[Cardiovascular manifestations in pediatric multisystem inflammatory syndrome associated with COVID-19 in a tertiary care pediatric center in Mexico City]. / Alteraciones cardiovasculares en el síndrome inflamatorio multisistémico pediátrico asociado a COVID-19 en un hospital pediátrico de tercer nivel de la Ciudad de México.

Objective: The objective is to expose the cardiovascular alterations in patients diagnosed with pediatric inflammatory multisystem syndrome (PIMS) associated with COVID-19 during the SARS-CoV-2 pandemic, in order to understand the disease, its evolution, and optimal management upon diagnosis. Method: Retrospective, observational, cross-sectional analytical study of patients diagnosed with PIMS according to the criteria of the World Health Organization at the National Institute of Pediatrics, from March 2020 to December 2021. Results: During the study period, 77 patients with PIMS were diagnosed. The results showed correlation between the shock state and alteration of laboratory markers (platelets 144217.29 ± 139321.6 µL [p < 0.001], procalcitonin 27.37 ± 38.37 ng/ml [p = 0.05] and ferritin 1937.87 ± 2562.63 [p < 0.001]). The ventricular function in patients with shock was significantly lower compared to those without shock (49.6 ± 9.1% vs. 58.1 ± 8.4 %; t-Student p < 0.001), as well as injury to the left coronary artery (p = 0.02). There is a correlation between NT-proBNP and ventricular dysfunction (Kruskal-Wallis p = 0.007). Statistical significance was found in the association between death, elevation of inflammatory markers and ventricular dysfunction (p < 0.001). Conclusions: The cardiovascular alterations observed, in order of frequency, were pericardial effusion (25.7%), myocarditis (15%), mild ventricular dysfunction (13.5%) and small coronary aneurysm with predominance of the left coronary artery and the anterior descending one.

Objetivo: Exponer las alteraciones cardiovasculares en los pacientes diagnosticados con síndrome inflamatorio multisistémico pediátrico (PIMS) asociado a COVID-19 durante la pandemia por SARS-CoV-2 con el fin de comprender la enfermedad, su evolución y el manejo óptimo al diagnóstico. Método: Estudio retrospectivo, observacional, transversal y analítico de pacientes con diagnóstico de PIMS de acuerdo con los criterios de la Organización Mundial de la Salud en el Instituto Nacional de Pediatría, de marzo de 2020 a diciembre de 2021. Resultados: Durante el periodo de estudio se diagnosticaron 77 pacientes con PIMS. Los resultados demostraron una correlación entre el estado de choque y la alteración de los marcadores de laboratorio (plaquetas 144217.29 ± 139321.6 µl [p < 0.001], procalcitonina 27.37 ± 38.37 ng/ml [p = 0.05] y ferritina 1937.87 ± 2562.63 [p < 0.001]). La función ventricular en los pacientes con choque se registró significativamente menor en comparación con aquellos sin choque (49.6 ± 9.1 % vs. 58.1 ± 8.4 %; t de Student p < 0.001), así como lesión en la arteria coronaria izquierda (p = 0.02). Existe una correlación entre el NT-proBNP y la disfunción ventricular (Kruskal-Wallis p = 0.007). Se encontró significancia estadística en la asociación entre fallecimiento, elevación de los marcadores inflamatorios y disfunción ventricular (p < 0.001). Conclusiones: Las alteraciones cardiovasculares observadas fueron, en orden de frecuencia, derrame pericárdico (25.7%), miocarditis (15%), disfunción ventricular leve (13.5%) y aneurisma pequeño coronario con predominio de la arteria coronaria izquierda y la descendente anterior.

Spiritual growth, sense of coherence and self-efficacy of family caregivers of people with disabilities.

OBJECTIVE: Analyze the spiritual growth of family caregivers of people with severe disabilities who reside in the Metropolitan District of Quito and identify the cognitive-affective factors, bio-sociocultural characteristics and care characteristics that model it. METHOD: Cross-sectional study, carried out during the second semester of 2021, probabilistic sample of 223 caregivers residing in Quito-Ecuador. Descriptive statistics, correlation coefficients and regression were applied. RESULTS: 49.8% perceived a high spiritual growth. This correlated with the manageability dimension of the sense of coherence and with the self-efficacy of care. Some cognitive-affective factors, bio-sociocultural characteristics and care characteristics explained 25% of its variation. CONCLUSION: The results showed a frequent practice of actions that promote spiritual growth, self-efficacy of care is highlighted as an important protective factor, these results can serve as a basis for planning interventions towards the evaluation and development of spiritual growth in search of a healthy lifestyle. in this vulnerable population.

Redescription of two species of Microcyclops (Copepoda, Cyclopoida) and use of ordination models to classify American species.

