Layered Double Hydroxides (LDH) as Delivery Vehicles of a Chimeric Protein Carrying Epitopes from the Porcine Reproductive and Respiratory Syndrome Virus.

The Porcine Reproductive and Respiratory Syndrome Virus (PRRSV) causes reproductive failure and respiratory symptoms, leading to huge economic losses for the pig farming industry. Although several vaccines against PRRSV are available in the market; they show an overall low efficacy, and several countries have the need for vaccines covering the local, circulating variants. This project aims at developing a new chimeric antigen targeting specific epitopes from PRRSV and evaluating two test adjuvants to formulate a vaccine candidate. The test antigen was called LTB-PRRSV, which was produced recombinantly in Escherichia coli and consisted of the heat labile enterotoxin B subunit from E. coli (LTB) and four epitopes from PRRSV. LTB-PRRSV was rescued as inclusion bodies and methods for its solubilization, IMAC-based purification, and refolding were standardized, leading to mean yields of 18 mg of pure protein per liter culture. Layered double hydroxides (LDH) have been used as vaccine adjuvants given their biocompatibility, low cost, and positive surface charge that allows an efficient adsorption of negatively charged biomolecules. Therefore, LDH were selected as delivery vehicles of LTB-PRRSV. Pure LTB-PRRSV was adsorbed onto LDH by incubation at different LDH:LTB-PRRSV mass ratios (1:0.25, 1:0.5, 1:1, and 1:2) and at pH 9.5. The best adsorption occurred with a 1:2 mass ratio, and in a sucrose-tween solution. The conjugates obtained had a polydispersity index of 0.26, a hydrodynamic diameter of 192 nm, and a final antigen concentration of 64.2 µg/mL. An immunogenicity assessment was performed by injecting mice with LDH:LTB-PRRSV, Alum/LTB-PRRSV, or LTB-PRRSV in a scheme comprising three immunizations at two-week intervals and two dose levels (1 and 5 µg). LTB-PRRSV was capable of inducing strong humoral responses, which lasted for a longer period when LDH was used as the delivery vehicle/adjuvant. The potential of LDH to serve as an attractive carrier for veterinary vaccines is discussed.

Effects of active exergames on physical performance in older people: an overview of systematic reviews and meta-analysis.

This overview assessed the available body of published peer-reviewed systematic reviews and meta-analyses related to the effects of active exergames compared with active/passive control on physical performance outcomes in older people. The methodological quality and certainty of evidence were assessed using PRISMA, AMSTAR 2, and GRADE. The protocol was registered in PROSPERO (code: CRD42023391694). The main outcomes indicate that 4,477 records, five systematic reviews, and 10 meta-analyses were included. The AMSTAR-2 reported six meta-analyses with high methodological quality, four moderate quality, two systematic reviews with low quality, and three very-low quality. Meta-analysis was performed on balance using the Berg Balance Scale (BBS) and Timed Up-and-Go (TUG) tests, on cardiorespiratory fitness using the 6-min walk test, and on upper and lower limbs muscle strength using the handgrip strength, knee extension, and 30-s chair stand tests. Significant differences in favor of the active exergames groups concerning active/passive groups were reported in BBS (SMD = 0.85; 95% CI = 0.12-1.58; I2 = 96%; p = 0.02), TUG (SMD = 1.44; 95% CI = 0.71-2.16; I2 = 97%; p < 0.0001), and 30-s chair stand test (SMD = 0.79; 95% CI = 0.33-1.25; I2 = 88%; p = 0.0008). However, no significant differences were reported in favor of the active exergames groups in 6-min walk (SMD = 0.93; 95% CI = -0.64 to 2.50; I2 = 95%; p = 0.24), handgrip strength (SMD = 0.67; 95% CI = -0.04 to 1.38; I2 = 84%; p = 0.06), and knee extension tests (SMD = 0.20; 95% CI = -0.05 to 0.44; I2 = 95%; p = 0.12) compared to active/passive control. However, it was impossible to perform a meta-analysis for the variables of walking speed as a fall risk due to the diversity of instruments and the small number of systematic reviews with meta-analysis. In conclusion, interventions utilizing active exergames have shown significant improvements in the static and dynamic balance and lower limb muscle strength of apparently healthy older people, compared to control groups of active/inactive participants, as measured by BBS, TUG, and 30-s chair stand tests. However, no significant differences were found in the 6-min walk, HGS, and knee extension tests. Systematic review registration: PROSPERO, CRD42023391694.

