la obesidad infantil. Es imperativo desarrollar estrategiasde educación y comunicación que proporcionen informaciónbasada en evidencia, de fácil acceso y disponible para madrescon la intención de prevenir problemas de nutrición durantela primera infancia.(AU)

Introduction: There is a worldwide trend of increasingrates of overweight and obesity in children under5 years of age. Mothers' beliefs, perceptions, andattitudes towards feeding practices and obesity havedirect implications on their children's health.Aim: To explore beliefs about feeding practices andchildhood obesity among mothers with children underfive years of age in northwestern Mexico.Methodology: Qualitative study with ethnographicapproach. Using purposive sampling, nine semi-structured interviews were conducted with womenwith an average of 12 years of education.Results: Beliefs included insecurity in assuming therole of mother, a low perception of family support, andbeliefs that were not aligned with the recommendations ofexclusive breastfeeding and introduction of complementary foods. In addition, these held the belief that obesity isnot a problem due to the young age of their children.Conclusions: There is ambivalence between theparticipants' beliefs and their practices regarding feedingand childhood obesity. It is imperative to developeducation and communication strategies that provideevidence-based information that is easily accessibleand available to mothers to prevent nutrition problemsduring early childhood.(AU)

Introdução: Há uma tendência mundial de aumentodas taxas de sobrepeso e obesidade em crianças commenos de 5 anos de idade. As crenças, percepções eatitudes das mães com relação às práticas alimentares eà obesidade têm implicações diretas na saúde infantil.Objetivo: explorar as crenças sobre práticas de alimentaçãoe obesidade infantil entre mães de crianças com menosde cinco anos de idade no noroeste do México.Metodologia: estudo qualitativo com uma abordagemetnográfica. Usando amostragem intencional, foramrealizadas nove entrevistas semiestruturadas commulheres com uma média de 12 anos de escolaridade.Resultados: As crenças incluíam insegurança em assumiro papel de mãe, baixa percepção de apoio familiar ecrenças que não se alinhavam com as recomendaçõesde amamentação exclusiva e introdução de alimentoscomplementares. Além disso, elas acreditavam quea obesidade não era um problema devido à poucaidade de seus filhos.Conclusões: Há uma ambivalência entre as crenças epráticas dos participantes com relação à alimentaçãoe à obesidade infantil. É imperativo desenvolverestratégias de educação e comunicação que forneçaminformações baseadas em evidências, facilmenteacessíveis e disponíveis para as mães, a fim de evitarproblemas de nutrição na primeira infância.(AU)

Ocular Mucous Membrane Pemphigoid: The Effect of Risk Factors at Presentation on Treatment Outcomes.

PURPOSE: Analyze the influence of risk factors at presentation in the long-term immunosuppressive therapy (IMT) outcomes of ocular mucous membrane pemphigoid (OMMP). DESIGN: Retrospective multicenter study. PARTICIPANTS: Patients with OMMP seen at the Duke Eye Center, Tecnologico de Monterrey, and Hospital Clinic of Barcelona from 1990 to 2022. METHODS: Data at presentation on demographics, direct immunofluorescence, ocular findings, sites of extraocular manifestations (EOMs), and previous treatments in patients with a clinical or laboratory diagnosis of OMMP, were analyzed with multivariable analysis and Kaplan-Meier plots to identify factors associated with adverse outcomes. MAIN OUTCOME MEASURES: (1) Inflammatory control (no conjunctival inflammation in both eyes at 3 months on IMT); (2) relapse (new-onset inflammation after absolute control in either eye); (3) progression (≥ 1 cicatrizing stage progression in either eye); and (4) vision loss (≥ 2 Snellen lines). RESULTS: A total of 117 patients (234 eyes), 61% (71/117) of whom were women, with a mean age of 66.6 (SD: 12.4) years (range: 37-97 years) and median follow-up of 34 months (interquartile range: 16-66 months; range: 3-265 months), were enrolled. Inflammatory control was achieved in 57% of patients (67/117), with high-risk EOM (HR-EOM), including esophageal, nasopharyngeal, and/or genital involvement (adjusted odds ratio [aOR]: 12.51; 95% confidence interval [CI]: 2.61-59.99; P = 0.002) and corneal scarring (aOR: 3.06; 95% CI, 1.15-8.14; P = 0.025), as significant risk factors for persistent inflammation. Disease relapse, progression, and vision loss occurred in 20% of patients (23/117), 12% of patients (14/117), and 27% of patients (32/117), respectively. Baseline corneal scarring was a risk factor for relapse (adjusted hazard ratio: 4.14; 95% CI: 1.61-10.62; P = 0.003), progression (aOR: 11.46; 95% CI: 1.78-73.75; P = 0.010), and vision loss (aOR: 3.51; 95% CI: 1.35-9.10; P = 0.010). HR-EOM was associated with stage progression (aOR, 34.57; 95% CI, 6.57-181.89; P<0.001) and vision loss (aOR, 8.42; 95% CI, 2.50-28.42; P = 0.001). No significant differences were found between IMT regimes and relapse (P = 0.169). CONCLUSIONS: Ocular mucous membrane pemphigoid presenting with HR-EOMs and corneal scarring has an increased risk of stage progression and vision loss. Corneal scarring and severe inflammation at baseline were associated with an increased risk of relapse. A disease progression staging system incorporating both the HR-EOMs and corneal involvement is required to predict the visual outcome of OMMP better. FINANCIAL DISCLOSURE(S): Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.

