Telemedicine can be a feasible means of guiding untrained general practitioners to perform point-of-care ultrasound in life-threatening situations: the case of a field hospital during the COVID-19 pandemic.

Objective: To evaluate the feasibility of telemedicine using a standardized multiorgan ultrasound assessment protocol to guide untrained on-site general practitioners at a field hospital during a life-threatening crisis. Materials and Methods: We evaluated 11 inpatients with shock, with or without acute dyspnea, for whom general practitioners spontaneously requested remote evaluation by a specialist. Results: All of the general practitioners accepted the protocol and were able to position the transducer correctly, thus obtaining key images of the internal jugular vein, lungs, and inferior vena cava when guided remotely by a telemedicine physician, who interpreted all of the findings. However, only four (36%) of the on-site general practitioners obtained the appropriate key image of the heart in the left parasternal long-axis view, and only three (27%) received an immediate interpretation of an image from the remote physician. The mean evaluation time was 22.7 ± 12 min (range, 7-42 min). Conclusion: Even in life-threatening situations, untrained general practitioners may be correctly guided by telemedicine specialists to perform multiorgan point-of-care ultrasound in order to improve bedside diagnostic evaluation.

Objetivo: Avaliar a viabilidade da orientação por telemedicina de médicos in situ não treinados na avaliação ultrassonográfica de múltiplos órgãos mediante protocolo padronizado, durante uma situação de risco de vida em hospital de campanha. Materiais e Métodos: Avaliamos 11 pacientes com choque e/ou dispneia de manifestação aguda durante a internação, cujos clínicos gerais solicitaram auxílio de especialista a distância. Resultados: Todos os médicos aceitaram o protocolo e, posicionando o transdutor, obtiveram imagens-chave da veia jugular interna, pulmão e veia cava inferior, quando guiados por um médico via telemedicina, que interpretou os achados desses órgãos. No entanto, apenas quatro (36%) médicos in situ obtiveram a imagem-chave apropriada do coração na janela paraesternal do eixo longo esquerdo e três (27%) tiveram imagem remotamente interpretada imediatamente. O tempo de avaliação variou de 7-42 minutos (média de 22,7 ± 12 minutos). Conclusão: Em situação de risco de vida, os clínicos gerais não treinados podem ser corretamente orientados por especialistas em telemedicina para realizar ultrassonografia multiórgãos in situ, melhorando o diagnóstico beira do leito.

Telemedicine can be a feasible means of guiding untrained general practitioners to perform point-of-care ultrasound in life-threatening situations: the case of a field hospital during the COVID-19 pandemic / O ultrassom guiado por telemedicina realizado por clínicos gerais não treinados pode ser viável em uma situação de risco de vida: o caso de um hospital de campanha durante a pandemia de COVID-19

Abstract Objective: To evaluate the feasibility of telemedicine using a standardized multiorgan ultrasound assessment protocol to guide untrained on-site general practitioners at a field hospital during a life-threatening crisis. Materials and Methods: We evaluated 11 inpatients with shock, with or without acute dyspnea, for whom general practitioners spontaneously requested remote evaluation by a specialist. Results: All of the general practitioners accepted the protocol and were able to position the transducer correctly, thus obtaining key images of the internal jugular vein, lungs, and inferior vena cava when guided remotely by a telemedicine physician, who interpreted all of the findings. However, only four (36%) of the on-site general practitioners obtained the appropriate key image of the heart in the left parasternal long-axis view, and only three (27%) received an immediate interpretation of an image from the remote physician. The mean evaluation time was 22.7 ± 12 min (range, 7-42 min). Conclusion: Even in life-threatening situations, untrained general practitioners may be correctly guided by telemedicine specialists to perform multiorgan point-of-care ultrasound in order to improve bedside diagnostic evaluation.

