Howler Monkey Die-Off in Southern Mexico.

In May and June 2024, a die-off of Mexican mantled howler monkeys (Alouatta palliata mexicana) occurred in southern Mexico. This commentary documents the event, attributing it to extreme heatwaves, drought, wildfires, and habitat impoverishment. Despite their reported resilience to habitat disturbances, mantled howler monkey mortality rate in some areas reached 31%. Key evidence points to heatstroke as the primary cause of death, exacerbated by limited hydration and reduced dietary diversity in disturbed habitats. Immediate responses included community-led rescues (e.g., hydrating the monkeys), coordination of rescue activities by nongovernmental organizations (NGOs) (e.g., managing donations), involvement of scientists (e.g., monitoring of primate populations), and assistance from government officials (e.g., providing legal support for animal management). This event underscores the urgency of developing action plans to prevent and attend future crises. Among other actions, we highlight (i) establishing primate care infrastructure with medical and rehabilitation centers; (ii) developing protocols and training programs to ensure rapid crisis response; (iii) fostering collaboration among government, NGOs, and academic institutions for effective crisis management; and (iv) developing targeted research on climate change impacts, predictive models, and long-term health monitoring. We emphasize the critical need for coordinated conservation efforts to protect wild primates and maintain natural ecosystem resilience in the face of escalating climate challenges.

Bot fly parasitism in mantled howler monkeys (Alouatta palliata): General patterns and climate influences.

Parasitism is a strong selective pressure, and its study is crucial for predicting the persistence of host species. Mantled howler monkeys are infected by the larvae of the bot fly Cuterebra baeri. This parasitosis produces myiasis and may have negative impacts on host health, although systematic information on the dynamics of this host-parasite relationship is very limited. Currently, all available information on infection patterns of C. baeri comes from a single mantled howler monkey population (Barro Colorado Island, Panama). Therefore, in this study we describe temporal variation in infection patterns for a newly mantled howler monkey population and analyze the relationship between climate and infection likelihood. We assessed the presence of C. baeri nodules in 17 adult individuals in Los Tuxtlas for 10 months through direct observation and compiled data on ambient temperature and rainfall. Most subjects had nodules during the study and there were no differences between sexes in the number of nodules. Nodules were usually located in the neck. Prevalence and abundance of nodules peaked thrice during the study (February, April, and September), a pattern that was very similar to that of parasitism intensity (February, April, and August). Incidence closely tracked these peaks, increasing before and decreasing after them. The likelihood of nodule appearance increased when both mean and minimum temperature decreased in the 24-21 prior days to nodule appearance. It also increased with decreased rainfall in the 5-2 prior days to nodule appearance. Although only three of the eight analyzed climate variables had a significant effect on parasitosis, these results suggest that climate may affect pupal development and the access of larvae to hosts. Besides contributing data on C. baeri parasitism for a new mantled howler monkey population, our study provides novel information on the influence of environmental factors on the dynamics of host-parasite systems.

[Tissue perfusion monitoring in children with acute circulatory dysfunction: narrative review]. / Monitorización de la perfusión tisular en el niño con disfunción circulatoria aguda: revisión narrativa.

Sepsis is one of the main causes of admission to Intensive Care Units (ICU). The hemodynamic objectives usually sought during the resuscitation of the patient in septic shock correspond to macrohemodynamic parameters (heart rate, blood pressure, central venous pressure). However, persistent alterations in microcirculation, despite the restoration of macrohemodynamic parameters, can cause organ failure. This dissociation between the macrocirculation and microcirculation originates the need to evaluate organ tissue perfusion, the most commonly used being urinary output, lactatemia, central venous oxygen saturation (ScvO2), and veno-arterial pCO2 gap. Because peripheral tissues, such as the skin, are sensitive to disturbances in perfusion, noninvasive monitoring of peripheral circulation, such as skin temperature gradient, capillary refill time, mottling score, and peripheral perfusion index may be helpful as early markers of the existence of systemic hemodynamic alterations. Peripheral circulation monitoring techniques are relatively easy to interpret and can be used directly at the patient's bedside. This approach can be quickly applied in the intra- or extra-ICU setting. The objective of this narrative review is to analyze the various existing tissue perfusion markers and to update the evidence that allows guiding hemodynamic support in a more individualized therapy for each patient.

Capacity for the management of kidney failure in the International Society of Nephrology Latin America region: report from the 2023 ISN Global Kidney Health Atlas (ISN-GKHA).