Physical activity habits associated with health variables in Chilean male school children / Hábitos de actividad física asociados a variables de salud en escolares chilenos varones

Introduction: Physical inactivity is a factor that con-tributes to increased cardiometabolic risk, such as overweightand obesity in schoolchildren.Aim: To associate physical activity habits with morphologi-cal variables (body mass index [BMI], waist circumference[WC], body fat, and fat-free mass), blood pressure, glycemia,handgrip strength (HGS), and countermovement jump (CMJ)in Chilean male schoolchildren. In addition, to compare phys-ically active (PA) schoolchildren to physically inactive (PI)schoolchildren on morphological variables, blood pressure,glycemia, HGS, and CMJ. Material and methods: A cross-sectional study analyzed160 schoolchildren with a mean age of 7.12 ± 4.5 years dis-tributed into PA schoolchildren (n=75) and PI schoolchildren(n=85). A logistic regression was performed to identify theassociation between physical activity habits with factors ofmorphological variables (BMI, WC, body fat, and fat-freemass), blood pressure, glycemia, HGS, and CMJ. In addition,to compare the differences in physical activity habits (physi-cally active vs. physically inactive), a student’s t-test was per-formed for independent samples. Results: Logistic regression showed that physical activityis protective factor against excess body fat of 46% (OR=0.46; 95%CI= 0.22 to 0.95; p= 0.03), hyperglycemia of 25%(OR= 0.25; 95%CI= 0.12 to 0.51; p< 0.0001), high bloodpressure of 31% (OR= 0.31; 95%CI= 0.15 to 0.67; p=0.002), and HGS dominant hand of 40% (OR= 0.40; 95%CI=0.19 to 0.83; p= 0.014). Conclusion: Physical activity protected against excessbody fat, hyperglycemia, hypertension, and decreased HGSin Chilean male schoolchildren. PA schoolchildren exhibitedlower body fat, reduced risk of hyperglycemia and hyper-tension, and improved HGS and CMJ compared to PI school-children.(AU)

Introducción: La inactividad física es un factor que contribuye al aumento del riesgo cardiometabólico, como el sobrepeso y la obesidad en escolares.Objetivo: Asociar los hábitos de actividad física con variables morfológicas (índice de masa corporal [IMC], circunferencia de cintura [CC], grasa corporal y masa libre de grasa), presión arterial, glucemia, fuerza de prensión manual (FPM) y salto con contramovimiento (CMJ) en escolares hombres chilenos. Además, comparar escolares físicamente activos (FA) con escolares físicamente inactivos (FI) en variables morfológicas, presión arterial, glucemia, FPM y CMJ.Material y métodos: Estudio transversal que analizó 160 escolares con una edad media de 7,12 ± 4,5 años distribuidos en escolares FA (n= 75) y escolares FI (n= 85). Se realizó una regresión logística para identificar la asociación entre los hábitos de actividad física con factores de las variables morfológicas (IMC, CC, grasa corporal y masa libre de grasa), presión arterial, glucemia, FPM y CMJ. Además, para comparar las diferencias en los hábitos de actividad física (físicamente activos vs. físicamente inactivos), se realizó la prueba t de Student para muestras independientes.Resultados: La regresión logística mostró que la actividad física es un factor protector contra el exceso de grasa corporal en un 46% (OR= 0,46; IC95%= 0,22 a 0,95; p= 0,03), hiperglucemia en un 25% (OR= 0,25; IC95%= 0,12 a 0,51; p< 0,0001), hipertensión arterial del 31% (OR= 0,31; IC95%= 0,15 a 0,67; p= 0,002), y FPM en mano dominante del 40% (OR= 0,40; IC95%= 0,19 a 0,83; p= 0,014).Conclusión: La actividad física protegió contra el exceso de grasa corporal, la hiperglucemia, la hipertensión arterial y la disminución de FPM en escolares hombres chilenos. Los escolares FA exhibieron menos grasa corporal, menor riesgo de hiperglucemia e hipertensión, y FPM, además de CMJ mejorados en comparación con los escolares FI.(AU)

Pendelluft in hypoxemic patients resuming spontaneous breathing: proportional modes versus pressure support ventilation.

