A novel presentation of diaphragmatic flutter in a patient with obstructive sleep apnea and recurrent cerebellar hemangioblastoma.

We report a unique case of diaphragmatic flutter in a patient with obstructive sleep apnea who had no respiratory symptoms related to flutter and a history of recurrent cerebellar hemangioblastoma. The flutter was detected during a routine follow-up monitoring through the built-in software of the positive airway pressure device; the flow and pressure curves showed abnormal and curious oscillations. The ultrasound confirmed the diagnosis and ruled out other causes of abnormal diaphragmatic movements. This case report contributes to the scientific literature by presenting a novel case of diaphragmatic flutter associated with recurrent cerebellar hemangioblastoma. It also emphasizes the need for more research on the pathophysiology and treatment of this rare condition. CITATION: Ciorba C, Espinoza Perez JA, Alfonso Imizcoz M, Errasti Viader J, Cebollero Rivas P, De Vito EL. A novel presentation of diaphragmatic flutter in a patient with obstructive sleep apnea and recurrent cerebellar hemangioblastoma. J Clin Sleep Med. 2024;20(2):313-317.

Uses, abundance perception, and potential geographical distribution of Smilax aristolochiifolia Mill (SMILACACEAE) on the Totonacapan Region of Puebla, Mexico.

BACKGROUND: In some regions of Mexico, edible wild plants have been displaced or eliminated from the traditional food systems, mainly by changes in land use, booming monoculture, herbicide use, and by changes among the new generations in the traditional foods and diets of indigenous populations. In the Totonacapan region of Puebla, the gradual change from the traditional acahual plantation to coffee-type agroecosystems has provoked the displacement of old-growth forests and the eradication of wild plants since 1970. One of the wild species which has been used in traditional medicine and food recipes by the Totonac culture is Smilax aristolochiifolia (SMILACACEAE), known as "kgentsililh". This species forms part of traditional Totonac recipes, in which the tender stems are still used in local medicine to treat menstrual pain, deal with dysentery, and prevent hair loss. According to the Maxent® Program, there are still potential areas with habitats suitable to promote its conservation in the Poblano Totonacapan. METHODS: We conducted 260 interviews with people in 13 locations in the northern Sierra of the State of Puebla. Variables taken into account in the interview related to the consumption frequency of the species, its abundance and distribution perception, reasons or arguments given by the Totonac indigenous population about the decreased presence of specimens of S. aristolochiifolia, its dates of collection, and the cutting prices of kgentsililh at the community level and in local markets. The relative abundance of S. aristolochiifolia was determined through 22 samples in 2ts of 600 m2. Later, its potential distribution in the state of Puebla was estimated using the Maxent® Program Ver. 3.3.3. RESULTS: Of the 260 Totonac families interviewed, 31% had stopped consuming kgentsililh. The residents reported that in the last 50 years the populations of this plant had diminished in the northern Sierra of the State of Puebla, mainly due to changes in land use, herbicide application, over-collection, and urban growth. In traditional medicine, the stem sap of S. aristolochiifolia is currently employed to help treat baldness, and the "tuberous root" or plant rhizome is used to prepare a tea infusion to treat dysentery. The cost of plant guides varies from 10.00 to 40.00 Mexican pesos for one bunch (around 0.5 to 2.00 US dollars), and every bundle consists of between 7 to 10 cuttings from 0.4 to 0.5 m long. From our 22 quadrats of sampling and collection of S. aristolochiifolia, we were able to recognize a total of 32 specimens. There is a considerable abundance of kgentsililh in acahual plantations and old-growth forests (evergreen lowland and mid-elevation perennial forest) concerning the coffee-type plantations and milpas. According to our analysis using the Maxent Program®, eight physical and climatic variables have a direct relationship to the potential distribution of the species. CONCLUSIONS: Smilax aristolochiifolia is still a plant of socioeconomic importance, mainly because of its food value and its use in traditional medicine by indigenous families in Poblano Totonacapan. It is evident that the villagers perceive that in the last 50 years the species has decreased its population mainly due to land-use change, the application of herbicides to the different family production units, and climate change. At the moment, there is no knowledge about the methods of propagation of the species, and therefore there is no intention on the part of the population to conserve the species. However, it would be of great importance to generate a biocultural conservation strategy and take advantage of the results obtained from the potential geographic distribution area, since according to the Maxent® Program, there are still potential areas with habitat suitable to promote conservation in Poblano Totonacapan.