Successful management of chronic kidney disease (CKD) in Latin America (LA) continues to represent a challenge due to high disease burden and geographic disparities and difficulties in terms of capacity, accessibility, equity, and quality of kidney failure care. Although LA has experienced significant social and economic progress over the past decades, there are still important inequities in health care access. Through this third iteration of the International Society of Nephrology Global Kidney Health Atlas, the indicators regarding kidney failure care in LA are updated. Survey responses were received from 22 of 31 (71%) countries in LA representing 96.5% of its total population. Median CKD prevalence was 10.2% (interquartile range: 8.4%-12.3%), median CKD disability-adjusted life year was 753.4 days (interquartile range: 581.3-1072.5 days), and median CKD mortality was 5.5% (interquartile range: 3.2%-6.3%). Regarding dialysis modality, hemodialysis continued to be the most used therapy, whereas peritoneal dialysis reached a plateau and kidney transplantation increased steadily over the past 10 years. In 20 (91%) countries, >50% of people with kidney failure could access dialysis, and in only 2 (9%) countries, people who had access to dialysis could initiate dialysis with peritoneal dialysis. A mix of public and private systems collectively funded most aspects of kidney replacement therapy (dialysis and transplantation) with many people incurring up to 50% of out-of-pocket costs. Few LA countries had CKD/kidney replacement therapy registries, and almost no acute kidney injury registries were reported. There was large variability in the nature and extent of kidney failure care in LA mainly related to countries' funding structures and limited surveillance and management initiatives.

The Biology and Genomics of Human Hair Follicles: A Focus on Androgenetic Alopecia.

Androgenetic alopecia is a highly prevalent condition mainly affecting men. This complex trait is related to aging and genetics; however, multiple other factors, for example, lifestyle, are also involved. Despite its prevalence, the underlying biology of androgenetic alopecia remains elusive, and thus advances in its treatment have been hindered. Herein, we review the functional anatomy of hair follicles and the cell signaling events that play a role in follicle cycling. We also discuss the pathology of androgenetic alopecia and the known molecular mechanisms underlying this condition. Additionally, we describe studies comparing the transcriptional differences in hair follicles between balding and non-balding scalp regions. Given the genetic contribution, we also discuss the most significant risk variants found to be associated with androgenetic alopecia. A more comprehensive understanding of this pathology may be generated through using multi-omics approaches.

Reference Values in the 6-Minute Walk Test in Chilean Children Aged 3-10 Years and Relationship With Cardiometabolic Risk.

PURPOSE: The aim of this study was to evaluate the performance of healthy Chilean children aged 3-10 years in the 6-minute walking test (6MWT) and cardiometabolic risk variables and to determine sex- and age-specific reference values. METHODS: This study involved 1165 healthy children (age = 6.36 [1.70] y old). The 6MWT was used to evaluate exercise performance. Furthermore, anthropometric measures were collected, like weight, height, body mass index, waist circumference, and skin folds. Resting heart rate and blood pressure (BP) were also evaluated. RESULTS: The prevalence of overweight and obesity was 35.0% and 25.4% in preschoolers and 29.0% and 36.2% in school-age children, respectively, showing significant differences (P < .05) between age groups. The distance walked (6-min walk distance) increased significantly year on year at ages from 3 to 10 years. According to the regression analysis, 6MWT performance was positively related to age, systolic BP, and height, whereas it was negatively related to ∑4 skinfold fat, resting heart rate, diastolic BP, and waist circumference. CONCLUSIONS: This study provides a reference equation and an age- and sex-adjusted percentile curve to assess the predicted 6MWT performance in a cohort of prepubertal Chilean children. The 6-minute walk distance depends mainly on age; however, other variables, such as resting heart rate, BP, skinfold fat, and waist circumference, add significant information and should be taken into account.