Resumo Objetivo: Avaliar a viabilidade da orientação por telemedicina de médicos in situ não treinados na avaliação ultrassonográfica de múltiplos órgãos mediante protocolo padronizado, durante uma situação de risco de vida em hospital de campanha. Materiais e Métodos: Avaliamos 11 pacientes com choque e/ou dispneia de manifestação aguda durante a internação, cujos clínicos gerais solicitaram auxílio de especialista a distância. Resultados: Todos os médicos aceitaram o protocolo e, posicionando o transdutor, obtiveram imagens-chave da veia jugular interna, pulmão e veia cava inferior, quando guiados por um médico via telemedicina, que interpretou os achados desses órgãos. No entanto, apenas quatro (36%) médicos in situ obtiveram a imagem-chave apropriada do coração na janela paraesternal do eixo longo esquerdo e três (27%) tiveram imagem remotamente interpretada imediatamente. O tempo de avaliação variou de 7-42 minutos (média de 22,7 ± 12 minutos). Conclusão: Em situação de risco de vida, os clínicos gerais não treinados podem ser corretamente orientados por especialistas em telemedicina para realizar ultrassonografia multiórgãos in situ, melhorando o diagnóstico beira do leito.

Prospective study of the Iliac Bicrest Pubic Angle through the 3D reconstruction of the bone pelvis and the correlation with giant incisional hernia.

OBJECTIVE: to describe and measure the Bicrista Iliaca Pubo Angle (APBCI) as a new anthropometric parameter. Correlate the measurement with patients with giant incisional hernia (HIG), in the midline of the anterior abdominal wall (AAW). METHODS: measurement of APBCI, through 3D reconstruction from computed tomography (CT). Measurements performed by two observers, R and C, in 246 women and 60 men, normal adults, in order to obtain the APBCI measurement and its correlation in patients with HIG of the AAW. RESULTS: after sample calculations, the measurement of APBCI in men: 92.5+6.3º to 93.8+6.7º; in women: 90+6.7° to 94.3+6.8° [p-value 0.337(R)/0.628(C)]. The mean age was 57.9+15.9 years (22 to 91 years). Female gender 57+15.7 years (22 to 91 years) and male 61.7+16.5 years (23 to 89 years) p=0.067. As for the distribution of the ranges from 5 to 5 degrees, there is no difference in the distribution of the angle [p-value 0.455(R)/0.672(C)]. The correlation between age and angle showed that the higher the age, the higher the APBCI. There was no variability between angle measurements: 0.97 (95% CI 0.97; 0.98). In men with HIG, the average is between 108.3+5.37º (102.92º to 113.67º), and in women, 107.8+6.64 (101.16º to 114.44º). CONCLUSION: the study allowed us to conclude that HIG is not just an isolated AAW defect. Determines skeletal changes, as the APBCI is influenced by the distance of the iliac crests.

Spanish version of Jenkins Sleep Scale in physicians and nurses: psychometric properties from a Peruvian nationally representative sample.

OBJECTIVE: To evaluate the psychometric properties of the Spanish version of Jenkins Sleep Scale with 4 items (JSS-4) of the Peruvian health system's (PHS) nurses and physicians. METHODS: We carried out a psychometric study based on secondary analysis in a sample from a nationally representative survey that used acomplex sampling design. The participants were physicians and nurses aged 18-65 years, working in PHS private and public facilities, who have fulfilled all JSS-4 items. We performed a confirmatory factor analysis. Reliability was evaluated via two estimates - classic alpha (α) and categorical omega (ω) coefficients. Also, we tested the invariance across groups of variables. The convergent validity was evaluated based on the relation between JSS-4 and PHQ-2 using Pearson's correlation coefficient and effect size (Cohen's d). Also, we designed normative values based on percentiles. RESULTS: We included 2100 physicians and 2826 nurses in the analysis. We observed that the unidimensional model has adequate goodness-of-fit indices and values of α and ω coefficients. No measurement invariance was found between the groups of professionals and age groups; however, invariance was achieved between sex, monthly income, work-related illness, and chronic illness groups. Regarding the relation with other variables, the JSS-4 has a small correlation with PHQ-2. Also, profession and age-specific normative values were proposed. CONCLUSION: JSS-4 Spanish version has adequate psychometric properties in PHS nurses and physicians.

Stability of SARS-CoV-2 and other airborne viruses under different stress conditions.