BACKGROUND: Internal redistribution of gas, referred to as pendelluft, is a new potential mechanism of effort-dependent lung injury. Neurally-adjusted ventilatory assist (NAVA) and proportional assist ventilation (PAV +) follow the patient's respiratory effort and improve synchrony compared with pressure support ventilation (PSV). Whether these modes could prevent the development of pendelluft compared with PSV is unknown. We aimed to compare pendelluft magnitude during PAV + and NAVA versus PSV in patients with resolving acute respiratory distress syndrome (ARDS). METHODS: Patients received either NAVA, PAV + , or PSV in a crossover trial for 20-min using comparable assistance levels after controlled ventilation (> 72 h). We assessed pendelluft (the percentage of lost volume from the non-dependent lung region displaced to the dependent region during inspiration), drive (as the delta esophageal swing of the first 100 ms [ΔPes 100 ms]) and inspiratory effort (as the esophageal pressure-time product per minute [PTPmin]). We performed repeated measures analysis with post-hoc tests and mixed-effects models. RESULTS: Twenty patients mechanically ventilated for 9 [5-14] days were monitored. Despite matching for a similar tidal volume, respiratory drive and inspiratory effort were slightly higher with NAVA and PAV + compared with PSV (ΔPes 100 ms of -2.8 [-3.8--1.9] cm H2O, -3.6 [-3.9--2.4] cm H2O and -2.1 [-2.5--1.1] cm H2O, respectively, p < 0.001 for both comparisons; PTPmin of 155 [118-209] cm H2O s/min, 197 [145-269] cm H2O s/min, and 134 [93-169] cm H2O s/min, respectively, p < 0.001 for both comparisons). Pendelluft magnitude was higher in NAVA (12 ± 7%) and PAV + (13 ± 7%) compared with PSV (8 ± 6%), p < 0.001. Pendelluft magnitude was strongly associated with respiratory drive (ß = -2.771, p-value < 0.001) and inspiratory effort (ß = 0.026, p < 0.001), independent of the ventilatory mode. A higher magnitude of pendelluft in proportional modes compared with PSV existed after adjusting for PTPmin (ß = 2.606, p = 0.010 for NAVA, and ß = 3.360, p = 0.004 for PAV +), and only for PAV + when adjusted for respiratory drive (ß = 2.643, p = 0.009 for PAV +). CONCLUSIONS: Pendelluft magnitude is associated with respiratory drive and inspiratory effort. Proportional modes do not prevent its occurrence in resolving ARDS compared with PSV.

Predictors of fall risk in older adults using the G-STRIDE inertial sensor: an observational multicenter case-control study.

