Preventability of ischemic stroke/transient ischemic attack in a tertiary care center in Argentina.

INTRODUCTION: Cardiovascular disease remains a leading cause of morbidity and mortality worldwide, with many individuals presenting with acute ischemic stroke or transient ischemic attack (AIS/TIA) due to underlying vascular risk factors (VRF). While these patients typically undergo routine evaluations for acute treatment, the prevention of these conditions is often underestimated. This study reports the prevalence of non-optimized VRF and estimates their degree of avoidability in a cohort of patients treated in a tertiary care center following AIS/TIA. METHODS: This retrospective study enrolled patients older than 18 years who experienced AIS/TIA over a two-year period. Preventability was defined as the degree to which an acute cerebrovascular event could have been prevented if the VRF had been appropriately treated. Using the variables determined at the onset of AIS or TIA, we developed a 10-point scale to classify the degree of preventability (not preventable [score of 0], low preventability [score of 1-3], and high preventability [score of 4 or higher]). We further defined sub-scores based on the effectiveness of treatment of high blood pressure [HBP] (0-2 points), dyslipidemia [DLP] (0-2 points), atrial fibrillation [AF] (1 point), active smoking [AS] (1 point), obesity (1 point), previous coronary heart disease [CHD] (1 point), and previous AIS/TIA (2 points). Demographic factors, etiologies, and imaging findings were evaluated, tabulated independently, and subsequently correlated with clinical findings extracted from the available patient records. RESULTS: Of the 395 patients (334 with AIS and 61 with TIA), 376 (95.19 %) exhibited some degree of preventability, whereas 19 (4.81 %) presented with a nonpreventable event. In total, 296 (74.94 %) presented a low preventable event, and 80 (20.25 %) presented a high preventable event. Applying the Chi-square test of independence to stroke etiology highlighted cardio-aortic embolism and large artery atherosclerosis as groups with a significantly higher burden of risk factors necessitating intervention, while patients with stroke of other etiologies had more adequate control of VRF. In terms of stroke severity, as determined by the National Institutes of Health Stroke Scale (NIHSS), patients with NIHSS scores >5 were more likely to experience preventable events. According to the ABCD2 score, higher risk scores were significantly associated with a higher preventive factor burden; however, age, sex, vascular territory, and Canadian TIA scores were not related to the prevention of AIS/TIA. CONCLUSIONS: The high percentage of preventable events reflects the need to study other factors that may contribute to unhealthy lifestyles in this population. Potential reasons for poor health include high levels of stress, sleep deprivation, working conditions and an unhealthy diet. Further studies are required to better understand these phenomena.

ARGEN-IAM-ST: adultos mayores con infarto, ¿son todos iguales? / ARGEN-IAM-ST Registry: older adults with infarction: Are they all the same?

Resumen Introducción : Actualmente se define al paciente como adulto mayor (AM) si su edad es al menos de 60 años. Dada la expectativa de vida prolongada resulta intere sante evaluar si todos los AM con infarto agudo de mio cardio (IAM) son iguales. Los objetivos fueron conocer la prevalencia de AM en el IAM y dentro de ellos, la de los ≥75 años y analizar características, tratamientos de reperfusión y mortalidad intrahospitalaria de acuerdo a si son < o ≥ 75 años. Métodos : Se analizaron los pacientes AM ingresados en el Registro Nacional de Infarto con supra desnivel del segmento ST (ARGEN-IAM-ST). Se los dividió en grupo 1: 60-74 años y grupo 2: ≥ 75 años y se compararon entre sí. Resultados : AM 3626, 75.92% del Grupo 1, el resto del Grupo 2. En el grupo 2 hubo más mujeres, hipertensos y con antecedentes coronarios. Hubo similar porcentaje de diabetes y dislipidemia, pero menos de tabaquistas. En el Grupo 2 se empleó menos tratamiento de reperfusión (aunque más angioplastia primaria), con similar tiempo puerta-balón. Los pacientes del Grupo 2 recibieron me nos medicamentos de probada eficacia y en la evolución hospitalaria, más sangrado (aunque no mayor), más insuficiencia cardíaca y más mortalidad: 18.3% vs 9.4%, p<0.001. La edad ≥75 años fue predictor independiente de mortalidad. Conclusiones : Uno de cada cuatro AM con IAM tiene más de 75 años; estos pacientes reciben menos reper fusión, presentan más insuficiencia cardíaca y sangrado y tienen el doble de mortalidad que los pacientes de entre 60 y 74 años.