Two species of the freshwater copepod genus Microcyclops are redescribed, M.finitimus Dussart, 1984, and M.minor Dussart, 1984 from type specimens. Redescription includes the microstructure of intercoxal sclerites and the basipodites of thoracic appendages, as well as the urosomal microstructure. According to the cluster (UPGMA and Euclidean distance) and PCA analyses performed, it was possible to improve the resolution between the American Microcyclops species by considering characters such as the distal region of antennal basis, the maxillary ornamentation, and the thoracic appendages, especially the intercoxal sclerites and medial margin of the basipodite of the first to fourth trunk limbs. Considering a set of 28 morphological characters in adult females, traditional features such as the length ratio of caudal rami, the length: width ratio of the third endopod of the fourth leg, or the length ratios between apical setae of the same segment, appear to be less important for defining differences between very similar species of American Microcyclops. In these analyses, the redescription of the Palearctic M.varicans was considered, and this species was clearly separated from the American M.dubitabilis Kiefer, 1934 and M.inarmatus Gutiérrez-Aguirre and Cervantes-Martínez, 2016.

Characteristics and outcomes of multisystem inflammatory syndrome in children: A multicenter, retrospective, observational cohort study in Mexico.

Introduction: Multisystem inflammatory syndrome in children associated with coronavirus disease 2019 (MIS-C), a novel hyperinflammatory condition secondary to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, is associated with severe outcomes such as coronary artery aneurysm and death. Methods: This multicenter, retrospective, observational cohort study including eight centers in Mexico, aimed to describe the clinical characteristics and outcomes of patients with MIS-C. Patient data were evaluated using latent class analysis (LCA) to categorize patients into three phenotypes: toxic shock syndrome-like (TSSL)-MIS-C, Kawasaki disease-like (KDL)-MIS-C, and nonspecific MIS-C (NS-MIS-C). Risk factors for adverse outcomes were estimated using multilevel mixed-effects logistic regression. Results: The study included 239 patients with MIS-C, including 61 (26%), 70 (29%), and 108 (45%) patients in the TSSL-MIS-C, KDL-MIS-C, and NS-MIS-C groups, respectively. Fifty-four percent of the patients were admitted to the intensive care unit, and 42%, 78%, and 41% received intravenous immunoglobulin, systemic glucocorticoids, and anticoagulants, respectively. Coronary artery dilatation and aneurysms were found in 5.7% and 13.2% of the patients in whom coronary artery diameter was measured, respectively. Any cause in-hospital mortality was 5.4%. Hospitalization after ten days of symptoms was associated with coronary artery abnormalities (odds ratio [OR] 1.6, 95% confidence interval [CI] 1.2-2.0). Age ≥10 years (OR: 5.6, 95% CI: 1.4-2.04), severe underlying condition (OR: 9.3, 95% CI: 2.8-31.0), platelet count <150,000 /mm3 (OR: 4.2, 95% CI: 1.2-14.7), international normalized ratio >1.2 (OR: 3.8, 95% CI: 1.05-13.9), and serum ferritin concentration >1,500 mg/dl at admission (OR: 52, 95% CI: 5.9-463) were risk factors for death. Discussion: Mortality in patients with MIS-C was higher than reported in other series, probably because of a high rate of cases with serious underlying diseases.

Spiritual growth, sense of coherence and self-efficacy of family caregivers of people with disabilities / Crescimento espiritual, senso de coerência e autoeficácia de cuidadores familiares de pessoas com deficiência / Crecimiento espiritual, sentido de coherencia y autoeficacia de las cuidadoras familiares de personas con discapacidad

ABSTRACT Objective: Analyze the spiritual growth of family caregivers of people with severe disabilities who reside in the Metropolitan District of Quito and identify the cognitive-affective factors, bio-sociocultural characteristics and care characteristics that model it. Method: Cross-sectional study, carried out during the second semester of 2021, probabilistic sample of 223 caregivers residing in Quito-Ecuador. Descriptive statistics, correlation coefficients and regression were applied. Results: 49.8% perceived a high spiritual growth. This correlated with the manageability dimension of the sense of coherence and with the self-efficacy of care. Some cognitive-affective factors, bio-sociocultural characteristics and care characteristics explained 25% of its variation. Conclusion: The results showed a frequent practice of actions that promote spiritual growth, self-efficacy of care is highlighted as an important protective factor, these results can serve as a basis for planning interventions towards the evaluation and development of spiritual growth in search of a healthy lifestyle. in this vulnerable population.