BACKGROUND: There are a lot of tools to use for fall assessment, but there is not yet one that predicts the risk of falls in the elderly. This study aims to evaluate the use of the G-STRIDE prototype in the analysis of fall risk, defining the cut-off points to predict the risk of falling and developing a predictive model that allows discriminating between subjects with and without fall risks and those at risk of future falls. METHODS: An observational, multicenter case-control study was conducted with older people coming from two different public hospitals and three different nursing homes. We gathered clinical variables ( Short Physical Performance Battery (SPPB), Standardized Frailty Criteria, Speed 4 m walk, Falls Efficacy Scale-International (FES-I), Time-Up Go Test, and Global Deterioration Scale (GDS)) and measured gait kinematics using an inertial measure unit (IMU). We performed a logistic regression model using a training set of observations (70% of the participants) to predict the probability of falls. RESULTS: A total of 163 participants were included, 86 people with gait and balance disorders or falls and 77 without falls; 67,8% were females, with a mean age of 82,63 ± 6,01 years. G-STRIDE made it possible to measure gait parameters under normal living conditions. There are 46 cut-off values of conventional clinical parameters and those estimated with the G-STRIDE solution. A logistic regression mixed model, with four conventional and 2 kinematic variables allows us to identify people at risk of falls showing good predictive value with AUC of 77,6% (sensitivity 0,773 y specificity 0,780). In addition, we could predict the fallers in the test group (30% observations not in the model) with similar performance to conventional methods. CONCLUSIONS: The G-STRIDE IMU device allows to predict the risk of falls using a mixed model with an accuracy of 0,776 with similar performance to conventional model. This approach allows better precision, low cost and less infrastructures for an early intervention and prevention of future falls.

Assessing falls in the elderly population using G-STRIDE foot-mounted inertial sensor.

Falls are one of the main concerns in the elderly population due to their high prevalence and associated consequences. Guidelines for the management of the elder with falls are comprised of multidimensional assessments, especially gait and balance. Daily clinical practice needs for timely, effortless, and precise tools to assess gait. This work presents the clinical validation of the G-STRIDE system, a 6-axis inertial measurement unit (IMU) with onboard processing algorithms, that allows the calculation of walking-related metrics correlated with clinical markers of fall risk. A cross-sectional case-control study was conducted with 163 participants (falls and non-falls groups). All volunteers were assessed with clinical scales and conducted a 15-min walking test at a self-selected pace while wearing the G-STRIDE. G-STRIDE is a low-cost solution to facilitate the transfer to society and clinical evaluations. It is open hardware and flexible and, thus, has the advantage of providing runtime data processing. Walking descriptors were derived from the device, and a correlation analysis was conducted between walking and clinical variables. G-STRIDE allowed measuring walking parameters in non-restricted walking conditions (e.g. hallway). Walking parameters statistically discriminate between falls and non-falls groups. We found good/excellent estimation accuracy (ICC = 0.885; [Formula: see text]) for walking speed, showing good/excellent correlation between gait speed and several clinical variables. G-STRIDE can calculate walking-related metrics that allow for discrimination between falls and non-falls groups, which correlates with clinical indicators of fall risk. A preliminary fall-risk assessment based on the walking parameters was found to improve the Timed Up and Go test in the identification of fallers.

Correction of Lacrimal Gland Ptosis in Blepharoplasty: A Systematic Review.

PURPOSE: Lacrimal gland ptosis has a prevalence of 10% to 15% in Caucasian patients, reaching up to 60% in older age. Its involuntary resection during blepharoplasty carries the potential risk of compromising corneal lubrication. The purpose of this systematic review is to check whether there is a consensus in the literature regarding the surgical procedure of choice and which outcomes and complications have been observed. METHODS: A systematic review was carried out following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. A search was carried out in the Medline, Scopus, and Cochrane databases in March 2022. RESULTS: A total of 16 studies involving 483 patients with lacrimal gland ptosis have been included. In 90.06% of patients, resuspension or direct refixation of the gland to the lacrimal fossa with suture to the orbital periosteum was performed. Follow up has been inconsistent, with an average of 18 months. Regarding complications, 5 recurrences and only 2 patients with persistent dry eye were observed. CONCLUSIONS: In general, the evidence is sparse. Nevertheless, repair of lacrimal gland ptosis is a relatively simple, reproducible, and safe surgical technique, with a low likelihood of recurrence, severe, or persistent complications. A classification is proposed for both the grading of ptosis and its treatment.

Corrigendum: Warm-up stretching exercises and physical performance of youth soccer players.

[This corrects the article DOI: 10.3389/fphys.2023.1127669.].

Warm-up stretching exercises and physical performance of youth soccer players.