Viral stability under stress conditions may directly affect viral dissemination, seasonality, and pathogenesis. We exposed airborne viruses, including severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), mumps virus, coxsackievirus B5, human rhinovirus A16, and respiratory syncytial virus, to different temperatures, UV light exposure time, pH values, and osmotic pressures and measured the remaining viral infectivity. Reduced thermal stability was observed for coxsackievirus B5 at 45 °C, while SARS-CoV-2 demonstrated residual infectivity at 55 °C. UV light exposure was an efficient means of viral inactivation but was less efficient for non-enveloped viruses. Rhinovirus A16 and respiratory syncytial virus demonstrated extreme sensitivity to acid conditions, while SARS-CoV-2, rhinovirus A16, and respiratory syncytial virus were unstable in an alkaline environment. The information obtained in this study will be useful for the development of viral inactivation methods and may be correlated with epidemiological and seasonal viral characteristics.

Prospective study of the Iliac Bicrest Pubic Angle through the 3D reconstruction of the bone pelvis and the correlation with giant incisional hernia / Estudo prospectivo do Ângulo Pubo Bicrista Ilíaca através da reconstrução 3D da pelve óssea e a correlação com a hérnia incisional gigante

ABSTRACT Objective: to describe and measure the Bicrista Iliaca Pubo Angle (APBCI) as a new anthropometric parameter. Correlate the measurement with patients with giant incisional hernia (HIG), in the midline of the anterior abdominal wall (AAW). Methods: measurement of APBCI, through 3D reconstruction from computed tomography (CT). Measurements performed by two observers, R and C, in 246 women and 60 men, normal adults, in order to obtain the APBCI measurement and its correlation in patients with HIG of the AAW. Results: after sample calculations, the measurement of APBCI in men: 92.5+6.3º to 93.8+6.7º; in women: 90+6.7° to 94.3+6.8° [p-value 0.337(R)/0.628(C)]. The mean age was 57.9+15.9 years (22 to 91 years). Female gender 57+15.7 years (22 to 91 years) and male 61.7+16.5 years (23 to 89 years) p=0.067. As for the distribution of the ranges from 5 to 5 degrees, there is no difference in the distribution of the angle [p-value 0.455(R)/0.672(C)]. The correlation between age and angle showed that the higher the age, the higher the APBCI. There was no variability between angle measurements: 0.97 (95% CI 0.97; 0.98). In men with HIG, the average is between 108.3+5.37º (102.92º to 113.67º), and in women, 107.8+6.64 (101.16º to 114.44º). Conclusion: the study allowed us to conclude that HIG is not just an isolated AAW defect. Determines skeletal changes, as the APBCI is influenced by the distance of the iliac crests.

RESUMO Objetivo: descrever e medir o Ângulo Pubo Bicrista Iliaca (APBCI) como novo parâmetro antropométrico. Correlacionar a medida com portadores de hérnia incisional gigante (HIG), da linha média da parede anterior do abdome (PAA). Métodos: medida do APBCI, através de reconstrução 3D a partir de tomografia computadorizada (TC). Realização de medidas por dois observadores, R e C, em 246 mulheres e 60 homens, adultos normais, afim de obter a medida do APBCI e sua correlação em portadores de HIG da PAA. Resultados: após cálculos de amostra, a medida do APBCI nos homens: 92,5+6,3º a 93,8+6,7º; nas mulheres: 90+6,7º a 94,3+6,8º [p-valor 0,337(R)/0,628(C)]. A média de idade foi de 57,9+15,9 anos (22 a 91 anos). Gênero feminino 57+15,7 anos (22 a 91 anos) e o masculino 61,7+16,5 anos (23 a 89 anos) p=0,067. Quanto à distribuição das faixas de 5 em 5 graus, inexiste diferença na distribuição do ângulo [p-valor 0,455(R)/0,672(C)]. A correlação idade e o ângulo demonstrou que quanto maior a idade, maior o APBCI. Não houve variabilidade entre as medidas do ângulo: 0,97 (IC95% 0,97; 0,98). Nos homens com HIG, a média está entre 108,3+5,37º (102,92º a 113,67º), e nas mulheres 107,8+6,64 (101,16º a 114,44º). Conclusão: o estudo permitiu concluir que a HIG não é apenas um defeito da PAA isolado. Determina alterações esqueléticas, na medida que o APBCI sofre a influência quanto ao afastamento das cristas ilíacas.