Abstract Introduction : Currently the patient is defined as an older adult (OA) when the age is at least 60 years. Given the long life expectancy, it is interesting to evaluate whether all OAs with acute myocardial infarction (AMI) are equal. The objectives were to know the prevalence of OA in AMI and within them, that of those ≥75 years of age and to analyze characteristics, reperfusion treat ments and in-hospital mortality according to whether they are < or ≥ 75 years of age. Methods : OA patients admitted to the National Reg istry of Infarction with ST segment elevation (ARGEN-IAM-ST) were analyzed. They were divided into group 1: 60-74 years old and group 2: ≥ 75 years old and compared with each other. Results : 3626 AM, 75.9% from Group 1, the rest from Group 2. In group 2 there were more women, hyperten sive and with a history of coronary arteries. There was a similar percentage of diabetes and dyslipidemia, but fewer of smokers. In Group 2, less reperfusion treat ment was used (although more primary angioplasty), with similar door-to-balloon time. Patients in Group 2 received fewer medications of proven efficacy and in the hospital course, they had more bleeding (although not major), more heart failure and more mortality: 18.3% vs. 9.4%, p<0.001. Age ≥75 years was an independent predictor of mortality. Conclusions : one in four patients with AMI is over 75 years old; they receive less reperfusion, have more heart failure, bleeding and twice the mortality rate than patients between 60 and 74 years.

[ARGEN-IAM-ST Registry: older adults with infarction: Are they all the same?] / ARGEN-IAM-ST: adultos mayores con infarto, ¿son todos iguales?

INTRODUCTION: Currently the patient is defined as an older adult (OA) when the age is at least 60 years. Given the long life expectancy, it is interesting to evaluate whether all OAs with acute myocardial infarction (AMI) are equal. The objectives were to know the prevalence of OA in AMI and within them, that of those ≥75 years of age and to analyze characteristics, reperfusion treatments and in-hospital mortality according to whether they are < or ≥ 75 years of age. METHODS: OA patients admitted to the National Registry of Infarction with ST segment elevation (ARGENIAM-ST) were analyzed. They were divided into group 1: 60-74 years old and group 2: ≥ 75 years old and compared with each other. RESULTS: 3626 AM, 75.9% from Group 1, the rest from Group 2. In group 2 there were more women, hypertensive and with a history of coronary arteries. There was a similar percentage of diabetes and dyslipidemia, but fewer of smokers. In Group 2, less reperfusion treatment was used (although more primary angioplasty), with similar door-to-balloon time. Patients in Group 2 received fewer medications of proven efficacy and in the hospital course, they had more bleeding (although not major), more heart failure and more mortality: 18.3% vs. 9.4%, p<0.001. Age ≥75 years was an independent predictor of mortality. CONCLUSIONS: one in four patients with AMI is over 75 years old; they receive less reperfusion, have more heart failure, bleeding and twice the mortality rate than patients between 60 and 74 years.

Introducción: Actualmente se define al paciente como adulto mayor (AM) si su edad es al menos de 60 años. Dada la expectativa de vida prolongada resulta interesante evaluar si todos los AM con infarto agudo de miocardio (IAM) son iguales. Los objetivos fueron conocer la prevalencia de AM en el IAM y dentro de ellos, la de los ≥75 años y analizar características, tratamientos de reperfusión y mortalidad intrahospitalaria de acuerdo a si son < o ≥ 75 años. Métodos: Se analizaron los pacientes AM ingresados en el Registro Nacional de Infarto con supra desnivel del segmento ST (ARGEN-IAM-ST). Se los dividió en grupo 1: 60-74 años y grupo 2: ≥ 75 años y se compararon entre sí. Resultados: AM 3626, 75.92% del Grupo 1, el resto del Grupo 2. En el grupo 2 hubo más mujeres, hipertensos y con antecedentes coronarios. Hubo similar porcentaje de diabetes y dislipidemia, pero menos de tabaquistas. En el Grupo 2 se empleó menos tratamiento de reperfusión (aunque más angioplastia primaria), con similar tiempo puerta-balón. Los pacientes del Grupo 2 recibieron menos medicamentos de probada eficacia y en la evolución hospitalaria, más sangrado (aunque no mayor), más insuficiencia cardíaca y más mortalidad: 18.3% vs 9.4%, p<0.001. La edad ≥75 años fue predictor independiente de mortalidad. Conclusiones: Uno de cada cuatro AM con IAM tiene más de 75 años; estos pacientes reciben menos reperfusión, presentan más insuficiencia cardíaca y sangrado y tienen el doble de mortalidad que los pacientes de entre 60 y 74 años.

Ticagrelor versus clopidogrel in dual antiplatelet therapy after minor stroke or transient ischemic attack: an updated network meta-analysis.

BACKGROUND: Dual antiplatelet therapy (DAPT) with clopidogrel plus aspirin is a well-established practice after a minor stroke or transient ischemic attack (TIA). However, ticagrelor plus aspirin may be an alternative. AIMS: We systematically searched PubMed, Embase, and Cochrane Central from inception to January 2024. We included randomized controlled trials (RCTs) enrolling adults with acute minor stroke or TIA within 72 hours of the onset of the symptoms. RESULTS: A total of 8 RCTs were included in our meta-analysis. Ticagrelor plus aspirin (RR, 0.70; 95% CrI 0.52, 0.91) and clopidogrel plus aspirin (RR, 0.79; 95% CrI 0.64, 0.98) were superior to aspirin in preventing stroke recurrence in overall analysis. Excluding studies with dual antiplatelet up to 90 days, ticagrelor plus aspirin was the only strategy that maintained superiority compared with aspirin regarding stroke recurrence (RR, 0.70; 95% CrI 0.51, 0.95) and ischemic stroke (RR, 0.68; 95% CrI 0.47, 0.94). There was no significant difference between treatment groups regarding hemorrhagic stroke, functional disability, and mortality. CONCLUSIONS: DAPTs were superior to aspirin in preventing recurrence or ischemic stroke. Although no significant difference was observed between DAPTs, ticagrelor plus aspirin may be related to worse major bleeding results, including intracranial bleeding. Ticagrelor plus aspirin is a considerable option for patients after a minor stroke or TIA.