This study aims to compare the effects of standard warm-up versus warm-up using stretching exercises on the physical performance of male youth soccer players. Eighty-five male soccer players (age: 10.3 ± 4.3 years; body mass index: 19.8 ± 4.3 kg/m2) were assessed for countermovement jump height (CMJ, cm), 10 m, 20 m and 30 m running sprint speed (s) and ball kicking speed (km/h) for the dominant and non-dominant leg under five (randomized) warm-up conditions. Using 72 h of recovery between conditions, the participants completed a control condition (CC) and four experimental conditions, including static stretching (SSC), dynamic stretching (DSC), ballistic stretching (BSC), and proprioceptive neuromuscular facilitation (PNFC) exercises. All warm-up conditions had a duration of 10 minutes. The main results indicate that no significant differences (p > 0.05) were found between warm-up conditions compared to CC in CMJ (CC = 28.1 ± 4.9; SSC = 28.4 ± 4.9; DSC = 30.9 ± 4.8; BSC = 30.9 ± 5.2; PNFC = 28.4 ± 5.0), 10 m sprint (CC = 2.42 ± 0.4; SSC = 2.50 ± 0.4; DSC = 2.30 ± 0.3; BSC = 2.27 ± 0.3; PNFC = 2.53 ± 0.4), 20 m sprint (CC = 5.42 ± 0.9; SSC = 5.59 ± 0.9; DSC = 5.37 ± 0.9; BSC = 5.40 ± 0.9; PNFC = 5.44 ± 0.9), 30 m sprint (CC = 8.05 ± 1.3; SSC = 8.27 ± 1.3; DSC = 8.01 ± 1.3; BSC = 8.00 ± 1.3; PNFC = 8.12 ± 1.3), ball kicking speed for dominant (CC = 56.2 ± 4.9; SSC = 55.3 ± 5.2; DSC = 56.9 ± 5.8; BSC = 57.3 ± 5.8; PNFC = 55.7 ± 5.2) and non-dominant leg (CC = 52.8 ± 3.4; SSC = 51.8 ± 4.6; DSC = 53.5 ± 5.4; BSC = 53.6 ± 4.9; PNFC = 52.5 ± 4.0). In conclusion, compared to standard warm-up, stretching-based warm-up exerts no effect on male youth soccer players jump height, sprint speed and ball kicking speed.

Inflammatory biomarkers and pendelluft magnitude in ards patients transitioning from controlled to partial support ventilation.

The transition from controlled to partial support ventilation is a challenge in acute respiratory distress syndrome (ARDS) patients due to the risks of patient-self-inflicted lung injury. The magnitude of tidal volume (VT) and intrapulmonary dyssynchrony (pendelluft) are suggested mechanisms of lung injury. We conducted a prospective, observational, physiological study in a tertiary academic intensive care unit. ARDS patients transitioning from controlled to partial support ventilation were included. On these, we evaluated the association between changes in inflammatory biomarkers and esophageal pressure swing (ΔPes), transpulmonary driving pressure (ΔPL), VT, and pendelluft. Pendelluft was defined as the percentage of the tidal volume that moves from the non-dependent to the dependent lung region during inspiration, and its frequency at different thresholds (- 15, - 20 and - 25%) was also registered. Blood concentrations of inflammatory biomarkers (IL-6, IL-8, TNF-α, ANGPT2, RAGE, IL-18, Caspase-1) were measured before (T0) and after 4-h (T4) of partial support ventilation. Pendelluft, ΔPes, ΔPL and VT were recorded. Nine out of twenty-four patients (37.5%) showed a pendelluft mean ≥ 10%. The mean values of ΔPes, ΔPL, and VT were - 8.4 [- 6.7; - 10.2] cmH2O, 15.2 [12.3-16.5] cmH2O and 8.1 [7.3-8.9] m/kg PBW, respectively. Significant associations were observed between the frequency of high-magnitude pendelluft and IL-8, IL-18, and Caspase-1 changes (T0/T4 ratio). These results suggest that the frequency of high magnitude pendelluft may be a potential determinant of inflammatory response related to inspiratory efforts in ARDS patients transitioning to partial support ventilation. Future studies are needed to confirm these results.