Chikungunya Virus Exposure Partially Cross-Protects against Mayaro Virus Infection in Mice.

Chikungunya virus (CHIKV) and Mayaro virus (MAYV) are closely related members of the Semliki Forest virus antigenic complex classified as belonging to the genus Alphavirus of the family Togaviridae. These viruses cause human disease, with sudden fever and joint inflammation that can persist for long periods. CHIKV is the causative agent of large outbreaks worldwide, and MAYV infection represents a growing public health concern in Latin America, causing sporadic cases and geographically limited outbreaks. Considering the relationship between CHIKV and MAYV, the present study aimed to evaluate if preexisting CHIKV immunity protects against MAYV infection. Immunocompetent C57BL/6 mice were intraperitoneally infected with CHIKV and, 4 weeks later, they were infected with MAYV in their hind paw. We observed that the preexistence of CHIKV immunity conferred partial cross-protection against secondary MAYV infection, reducing disease severity, tissue viral load, and histopathological scores. Interestingly, CHIKV antibodies from humans and mice showed low cross-neutralization to MAYV, but neutralizing activity significantly increased after secondary infection. Furthermore, depletion of adaptive immune cells (CD4+ T, CD8+ T, and CD19+ B cells) did not alter the cross-protection phenotype, suggesting that distinct cell subsets or a combination of adaptive immune cells stimulated by CHIKV are responsible for the partial cross-protection against MAYV. The reduction of proinflammatory cytokines, such as interferon gamma (IFN-γ), in animals secondarily infected by MAYV, suggests a role for innate immunity in cross-protection. Our findings shed light on how preexisting immunity to arthritogenic alphaviruses may affect secondary infection, which may further develop relevant influence in disease outcome and viral transmission. IMPORTANCE Mosquito-borne viruses have a worldwide impact, especially in tropical climates. Chikungunya virus has been present mostly in developing countries, causing millions of infections, while Mayaro virus, a close relative, has been limited to the Caribbean and tropical regions of Latin America. The potential emergence and spread of Mayaro virus to other high-risk areas have increased the scientific community's attention to an imminent worldwide epidemic. Here, we designed an experimental protocol of chikungunya and Mayaro virus mouse infection, which develops a measurable and quantifiable disease that allows us to make inferences about potential immunological effects during secondary virus infection. Our results demonstrate that previous chikungunya virus infection is able to reduce the severity of clinical outcomes during secondary Mayaro infection. We provide scientific understanding of immunological features during secondary infection with the closely related virus, thus assisting in better comprehending viral transmission and the pathological outcome of these diseases.

Convolutional Neural Networks to Estimate Dry Matter Yield in a Guineagrass Breeding Program Using UAV Remote Sensing.

Forage dry matter is the main source of nutrients in the diet of ruminant animals. Thus, this trait is evaluated in most forage breeding programs with the objective of increasing the yield. Novel solutions combining unmanned aerial vehicles (UAVs) and computer vision are crucial to increase the efficiency of forage breeding programs, to support high-throughput phenotyping (HTP), aiming to estimate parameters correlated to important traits. The main goal of this study was to propose a convolutional neural network (CNN) approach using UAV-RGB imagery to estimate dry matter yield traits in a guineagrass breeding program. For this, an experiment composed of 330 plots of full-sib families and checks conducted at Embrapa Beef Cattle, Brazil, was used. The image dataset was composed of images obtained with an RGB sensor embedded in a Phantom 4 PRO. The traits leaf dry matter yield (LDMY) and total dry matter yield (TDMY) were obtained by conventional agronomic methodology and considered as the ground-truth data. Different CNN architectures were analyzed, such as AlexNet, ResNeXt50, DarkNet53, and two networks proposed recently for related tasks named MaCNN and LF-CNN. Pretrained AlexNet and ResNeXt50 architectures were also studied. Ten-fold cross-validation was used for training and testing the model. Estimates of DMY traits by each CNN architecture were considered as new HTP traits to compare with real traits. Pearson correlation coefficient r between real and HTP traits ranged from 0.62 to 0.79 for LDMY and from 0.60 to 0.76 for TDMY; root square mean error (RSME) ranged from 286.24 to 366.93 kg·ha-1 for LDMY and from 413.07 to 506.56 kg·ha-1 for TDMY. All the CNNs generated heritable HTP traits, except LF-CNN for LDMY and AlexNet for TDMY. Genetic correlations between real and HTP traits were high but varied according to the CNN architecture. HTP trait from ResNeXt50 pretrained achieved the best results for indirect selection regardless of the dry matter trait. This demonstrates that CNNs with remote sensing data are highly promising for HTP for dry matter yield traits in forage breeding programs.