RESUMO Objetivo: Analisar o crescimento espiritual dos cuidadores familiares de pessoas com deficiência grave que residem no Distrito Metropolitano de Quito e identificar os fatores cognitivo-afetivos, as características bio-socio-culturais e características do cuidado que o modelam. Método: Estudo transversal, realizado durante o segundo semestre de 2021, amostra probabilística de 223 cuidadores residentes em Quito-Equador. Foram aplicadas estatísticas descritivas, coeficientes de correlação e regressão. Resultados: 49,8% perceberam um alto crescimento espiritual. Isso se correlacionou com a dimensão gerencial do senso de coerência e com a autoeficácia do cuidado. Alguns fatores cognitivo-afetivos, características bio-socio-culturais e características do cuidado explicaram 25% de sua variação. Conclusão: Os resultados mostraram uma prática frequente de ações que promovam o crescimento espiritual, a autoeficácia do cuidado é destacada como importante fator de proteção, esses resultados podem servir de base para o planejamento de intervenções voltadas à avaliação e desenvolvimento do crescimento espiritual em busca de uma vida saudável estilo de vida nesta população vulnerável.

RESUMEN Objetivo: Analizar el crecimiento espiritual de las cuidadoras familiares de personas con discapacidad severa que residen en el Distrito Metropolitano de Quito e identificar los factores cognitivo-afectivos, características bio-socioculturales y características del cuidado que modelen el mismo. Método: Estudio transversal, realizado durante el segundo semestre del 2021, muestra probabilística de 223 cuidadoras residentes en Quito-Ecuador. Se aplicó estadística descriptiva, coeficientes de correlación y regresión. Resultados: El 49,8% percibieron un alto crecimiento espiritual. Este correlacionó con la dimensión manejabilidad del sentido de coherencia y con la autoeficacia del cuidado. Algunos factores cognitivo-afectivos, características bio-socioculturales y características del cuidado, explicaron el 25% de la variación del mismo. Conclusión: Los resultados mostraron una práctica frecuente de acciones promotoras del crecimiento espiritual, se destaca la autoeficacia del cuidado como factor protector importante, estos resultados pueden servir de base para planificar intervenciones hacia la evaluación y desarrollo del crecimiento espiritual en busca de un estilo de vida saludable en esta población vulnerable.

Identification of Microcrustaceans as Potential Bioindicators of Arsenic in Tropical Water Bodies.

We investigated microcrustaceans inhabiting arsenic contaminated and non-contaminated freshwater to identify potential bioindicators of arsenic contamination in the tropical freshwater of Matehuala in northern Mexico. We collected water, sediment, and zooplankton, at five sampling points during three sampling campaigns. We determined water temperature, pH, electrical conductivity, dissolved oxygen, alkalinity, salinity, and total arsenic concentration in water. Additionally, we determined total arsenic and arsenic speciation in sediment samples. We identified microcrustaceans and determined abundance, richness, and Shannon Index. We also investigated relationships and correlations between physiochemical and ecological variables. Results showed that arsenic concentrations in freshwater ranged from 0.001 to 53.23 mg/L, while total arsenic in sediments ranged from 10.37 to 2472.84 mg/kg as As + 5. Six microcrustacean species were found in highly and moderately contaminated water (Latonopsis australis, Eucyclops chihuahuensis, Acanthocyclops americanus, Pleuroxus (Picripleuroxus) quasidenticulatus, Macrocyclops albidus, and Paracyclops chiltoni), while five species were found in arsenic-free water (Simocephalus punctatus, Alona glabra, Eucyclops leptacanthus, M. albidus, and P. quasidenticulatus). An inverse relationship was observed between microcrustacean richness and arsenic. However, the scope of the data did not allow for a strong and significant correlation. Nevertheless, among the species inhabiting As-free water, S. punctatus showed potential to be further tested as a bioindicator of As contamination in Matehuala. Identification of potential bioindicators could help monitor water quality and increase understanding of the incorporation and toxicity of As in freshwater-sensitive and freshwater-metallotolerant microcrustaceans, which, in turn, might help us to understand As incorporation in the food web.

The effect of ovarian follicle size on oocyte and embryology outcomes.