Warm-Up and Handgrip Strength in Physically Inactive Chilean Older Females According to Baseline Nutritional Status.

This study aims to analyze the effect of different types of warm-ups on handgrip strength (HGS) in physically inactive older females. Secondarily, it aims to compare HGS according to their baseline nutritional status. A randomized crossover trial study was conducted with 44 physically inactive older females distributed into normal weight (n = 12, BMI = 23.9 ± 3.2 kg/m2), overweight (n =16, BMI = 27 ± 4.7 kg/m2) and obese (n = 16, BMI = 31.6 ± 5.3 kg/m2), who participated in three warm-up conditions (static stretching condition, SSC; elastic band condition, EBC; and therapeutic compression ball condition, TCBC) and one control condition (CC, no warm-up). All participants performed the four randomized conditions with recovery within 72 h. A significant decrease (p < 0.05) in HGS for the dominant and non-dominant hands was observed when comparing SSC vs. CC. In contrast, comparing the warm-up conditions according to the baseline nutritional status, statistically significant differences (p < 0.05) were only reported in the obese group in the dominant and non-dominant hand in favor of CC concerning SSC. In conclusion, warm-up with static flexibility led to a decrease in HGS in physically inactive older females. Only the obese group exhibited this result when analyzed by nutritional status.

Severity of gastrointestinal bleeding is similar between patients receiving direct oral anticoagulants or vitamin K antagonists

Background: gastrointestinal bleeding (GIB) is a commonadverse event related to anticoagulation therapy. However,evidence comparing the severity, etiology and outcome ofGIB in patients taking direct oral anticoagulants (DOAC) vs.vitamin K antagonists (VKA) is scarce.Aim: to evaluate the severity, etiology and outcomes of GIBin patients under DOACs compared to VKA.Methods: patients under oral anticoagulant therapy admitted to the emergency department with acute GIB wereprospectively recruited from July 2016 to January 2018 ata tertiary referral hospital. Demographic and clinical out comes were obtained from medical records. GIB severitywas classified as mild, major, or severe according to theclinical presentation and type of support needed. Etiologyand location of bleeding, number of packed red blood cells(PRBC) transfused, and length of hospital stay were recorded until discharge or in-hospital death.Results: a total of 208 patients with acute GIB under oralanticoagulant treatment were recruited: 119 patients wereon VKA and 89 patients on DOAC, with similar characteristics. Thirty-one patients had severe GIB; 134 had major and43 had mild GIB, with no differences in severity, numberof PRBC, and length of hospital stay between the groups.Peptic disease was the most frequent etiology of GIB inpatients on VKA (20.2 % vs. 13.6 %, p = 0.20). Diverticularbleeding was the most frequent adverse event in patientson DOAC (14.3 % vs. 24.8 %, p = 0.056).Conclusions: severity and clinical outcomes of GIB aresimilar between patients on DOAC and patients on VKA,regardless of GIB etiology. (AU)

Presencia de síntomas de ansiedad y depresión en estudiantes de medicina durante la pandemia de COVID-19 / Anxiety and depression among medical students during COVID-19 pandemic

BACKGROUND: Medical students are especially prone to anxiety and depression. AIM: To characterize the presence of anxiety and depression and their association with gender and academic year among medical students. MATERIAL AND METHODS: Standardized electronic surveys about anxiety and depression symptoms were sent to 498 medical students with a response rate of 78%. Results: We analyzed 359 surveys. A mean of 11.4 points out of 27 was observed in the depression symptoms scale. Also, 23 and 10% of respondents had moderately severe or symptoms of depression, respectively. A mean of 8.9 out of 21 points in the anxiety symptoms scale was observed. Moderate or severe anxiety symptoms were present in 26 and 15% of respondents, respectively. Women and preclinical students had higher depression and anxiety scores. CONCLUSIONS: A high presence of anxiety and depression symptoms was characterized among medical students during the pandemic. Preclinical students and women had higher scores in both scales.

Developing Immune Profiles of Endangered Australian Sea Lion (Neophoca cinerea) Pups Within the Context of Endemic Hookworm (Uncinaria sanguinis) Infection.