Lying in wait: the resurgence of dengue virus after the Zika epidemic in Brazil.

After the Zika virus (ZIKV) epidemic in the Americas in 2016, both Zika and dengue incidence declined to record lows in many countries in 2017-2018, but in 2019 dengue resurged in Brazil, causing ~2.1 million cases. In this study we use epidemiological, climatological and genomic data to investigate dengue dynamics in recent years in Brazil. First, we estimate dengue virus force of infection (FOI) and model mosquito-borne transmission suitability since the early 2000s. Our estimates reveal that DENV transmission was low in 2017-2018, despite conditions being suitable for viral spread. Our study also shows a marked decline in dengue susceptibility between 2002 and 2019, which could explain the synchronous decline of dengue in the country, partially as a result of protective immunity from prior ZIKV and/or DENV infections. Furthermore, we performed phylogeographic analyses using 69 newly sequenced genomes of dengue virus serotype 1 and 2 from Brazil, and found that the outbreaks in 2018-2019 were caused by local DENV lineages that persisted for 5-10 years, circulating cryptically before and after the Zika epidemic. We hypothesize that DENV lineages may circulate at low transmission levels for many years, until local conditions are suitable for higher transmission, when they cause major outbreaks.

Infected Cavitations, Bullae and Interstitial Lung Disease in a COVID-19 Patient in Lima, Peru.

A 48-year-old Peruvian man was diagnosed with COVID-19 in December 2020. His infection resolved and he was discharged from hospital after 14 days. However, 1 week later he presented with haemoptysis, malaise, pleuritic pain, infected cavitations, bullae, extensive interstitial lung disease and pneumomediastinum. He recovered after antibiotic treatment and was discharged after 8 days. His symptoms may have been due alveolar rupture due to persistent cough during and after diffuse inflammation of the lung parenchyma caused by COVID-19 infection. LEARNING POINTS: SARS-CoV-2 infection may be associated with lung bullae and cavitations as COVID-19 sequelae.Patients with respiratory problems after COVID-19 should be monitored closely and undergo pulmonary tests.COVID-19 patients may experience complications for several months due to bacterial infections.

Accessibility and adherence to positive airway pressure treatment in patients with obstructive sleep apnea: a multicenter study in Latin America.

PURPOSE: Information on access and adherence to positive airway pressure (PAP) treatment is lacking at the regional level in Latin America. This study characterized access and adherence to PAP in patients with moderate-severe obstructive sleep apnea (OSA) in Latin America. METHODS: Cross-sectional study, conducted at 9 sleep centers across Argentina, Brazil, Chile, Colombia, Mexico, and Peru. Adults diagnosed with moderate-severe OSA (apnea-hypopnea index [AHI] ≥ 15/h) in the previous 12-18 months were eligible. Anthropometrics, health coverage, and OSA severity data were collected. Data on access to therapy, barriers to access, adherence, and factors related to non-compliance were obtained via standardized telephone survey. RESULTS: Eight hundred eighty patients (70% male, 54 ± 13 years, AHI 49 ± 28/h, body mass index 32 ± 7 kg/m2) were included. Four hundred ninety patients (56%) initiated PAP, 70 (14%) discontinued therapy during the first year (mainly due to intolerance), and 420 (48%) were still using PAP when surveyed. Health insurance was private in 36.9% of patients, via the social security system in 31.1%, and via the state in 13.3%, and 18.7% did not have any coverage; 49.5% of patients had to pay all equipment costs. Reasons for not starting PAP were unclear or absent indication (42%), coverage problems (36%), and lack of awareness of OSA burden (14%). Patients with better adherence were older (55.3 ± 13 vs 52 ± 13; p = 0.002) and had more severe OSA (AHI 51.8 ± 27 vs 45.6 ± 27; p = 0.001). CONCLUSIONS: Less than half moderate-severe OSA patients started and continue to use PAP. Unclear or absent medical indication and financial limitations were the most relevant factors limiting access to therapy.