Changes in GC-MS metabolite profile, antioxidant capacity and anthocyanins content during fermentation of fine-flavor cacao beans from Ecuador.

The fermentation of fine-flavor cacao beans is a key process contributing to the enhancement of organoleptic attributes and monetary benefits for cacao farmers. This work aimed to describe the dynamics of the gas chromatography-mass spectrometry (GC-MS) metabolite profile as well as the antioxidant capacity and anthocyanin contents during fermentation of fine-flavor cacao beans. Samples of Nacional x Trinitario cacao beans were obtained after 0, 24, 48, 72, 96, and 120 hours of spontaneous fermentation. Total phenolic content (TPC), ferric reducing antioxidant power (FRAP), and total anthocyanin content were measured by ultraviolet-visible (UV-Vis) spectrophotometry. Volatiles were adsorbed by headspace solid phase microextraction (HS-SPME) while other metabolites were assessed by an extraction-derivatization method followed by gas chromatography-mass spectrometry (GC-MS) detection and identification. Thirty-two aroma-active compounds were identified in the samples, including 17 fruity, and 9 floral-like volatiles as well as metabolites with caramel, chocolate, ethereal, nutty, sweet, and woody notes. Principal components analysis and Heatmap-cluster analysis of volatile metabolites grouped samples according to the fermentation time. Additionally, the total anthocyanin content declined during fermentation, and FRAP-TPC values showed a partial correlation. These results highlight the importance of fermentation for the improvement of the fine-flavor characteristics of cacao beans.

Speaking up for the invisible minority: First-generation students in higher education.

A first-generation college student is typically defined as a student whose biological parent(s) or guardian(s) never attended college or who started but did not finish college. However, "first-generation" can represent diverse family education situations. The first-generation student community is a multifaceted, and intersectional group of individuals who frequently lack educational/financial resources to succeed and, consequently, require supportive environments with rigorous mentorship. However, first-generation students often do not make their identity as first-generation students known to others due to several psychosocial and academic factors. Therefore, they are often "invisible minorities" in higher education. In this paper, we describe the diverse family situations of first-generation students, further define "first-generation," and suggest five actions that first-generation trainees at the undergraduate/graduate stages can engage in to succeed in an academic climate. We also provide suggestions for mentors to accommodate first-generation students' unique experiences and equip them with tools to deliver intentional mentoring practices. We hope that this paper will help promote first-generation student success throughout the academic pipeline.

Atypical presentation of Pearson syndrome in an infant with suspected myelodysplastic syndrome.

BACKGROUND: Anemia exhibits complex causation mechanisms and genetic heterogeneity. Some cases result in poor outcomes with multisystemic dysfunction, including renal tubulopathy. Early diagnosis is crucial to improve management. CASE-DIAGNOSIS/TREATMENT: A 21-month-old female patient was admitted with severe anemia. Persistent neutropenia and dysplastic signs suggested myelodysplastic syndrome, but targeted gene panel results were negative. After multiple transfusions, spontaneous hematologic recovery was observed. At 4 years old, she presented failure to thrive, renal Fanconi syndrome, and severe metabolic acidosis. Differential diagnosis included Pearson syndrome (PS), a life-threatening condition associated with mitochondrial DNA (mtDNA), featuring anemia and pancreatic insufficiency. Further analysis revealed a ~ 7.5 kb mtDNA deletion. Until the age of 5, supportive care has been provided, without pancreatic insufficiency. CONCLUSIONS: This PS case highlights the importance of genetic testing, even in the absence of typical features. Understanding the nature of mitochondrial disorders enables treatment tailoring and counseling about the prognosis.