As a top predator, the endangered Australian sea lion (Neophoca cinerea) is a sentinel of ecosystem change, where population trends can reflect broader shifts in the marine environment. The population of this endemic pinniped was historically diminished by commercial sealing, and recovery has been slowed by fishery interactions, disease and, potentially, pollutants. Hookworm infects 100% of neonatal pups and has been identified as a contributor to population decline. Here, a multivariable approach using traditional serological and novel molecular tools such as qPCR and ddPCR was used to examine immune phenotypes of developing Australian sea lion pups infected with the endemic hookworm (Uncinaria sanguinis) from two South Australian colonies. Results show changing immunophenotypes throughout the patent period of infection represented by pro-inflammatory cytokines (IL-6), IgG and acute-phase proteins. Although cytokines may prove useful as markers of resistance, in this study, IL-6 is determined to be an early biomarker of inflammation in Australian sea lion pups, excluding the alternative hypothesis. Additionally, immunological differences between animals from high- and low-intensity hookworm seasons, as well as ivermectin-treated animals, indicate hookworm infection modulation of the host immune response, as evidenced by a lower IL-6 mRNA expression in the non-treated groups. This study of the Australian sea lion is an example of an ecoimmunological approach to disease investigation, which can be applied to evaluate the impact of environmental and anthropogenic factors on susceptibility to infectious diseases in free-ranging species.

Systemic inflammation and sympathetic activation in gestational diabetes mellitus with obstructive sleep apnea.

BACKGROUND: Although some evidence suggests an association between obstructive sleep apnea (OSA) and gestational diabetes mellitus (GDM), its consequences still remain largely unknown. We sought to determine whether OSA is associated with higher inflammation and sympathetic levels in GDM, and to relate them with insulin resistance and perinatal outcomes. METHODS: OSA was identified by polysomnography and defined as an apnea-hypopnea index of ≥ 5 h-1. Plasma cytokines (TNF-α, IL-1ß, IL-6, IL-8, IL-10), metanephrine, and normetanephrine were determined by immunoassays. RESULTS: We included 17 patients with GDM and OSA and 34 without OSA. Women with GDM and OSA had higher normetanephrine concentrations [81 IQR (59-134) vs. 68 (51-81) pg/mL]. No differences in the inflammatory profile were found, while IL-1ß was higher in patients with mean nocturnal oxyhemoglobin saturation ≤ 94%. We found positive correlations between increased sympathetic activation and IL-1ß, with obstructive apneas, while time in REM showed an inverse relationship with IL-1ß and metanephrine. Furthermore, IL-10 was inversely related with time in sleep stages 1-2, and with the arousal index, and it was positively related with time in slow-wave sleep. Significant correlations were also found between IL-1ß and insulin resistance. There were no significant differences in neonatal characteristics; however, we found inverse relationships between IL-10 and birth weight (BW), and percentile of BW. CONCLUSIONS: OSA increased sympathetic activity, and IL-1ß concentration was higher in patients with GDM with lower nocturnal oxygenation, all of which were related with obstructive events, and time in REM. Moreover, IL-1ß was related with insulin resistance, and IL-10 inversely correlated with neonatal BW.

Síndrome de vena cava superior en varón de 93 años / Superior vena cava syndrome in a 93-year-old man

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Severity of gastrointestinal bleeding is similar between patients receiving direct oral anticoagulants or vitamin K antagonists.