OBJECTIVE: To identify relationships between the size of punctured ovarian follicles and subsequent embryology outcomes. DESIGN: Prospective observational cohort study. SETTING: Private fertility center. PATIENTS: One hundred fifty-seven oocyte retrievals performed during the study period. INTERVENTIONS: The diameter of punctured follicles was ultrasonically measured during routine oocyte collection. The resulting embryos were group-cultured to the blastocyst stage and classified into 8 groups according to follicle size (≤9.5, 10-12.5, 13-15.5, 16-18.5, 19-21.5, 22-24.5, 25-27.5, and ≥28 mm). MAIN OUTCOME MEASURE: Rate of good-quality blastocysts per follicle puncture. RESULTS: This study included 4,539 follicle punctures, 2,348 oocytes, 1,772 mature oocytes, 1,258 bipronuclear (2pn) oocytes, and 571 good-quality blastocysts derived from 157 oocyte retrievals. The per-puncture yields of oocytes, mature oocytes, 2pn oocytes, and good-quality blastocysts were associated with the size of the punctured follicle. The rates of good-quality blastocysts per punctured follicle were 2.2% (≤9.5 mm), 6.2% (10-12.5 mm), 11.9% (13-15.5 mm), 14.5% (16-18.5 mm), 18.9% (19-21.5 mm), 17.5% (22-24.5 mm), 15.9% (25-27.5 mm), and 16.0% (≥28 mm). When compared with the overall average, punctures of follicles in groups ≤12.5 mm in diameter had significantly inferior yields of good-quality blastocysts, whereas punctures of follicles in groups 19-24.5 mm in diameter were associated with significantly greater than average yields of good-quality blastocysts. Other groups did not differ significantly from average. No correlation was observed between follicle diameter and ploidy of biopsied blastocysts. CONCLUSIONS: Punctures of follicles ≤12.5 mm in diameter rarely result in good-quality blastocysts. The yield of good-quality blastocysts progressively increases with follicle size up to approximately 19 mm in diameter, with no substantial decline above that size. The ploidy of the blastocysts that form appears to be unaffected by follicle size.

Evaluation of arsenic effects on Paracyclops novenarius Reid, 1987: a cyclopoid copepod in central-north of Mexico.

Description and morphological analysis of copepods inhabiting a water body with high arsenic concentrations (32.79 to 62.29 mg L-1) were performed to identify some effect on the development of individuals due to the arsenic concentrations. Detailed morphology of prosomal and urosomal appendages along the development of the specimens was considered. The results showed that the freshwater copepod Paracyclops novenarius Reid, 1987 inhabits this water body, and previously, it was recorded as Paracyclops chiltoni (Thomson GM, 1882) on this site. Moreover, this becomes the first record of P. novenarius in Mexico. Morphological analysis showed a normal and stable development along the different instars, different arsenic concentrations in the media, and different sampled dates between the analyzed specimens, suggesting that the high arsenic concentrations do not affect the morphology of P. novenarius, including all its development and adult instars, which differs from other copepods and other groups such as Cladocera and Rotifera, where morphological changes due to metals and metalloids have been observed but in low concentrations of these elements. The results of this study contribute to the existing reports of the genus Paracyclops (Claus 1893) in Mexico and could provide information for environmental impact assessments on aquatic systems.

Paracyclops chiltoni inhabiting water highly contaminated with arsenic: Water chemistry, population structure, and arsenic distribution within the organism.

We investigated population structure and arsenic bioaccumulation and distribution in zooplankton inhabiting highly contaminated freshwater with arsenic. We collected water and zooplankton samples over a 4 year period, determined environmental temperature as well as water temperature, pH, electrical conductivity (EC), total dissolved solids (TDS), oxidation-reduction potential (ORP), dissolved oxygen (DO), major cations and anions and total arsenic concentration. We identified zooplankton species and determined their abundance, length, sex ratios, and arsenic bioaccumulation and distribution in exposed organisms. At the study site, an extremophile, Paracyclops chiltoni, was found to survive in an environment with high concentration of arsenic, sulfate and fluoride in freshwater as a well-adapted organism. Results showed that the average arsenic concentration in freshwater was 53.64 ± 10.58 mg/L. Exposed organisms of Paracyclops chiltoni showed arsenic accumulation (up to 9.6 ± 5.4 mgAs/kg) in its body, likely in the digestive tract as well as typical abundance and length, which showed a relationship to environmental temperature and oxic conditions in freshwater. Metallotolerant copepods might help to better understand if arsenic methylation processes occur in freshwater aquatic organisms.

Determinantes sociales y desafíos para la deconstrucción social de la pandemia por COVID-19 / Determinantes sociais e desafios para a desconstrução social da pandemia covid-19 / Social determinants and challenges for the social deconstruction of the COVID-19 pandemic

Objetivo: analizar los determinantes sociales de salud y su relación con el impacto de la COVID-19 en la salud de personas y comunidades, con el fin de suscitar nuevas reflexiones sobre los desafíos sociales que implica el abordaje de esta enfermedad. Síntesis de contenido: la salud y la enfermedad son construidas y determinadas socialmente. Ambas están presentes en la forma en que vivimos y el tipo de sociedad que construimos. La pandemia actual ha evidenciado nuevamente profundas disparidades que están vinculadas a un mayor riesgo. Si bien la COVID-19 puede afectar a todas las personas, los impactos derivados de ella se perciben de formas diferentes según el estado de vulnerabilidad en el que se encuentre cada individuo, que es dado principalmente por determinantes sociales. Por tanto, cumplir con medidas de confinamiento en casa, higiene y distanciamiento social se convierten en una cuestión de privilegio imposible de acatar para ciertos sectores, especialmente en los países de América Latina. Conclusiones: el abordaje de la pandemia como problema social requiere mirar más allá de las características del virus, su capacidad de propagación y los factores biológicos individuales, para enfocarse en los verdaderos determinantes sociales y así promover equidad en los servicios de salud e identificar dónde intervenir de manera efectiva. La reconstrucción de la sociedad pospandemia exige que la salud sea comprendida y practicada como un derecho humano y un bien público garantizado por el Estado. De lo contrario, una de las consecuencias de abordar la pandemia como un "problema del virus" es perpetuar la negligencia en los procesos políticos, económicos y sociales, es decir, exige un análisis amplio de los contextos y las circunstancias sociales.