Measurement of optic nerve sheath diameter on computed tomography for the differentiation of transient ischemic attacks

SUMMARY OBJECTIVE: The objective of this study was to investigate whether the measurement of mean optic nerve sheath diameter in patients with transient ischemic attack could be used to distinguish between control groups, the acute ischemic stroke group, and subgroups within the acute ischemic stroke category. METHODS: Retrospectively, the mean optic nerve sheath diameters of patients aged 18 years and older belonging to control, transient ischemic attack, acute ischemic stroke, and subgroups within the acute ischemic stroke category were measured with initial computed tomography conducted in the emergency department. RESULTS: Out of the 773 patients included in the study, 318 (41.1%) were in the control group, 77 (10%) had transient ischemic attack, and 378 (49%) were categorized as stroke patients. The average mean optic nerve sheath diameter was significantly higher in both the stroke and transient ischemic attack groups compared with the control group (p<0.001 for both comparisons). Furthermore, the mean optic nerve sheath diameter in the stroke subgroups was significantly higher than in both the transient ischemic attack and control groups (p<0.001 for all comparisons). In transient ischemic attack patients, the mean optic nerve sheath diameter showed a significant ability to predict transient ischemic attack (AUC=0.913, p<0.001), with a calculated optimal cutoff value of 4.72, sensitivity of 94.8%, and specificity of 73.9%. CONCLUSION: The mean optic nerve sheath diameter of patients in the transient ischemic attack group was lower compared with those in the stroke subgroups but higher compared with the control group.

High prevalence of intracranial arterial stenosis among acute ischemic stroke patients in a Brazilian center: a transcranial color-coded duplex sonography study / Alta prevalência de estenose arterial intracraniana nos pacientes com acidente vascular isquêmico agudo em um centro brasileiro: um estudo com Doppler transcraniano colorido

Abstract Background There is limited data available regarding the prevalence of intracranial arterial stenosis (ICAS) among acute ischemic stroke (AIS) patients in Brazil and Latin America. Objective The present study sought to investigate the frequency and predictors of ICAS among patients with AIS or transient ischemic attack (TIA) in a Brazilian center, with transcranial color-coded duplex sonography (TCCS) technique. Methods Consecutive AIS and TIA patients, admitted to an academic public comprehensive stroke center in Brazil from February to December 2014, evaluated by TCCS were prospectively selected. Vascular narrowings > 50% were considered as ICAS, based on ultrasound criteria previously defined in the literature. Results We assessed 170 consecutive patients with AIS or TIA, of whom 27 (15.9%) were excluded due to an inadequate transtemporal acoustic bone window. We confirmed ICAS in 55 patients (38.5%). The most common location was the proximal segment of the middle cerebral artery (28.2%), followed by the vertebral (15.4%), posterior cerebral (13.6%), terminal internal carotid (9.1%) and basilar (8.2%) arteries. On multivariate models adjusting for potential confounders, systolic blood pressure (OR: 1.03, 95%CI: 1.01-1.04; p = 0.008) was independently associated with ICAS. Conclusion We found significant ICAS in approximately ⅓ of patients admitted with symptoms of AIS or TIA in a public tertiary academic stroke center in Brazil. The TCCS is an accessible and noninvasive technique that can be used to investigate the presence of moderate and severe ICAS, especially in patients who cannot be exposed to more invasive exams, such as the use of intravenous contrast agents.

