Prevalence of Drug-Resistant Tuberculosis in HIV-Positive and Diabetic Patients in Sinaloa, Mexico: A Retrospective Cross-Sectional Study.

Tuberculosis (TB) is a disease caused by the bacillus Mycobacterium tuberculosis (MTB). Human immunodeficiency virus (HIV) infection and type 2 diabetes mellitus (T2DM) are among the main risk factors for the development of TB and increase the risk of drug-resistant TB developing (DR-TB). The aim of this study was to estimate the prevalence of DR-TB in patients with HIV or T2DM in Sinaloa, Mexico. This was an observational and cross-sectional study. The analysis was conducted using the clinical data of patients registered on the National Epidemiological Surveillance System for TB (SINAVE/PUI-TB) platform with a presumed diagnosis of TB during 2019 to 2021 in Sinaloa, Mexico. The prevalence of DR-TB was estimated in HIV and T2DM patients, as well as the odds ratios for their sociodemographic variables, using the Chi-square test. There were 2, 4, and 4 TB-HIV cases and 2, 6, and 9 TB-T2DM cases during 2019, 2020, and 2021, respectively, whereas there were 2 and 1 DRTB-HIV and DRTB-T2DM cases, respectively. The results indicated that the WHO guidelines for DR-TB were not properly applied to this high-risk population. Hence, the appropriate application of guidelines for TB and DR-TB detection in these patients needs to be immediately implemented by the State health system.

Influence of Materials of Moulds and Geometry of Specimens on Mechanical Properties of Grouts Based on Ultrafine Hydraulic Binder.

Ultrafine hydraulic binder grout injection is a technique utilised for repairing masonry, either to connect sections, seal joints, or fill voids due to its great capacity for penetration and higher mechanical strength than lime grout. In this research, the mechanical properties of ultrafine hydraulic cement grout are analysed considering the influence of the mould material for preparing the specimens and their geometry characteristics in the context of the specifications set out in several international standards. The test campaign to ascertain compressive and flexural strength in different circumstances is supplemented with a physical and chemical characterisation of both binder and fresh and hardened grout. Significant differences in mechanical properties between specimens prepared with absorbent or non-absorbent-water material are found due to the influence of drying shrinkage and decanting binder during the curing process. Furthermore, the slenderness of specimens is presented as an important factor in determining the compressive strength of mixtures.

In-hospital outcomes of transcatheter aortic valve replacement in patients with chronic and end-stage renal disease: a nationwide database study.

BACKGROUND: Chronic kidney disease (CKD) and end-stage renal disease (ESRD) have been associated with worse outcomes after transcatheter aortic valve replacement (TAVR). With TAVR indications extending to a wider range of patient populations, it is important to understand the current implications of chronic renal insufficiency on clinical outcomes. We aim to determine the impact of CKD and ESRD on in-hospital outcomes after TAVR. METHODS: We queried the National Inpatient Sample for TAVR performed between 2016 and 2020 using International Classification of Diseases-10th Revision codes. We compared in-hospital mortality and clinical outcomes between three groups: normal renal function, CKD and ESRD. The association between CKD/ESRD and outcomes was tested with multivariable logistic regression analyses, using normal renal function as baseline. RESULTS: In the five-year study period, 279,195 patients underwent TAVR (mean age 78.9 ± 8.5 years, 44.4% female). Of all patients, 67.1% had normal renal function, 29.2% had CKD, and 3.7% had ESRD. There were significant differences in age, sex, and prevalence of comorbidities across groups. In-hospital mortality was 1.3%. Compared to patients with normal renal function, patients with renal insufficiency had higher in-hospital mortality, with the highest risk found in patients with ESRD (adjusted odds ratio: 1.4 [95% confidence interval: 1.2-1.7] for CKD; adjusted odds ratio: 2.4 [95% confidence interval: 1.8-3.3] for ESRD). Patients with CKD or ESRD had a higher risk of cardiogenic shock, need for mechanical circulatory support, and vascular access complications, compared to those with normal renal function. In addition, patients with ESRD had a higher risk of cardiac arrest and periprocedural acute myocardial infarction. The incidence of conversion to open heart surgery was 0.3% and did not differ between groups. Post-procedural infectious and respiratory complications were more common among patients with CKD or ESRD. CONCLUSION: Patients with CKD and ESRD are at higher risk of in-hospital mortality, cardiovascular, and non-cardiovascular complications after TAVR. The risk of complications is highest in patients with ESRD and does not result in more frequent conversion to open heart surgery. These results emphasize the importance of individualized patient selection for TAVR and procedural planning among patients with chronic renal insufficiency.