Objetivo: analisar os determinantes sociais da saúde e sua relação com o impacto da covid-19 na saúde das pessoas e das comunidades para suscitar novas reflexões sobre os desafios sociais que a abordagem dessa doença envolve. Síntese de conteúdo: saúde e doença são socialmente construídas e determinadas. Ambas estão presentes na forma como vivemos e no tipo de sociedade que construímos. A atual pandemia mais uma vez evidenciou profundas disparidades que estão associadas a um risco aumentado. Embora a covid-19 possa afetar a todas as pessoas, esses impactos são percebidos de forma diferenciada de acordo com a vulnerabilidade de cada indivíduo, a qual existe principalmente pelos determinantes sociais. Cumprir as medidas de confinamento em casa, higiene e distanciamento social torna-se uma questão de privilégio, impossível para alguns setores, em especial nos países da América Latina Conclusões: a abordagem da pandemia como problema social requer olhar além das características do vírus, da sua capacidade de propagação e dos fatores biológicos individuais para se enfocar nos verdadeiros determinante sociais para promover a equidade nos serviços de saúde e identificar onde intervir efetivamente. A reconstrução da sociedade pós-pandêmica exige que a saúde seja entendida e praticada como um direito humano e um bem público garantido pelo Estado; do contrário, uma das consequências de abordar a pandemia como um "problema do vírus" é perpetuar a negligência nos procesos políticos, econômicos e sociais, ou seja, requer uma ampla análise dos contextos e circunstâncias sociais.

Objective: To examine the social determinants of health and their relationship with the impact of COVID-19 on people's health and their communities, in order to elicit new reflections on the social challenges involved in addressing this disease. Content synthesis: Health and disease are socially constructed and determined. They are present in the way we live and the type of society we build. The current pandemic has uncovered long-existing deep disparities that are linked to increased risks. Although COVID-19 can affect everyone, the impacts of this disease are differently perceived according to the vulnerability given, above all, by social determinants. Complying with lockdown measures at home, hygiene habits, and social distancing become a matter of privilege that is impossible for certain sectors, especially in Latin American countries. Conclusions: Addressing the pandemic as a social problem requires looking beyond the characteristics of the virus, its ability to spread, and individual biological factors, thus switching the current focus to its true social determinants in order to promote equity in health services and identify intervention areas effectively. The reconstruction of the post-pandemic society requires that health be understood and practiced as a human right and public good guaranteed by the State. Otherwise, one of the consequences of adressing the pandemic as a "virus problem" will be to perpetuate negligence of political, economic, and social processes, that is, it requires a broad analysis of social contexts and circumstances.

Autoeficacia en cuidadores de personas con discapacidad: Revisión integrativa / Auto-eficácia em cuidadores de pessoas com deficiência: Revisão integrativa / Self-efficacy in caregivers of persons with disabilities: Integrative review

CONTEXTO: La capacidad de los cuidadores familiares para enfrentar las demandas del cuidado en el hogar se desarrolla individualmente según la capacidad de autoeficacia que logre alcanzar a lo largo de la vida. OBJETIVO: Conocer la percepción de autoeficacia de los cuidadores familiares de personas con discapacidad. METODOLOGÍA: Se utilizó el formato PICO para la pregunta de investigación. Se buscaron artículos científicos en las bases de datos Scopus, PubMed, SciELO, BVS y WOS, teniendo en cuenta los descriptores: autoeficacia, cuidadores y personas con discapacidad, con sus respectivas traducciones al inglés y portugués. Se establecieron cuatro estrategias de búsqueda diferentes utilizando el booleano AND. Los filtros aplicados fueron: texto completo y límite de temporalidad 2008 a 2018. RESULTADOS: Se identificaron 74 estudios de los cuales se eliminaron 68, finalmente, el estudio incluyó 6 investigaciones que evalúan la percepción de autoeficacia en el cuidador familiar de personas con discapacidad. Los estudios reportan a la autoeficacia como un mecanismo de afrontamiento con fuerte validez predictiva en las condiciones de salud y los dominios de las conductas de salud. La asociación más comúnmente reportada es entre la autoeficacia y la sobrecarga percibida, en donde existe una asociación lineal negativa. CONCLUSIONES: La autoeficacia es un determinante poderoso y modificable de la conducta por lo que debe ser foco de atención de los profesionales de enfermería. Surge la necesidad de definir modelos de intervención en enfermería en conjunto con las familias a través de un acompañamiento a lo largo del tiempo.