Resumo Antecedentes Dados acerca da prevalência da estenose arterial intracraniana (EAIC) entre os pacientes com acidente vascular isquêmico (AVCi) agudo no Brasil e América Latina são limitados. Objetivo O presente estudo pretendeu investigar a frequência e os preditores da EAIC nos pacientes AVCi ou ataque isquêmico transitório (AIT) em um centro brasileiro utilizando o Doppler transcraniano colorido (duplex transcraniano). Métodos Pacientes consecutivos com AVCi ou AIT, admitidos entre fevereiro e dezembro de 2014 em um centro acadêmico brasileiro especializado em doenças cerebrovasculares, foram avaliados prospectivamente com duplex transcraniano. Os estreitamentos vasculares > 50% foram considerados como EAIC, baseado em critérios ultrassonográficos definidos previamente na literatura. Resultados Foram avaliados 170 pacientes com AVCi ou AIT, dos quais 27 (15,9%) foram excluídos em decorrência da janela óssea transtemporal acústica inadequada. Confirmamos EAIC em 55 pacientes (38,5%). A localização mais comum foi o segmento proximal da artéria cerebral média (28,2%), seguida pelas artérias vertebral (15,4%), cerebral posterior (13,6%), carótida interna terminal (9,1%) e basilar (8,2%). No modelo multivariado, ajustado para os potenciais confundidores, a pressão arterial sistólica aumentada (OR: 1,03; IC 95%: 1,01-1,04; p = 0,008) foi independentemente associada a EAIC. Conclusão Foi identificada EAIC significativa em quase ⅓ dos pacientes admitidos com sintomas de AVCi ou AIT em um serviço acadêmico público de atendimento especializado em doenças cerebrovasculares. O Doppler transcraniano colorido é uma ferramenta acessível e não invasiva que pode ser utilizada com segurança para a investigação da presença de EAIC moderada ou grave, especialmente nos pacientes que não podem ser expostos a exames complementares mais invasivos com uso de contraste intravenoso.

Prevalence of myocardial bridges in the Mexican population: A morphometric and histological analysis.

BACKGROUND: Myocardial bridge (MB) is described as an abnormal band of myocardium covering a variable portion of any coronary artery. METHODS: The current study explores the presence of MB throughout the coronary arterial system and provides a morphometric description through instrumented dissection of a sample of 100 human hearts. The study shows a higher prevalence of MB in the Mexican population than in previous reports. RESULTS: In the total sample (n=100), MB was identified in 96% of it. A total of 421 MBs were observed, with a mean of 4.38mm (±0.28) per dissected heart. The most frequently affected vessel is the anterior interventricular artery where a total of 52 MBs were found, of the total sample studied. DISCUSSION: The high prevalence of MB among Mexican patients could be the result of a genetic association for this population or the neoformation of MB after birth due to lifestyle-associated factors. Further studies are required to better understand the high prevalence of MB among Mexican subjects.

Interdisciplinary training program for pediatric cardiorespiratory arrest using rapid cycle deliberate practice: A descriptive cross-sectional study

ABSTRACT BACKGROUND: cardiorespiratory arrest (CRA) is a severe public health concern, and clinical simulation has proven to be a beneficial educational strategy for training on this topic. OBJECTIVE: To describe the implementation of a program for pediatric cardiac arrest care using rapid-cycle deliberate practice (RCDP), the quality of the technique employed, and participants' opinions on the methodology. DESIGN AND SETTING: This descriptive cross-sectional study of pre- and post-performance training in cardiopul monary resuscitation (CPR) techniques and reaction evaluation was conducted in a hospital in São Paulo. METHODS: Multidisciplinary groups performed pediatric resuscitation in a simulated scenario with RCDP mediated by a facilitator. The study sample included professionals working in patient care. During the simulation, the participants were evaluated for their compliance with the CRA care algorithm. Further, their execution of chest compressions was assessed pre- and post-intervention. RESULTS: In total, 302 professionals were trained in this study. The overall quality of CPR measured pre-intervention was inadequate, and only 26% had adequate technique proficiency, whereas it was 91% (P < 0.01) post-intervention. Of the participants, 95.7% responded to the final evaluation and provided positive comments on the method and their satisfaction with the novel simulation. Of these, 88% considered that repetition of the technique used was more effective than traditional simulation. CONCLUSIONS: The RCDP is effective for training multidisciplinary teams in pediatric CPR, with an emphasis on the quality of chest compressions. However, further studies are necessary to explore whether this trend translates to differential performances in practical settings.

A Novel Approach of a Low-Cost Voltage Fault Injection Method for Resource-Constrained IoT Devices: Design and Analysis.

The rapid development of the Internet of Things (IoT) has brought about the processing and storage of sensitive information on resource-constrained devices, which are susceptible to various hardware attacks. Fault injection attacks (FIAs) stand out as one of the most widespread. Particularly, voltage-based FIAs (V-FIAs) have gained popularity due to their non-invasive nature and high effectiveness in inducing faults by pushing the IoT hardware to its operational limits. Improving the security of devices and gaining a comprehensive understanding of their vulnerabilities is of utmost importance. In this study, we present a novel fault injection method and employ it to target an 8-bit AVR microcontroller. We identify the optimal attack parameters by analyzing the detected failures and their trends. A case study is conducted to validate the efficacy of this new method in a more realistic scenario, focusing on a simple authentication method using the determined optimal parameters. This analysis not only demonstrates the feasibility of the V-FIA but also elucidates the primary characteristics of the resulting failures and their propagation in resource-constrained devices. Additionally, we devise a hardware/software countermeasure that can be integrated into any resource-constrained device to thwart such attacks in IoT scenarios.

Molecular modeling of Mannich phenols as reactivators of human acetylcholinesterase inhibited by A-series nerve agents.