Undergraduate Occupational Health Nursing Education in Chile, Colombia, Brazil, and Mexico.

BACKGROUND: Occupational health nursing plays a fundamental role in addressing the health of the working population; however, training in this area differs around the world in terms of levels, duration, content, and requirements, and the current situation in Latin American countries is unknown. The objective of this study was to analyze undergraduate nursing education in occupational health from an international perspective considering Chile, Colombia, Brazil, and Mexico. METHODS: We conducted a multicenter, descriptive study, based on bibliographic methodology, whose sample was documentary, consulting government databases in Chile, Colombia, Brazil, and Mexico. FINDINGS: Heterogeneity was identified within the training in the countries analyzed, with a small number of courses in the course structures; in most cases, the courses were taught in the last years of training and predominantly as elective courses. CONCLUSIONS: The authors recommend that training centers develop programs associated with occupational nursing, which is considered an imperative to strengthen public health in developing countries and an ethical and equitable response to the working population.

Early career Latinas in STEM: Challenges and solutions.

Mexican, Puerto Rican, and Central American Ancestry (MPRCA) individuals represent 82% of US Latinos. An intergenerational group of MPRCA women and allies met to discuss persistent underrepresentation of MPRCA women in STEM, identifying multi-level challenges and solutions. Implementation of these solutions is important and will benefit MPRCA women and the entire academic community.

Ansiedad, estrés y calidad de sueño asociados a COVID-19 en universitarios del noroeste de México / Anxiety, stress and sleep quality associated to COVID-19 in university students in northwestern Mexico

Resumen Objetivo: Identificar los niveles de ansiedad, estrés percibido y calidad del sueño en universitarios del noroeste de México durante la pandemia por COVID-19 y examinar su asociación con variables sociodemográficas y con preguntas relacionadas con el COVID-19. Materiales y métodos: Estudio descriptivo, correlacional y transversal, en una muestra no probabilística de 1691 estudiantes. Se aplicaron encuestas en línea por medio de Google Forms. Se utilizó la prueba Ji-cuadrado (X2), la correlación de Spearman y análisis de regresión logística multivariado, se contó con aprobación de comité de ética y consentimiento informado de los participantes. Resultados: El 38.4% de los estudiantes presentaron ansiedad moderada y 36.5% severa. Predominó un nivel moderado de estrés (50.1%) y mala calidad del sueño (65.8%). La variable sexo se asoció con ansiedad (X2 = 88.87, p < .001), estrés percibido (X2 = 72.34, p < .001) y mala calidad del sueño (X2 = 31.26, p < .001). La regresión logística determinó que los estudiantes cuyos ingresos familiares disminuyeron a causa de la pandemia presentaron mayor riesgo de ansiedad (OR = 1.67, p =.001), estrés (OR= 1.57, p =.011) y mala calidad del sueño (OR = 1.46). Conclusiones: Más de la mitad de los estudiantes universitarios que participaron en esta investigación presentaron algún nivel de ansiedad, estrés y mala calidad de sueño durante la pandemia por COVID-19, por lo anterior, se requiere el desarrollo de programas de intervención psicosocial de salud mental dirigidos a estudiantes universitarios.

Abstract Objective: Identify the levels of anxiety, perceived stress, and sleep quality in university students in northwestern Mexico during the COVID-19 pandemic and examine their association to sociodemographic variables and questions related to COVID-19. Materials and methods: Descriptive, correlational, cross-sectional study in a non-probabilistic sample of 1691 students. Online surveys were administered using Google Forms. The chi-square test (X2), Spearman's correlation and multivariate logistic regression analysis were used, with the approval of the ethics committee and informed consent of the participants. Results: 38.4% of the students presented moderate anxiety and 36.5% severe anxiety. Moderate level of stress (50.1%) and poor sleep quality (65.8%) predominated. The sex variable was associated to anxiety (X2 = 88.87, p < .001), perceived stress (X2 = 72.34, p < .001) and poor sleep quality (X2 = 31.26, p < .001). Logistic regression determined that students whose family income decreased because of the pandemic were at higher risk of experiencing anxiety (OR = 1.67, p =.001), stress (OR= 1.57, p =.011), and poor sleep quality (OR = 1.46). Conclusions: More than half of the university students who participated in this study presented some level of anxiety, stress and poor sleep quality during the COVID-19 pandemic. Therefore, the development of psychosocial mental health intervention programs aimed at university students is required.