CONTEXTO: A capacidade dos cuidadores familiares de atender às demandas do cuidado domiciliar é desenvolvida individualmente, de acordo com a capacidade de autoeficácia que eles alcançam ao longo da vida. OBJETIVO: Conhecer a percepção de autoeficácia de cuidadores familiares de pessoas com deficiência. MÉTODOS: Foi utilizado o formato PICO para a questão de pesquisa. Pesquisámos artigos científicos nas bases de dados Scopus, PubMed, SciELO, BVS e WOS, levando em consideração os descritores: autoeficácia, cuidadores e pessoas com deficiência, com suas respectivas traduções para inglês e português. Foram estabelecidas quatro estratégias de busca diferentes usando o AND booleano. Os filtros aplicados foram: texto completo e prazo de 2008 a 2018. RESULTADOS: Foram identificados 74 estudos, dos quais 68 foram eliminados e, por fim, foram incluídos 6 estudos que avaliam a percepção de autoeficácia no cuidador familiar de pessoas com deficiência. Estudos relatam a autoeficácia como um mecanismo de enfrentamento com forte validade preditiva nas condições de saúde e nos domínios dos comportamentos de saúde. A associação mais comumente relatada é entre autoeficácia e sobrecarga percebida, onde há uma associação linear negativa. CONCLUSÕES: A autoeficácia é um determinante poderoso e modificável do comportamento, devendo ser o foco dos profissionais de enfermagem. Surge a necessidade de definir modelos de intervenção em enfermagem junto às famílias por meio de um acompanhamento ao longo do tempo.

BACKGROUND: The capacity of family caregivers to meet the demands of home care is developed individually according to the capacity of self-efficacy that they achieve throughout life. AIM: To know the perception of self-efficacy of family caregivers of people with disabilities. METHODS: The PICO format was used for the research question. Scientific articles were searched in the Scopus, PubMed, SciELO, BVS and WOS databases, taking into account the descriptors: self-efficacy, caregivers and people with disabilities, with their respective translations into English and Portuguese. Four different search strategies were established using the AND boolean. The filters applied were: full text and time limit from 2008 to 2018. RESULTS: 74 studies were identified, 68 of which were eliminated. Finally, the study included 6 studies that evaluate the perception of self-efficacy in the family caregiver of people with disabilities. Studies report self-efficacy as a coping mechanism with strong predictive validity in health conditions and domains of health behaviors. The most commonly reported association is between self-efficacy and perceived overload, where there is a negative linear association. CONCLUSIONS: Self-efficacy is a powerful and modifiable determinant of behavior, so it should be the focus of nursing professionals. The need arises to define models of intervention in nursing together with families through an accompaniment over time.

Remarks on Mastigodiaptomus (Calanoida: Diaptomidae) from Mexico using integrative taxonomy, with a key of identification and three new species.

BACKGROUND: In Mexico, species of four families of free-living calanoid copepods have been recorded as inhabitants of several freshwater systems. These families are Centropagidae, Temoridae, Pseudodiaptomidae and Diaptomidae. The genera Leptodiaptomus and Mastigodiaptomus are the most speciose diaptomid genera in Mexico, and they inhabit natural and artificial lakes, ephemeral ponds, springs, and caverns. Leptodiaptomus is considered as an endemic Nearctic genus, whereas Mastigodiaptomus is a widely distributed Neotropical genus in the southern USA, Mexico, the Caribbean Islands and Central America. Based on new and recent evidence, Mastigodiaptomus diversity has been underestimated: six species of the genus were known before 2000. In this work three new Mastigodiaptomus species have been described from different regions of Mexico by using integrative taxonomy. We also gave amended diagnosis of M. nesus Bowman (1986) and M. patzcuarensis s. str. (Kiefer, 1938). METHODS: In this work, the taxonomic status of the species was clarified using modern, integrative method based on the COI gene as a DNA marker, plus micro-structural analysis (based on SEM and ligth microscopy). RESULTS: Three new species of Mastigodiaptomus were described based on genetic and morphological analyses: M. alexei sp. n., M. ha sp. n. and M. cihuatlan sp. n. Also amended description of M. nesus, morphological variation of M. patzcuarensis s. str., and a comparison of them with all known sequences within the genus are provided. These new findings show that in Mastigodiaptomus differences in several cuticular microstructures of several appendages (such as the antennules, the fifth legs, or the urosomites of these copepods) agree with the interspecific genetic divergence >3% observed in sequences of the COI gene, and the integration of this information is a powerful tool in species delineation.