The A-series is the most recent generation of chemical warfare nerve agents (CWA) which act directly on the inhibition of the human acetylcholinesterase (HssAChE) enzyme. These compounds lack accurate experimental data on their physicochemical properties, and there is no evidence that traditional antidotes effectively reactivate HssAChE inhibited by them. In the search for potential antidotes, we employed virtual screening, molecular docking, and molecular dynamics (MD) simulations for the theoretical assessment of the performance of a library of Mannich phenols as potential reactivators of HssAChE inhibited by the Novichok agents A-230, A-232, and A-234, in comparison with the commercial oximes pralidoxime (2-PAM), asoxime (HI-6), trimedoxime (TMB-4), and obidoxime. Following the near-attack conformation (NAC) approach, our results suggest that the compounds assessed would face difficulties in triggering the proposed nucleophilic in-line displacement mechanism. Despite this, it was observed that certain Mannich phenols presented similar or superior results to those obtained by reference oximes against A-232 and A-234 model, suggesting that these compounds can adopt more favourable conformations. Additional binding energy calculations confirmed the stability of the model/ligands complexes and the reactivating potential observed in the molecular docking and MD studies. Our findings indicate that the Mannich phenols could be alternative antidotes and that their efficacy should be evaluated experimentally against the A-series CWA.

Impact of adding xylooligosaccharides encapsulated in butter: Microstructural, optical, rheological and sensory aspects.

This study investigated the microstructure, rheological properties, and sensory characteristics of butters produced with free and encapsulated xylooligosaccharides (XOS). Four formulations of butter were processed: BCONT: 0 % w/w XOS (control); BXOS: 20% w/w free XOS; BXOS-ALG: 20% w/w XOS microencapsulated with alginate (XOS-alginate ratio of 3:1 w/w); and BXOS-GEL: 20% w/w XOS microencapsulated with alginate-gelatin (XOS-alginate-gelatin ratio of 3:1:1.5 w/w). The microparticles showed a bimodal distribution, low size and low span values, demonstrating physical stability to be included in emulsions. The XOS-ALG presented surface weighted mean diameter (D3.2) of 90.24 µm, volume-weighted mean diameter (D4.3) of 131.8 µm, and Span of 2.14. In contrast, the XOS-GEL presented D3.2 of 82.80 µm, D4.3 of 141.0 µm, and a Span of 2.46. Products with XOS were characterized by higher creaminess, sweet taste, and lower salty taste than the control. However, the addition form significantly impacted the other evaluated parameters. The utilization of XOS in a free form (BXOS) resulted in smaller droplet sizes (1.26 µm) than encapsulated XOS and control (XOS-ALG = 1.32 µm / XOS-GEL = 1.58 µm, / BCONT = 1.59 µm), and changes in the rheological parameters (higher values of shear stress, viscosity, consistency index, rigidity (J0), and Newtonian viscosity (ηN) and lower elasticity (τ)). Furthermore, it changed the color parameters (more yellow and dark color, lower L* and higher b* values). On the other hand, the utilization of micropaticles of XOS (BXOS-ALG and BXOS-GEL) kept shear stress, viscosity, consistency index, rigidity (J0), and elasticity (τ) more similar to control. The products had a less intense yellow color (lower b* values) and was perceived with more consistency and butter taste. However, the presence of particles was perceived by consumers. The results suggest that consumers were more attentive to reporting flavor-related attributes than texture. In conclusion, adding microparticles of XOS could improve butter's rheological and sensory properties. In conclusion, adding microparticles of XOS could improve butter's rheological and sensory properties.

Violencia intrafamiliar en Colombia en los últimos doce años

La presente investigación consiste en evaluar y comparar estadísticamente el número de casos de violencia intrafamiliar en Colombia entre los años 2010-2021, con base en los reportes de la Policía Nacional. La base de datos está compuesta por 896.017 casos de violencia denunciados. Se empleó distribución de frecuencias, análisis comparativo por el método GLM y proyección Biplot. Cundinamarca diverge estadísticamente respecto a las demás regiones evaluadas, donde las mujeres presentan el mayor porcentaje de violencia intrafamiliar. Factores como las restricciones de movilidad, la incertidumbre, el estrés entre otros componentes, son la raíz de situaciones complejas familiares.

The present research consists of evaluating and statistically comparing the number of cases of intrafamily violence in Colombia between the years 2010-2021, based on the reports of the National Police. The database is made up of 896,017 reported cases of violence. Frequency distribution, comparative analysis by the GLM method and Biplot projection were used. Cundinamarca differs statically with respect to the other regions evaluated, where women present the highest percentage of domestic violence. Factors, such as mobility restrictions, uncertainty, stress, among other components, are at the root of complex family situations.