Near-fatal cocaine intoxication in an infant with thrombotic microangiopathy associated with multiple organ failure / Intoxicação grave por cocaína em criança com microangiopatia trombótica associada à falência múltipla de órgãos

ABSTRACT Objective: To report a pediatric case of drug-induced thrombotic microangiopathy caused by cocaine Case description: We report a nine-month-old patient who developed thrombotic microangiopathies after extreme cocaine intoxication, multiple organ dysfunction syndrome with hemodynamic dysfunction, anuric renal failure, liver failure, encephalopathy, and myocardial injury, corresponding phenotypically to thrombocytopenia-associated multiple organ failure. The patient received continuous venous hemofiltration and therapeutic plasma exchange, recovering satisfactorily. She was discharged after 30 days of hospitalization under the guidance of the childcare service, and was healthy after one year of follow-up. Toxicological samples confirmed high levels of cocaine and derivatives in blood, urine and hair. Comments: To our knowledge, this is the first reported pediatric case. There are particularities of cocaine intoxication pathophysiology that can trigger thrombotic microangiopathies because of vasoconstriction, direct endothelial injury, platelet activation, and increasing von Willebrand factor and fibrinogen levels. All of which results in a prothrombotic state, inflammatory dysregulation, and microvascular thrombi. The increasing use of cocaine, especially among young adults, puts children at high risk of toxicity, either by passive unintentional exposure, or abuse due to the increased availability in homes.

RESUMO Objetivo: Relatar um caso pediátrico de microangiopatia trombótica induzida por drogas causada por cocaína Descrição do caso: Relatamos uma paciente de nove meses de idade que desenvolveu microangiopatia trombótica após intoxicação extrema por cocaína, síndrome de disfunção de múltiplos órgãos com disfunção hemodinâmica, insuficiência renal anúrica, insuficiência hepática, encefalopatia e lesão miocárdica, correspondendo fenotipicamente à falência múltipla de órgãos associada à trombocitopenia. A paciente recebeu hemofiltração venosa contínua e plasmaférese terapêutica, recuperando-se satisfatoriamente. Recebeu alta após 30 dias de internação sob orientação do serviço de puericultura e estava saudável após um ano de seguimento. Amostras toxicológicas confirmaram altos níveis de cocaína e derivados no sangue, urina e cabelos. Comentários: Até onde sabemos, este é o primeiro caso pediátrico relatado. Existem particularidades da fisiopatologia da intoxicação por cocaína que podem desencadear a microangiopatia trombótica devido à vasoconstrição, lesão endotelial direta, ativação plaquetária e aumento do fator de von Willebrand e dos níveis de fibrinogênio. Tudo isso resulta em um estado pró-trombótico, desregulação inflamatória e trombos microvasculares. O uso crescente de cocaína, principalmente entre adultos jovens, coloca as crianças em alto risco de toxicidade, seja por exposição passiva não intencional ou abuso devido à maior disponibilidade nas residências.

Hybrid Therapies for Supporting Critically Ill Patients with Acute Kidney Injury: When, how, and for Whom?

UNASSIGNED: Acute kidney injury (AKI) is common in critically ill patients. There is no specific pharmacological treatment for established severe AKI. Therefore, the conventional therapeutic strategy is limited to the use of kidney replacement therapy (KRT) to maintain homeostasis. Hybrid therapies optimize the advantages of intermittent and continuous modalities of KRT, combining lower hourly efficiency, longer application time, at lesser cost, but also adding different physicochemical principles of extracorporeal clearance. The sum of convection and diffusion, with or without adsorption or apheresis, and in different time combinations gives hybrid techniques great flexibility in prescribing a personalized treatment adapted to the needs of each patient at any given time. Hybrid therapies are increasingly being used due to their flexibility, which is determined by the combination of equipment, membranes, and available resources (machines and health-care personnel experience). The required technology is widely available in most intensive care units and uses low-cost consumables compared to other types of AKI treatment modalities, favoring its widespread use. Hybrid therapies are feasible and provide a viable form of KRT, either alone or as a transition therapy from continuous kidney replacement therapy to intermittent hemodialysis. (Rev Invest Clin. 2023;75(6):337-47).

Hybrid Therapies for Supporting Critically Ill Patients with Acute Kidney Injury: When, how, and for Whom?

ABSTRACT Acute kidney injury (AKI) is common in critically ill patients. There is no specific pharmacological treatment for established severe AKI. Therefore, the conventional therapeutic strategy is limited to the use of kidney replacement therapy (KRT) to maintain homeostasis. Hybrid therapies optimize the advantages of intermittent and continuous modalities of KRT, combining lower hourly efficiency, longer application time, at lesser cost, but also adding different physicochemical principles of extracorporeal clearance. The sum of convection and diffusion, with or without adsorption or apheresis, and in different time combinations gives hybrid techniques great flexibility in prescribing a personalized treatment adapted to the needs of each patient at any given time. Hybrid therapies are increasingly being used due to their flexibility, which is determined by the combination of equipment, membranes, and available resources (machines and health-care personnel experience). The required technology is widely available in most intensive care units and uses low-cost consumables compared to other types of AKI treatment modalities, favoring its widespread use. Hybrid therapies are feasible and provide a viable form of KRT, either alone or as a transition therapy from continuous kidney replacement therapy to intermittent hemodialysis.