Cinnamomum cassia on Arterial Stiffness and Endothelial Dysfunction in Type 2 Diabetes Mellitus: Outcomes of a Randomized, Double-Blind, Placebo-Controlled Clinical Trial.

Cinnamomum cassia is a medicinal plant whose use has demonstrated benefits on body weight, blood pressure, glucose, and lipids. This study aimed to evaluate the effect of C. cassia on arterial stiffness and endothelial dysfunction (ED) in patients with type 2 diabetes mellitus (T2DM). A randomized, double-blind, placebo-controlled clinical trial was carried out in 18 subjects aged 40-65 years, with a diagnosis of T2DM of one year or less since diagnosis and treated with Metformin 850 mg daily. Patients were randomly assigned to receive either C. cassia or a placebo in 1000 mg capsules, thrice a day, before each meal for 12 weeks. At baseline and after 12 weeks of intervention, brachial-ankle pulse wave velocity and Flow Mediated Dilation were measured, as well as body weight, body mass index (BMI), blood pressure (BP), fasting glucose (FG), glycated hemoglobin A1c (HbA1c), total cholesterol, high density lipoprotein cholesterol, low density lipoprotein cholesterol, and very low density lipoprotein cholesterol, respectively, triglycerides, creatinine, and transaminases. The Mann-Whitney U test for differences between groups and the Wilcoxon signed-rank test for intragroup differences were used, and a P ≤ .05 was considered statistically significant. After C. cassia administration, statistically significant reductions in body weight (81.4 ± 10.4 kg vs. 79.9 ± 9.0 kg, P = .037), BMI (30.6 ± 4.2 kg/m2 vs. 30.1 ± 4.2 kg/m2, P = .018), and HbA1c (53 ± 5.4 mmol/mol vs. 45 ± 2.1 mmol/mol, P = .036) were observed. No changes statistically significant on arterial stiffness, ED, FG, BP, and lipids were observed. C. cassia administration decreases body weight, BMI, and HbA1c without statistically significant changes on arterial stiffness, ED, FG, BP, and lipids. CTR Number: NCT04259606.

Surgically induced scleral necrosis associated with concomitant tuberculosis infection: a diagnostic challenge.

Objective: Surgically induced scleral necrosis (SISN) is a potentially blinding sequela that may occur after any ocular procedure. SISN in the context of active tuberculosis is seldom seen. We report a case of a patient with asymptomatic tuberculosis who developed SISN after pterygium surgery. Methods: A 76-year-old Mexican-mestizo woman from Veracruz, Mexico, was referred to our clinic because of severe disabling pain and scleral thinning in her right eye. Results: Tubercular-related SISN was finally diagnosed and managed successfully with antitubercular therapy, topical and systemic corticosteroids. Conclusion: Tuberculosis must be considered as a differential diagnosis of high-risk patients in the context of refractory SISN in endemic countries.

Retinal Ischemia Following Focal Cerebral Arteriopathy in a Young Girl.

PURPOSE: We present a case of an ischemic retinopathy with severe vision loss secondary to a childhood stroke. METHODS: Case report. RESULTS: An otherwise healthy 9-year-old girl presented with a 1-day history of impaired gait and speech. After performing Computed Tomography and Magnetic Resonance Imaging, thrombosis of the left Internal Carotid Artery was observed and a diagnosis of ischemic stroke was established. Serological autoimmune, coagulation, and viral panels were unrewarding. Cardiac, inflammatory and coagulation disorders were ruled out. The cause was attributed to a Focal Cerebral Arteriopathy, a common cause of childhood stroke. The patient was treated with mechanical thrombectomy followed by anticoagulation. The day after, the patient referred vision loss of 20/100 in the left eye. Fundus evaluation of the left eye depicted diffuse intraretinal hemorrhages as well as cotton-wool spots and there was retinal whitening at the posterior pole. Six weeks after, visual acuity dropped to counting fingers. CONCLUSIONS: A macular optical coherence tomography revealed diffuse atrophic changes in the inner retinal layers at the macula, and the Angio-OCT showed an enlarged Foveal Avascular Zone. We propose ischemia-reperfusion as the primary explanation of this unusual event.

Percentage of change and increment of the glucose level after a normal oral tolerance curve between 24 and 28 weeks of pregnancy.