Papel de la neuropatía diabética en la aparición y desarrollo del síndrome del pie diabético / Role of Diabetic Neuropathy in the Onset and Development of Diabetic Foot Syndrome

Introducción: La neuropatía diabética es la complicación más frecuente de la diabetes mellitus y una de sus posibles consecuencias es el síndrome del pie diabético. Los médicos del primer nivel de atención deben conocer el comportamiento clínico de la neuropatía diabética y, sobre todo, como influye en la aparición y desarrollo del síndrome del pie diabético. Objetivo: Describir el papel de la neuropatía diabética en la aparición y desarrollo del síndrome del pie diabético. Métodos: Para la obtención de la información se utilizaron como motores de búsqueda de información científica los correspondientes a Scielo, Pubmed, y Google Académico. Se usaron como palabras clave: diabetes mellitus; neuropatía diabética; pie diabético; síndrome de pie diabético; úlcera de pie diabético; ataque de pie diabético. Se evaluaron diferentes trabajos de revisión, investigación y páginas web, y se excluyeron los artículos que tuvieran más de 10 años de publicados, en idiomas diferentes al español, portugués e inglés y que no se refirieran al tema de estudio a través del título. Esto permitió la cita de 45 referencias bibliográficas. Conclusiones: La neuropatía diabética constituye el principal factor de riesgo en la aparición y desarrollo del síndrome del pie diabético, sobre todo cuando se asocia a artropatía (defectos podálicos), enfermedad vascular periférica y/o sepsis. El control de la glucemia, la detección temprana del pie de riesgo y el cuidado preventivo de los miembros inferiores, repercutirá favorablemente en la salud y bienestar del paciente(AU)

Introduction: Diabetic neuropathy is the most frequent complication of diabetes mellitus and one of its possible consequences is diabetic foot syndrome. First level of care physicians should know the clinical behavior of diabetic neuropathy and, above all, how it influences the appearance and development of diabetic foot syndrome. Objective: To describe the role of diabetic neuropathy in the appearance and development of diabetic foot syndrome. Methods: To obtain the information, SciELO, PubMed and Google Scholar were used as search engines for scientific information. The keywords used were: diabetes mellitus; diabetic neuropathy; diabetic foot; diabetic foot syndrome; diabetic foot ulcer; diabetic foot attack. Different review papers, research papers and web pages were evaluated and articles that were more than 10 years old and published in languages other than Spanish, Portuguese and English and that did not refer to the subject of the study through the title were excluded. This allowed the citation of 45 bibliographic references. Conclusions: Diabetic neuropathy constitutes the main risk factor in the appearance and development of diabetic foot syndrome, especially when associated with arthropathy (foot defects), peripheral vascular disease and/or sepsis. Glycemic control, early detection of the foot at risk and preventive care of the lower limbs will have a favorable impact on the patient's health and well-being(AU)

COVID-19 Outbreak during Summer Courses at an Elementary School.

Due to the COVID-19 emergency, face-to-face classes were suspended. After the vaccination of teachers and to mitigate educational backwardness, the schools have begun to reopen with protocols established by the government. Here, we investigated the COVID-19 outbreak in summer courses during the reopening of a private elementary school in July 2021. We report confirmed cases of COVID-19 in staff members, students, and their families. A total community of 290 people was part of this study, and we built the contact network. The clinical features of all cases are described. We used the methodology of cases and contacts. The index case was identified by epidemiological tracking, and containment measures were activated, as well as further infection chains in the setting. We estimate the attack rate for staff members at 15.68% (95% CI 7.0-28.6), students at 12.24% (95% CI 4.6-24.8), and family members at 2.6% (95% CI 0.8-6.0). An incubation period of 48-72 h was determined. A student-teacher-student-family transmission sequence was identified. The area where the infection was identified was the school swimming pool, an area where face masks are not worn or, in some cases, inadequately used. Finally, we continue with intermittent staff testing and early detection actions, reinforcing prevention measures, environmental control, cleaning, and educational interventions with students regarding the implementation of preventive measures through classes led by school health staff.

Infection-Induced Immunity Is Associated With Protection Against Severe Acute Respiratory Syndrome Coronavirus 2 Infection and Decreased Infectivity.

BACKGROUND: The impact of infection-induced immunity on severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) transmission has not been well established. Here we estimate the effects of prior infection induced immunity in adults and children on SARS-CoV-2 transmission in households. METHODS: We conducted a household cohort study from March 2020-November 2022 in Managua, Nicaragua; following a housheold SARS-CoV-2 infection, household members are closely monitored for infection. We estimate the association of time period, age, symptoms, and prior infection with secondary attack risk. RESULTS: Overall, transmission occurred in 70.2% of households, 40.9% of household contacts were infected, and the secondary attack risk ranged from 8.1% to 13.9% depending on the time period. Symptomatic infected individuals were more infectious (rate ratio [RR] 21.2, 95% confidence interval [CI]: 7.4-60.7) and participants with a prior infection were half as likely to be infected compared to naïve individuals (RR 0.52, 95% CI:.38-.70). In models stratified by age, prior infection was associated with decreased infectivity in adults and adolescents (secondary attack risk [SAR] 12.3, 95% CI: 10.3, 14.8 vs 17.5, 95% CI: 14.8, 20.7). However, although young children were less likely to transmit, neither prior infection nor symptom presentation was associated with infectivity. During the Omicron era, infection-induced immunity remained protective against infection. CONCLUSIONS: Infection-induced immunity is associated with decreased infectivity for adults and adolescents. Although young children are less infectious, prior infection and asymptomatic presentation did not reduce their infectivity as was seen in adults. As SARS-CoV-2 transitions to endemicity, children may become more important in transmission dynamics.