Near-fatal cocaine intoxication in an infant with thrombotic microangiopathy associated with multiple organ failure.

OBJECTIVE: To report a pediatric case of drug-induced thrombotic microangiopathy caused by cocaine. CASE DESCRIPTION: We report a nine-month-old patient who developed thrombotic microangiopathies after extreme cocaine intoxication, multiple organ dysfunction syndrome with hemodynamic dysfunction, anuric renal failure, liver failure, encephalopathy, and myocardial injury, corresponding phenotypically to thrombocytopenia-associated multiple organ failure. The patient received continuous venous hemofiltration and therapeutic plasma exchange, recovering satisfactorily. She was discharged after 30 days of hospitalization under the guidance of the childcare service, and was healthy after one year of follow-up. Toxicological samples confirmed high levels of cocaine and derivatives in blood, urine and hair. COMMENTS: To our knowledge, this is the first reported pediatric case. There are particularities of cocaine intoxication pathophysiology that can trigger thrombotic microangiopathies because of vasoconstriction, direct endothelial injury, platelet activation, and increasing von Willebrand factor and fibrinogen levels. All of which results in a prothrombotic state, inflammatory dysregulation, and microvascular thrombi. The increasing use of cocaine, especially among young adults, puts children at high risk of toxicity, either by passive unintentional exposure, or abuse due to the increased availability in homes.

Demography and life-history parameters of mantled howler monkeys at La Flor de Catemaco: 20 years post-translocation.

Translocations usually aim at maintaining and enhancing wild populations. Thus, the long-term monitoring of translocated individuals is critical for assessing translocation success. In this study, we report the demographic and life-history parameters of mantled howler monkeys that were translocated to La Flor de Catemaco (Los Tuxtlas, Mexico) to determine the success of the translocation process. Nine individuals belonging to two social groups living in areas that were going to be destroyed were released into La Flor de Catemaco between 2002 and 2004. Before 2022 there were no resident monkeys at the site. From January 2012 to December 2021, we recorded births, deaths, migrations, and group formation (1535 sampling days). The population grew until reaching 35 mantled howler monkeys. Two new groups including both individuals born at the site and migrants were founded. Mean ± SD group size was 8.1 ± 1.1 individuals. We recorded 42 births and 14 deaths, mostly of young infants (< 6 months of age). We recorded emigrations and immigrations of adult and immature individuals as well as several instances of individuals that remained and reproduced in their natal groups. Mean female age at first birth was 57.8 ± 18.5 months, interbirth intervals were 23.3 ± 11.3 months, and birth rates were 0.5 ± 0.2 births per female per year. The growth and persistence of the groups at the site, as well as similarity in demographic and life-history parameters between this and unmanaged populations, suggest that mantled howler monkeys living at La Flor de Catemaco represent a stable population and thus that this was a successful translocation.

[Childhood and COVID-19: The indirect effects of the COVID-19 pandemic on the well-being of children and adolescents]. / Infancia y COVID-19: Los efectos indirectos de la pandemia COVID-19 en el bienestar de niños, niñas y adolescentes.

The impact of the COVID-19 pandemic has been overlooked in children and adolescents since many of the negative effects have been the result of containment and mitigation measures and will only be quantifiable in the medium and long term. Although the global response has been successful in reducing the lethality of the disease, the harmful effect on vulnerable populations, such as children and adolescents, is enormous and has been classified as catastrophic by international organizations. The pandemic has deeply affected the physical and mental health of children and adolescents, but also silently its negative effects extend across many areas such as schooling, familiar economy, child labor and food security. The third year of the pandemic is an opportunity to include the multidimen sional well-being of children and adolescents as a cornerstone of society's response to a global crisis, whether health, economic or political.

[Extreme electrolyte depletion associated with septic shock as a form of presentation of cystic fibrosis]. / Depleción electrolítica extrema asociada con shock séptico como forma de presentación de fibrosis quística.