Variabilidad de la frecuencia cardíaca Validez de grabaciones ultra cortas de índices de balance autonómico de sujetos en reposo / Heart rate variability Validity of ultra-short recordings of autonomic balance indices of subjects at rest

Objetivo: hallar los tiempos mínimos de registro de variabilidad de la frecuencia cardíaca (VFC) de plazo-ultra-corto, menor a 5min, para que los índices extraídos del diagrama de Poincaré, SS y S/PS, indicadores del balance autonómico puedan ser equivalentes a los obtenidos mediante VFC de corto-plazo (5min). Método: el estudio incluyó un grupo de 23 sujetos. Las series RR, extraídas de la señal del electrocardiograma, fueron registradas durante 300s en reposo y se obtuvieron series de 60s, 90s, 120s y 240s. Los índices de VFC se calcularon para cada serie y fueron comparados con el índice correspondiente de la serie de 300s, empleando diferentes métodos de análisis de concordancia, correlación de Pearson, Bland y Altman y Delta de Cohen. Resultados: los índices SS en registros de duración mínima de 120s mostraron ser equivalentes a los de VFC de corto-plazo y ln(S/PS) de 90s. Conclusiones: se obtuvieron índices de VFC de plazo-ultra-corto equivalentes a los obtenidos para análisis de VFC de corto-plazo. Esta reducción en los tiempos de medición permitirá ampliar el empleo de la VFC para el monitoreo del estado de salud y bienestar de las personas, y ayudando a que los preparadores físicos logren un mejor rendimiento en el registro y procesamiento de la información obtenida. Los resultados hallados motivan la realización de nuevos estudios para analizar el comportamiento de estos indicadores en diferentes poblaciones y con el empleo de distintos métodos de pre-procesamiento de las series RR. (AU)

Immune response induced by coinfection of the sea louse Caligus rogercresseyi and the intracellular bacteria Piscirickettsia salmonis in vaccinated Atlantic salmon.

Recently, we showed that Atlantic salmon vaccinated against Piscirickettsia salmonis lose their protection upon coinfection with Caligus rogercresseyi (sea lice). However, the causes of the overriding effect of C. rogercresseyi infection have not been elucidated, and the molecular basis of the cellular and humoral immune responses upon C. rogercresseyi infection has not been described for vaccinated salmon. Therefore, we studied changes in the transcription of immune genes in vaccinated Atlantic salmon that were experimentally challenged by co-infecting them with C. rogercresseyi and P. salmonis. In general, coinfection treatments showed immune gene expression similar to treatments with a single P. salmonis infection, showing a decreased cellular response. However, a high variance was found between individual fish in the case of crucial cellular immune genes, with a few fish reacting overwhelmingly highly compared to the majority. This supports our previous findings on vaccination response variation and reinforces the idea that vaccination failures in the field might be caused by an overwhelming amount of vaccinated fish that display a deficient immune response to the infection.

Phytochemical Analysis and Biological Activities of Ripe Fruits of Mistletoe (Psittacanthus calyculatus).

Psittacanthus calyculatus is a hemiparasitic plant of an arboreal species (e.g., forest, fruit trees). Its foliage has therapeutic potential; however, little is known about its fruits. In this study, the phytochemical profile and biological activities of P. calyculatus fruits hosted by Prosopis laevigata and Quercus deserticola were evaluated. The fruits of P. calyculatus from P. laevigata showed the highest content of total phenols (71.396 ± 0.676 mg GAE/g DW). The highest content of flavonoids and anthocyanins was presented in those from Q. deserticola (14.232 ± 0.772 mg QE/g DW; 2.431 ± 0.020 mg C3GE/g DW). The anthocyanin cyanidin-3-glucoside was detected and quantified via high-performance thin-layer chromatography (HPTLC) (306.682 ± 11.804 mg C3GE/g DW). Acidified extracts from host P. laevigata showed the highest antioxidant activity via ABTS•+ (2,2'azinobis-(3-ethylbenzothiazdin-6-sulfonic acid) (214.810 ± 0.0802 mg TE/g DW). Fruit extracts with absolute ethanol from the P. laevigata host showed the highest antihypertensive activity (92 ± 3.054% inhibition of an angiotensin converting enzyme (ACE)). Fruit extracts from both hosts showed a minimum inhibitory concentration (MIC) of 6.25 mg/mL and a minimum bactericidal concentration (MBC) of 12.5 mg/mL against Escherichia coli, Salmonella choleraesuis and Shigella flexneri. Interestingly, a significant host effect was found. P. calyculatus fruits extract could be used therapeutically. However, further confirmation experiments should be carried out.

Psychosocial dysfunction of children and adolescents during the COVID-19 lockdown in Ecuador: a cross-sectional study.