Chitosan-Based Scaffolds for the Treatment of Myocardial Infarction: A Systematic Review.

Cardiovascular diseases (CVD), such as myocardial infarction (MI), constitute one of the world's leading causes of annual deaths. This cardiomyopathy generates a tissue scar with poor anatomical properties and cell necrosis that can lead to heart failure. Necrotic tissue repair is required through pharmaceutical or surgical treatments to avoid such loss, which has associated adverse collateral effects. However, to recover the infarcted myocardial tissue, biopolymer-based scaffolds are used as safer alternative treatments with fewer side effects due to their biocompatibility, chemical adaptability and biodegradability. For this reason, a systematic review of the literature from the last five years on the production and application of chitosan scaffolds for the reconstructive engineering of myocardial tissue was carried out. Seventy-five records were included for review using the "preferred reporting items for systematic reviews and meta-analyses" data collection strategy. It was observed that the chitosan scaffolds have a remarkable capacity for restoring the essential functions of the heart through the mimicry of its physiological environment and with a controlled porosity that allows for the exchange of nutrients, the improvement of the electrical conductivity and the stimulation of cell differentiation of the stem cells. In addition, the chitosan scaffolds can significantly improve angiogenesis in the infarcted tissue by stimulating the production of the glycoprotein receptors of the vascular endothelial growth factor (VEGF) family. Therefore, the possible mechanisms of action of the chitosan scaffolds on cardiomyocytes and stem cells were analyzed. For all the advantages observed, it is considered that the treatment of MI with the chitosan scaffolds is promising, showing multiple advantages within the regenerative therapies of CVD.

Evidence of the Cardioprotective Effects of Aloysia polystachya in Isoproterenol-Induced Myocardial Infarction in Rats.

Aloysia polystachya is a plant species that is widely used in Brazilian folk medicine for the treatment of different disorders that affect the cardiovascular system. The aim of the study was to investigate the cardioprotective effects of an ethanol-soluble fraction of A. polystachya (ESAP) on isoproterenol-induced myocardial infarction in rats. Different groups of rats (n = 8) were orally treated with ESAP (30, 100, and 300 mg/kg), carvedilol (10 mg/kg), or vehicle (filtered water; 1 mL/100 g) for 7 days. Naive rats received no treatment. On the morning of day 6, acute myocardial infarction was induced by the acute oral administration of isoproterenol (100 mg/kg). On the morning of day 8, all rats underwent electrocardiography and transthoracic echocardiography. Blood samples were then collected, and serum levels of creatine kinase-MB fraction (CK-MB) and cardiac troponin T (cTNT) were quantified. ESAP significantly reduced electrocardiographic changes, improved the ventricular ejection fraction, and reduced serum levels of CK-MB and cTNT in infarcted rats. The cardioprotective effects of ESAP could be exploited as an effective tool against isoproterenol-induced myocardial infarction in rats.

Histologia do miocárdio normal e infartado / Histology of normal and infarcted myocardial

Introdução: O infarto do miocárdio é uma patologia que apresenta grande morbidade e mortalidade. Ele é resultado da necrose de cadiomiócitos provocada por dificuldade de oxigenação. Objetivo: O objetivo deste estudo foi rever a histologia do miocárdio e suas alterações histológicas quando infartado. Método: Trata-se de uma revisão narrativa em livros técnicos e artigos cinetíficos publicados na SciELO e PubMed. Resultados: O miocárdio é formado por cardiomiócitos, que se contraem em função dos sarcômeros dispostos em suas miofibrilas e apresentam eficiente comunicação elétrica entre si por meio de junções comunicantes. O infarto do miocárdio promove morte dos cardiomiócitos, alterações em elementos citoplasmáticos e na condução elétrica além da formação de tecido cicatricial fibroso. Conclusão: Em conclusão, o miocárdio é altamente vascularizado e formado por cardiomiócitos contráteis alongados e de composição sarcométrica. Em condições isquêmicas, como no infarto do miocárdio, há uma remodelação histológica no tecido muscular cardíaco que leva à fibrose e perda das funções contráteis.