Two patients with rituximab associated low gammaglobulin levels and relapsed covid-19 infections treated with convalescent plasma.

Patients with haematological malignancies are considered to be a risk group for developing severe Coronavirus disease (Covid-19). Because of the limitations of therapeutic options, the development of new treatment strategies is mandatory, such as convalescent plasma (CP). Herein we report the use of CP therapy as an off-label indication in two lymphoma patients with relapsed COVID-19 in the setting of low gammaglobulin levels because of previous rituximab chemo-immunotherapy. Both were PCR positive for SARS-CoV-2 but had an absence of antibodies to the virus more than one month later of symptoms initiation. They developed important respiratory and neurological complications. After CP infusion, neutralising antibodies were detected and viral load dissapeared in both patients leading to clinical improvement with no more Covid-19 relapse.

Morphological and phytochemical data of Vanilla species in Mexico.

This systematic determination of morphological and phytochemical data was conducted with the purpose of conserving and identifying the phylogenetic relationship among the Vanilla species of the Totonacapan region in Mexico to increase awareness of the genetic biodiversity. Samples of Vanilla planifolia, V. planifolia cv. "oreja de burro", V. pompona, V. insignis, and V. inodora, are distributed across 19 municipalities of the State of Veracruz and 19 municipalities of the State of Puebla. Morphological data parameters were determined in situ and included leaf length, leaf width, leaf thickness, stem diameter, stem thickness, node distance, stem texture degree, flower colour intensity, and fruit length. Similarly, alkaloids, tannins, saponins, phenols, flavonoids, and terpenes were determined by specifically phytochemical tests and quantified by thin layer chromatography. Both, morphological and phytochemical data parameters, were successfully used in assembling dendrograms by using the Euclidian distance method and by principal component analysis.

Factores que intensifican el riesgo toxicológico en comunidades expuestas al arsénico en agua / Factors that intensify toxicological risk in communities exposed to arsenic in water

Resumen La exposición prolongada al arsénico (As), a través de los alimentos y el agua de consumo, incrementa el riesgo de padecer cáncer, diabetes e hipertensión arterial, entre otras enfermedades. Las familias marginadas, que reemplazan el agua potable comercial por agua de pozo o de la llave, en zonas contaminadas con As, presentan mayores riesgos. El objetivo de este trabajo fue identificar los principales factores de riesgo toxicológico por exposición a la contaminación con arsénico presente en agua, en población que habita en zonas donde se han detectado altos niveles de este metaloide, del estado de Guanajuato. Se realizó un estudio analítico y transversal. Se aplicó una encuesta a 30 jefas de familia encargadas de la alimentación. La seguridad alimentaría se midió con la aplicación de la escala Latinoamericana y Caribeña. El 93 % de las familias tenía acceso a agua de la llave no potable. En relación a la preparación de alimentos, el 26.7 % de las familias utilizaba agua de la llave, el 13.3 % agua de pozo y el 43.3 % agua de pipa. El 70 % de las familias estudiadas presentaron algún nivel de inseguridad alimentaria. Otro factor de riesgo a considerar fue el nivel de escolaridad de la jefa de familia. La identificación de los principales factores de riesgo, incluyendo ausencia de seguridad alimentaria, permitirá diseñar una escala de validación, con la cual se obtendrá un tamizaje oportuno para prevenir posibles intoxicaciones por arsénico en comunidades en donde el agua del subsuelo está contaminada.