Factores asociados a somnolencia diurna en conductores de transporte público de Lima Metropolitana / Factors associated with daytime sleepiness in public transportation drivers in Lima Metropolitan area

RESUMEN Objetivos . Determinar la frecuencia de somnolencia y sus factores asociados en conductores de transporte público de Lima Metropolitana. Materiales y métodos . Estudio analítico transversal realizado en conductores de entre 18 y 65 años, que laboren en alguna empresa de transporte público registrada en la Municipalidad de Lima. La somnolencia se evaluó mediante una versión de la Escala de Somnolencia de Epworth validada en Perú. Las variables que se pudieron comportar como factores asociados se obtuvieron mediante una ficha de recolección de datos. Se utilizó la regresión logística para estimar la magnitud de la asociación entre la somnolencia y las variables consideradas como factores asociados. Resultados . Se incluyeron a 440 conductores, cuya mediana de edad fue 38,0 años y la mayoría (99,3%) fueron varones. Del total de conductores el 17,7% (78) presentaron somnolencia diurna. Se encontró una asociación significativa entre la somnolencia y el sistema de rotación 2 x 1 (p=0,038) y entre la somnolencia y las horas de sueño menores a siete (p=0,011). El análisis de regresión logística demostró que aquellos conductores con seis o menos horas de sueño tienen mayor probabilidad de somnolencia diurna (OR 1,83; IC95%: 1,03-3,25). Conclusiones . Aproximadamente, uno de cada cinco conductores presentó somnolencia diurna, la cual estuvo asociada con tener seis o menos horas de sueño al día.

ABSTRACT Objective . To determine the frequency of sleepiness and its associated factors in public transportation drivers in Lima metropolitan area. Materials and Methods . Transversal analytical study carried out on drivers between 18 and 65 years old who work in a public transportation company registered in the Municipality of Lima. Sleepiness was assessed using a version of the Epworth Sleepiness Scale validated in Peru. The variables that could behave as associated factors were obtained by a data collection sheet. Logistic regression was used to estimate the magnitude of the association between sleepiness and variables considered as associated factors. Results . Four hundred forty (440) drivers were included, median age was 38.0 years and the majority (99.3%) were males. From the total number of drivers, 17.7% (78) experienced daytime sleepiness. A significant association was found between sleepiness and the 2 x 1 rotation system (p=0.038), and between sleepiness and hours of sleep under seven (p=0.011). Logistic regression analysis showed that drivers with six or fewer hours of sleep were more likely to have daytime sleepiness (OR 1.83, 95% CI: 1.03-3.25). Conclusions . Approximately one out of five drivers experienced daytime sleepiness, which was associated with having six or fewer hours of sleep per day.

The NLRP3 inflammasome is involved with the pathogenesis of Mayaro virus.

Mayaro virus (MAYV) is an arbovirus that circulates in Latin America and is emerging as a potential threat to public health. Infected individuals develop Mayaro fever, a severe inflammatory disease characterized by high fever, rash, arthralgia, myalgia and headache. The disease is often associated with a prolonged arthralgia mediated by a chronic inflammation that can last months. Although the immune response against other arboviruses, such as chikungunya virus (CHIKV), dengue virus (DENV) and Zika virus (ZIKV), has been extensively studied, little is known about the pathogenesis of MAYV infection. In this study, we established models of MAYV infection in macrophages and in mice and found that MAYV can replicate in bone marrow-derived macrophages and robustly induce expression of inflammasome proteins, such as NLRP3, ASC, AIM2, and Caspase-1 (CASP1). Infection performed in macrophages derived from Nlrp3-/-, Aim2-/-, Asc-/-and Casp1/11-/-mice indicate that the NLRP3, but not AIM2 inflammasome is essential for production of inflammatory cytokines, such as IL-1ß. We also determined that MAYV triggers NLRP3 inflammasome activation by inducing reactive oxygen species (ROS) and potassium efflux. In vivo infections performed in inflammasome-deficient mice indicate that NLRP3 is involved with footpad swelling, inflammation and pain, establishing a role of the NLRP3 inflammasome in the MAYV pathogenesis. Accordingly, we detected higher levels of caspase1-p20, IL-1ß and IL-18 in the serum of MAYV-infected patients as compared to healthy individuals, supporting the participation of the NLRP3-inflammasome during MAYV infection in humans.