AIM: To determine the percentage of change and increment in glucose levels after a normal oral glucose tolerance test between 24 and 28 weeks of pregnancy. METHODS: We studied 3510 pregnant women who attended their obstetric delivery at a tertiary care hospital in Guadalajara, Mexico in 2018, according to characteristics and risk 1647 (47%) patients were screened for diabetes diagnosis using the oral glucose tolerance test, 501 patients reported normal values between their 24th and 28th week of pregnancy, only 400 patients had their fasting glucose level measured on the same day of their obstetric delivery, to be compared. RESULTS: Average age was 30 years, with an average of 25.3 weeks of pregnancy. The fasting serum glucose levels taken after 28 weeks of pregnancy and before the obstetrical delivery showed an increase of 1.1 mmol/L in women who develop gestational diabetes mellitus, in contrast to women who did not develop gestational diabetes mellitus after 28 weeks their blood glucose only increased on average 0.4 mmol/L. The incidence of gestational diabetes mellitus in the study population during 2018 was 32.7%. Patients who developed gestational diabetes mellitus after a normal oral glucose tolerance test had greater body mass index before the pregnancy and newborns had a higher weight than babies born to mothers without gestational diabetes mellitus. CONCLUSION: Changes in glucose levels after the oral tolerance test of normal glucose require strict monitoring, in that it was demonstrated that 3% of patients developed gestational diabetes mellitus after week 28 of gestation.

A cross-sectional national investigation of COVID-19 outbreaks in nurseries during rapid spread of the Alpha (B.1.1.7) variant of SARS-CoV-2 in England.

BACKGROUND: In England, the emergence the more transmissible SARS-CoV-2 variant Alpha (B.1.1.7) led to a third national lockdown from December 2020, including restricted attendance at schools. Nurseries, however, remained fully open. COVID-19 outbreaks (≥ 2 laboratory-confirmed cases within 14 days) in nurseries were investigated to assess the risk of SARS-CoV-2 infection and cumulative incidence in staff and children over a three-month period when community SARS-CoV-2 infections rates were high and the Alpha variant was spreading rapidly across England. METHODS: This was a cross-sectional national investigation of COVID-19 outbreaks in nurseries across England. Nurseries reporting a COVID-19 outbreak to PHE between November 2020 and January 2021 were requested to complete a questionnaire about their outbreak. RESULTS: Three hundred and twenty-four nurseries, comprising 1% (324/32,852) of nurseries in England, reported a COVID-19 outbreak. Of the 315 (97%) nurseries contacted, 173 (55%) reported 1,657 SARS-CoV-2 cases, including 510 (31%) children and 1,147 (69%) staff. A child was the index case in 45 outbreaks (26%) and staff in 125 (72%) outbreaks. Overall, children had an incidence rate of 3.50% (95%CI, 3.21-3.81%) and was similar irrespective of whether the index case was a child (3.55%; 95%CI, 3.01-4.19%) or staff (3.44%; 95%CI, 3.10-3.82%). Among staff, cumulative incidence was lower if the index case was a child (26.28%; 95%CI, 23.54-29.21%%) compared to a staff member (32.98%; 95%CI, 31.19-34.82%), with the highest cumulative incidence when the index case was also a staff member (37.52%; 95%CI, 35.39-39.70%). Compared to November 2020, outbreak sizes and cumulative incidence was higher in January 2021, when the Alpha variant predominated. Nationally, SARS-CoV-2 infection rates in < 5 year-olds remained low and followed trends in older age-groups, increasing during December 2020 and declining thereafter. CONCLUSIONS: In this cross-sectional study of COVID-19 outbreaks in nurseries, one in three staff were affected compared to one in thirty children. There was some evidence of increased transmissibility and higher cumulative incidence associated with the Alpha variant, highlighting the importance of maintaining a low level of community infections.

Effective Methods Based on Distinct Learning Principles for the Analysis of Hyperspectral Images to Detect Black Sigatoka Disease.