Abstract Prolonged exposure to arsenic (As), through food and drinking water, increases the risk of cancer, diabetes and high blood pressure, among others diseases. Marginalized families, who replace commercial drinking water with well water or tap water, in areas contamina ted with As, present greater risks. The objective of this work was to identify the main toxicological risk factors due to exposure to arsenic contamination of water. An analytical and transversal study was carried out in two populations from the state of Guanajuato that live in an area where high levels of this metalloid have been detected. A survey was administered to 30 heads of households responsible for feeding their families. Food security was measured with the application of the Latin American and Caribbean Food Security Scale (ELCSA). Findings indicate that 93 % of the families had access to non-potable tap water. In relation to food preparation, 26.7 % of the families used tap water, 13.3 % well water, and 43.3 % water delivered by tanker trucks. 70 % of the surveyed families showed some level of food insecurity. Another risk factor to consider was the educational level of household heads. The identification of the main risk factors, including the absence of food safety, will allow the design of a validation scale, with which timely screening will be obtained to prevent possible arsenic poisoning in communities where subsoil water is contaminated.

Evaluación de las prácticas de alimentación y nutrición en una población expuesta a arsénico: una propuesta para integrar indicadores de exposición nutricional / Assessment practices of food and nutrition in a population exposed to arsenic: a proposal to integrate nutritional risk indicators

Introducción: La contaminación de agua con arsénico en un problema de salud pública. Estado nutricio, hábitos de consumo y fuente de exposición al metaloide se sabe pueden atenuar su toxicidad. Objetivo: El objetivo del estudio fue evaluar las prácticas de alimentación y nutrición en comunidades del estado de Guanajuato expuestas a arsénico y poder identificar algunos indicadores de riesgo nutricional que coadyuven con los efectos a la salud del metal. Métodos: Con un diseño transversal, se aplicó una encuesta a 30 jefas de familia, que fueron seleccionadas de un estudio previo, donde se analizó la presencia de arsénico en niños; se evaluaron las prácticas de culinarias, consumo de alimentos, características sociodemográficas. Resultados: El promedio de integrantes por familia fue de seis, y el ingreso mensual promedio por familia fue de 259 USD. Los recipientes que principalmente se usaron para preparar alimentos como sopas fueron a base de peltre, aluminio y barro vidriado. El consumo de frutas y verduras fue bajo y con poca variedad, con un alto consumo de refresco y otros alimentos que no aportan nutrimentos como los antioxidantes. Además de que desde el primer año de vida se ofrecen alimentos no adecuados a la edad. Conclusión: Se detectaron a las prácticas culinarias y alimentarias como indicadores de riesgo en una población expuesta al arsénico, donde el consumo de nutrimentos que promueven la detoxificación del metal fueron bajos. Por lo que se deberían considerar estas prácticas como indicadores en la evaluación de los efectos a la salud de la exposición al metaloide y a otros contaminantes (AU)

Introduction: The contamination of water with arsenic is a public health problem. Nutritional status, foods habits and exposure source of this metalloid, can reduce its toxicity. Objective: The objective of the study was to assess feeding and nutrition practices into communities in the state of Guanajuato exposed to arsenic and to identify some nutritional risk indicators that contribute to the health effects of metalloid. Methods: A cross seccional study, a survey was applied to 30 heads of household, who were selected from a previous study, where the presence of arsenic in children was analyzed; culinary practices, food consumption, sociodemographic characteristics were evaluated. Results: The average of integrants per family was of six and the average monthly income per household was 259 USD. Containers mainly used to prepare foods, such as soups, were based pewter, aluminum and glazed earthenware. Consumption of fruits and vegetables was low, with little variety, with a high consumption of soda and other foods that do not add nutrients like antioxidants. In addition to food offered from the first year of life is not age appropriate. Conclusion: We detected the culinary and dietary practices as risk in a population exposed to arsenic, where the low consumption of nutrients that promote the detoxification of metal were low. As these practices should be considered as indicators in assessing the health effects of exposure to metalloid and other contaminants (AU)