Systems analysis of subjects acutely infected with the Chikungunya virus.

The largest ever recorded epidemic of the Chikungunya virus (CHIKV) broke out in 2004 and affected four continents. Acute symptomatic infections are typically associated with the onset of fever and often debilitating polyarthralgia/polyarthritis. In this study, a systems biology approach was adopted to analyze the blood transcriptomes of adults acutely infected with the CHIKV. Gene signatures that were associated with viral RNA levels and the onset of symptoms were identified. Among these genes, the putative role of the Eukaryotic Initiation Factor (eIF) family genes and apolipoprotein B mRNA editing catalytic polypeptide-like (APOBEC3A) in the CHIKV replication process were displayed. We further compared these signatures with signatures induced by the Dengue virus infection and rheumatoid arthritis. Finally, we demonstrated that the CHIKV in vitro infection of murine bone marrow-derived macrophages induced IL-1 beta production in a mechanism that is significantly dependent on the inflammasome NLRP3 activation. The observations provided valuable insights into virus-host interactions during the acute phase and can be instrumental in the investigation of new and effective therapeutic interventions.

[Factors associated with daytime sleepiness in public transportation drivers in Lima Metropolitan area]. / Factores asociados a somnolencia diurna en conductores de transporte público de Lima Metropolitana.

OBJECTIVE: . To determine the frequency of sleepiness and its associated factors in public transportation drivers in Lima metropolitan area. MATERIALS AND METHODS: . Transversal analytical study carried out on drivers between 18 and 65 years old who work in a public transportation company registered in the Municipality of Lima. Sleepiness was assessed using a version of the Epworth Sleepiness Scale validated in Peru. The variables that could behave as associated factors were obtained by a data collection sheet. Logistic regression was used to estimate the magnitude of the association between sleepiness and variables considered as associated factors. RESULTS: . Four hundred forty (440) drivers were included, median age was 38.0 years and the majority (99.3%) were males. From the total number of drivers, 17.7% (78) experienced daytime sleepiness. A significant association was found between sleepiness and the 2 x 1 rotation system (p=0.038), and between sleepiness and hours of sleep under seven (p=0.011). Logistic regression analysis showed that drivers with six or fewer hours of sleep were more likely to have daytime sleepiness (OR 1.83, 95% CI: 1.03-3.25). CONCLUSIONS: . Approximately one out of five drivers experienced daytime sleepiness, which was associated with having six or fewer hours of sleep per day.

OBJETIVOS: . Determinar la frecuencia de somnolencia y sus factores asociados en conductores de transporte público de Lima Metropolitana. MATERIALES Y MÉTODOS: . Estudio analítico transversal realizado en conductores de entre 18 y 65 años, que laboren en alguna empresa de transporte público registrada en la Municipalidad de Lima. La somnolencia se evaluó mediante una versión de la Escala de Somnolencia de Epworth validada en Perú. Las variables que se pudieron comportar como factores asociados se obtuvieron mediante una ficha de recolección de datos. Se utilizó la regresión logística para estimar la magnitud de la asociación entre la somnolencia y las variables consideradas como factores asociados. RESULTADOS: . Se incluyeron a 440 conductores, cuya mediana de edad fue 38,0 años y la mayoría (99,3%) fueron varones. Del total de conductores el 17,7% (78) presentaron somnolencia diurna. Se encontró una asociación significativa entre la somnolencia y el sistema de rotación 2 x 1 (p=0,038) y entre la somnolencia y las horas de sueño menores a siete (p=0,011). El análisis de regresión logística demostró que aquellos conductores con seis o menos horas de sueño tienen mayor probabilidad de somnolencia diurna (OR 1,83; IC95%: 1,03-3,25). CONCLUSIONES: . Aproximadamente, uno de cada cinco conductores presentó somnolencia diurna, la cual estuvo asociada con tener seis o menos horas de sueño al día.