BACKGROUND: Gastrointestinal bleeding (GIB) is a common adverse event related to anticoagulation therapy. However, evidence comparing the severity, etiology and outcome of GIB in patients taking direct oral anticoagulants (DOAC) vs. vitamin K antagonists (VKA) is scarce. AIMS: To evaluate the severity, etiology and outcomes of GIB in patients under DOACs compared to VKA. METHODS: Patients under oral anticoagulant therapy admitted to the emergency department with acute GIB were prospectively recruited from July 2016 to January 2018 at a tertiary referral hospital. Demographic and clinical outcome were obtained from medical records. Severity of the GIB event was classified as mild, major or severe according to clinical presentation and the type of support needed. Etiology and location of bleeding, number of packed red blood cells transfused (PRBC) and length of hospital stay were recorded until discharge or in-hospital death. RESULTS: A total of 208 patients with acute GIB under oral anticoagulant treatment were recruited: 119 patients were on VKA and 89 patients on DOAC with similar characteristics. Thirty-one patients had severe GIB; 134 major and 43 mild, with no differences in severity, number of PRBC and length of hospital stay between the groups. Peptic disease was the most frequent etiology of GIB in patients on VKA (20.2 % vs. 13.6%, p=0.20). Diverticular bleeding was the most frequent adverse event in patients on DOAC (14.3% vs. 24.8%, p= 0.056). CONCLUSIONS: Severity and clinical outcomes of GIB are similar between patients on DOAC and patients on VKA, regardless of etiology of GIB.

[Anxiety and depression among medical students during COVID-19 pandemic]. / Presencia de síntomas de ansiedad y depresión en estudiantes de medicina durante la pandemia de COVID-19.

BACKGROUND: Medical students are especially prone to anxiety and depression. AIM: To characterize the presence of anxiety and depression and their association with gender and academic year among medical students. MATERIAL AND METHODS: Standardized electronic surveys about anxiety and depression symptoms were sent to 498 medical students with a response rate of 78%. RESULTS: We analyzed 359 surveys. A mean of 11.4 points out of 27 was observed in the depression symptoms scale. Also, 23 and 10% of respondents had moderately severe or symptoms of depression, respectively. A mean of 8.9 out of 21 points in the anxiety symptoms scale was observed. Moderate or severe anxiety symptoms were present in 26 and 15% of respondents, respectively. Women and preclinical students had higher depression and anxiety scores. CONCLUSIONS: A high presence of anxiety and depression symptoms was characterized among medical students during the pandemic. Preclinical students and women had higher scores in both scales.

Satisfacción laboral y compromiso organizacional: un análisis de percepción en el sector sanitario / Job satisfaction and organizational commitment: an analysis of perception in the healthcare sector

Es importante el estudio de variables del comportamiento organizacional, ya que ayudan a la empresa a tener una mejor gestión de los recursos humanos, debido a que la satisfacción laboral tiene relaciones positivas y estadísticamente significativas con el desempeño laboral. El objetivo de este estudio fue medir los niveles de percepción laboral de empleados del sector sanitario del área pública y privada, con respecto a las variables satisfacción laboral y compromiso organizacional. El estudio es de tipo transversal y descriptivo, el instrumento de medición es una encuesta que consta de 3 partes y la muestra estuvo conformada por 271 administrativos. Se presentaron análisis univariados principales, luego un análisis de conglomerados para segmentar a los participantes, y finalmente se efectúan modelos de regresión. Se determinó que existen tres segmentos de trabajadores que son claramente definidos, compuestos por aquellos administrativos con una baja percepción en general (21% y 42%, respectivamente), aquellos con una percepción media (54% y 38%, respectivamente) y aquellos con una percepción alta (25% y 20%, respectivamente). Se confirma que el compromiso organizacional afecta significativamente y de forma positiva a la satisfacción laboral(AU)

The study of variables of organizational behavior is important, since they help the company better manage its human resources, as job satisfaction has been positively and significantly correlated with job performance. The objective of this study was to measure the levels of job perception of employees in the public and private healthcare sector, with respect to job satisfaction and organizational commitment. The study was cross-sectional and descriptive, and the measurement instrument was a survey consisting of three sections. The study sample consisted of 271 administrative staff. We present the main univariate analysis results, followed by a cluster analysis to segment the participants, and then regression analysis. We identified three clearly defined segments of workers, consisting of administrative staff with a low overall perception of hob satisfaction and organizational commitment (21% and 42%, respectively), those with a medium perception (54% and 38%, respectively) and those with a high perception (25% and 20%, respectively). The results confirm that organizational commitment significantly and positively affects job satisfaction(AU)