In the pediatric emergency department, dehydrated children are one of the most frequent causes for consultation, however, the coexistence of hyponatremia with hypochloremia and metabolic alkalosis is rare. The presence of metabolic alkalosis due to chloride depletion has been reported as a form of presentation of Cystic Fibrosis (CF). OBJECTIVE: to describe a case of cystic fibrosis of unusual presen tation in a pediatric patient. CLINICAL CASE: we report a 3-month-old previously healthy male infant who presented with internal environment abnormalities consisting of metabolic alkalosis, hypona tremia, hypokalemia, and extreme hypochloremia associated with septic shock due to mixed viral- bacterial pneumonia (Rhino/enterovirus, Streptococcus pneumoniae, and Staphylococcus aureus). Cys tic fibrosis (CF) was suspected, thus the diagnosis was corroborated by sweat test and genetic study which showed the pathogenic variants c.2834C>T (p.Ser945Leu) and c.3484C>T (p.Arg1162X), both heterozygous. CONCLUSION: special attention should be paid to the existence of hypochloremia with metabolic alkalosis and hyponatremia associated or not with pulmonary disease, suspecting CF as the first option. This consideration becomes more relevant in those countries where the neonatal screening test is not widely available.

[About an epidemic, ventilators and intensive care. A Déjà vu?] / De una epidemia, ventiladores y cuidados intensivos. ¿Un Déjà vu?

The birth of intensive care was a process that took place in Copenhagen, Denmark, during and after the polio epidemic of 1952-1953. The fact that marks its beginning was that anesthesiologist Björn Ibsen was asked to help and "came out of the operating room", not without some controversy. Ib sen proposed and advocated the use of tracheostomy, suctioning and ventilation. Given the lack of positive pressure ventilators, this task was carried out by students who contributed 165,000 hours of manual ventilation. Few years later, in Gothenburg, Sweden, the anesthesiologist Göran Haglund, motivated by the case of a four years old boy with complicated appendicitis, created the first multi disciplinary pediatric intensive care unit in the world (1955). In Chile, during the 1950s, the concept of pediatric intensive care began to develop under the direction of physicians with a solid vision of the future. Given that the planet is experiencing a pandemic, it seems an appropriate moment to review the role of the polio epidemic in the development of positive pressure ventilation, the birth of intensive care medicine and intensive care units, in order to assess the role of the various tasks and innovations carried out.

Otto Frank y Ernest Starling. Más allá de una ley o un mecanismo. Breve reseña histórica / Otto Frank and Ernest Starling. Beyond a law or a mechanism. Brief historical relate

Resumen La ley o mecanismo de Frank-Starling describe la relación entre la longitud inicial de las fibras miocárdicas y la fuerza generada por su poder de contracción. Aunque ni Otto Frank (1895) como tampoco Ernest Starling (1915) fueron los primeros en descubrir que el volumen diastólico final regula el trabajo del corazón, su participación para este famoso epónimo fisiológico es indiscutible, y de ahí que sus nombres perduraran por más de un siglo en el ambiente de la fisiología, la cardiología y los cuidados intensivos, entre otras disciplinas. Se revisa la biografía de Otto Frank (1865-1944), un excepcional fisiólogo alemán con un amplio conocimiento en física, matemáticas y ciencias naturales, que formuló principios teóricos para la fisiología muscular y cardiovascular, además de muchas otras contribuciones metodológicas e instrumentales. También se examina la vida del gran médico y fisiólogo inglés Ernest Henry Starling (1866-1927), quien elaboró diversos y relevantes aportes científicos, más allá de sus afamadas publicaciones sobre la función circulatoria. Finalmente, el presente artículo comenta en forma breve sus principales y más importantes contribuciones, así como también aspectos menos conocidos de sus logros científicos.

Abstract Frank-Starling's law or mechanism describes the relationship between the initial length of myocardial fibers and the force generated by their contraction power. Although neither Otto Frank (1895) nor Ernest Starling (1915) were the first to discover that the final diastolic volume regulates the work of the heart, their participation for this famous physiological eponym is indisputable, enduring their names for more than a century in the environment of physiology, cardiology and intensive care, among other disciplines. The biography of Otto Frank (1865-1944) is reviewed, who was an exceptional German physiologist with extensive knowledge in physics, mathematics and natural sciences who formulated theoretical principles for muscular and cardiovascular physiology, in addition to many other methodological contributions in instrumentals. Also examined the life of the great English physician and physiologist Ernest Henry Starling (1866-1927), who produced various and relevant scientific contributions, beyond his famous publications on circulatory function. Finally, this article briefly comments on its main and most important contributions, as well as less known aspects of its scientific achievements.