Introduction: Myocardial infarction is a pathology that presents high morbidity and mortality. It is the result of cardiomyocyte necrosis caused by oxygenation difficulties. Objective: The aim of this study was to review the histology of the myocardium and its histological changes when infarcted. Method: This is a narrative review of technical books and scientific articles published in SciELO and PubMed. Results: The myocardium is formed by cardiomyocytes, which contract due to the sarcomeres arranged in their myofibrils and present efficient electrical communication with each other through gap junctions. Myocardial infarction promotes the death of cardiomyocytes, alterations in cytoplasmic elements and electrical conduction, in addition to the formation of fibrous scar tissue. Conclusion: In conclusion, the myocardium is highly vascularized and formed by elongated contractile cardiomyocytes with a sarcometric composition. In ischemic conditions, such as myocardial infarction, there is histological remodeling in cardiac muscle tissue that leads to fibrosis and loss of contractile functions

Offensive Difference Styles and Technical Situational Variables Between European and South American Elite Football Leagues / Diferencias de estilos ofensivos y variables situacionales técnicas entre las ligas de fútbol de élite europeas y sudamericanas

Abstract We aimed to compare teams' attack styles in Europe and South America elite football in the two most valued domestic leagues in both continents (Spanish La Liga & English Premier League in Europe, and Argentinian Superliga & Brazilian Série A in South America). For this purpose, we used a sample of 84 teams and 3,780 cases in 1,214 games. Using an observational tool, we analyzed performance indicators (goals, shots, dribbles, and passes) and attack situations. Effect size (ES) and non-clinical magnitude-based inference (MBI) were used to evaluate uncertainty. Results revealed that European teams scored more goals per game related to fast (ES = 0.35; likely MBI) and positional attack (ES = 0.36; likely MBI). In addition, teams from the European leagues spent more time playing in the opposition third zone of the pitch, performed a higher number of assists (ES = 0.38; likely MBI) and through-ball assists (ES = 0.46; likely MBI) than South American ones. Finally, South American teams made higher numbers of shots out of the box (ES = 1.52, almost certain MBI) and off-target shots (ES = 1.08; almost certain MBI), and they also spent more time playing in the middle third zone (ES = 1.65; almost certain MBI). No differences were identified in set-pieces goals, length passing, and aerial duels. These findings may provide information regarding attack style profiles from each continent league. Also, it could be highly beneficial for coaches to be able to continuously design the specific training situations of the offensive process.

Resumen El objetivo fue comparar estilos de ataque de los equipos en el fútbol de élite de Europa y Sudamérica en las dos ligas nacionales más valoradas de ambos continentes (Europa: Liga española y Premier League inglesa; Sudamérica: Superliga argentina y Serie A brasileña). Para ello, se empleó una muestra de 84 equipos y 3780 casos en 1214 partidos. Mediante una herramienta de observación, se analizaron indicadores de rendimiento (goles, tiros, regates y pases) y situaciones posicionales de ataque. Para evaluar la incertidumbre, se calculó el tamaño del efecto (ES) y la inferencia basada en la magnitud no clínica (MBI). Los resultados revelaron que los equipos europeos lograron más goles por partido mediante transición rápida (ES = 0,35; ''probable'' MBI) y ataque posicional (ES = 0,36; ''probable'' MBI). Además, los europeos pasaron más tiempo jugando en el último tercio del campo rival, realizaron más asistencias (ES = 0,38; ''probable'' MBI) y asistencias con pase entre defensores rivales (ES = 0,46; ''probable'' MBI) que los sudamericanos. Finalmente, los equipos sudamericanos realizaron más tiros desde fuera del área (ES = 1,52; ''casi seguro'' MBI) y tiros fuera de la portería (ES = 1,08; ''casi seguro'' MBI), y también pasaron más tiempo jugando en el tercio medio del campo (ES = 1,65; ''casi seguro'' MBI). No se identificaron diferencias en goles mediante jugadas a balón parado, pases largos y duelos aéreos. Estos hallazgos informan sobre estilos de ataque de cada liga continental y podrían ayudar a diseñar situaciones de entrenamiento del proceso ofensivo.

Resumo O objetivo era comparar os estilos de ataque das equipes de futebol de elite europeu e sul-americano nas duas ligas nacionais mais valorizadas de ambos os continentes (Europa: Liga espanhola e Premier League inglesa; América do Sul: Superliga argentina e Serie A Brasileira). Para este fim, foi utilizada uma amostra de 84 equipes e 3780 casos em 1214 jogos. Usando uma ferramenta de observação, foram analisados indicadores de desempenho (metas, tiros, dribles e passes) e situações de ataque posicional. Para avaliar a incerteza, foram calculados o tamanho do efeito (ES) e a inferência baseada em magnitude não-clínica (MBI). Os resultados revelaram que os times europeus marcaram mais gols por jogo através de uma transição rápida (ES = 0,35; MBI "provável") e ataque posicional (ES = 0,36; MBI "provável"). Além disso, os europeus passaram mais tempo jogando no último terço do campo rival, fizeram mais assistências (ES = 0,38; MBI 'provável') e assistência com um passe entre os defensores adversários (ES = 0,46; MBI 'provável') do que os sul-americanos. Finalmente, as equipes sul-americanas chutaram mais fora da área (ES = 1,52; 'quase certamente' MBI) e chutes fora do gol (ES = 108; 'quase certamente' MBI), e passaram mais tempo jogando no meio terço do campo (ES = 1,65; 'quase certamente' MBI). Não foram identificadas diferenças nos gols por meio de jogos com a bola parada, nos passes longos e nos passes aéreos. Estas descobertas informam os estilos de ataque de cada liga continental e poderiam ajudar a projetar situações de treinamento para o processo de ataque.