Reliability and Validity of the Functional Outcomes of Sleep Questionnaire - Spanish Short Version (FOSQ-10SV) in Peruvian Patients With Obstructive Sleep Apnea.

STUDY OBJECTIVES: The aim of this study was to verify the reliability and validity of the Spanish short version of the Functional Outcomes of Sleep Questionnaire (FOSQ-10SV) in Peruvian patients with obstructive sleep apnea (OSA). METHODS: Participants underwent physical examinations, completed the FOSQ-10SV, and polysomnography tests were carried out. RESULTS: A total of 672 patients were analyzed, 75 females (11%), mean age 50.5 ± 13.8 years. A total of 563 patients (84%) had OSA. The mean FOSQ-10SV score was 15.96 ± 3.23. The FOSQ-10SV Cronbach alpha was 0.84 and two significant factors were extracted in the factor analysis-both factors explained a variance of 43% and 14%. A significant correlation was found between the FOSQ-10SV score and the apnea-hypopnea index. Patients with more severe disease have a lower FOSQ-10SV score (P = .003). Ninety-nine patients with OSA who started continuous positive airway pressure treatment were followed, and we observed an improvement in the FOSQ-10SV score from pretreatment to posttreatment (P < .001). CONCLUSIONS: The FOSQ-10SV has internal consistency, construct validity, and the sensitivity to change in Peruvian patients with OSA who undergo treatment.

Mycotic aneurysm with aortoduodenal fistula.

Firstly described in the 19th century by Sir William Osler, the mycotic aneurysm (MA) is a rare entity characterized by an abnormal arterial dilation, which is potentially fatal, and is associated with the infection of the vascular wall. Elderly patients are mostly involved, especially when risk factors like chronic diseases, immunosuppression, neoplasia, and arterial manipulation are associated. The authors report the case of a young male patient diagnosed with an aortic aneurysm of infectious origin in the presence of repeated negative blood cultures. The diagnostic hypothesis was raised when the patient was hospitalized for an inguinal hernia surgery. The diagnosis was confirmed based on imaging findings consistent with mycotic aneurism. The patient was treated with an endovascular prosthesis associated with a long-lasting antibiotic therapy. Five months later, the patient attended the emergency unit presenting an upper digestive hemorrhage and shock, from which he died. The autopsy revealed a huge aneurysm of the abdominal aorta with an aortoduodenal fistula. The histological examination of the arterial wall revealed a marked inflammatory process, extensive destruction of the arterial wall, and the presence of Gram-positive bacteria. This case highlights the atypical presentation of a MA associated with an aortoduodenal fistula. Besides the early age of the patient, no primary arterial disease could be found, and no source of infection was detected.

Mycotic aneurysm with aortoduodenal fistula

Firstly described in the 19th century by Sir William Osler, the mycotic aneurysm (MA) is a rare entity characterized by an abnormal arterial dilation, which is potentially fatal, and is associated with the infection of the vascular wall. Elderly patients are mostly involved, especially when risk factors like chronic diseases, immunosuppression, neoplasia, and arterial manipulation are associated. The authors report the case of a young male patient diagnosed with an aortic aneurysm of infectious origin in the presence of repeated negative blood cultures. The diagnostic hypothesis was raised when the patient was hospitalized for an inguinal hernia surgery. The diagnosis was confirmed based on imaging findings consistent with mycotic aneurism. The patient was treated with an endovascular prosthesis associated with a long-lasting antibiotic therapy. Five months later, the patient attended the emergency unit presenting an upper digestive hemorrhage and shock, from which he died. The autopsy revealed a huge aneurysm of the abdominal aorta with an aortoduodenal fistula. The histological examination of the arterial wall revealed a marked inflammatory process, extensive destruction of the arterial wall, and the presence of Gram-positive bacteria. This case highlights the atypical presentation of a MA associated with an aortoduodenal fistula. Besides the early age of the patient, no primary arterial disease could be found,and no source of infection was detected.