Current chemical methods used to control plant diseases cause a negative impact on the environment and increase production costs. Accurate and early detection is vital for designing effective protection strategies for crops. We evaluate advanced distributed edge intelligence techniques with distinct learning principles for early black sigatoka disease detection using hyperspectral imaging. We discuss the learning features of the techniques used, which will help researchers improve their understanding of the required data conditions and identify a method suitable for their research needs. A set of hyperspectral images of banana leaves inoculated with a conidial suspension of black sigatoka fungus (Pseudocercospora fijiensis) was used to train and validate machine learning models. Support vector machine (SVM), multilayer perceptron (MLP), neural networks, N-way partial least square-discriminant analysis (NPLS-DA), and partial least square-penalized logistic regression (PLS-PLR) were selected due to their high predictive power. The metrics of AUC, precision, sensitivity, prediction, and F1 were used for the models' evaluation. The experimental results show that the PLS-PLR, SVM, and MLP models allow for the successful detection of black sigatoka disease with high accuracy, which positions them as robust and highly reliable HSI classification methods for the early detection of plant disease and can be used to assess chemical and biological control of phytopathogens.

Cross-Sectional Study of University Students' Attitudes to 'On Campus' Delivery of COVID-19, MenACWY and MMR Vaccines and Future-Proofing Vaccine Roll-Out Strategies.

University students are a critical group for vaccination programmes against COVID-19, meningococcal disease (MenACWY) and measles, mumps and rubella (MMR). We aimed to evaluate risk factors for vaccine hesitancy and views about on-campus vaccine delivery among university students. Data were obtained through a cross-sectional anonymous online questionnaire study of undergraduate students in June 2021 and analysed by univariate and multivariate tests to detect associations. Complete data were obtained from 827 participants (7.6% response-rate). Self-reporting of COVID-19 vaccine status indicated uptake by two-thirds (64%; 527/827), willing for 23% (194/827), refusal by 5% (40/827) and uncertain results for 8% (66/827). Hesitancy for COVID-19 vaccines was 5% (40/761). COVID-19 vaccine hesitancy was associated with Black ethnicity (aOR, 7.01, 95% CI, 1.8-27.3) and concerns about vaccine side-effects (aOR, 1.72; 95% CI, 1.23-2.39). Uncertainty about vaccine status was frequently observed for MMR (11%) and MenACWY (26%) vaccines. Campus-associated COVID-19 vaccine campaigns were favoured by UK-based students (definitely, 45%; somewhat, 16%) and UK-based international students (definitely, 62%; somewhat, 12%). Limitations of this study were use of use of a cross-sectional approach, self-selection of the response cohort, slight biases in the demographics and a strict definition of vaccine hesitancy. Vaccine hesitancy and uncertainty about vaccine status are concerns for effective vaccine programmes. Extending capabilities of digital platforms for accessing vaccine information and sector-wide implementation of on-campus vaccine delivery are strategies for improving vaccine uptake among students. Future studies of vaccine hesitancy among students should aim to extend our observations to student populations in a wider range of university settings and with broader definitions of vaccine hesitancy.

Microbial Diversity and Contribution to the Formation of Volatile Compounds during Fine-Flavor Cacao Bean Fermentation.

Cacao demand is continuously increasing, and variations in cacao prices have been associated with the aroma of fermented cacao beans. However, the role of microorganisms in the formation of volatile-aroma compounds during fermentation remains unclear. Microbial diversity in Nacional × Trinitario cacao was characterized during spontaneous fermentation by using culture-based methods and next-generation sequencing (NGS) of DNA amplicons. Cacao beans that were spontaneously fermented for 0, 24, 48, 72 and 96 h were UV-sterilized prior to the inoculation of the microbial isolates obtained by the culture-based methods. The volatile formation in inoculated cacao beans was evaluated by GC-MS. The species isolated during fermentation included yeast, such as Saccharomyces cerevisiae and Candida metapsilosis; lactic acid bacteria (LAB), such as Limosilactobacillus fermentum and Liquorilactobacillus nagelii; acetic acid bacteria (AAB), such as Acetobacter pasteurianus, Acetobacter ghanensis and Acetobacter syzygii, as well as other species, such as Bacillus subtilis and Bacillus amyloliquefaciens. Additionally, NGS revealed an abundance of environmental microorganisms, including Escherichia spp., Pantoea spp., Staphylococcus spp., Botrytis spp., Tetrapisispora spp. and Pichia spp., among others. During the lab-scale fermentation, the inoculation of S. cerevisiae mostly yielded alcohols, while LAB and AAB produced volatiles associated with floral, almond and fruity notes throughout the fermentation, but AAB also produced acetic acid with a sour aroma. Similarly, the inoculation of C. metapsilosis and Bacillus spp. in 96 h fermented cacao beans yielded esters with floral aromas. This is the first report describing the role of microorganisms in volatile formation during fine-flavor cacao fermentation.