A new anchialine Stephos Scott from the Yucatan Peninsula with notes on the biogeography and diversity of the genus (Copepoda, Calanoida, Stephidae).

Surveys of the anchialine crustacean fauna of the Yucatan Peninsula (YP), Mexico, have revealed the occurrence of calanoid copepods. The genus Stephos Scott, 1892, belonging to the family Stephidae is among the most frequent and widely distributed groups in anchialine caves but has not been hitherto recorded from the YP. Recent collections from an anchialine cave in an island off the northern coast of the YP yielded many specimens of a new species of Stephos. The new taxon, S. fernandoisp. n., is described here based on male and female specimens. The new species is clearly distinguished from its congeners by the following characters: male left fifth leg with three terminal lamellae plus subdistal process, right leg with distal row of peg-like elements; female fifth leg with single long, acute apical process; genital double-somite with two rows each of 4 long spinules adjacent to operculum; legs 2-4 with articulated setae. The diversity of the genus shows regional differences; the Australia-Western Pacific region is the most diverse (eleven species), followed by the Mediterranean (seven species) and the Northeastern Atlantic (six species); only four species are known from the Northwestern Tropical Atlantic (NWTA). The morphology of the female fifth leg was examined to explore possible biogeographic trends in the genus; patterns suggest multiple colonization events in the highly diverse regions and a relatively recent radiation in the NWTA, characterized by anchialine forms. The introduction of stephid copepods in the region may be a relatively recent event derived from colonization of benthopelagic ancestral forms and subsequent invasion onto cave habitats. The new species appears to be linked to the strictly anchialine Miostephos.

Taxonomic evaluation of eleven species of Microcyclops Claus, 1893 (Copepoda, Cyclopoida) and description of Microcyclops inarmatus sp. n. from America.

Description and meristic analysis of eleven species of Microcyclops recorded in America were performed based on the examination of type specimens and fresh material. Microscopic analysis of oral appendages, such as the shape and armature of the distal coxal endite of the maxilla, the ornamentation on the caudal surface of the antenna, and the intercoxal sclerites and armament of the inner basis of all swimming appendages, were characteristics that allowed the differentiation between species. Among these species, our study confirmed the synonymy of Microcyclops diversus Kiefer, 1935 with Microcyclops ceibaensis (Marsh, 1919). The results of our observations showed that Microcyclops alius (Kiefer, 1935) is a junior synonym of Microcyclops dubitabilis Kiefer, 1934; the latter being confirmed as a valid species. Also, it is proposed that the records of Microcyclops rubellus (Lilljeborg, 1901) and Microcyclops varicans (Sars, 1863) in America should be revised as there are serious doubts about their distribution in America. The analysis suggested that Microcyclops anceps pauxensis Herbst, 1962 is distinct from Microcyclops anceps var. minor Dussart, 1984 and that both are likely different from Microcyclops anceps anceps (Richard, 1897). Finally a full morphological description of adult females of Microcyclops inarmatus sp. n. is presented.

The risk of embryo-endometrium asynchrony increases with maternal age after ovarian stimulation and IVF.

This retrospective cohort analysis examined the effects of maternal age on the incidence of factors associated with embryo-endometrium asynchrony in fresh autologous blastocyst transfer. The study included 1169 routine fresh autologous blastocyst transfers. The main outcome measure was asynchronous transfer defined by delayed (day 6) blastocyst transfer or elevated pre-ovulatory serum progesterone level. Compared with patients younger than 35 years, patients 35 years or older had increased risk of having at least one risk factor for asynchronous transfer, including premature progesterone elevation or delayed blastocyst transfer (RR 1.36; 95% CI 1.24 to 1.50). The older group had increased risk of simultaneously having both risk factors (RR 1.61, 95% CI 1.17 to 2.21) compared with the younger group. In patients younger than 35 years, live birth rate per transfer was 62.9% with day 5 transfer and low progesterone, declining to 27.9% for day 6 transfer combined with elevated progesterone. In patients 35 years or older, live birth rate per transfer was 38.0% with day 5 transfer and low progesterone, declining to 18.1% for day 6 transfer combined with elevated progesterone. Indicators of embryo-endometrium asynchrony increase in prevalence as women age and asynchrony disproportionately decreases birth rates in older patients.

A new species of Mastigodiaptomus Light, 1939 from Mexico, with notes of species diversity of the genus (Copepoda, Calanoida, Diaptomidae).

A new species of the genus Mastigodiaptomus Light, 1939, named Mastigodiaptomus cuneatussp. n. was found in a freshwater system in the City of Mazatlán, in the northern region of Mexico. Morphologically, the females of this new species are distinguishable from those of its congeners by the following combination of features: the right distal corner of the genital double-somite and second urosomite have a wedge-shaped projection, the fourth urosomite has no dorsal projection and its integument is smooth. The males are distinct by the following features: the right caudal ramus has a wedge-shaped structure at the disto-ventral inner corner; the basis of the right fifth leg has one triangular and one rounded projection at the distal and proximal margins, respectively, plus one hyaline membrane on the caudal surface close to the inner margin; the aculeus length is almost the width of the right second exopod (Exp2); and the frontal and caudal surfaces of the right Exp2 are smooth. Furthermore, the analysis of the COI gene of Mastigodiaptomus cuneatus sp. n. has revealed that Mastigodiaptomus albuquerquensis (Herrick, 1895) is its nearest congener, with 18.64% of genetic distance. A key for the identification of the known species of the genus is provided.

Freeze-all at the blastocyst or bipronuclear stage: a randomized clinical trial.

OBJECTIVE: To compare outcomes for patients randomized to have all embryos cryopreserved at the blastocyst stage or at the bipronuclear stage with subsequent post-thaw culture to the blastocyst stage. DESIGN: Randomized controlled trial. SETTING: Private fertility center. PATIENT(S): This study included 140 women, age 18-40 years, with at least eight antral follicles, and day 3 FSH <10 IU/L undergoing IVF. INTERVENTION(S): After oocyte retrieval, subjects were randomized to have entire embryo cohorts cryopreserved at either the bipronuclear stage (2PN Cryo group) or at the blastocyst stage (Blast Cryo group). MAIN OUTCOME MEASURE(S): Ongoing pregnancy (viable fetal heart motion at 10 weeks' gestation) per oocyte retrieval through the first transfer attempt. RESULT(S): No significant differences were observed between the two study groups in age at retrieval, body mass index, antral follicle count, day 3 FSH level, or IVF cycle parameters. No significant differences were observed in ongoing pregnancy rate per retrieval (62.0%; 95% confidence interval [CI], 50.3%-72.4%) in the 2PN Cryo group; and 55.1%; 95% CI, 42.6%-67.1% in the Blast Cryo group), implantation rate (60.0% vs. 62.7%), ongoing pregnancy rate per thaw (62.0% vs. 59.4%), ongoing pregnancy rate per transfer (67.7% vs. 69.1%), and the cumulative ongoing pregnancy rate per retrieval from all thaws to date of embryos derived from the study retrieval cycle (64.8% vs. 60.9%). CONCLUSION(S): Freeze-all at the blastocyst stage or at the bipronuclear stage has similar efficacy and IVF outcomes. The choice between them may depend primarily on logistical factors. CLINICAL TRIAL REGISTRATION NUMBER: NCT01247987.

Freeze-all can be a superior therapy to another fresh cycle in patients with prior fresh blastocyst implantation failure.

Implantation failure has various causes, including impaired uterine receptivity following ovarian stimulation. This retrospective cohort study compared outcomes in patients with prior implantation failure who elected to undergo another fresh cycle versus those who opted for embryo cohort cryopreservation (freeze-all) and subsequent thaw. There were 269 patients with implantation failure following fresh autologous blastocyst transfer opting to undergo a subsequent cycle, with 163 choosing another fresh cycle and 106 electing freeze-all and subsequent thaw. Multiple logistic regression analysis indicated that cohort cryopreservation was associated with greater chance of live birth when compared with another fresh cycle (P < 0.0001). The odds ratio for live birth with freeze-all relative to a fresh cycle was 3.8 (95% CI 2.1-7.2). A second analysis was then performed using cumulative live birth rate as the outcome measure. Multiple logistic regression indicated freeze-all was associated with greater cumulative live birth rate than was a fresh cycle (OR 1.9, 95% CI 1.1-3.3, P = 0.0287). These findings suggest that, following implantation failure with fresh blastocysts, patients have a significantly greater chance of live birth with freeze-all and subsequent thaw than with another fresh cycle.

Clinical rationale for cryopreservation of entire embryo cohorts in lieu of fresh transfer.

Recent dramatic increases in success rates with frozen-thawed embryo transfer (FET) are encouraging, as are numerous findings of several reduced risks with FET when compared with fresh transfer. These reduced risks include low birth weight and prematurity, among others. However, FET is also associated with increased risks of macrosomia and large for gestational age. There have been reports of greater implantation and pregnancy rates with FET than with fresh autologous embryo transfer, suggesting superior endometrial receptivity in the absence of ovarian stimulation. As cryo-technology evolves, there is potential for further increase in FET success rates, but for now it may be best to follow an individualized approach, balancing fresh transfer and embryo cohort cryopreservation options while considering patient characteristics, cycle parameters, and clinic success rates.