OBJECTIVE: Although the risk of morbidity and mortality of children and adolescents was lower during the COVID-19 pandemic, it appears that their mental health was strongly impacted. The goal of this study is to document psychological dysfunction among children and adolescents who underwent confinement due to COVID-19 in Ecuador. DESIGN: A cross-sectional, internet-based questionnaire. SETTING: Ecuador. PARTICIPANTS: A total of 1077 caregivers of children and adolescents (4-16 years old). OUTCOME MEASURES: Caregivers responded to Pediatric Symptom Checklist-35 to assess psychosocial dysfunction. RESULTS: The prevalence of psychosocial dysfunction was 20.8%, with internalising symptoms being the most common (30.7%). The prevalence of psychosocial dysfunction was higher in children who had a poor family relationship during confinement (prevalence ratio (PR) 2.23; 95% CI 1.22 to 4.07), children who never helped with housework (PR 2.63; 95% CI 1.13 to 6.14) and those whose caregivers were worried about children's need for emotional therapy (PR 2.86; 95% CI 1.97 to 4.15). Never playing video games (PR 0.34; 95% CI 0.17 to 0.69) or playing video games infrequently (PR 0.39; 95% CI 0.20 to 0.79) was a protective factor for the psychosocial problems of children and adolescents. CONCLUSION: Our study demonstrates that children and adolescents have experienced a deterioration of mental health due to the pandemic. Family factors played an important role in the mental health of children during the lockdown. When a public crisis occurs, supportive mental health policies should be developed and implemented to promote children's psychological welfare.

Bruxismo de la vigilia por autoreporte y factores asociados en estudiantes universitarios de educación física

El bruxismo es una actividad parafuncional de los músculos masticatorios con alta prevalencia en la población general. Asimismo, se ha descrito como un fenómeno frecuente en estudiantes universitarios de algunas disciplinas. En este sentido, el presente trabajo analizó la autopercepción y algunos factores asociados al bruxismo de la vigilia en estudiantes universitarios de educación física (ISEF-UdelaR). Se presenta un estudio observacional, descriptivo, transversal, en una muestra de 178 jóvenes universitarios. Para la recolección de los datos se utilizó un cuestionario de autoreporte. El 67,9% de los participantes conocían el bruxismo y el 33% lo reportaron (el 21% y 13%, representado por mujeres y hombres respectivamente). Asimismo, seis de cada diez voluntarios que reportaron bruxismo también reportaron ansiedad y tres de cada diez voluntarios con reporte de bruxismo reportan estrés. En suma, el bruxismo "probable" de vigilia es altamente prevalente en estudiantes de educación física y el factor más asociado al bruxismo de la vigilia es la ansiedad.

O bruxismo é uma atividade parafuncional dos músculos mastigatórios com alta prevalencia na população em geral. Assim mesmo, vem sendo descrito como um fenômemo frequente em estudantes universitários de algumas disciplinas. Neste sentido, o trabalho atual analisou a autopercepção e alguns fatores associados ao bruxismo da vigília em estudantes universitários de educação física (ISEF-UdelaR). Trata-se de um estudo observacional, descritivo, transversal, com uma amostra de 178 jovens universitários. Os dados foram coletados através de um questionário de auto-relato. Os 67,9% dos participantes conheciam o bruxismo e 33% lhe relataram (21% e 13% representado por mulheres e homens, respectivamente). Assim mesmo, seis de cada dez voluntários que relataram bruxismo, também relataram ansiedade e três dos dez voluntários que relataram bruxismo, relataram estresse. Então, o bruxismo "provável" da vigília é altamente prevalente em estudantes de educação física e o principal fator associado ao bruxismo da vigília seria a ansiedade.

An overview of mineralocorticoid receptor antagonists as a treatment option for patients with heart failure: the current state-of-the-art and future outlook.

INTRODUCTION: Mineralocorticoid receptor antagonists (MRAs) improve cardiovascular outcomes in patients with heart failure. These benefits of MRAs vary in different heart failure populations based on left ventricular ejection fraction and associated comorbidities. AREAS COVERED: We define the pharmacologic properties of MRAs and the pathophysiological rationale for their utility in heart failure. We outline the current literature on the use of MRAs in different heart failure populations, including reduced and preserved ejection fraction (HFrEF/HFpEF) and acute heart failure decompensation. Finally, we describe the limitations of currently available data and propose future directions of study. EXPERT OPINION: While there is strong evidence supporting the use of MRAs in HFrEF, evidence in patients with HFpEF or acute heart failure is less definitive. Comorbidities such as obesity or atrial fibrillation could be clinical modifiers of the response to MRAs and potentially alter the risk/benefit ratio in these subpopulations. Emerging evidence for new non-steroidal MRAs reveal promising preliminary results that, if confirmed in large randomized clinical trials, could favor a change in clinical practice.

High prevalence of chronic malnutrition in indigenous children under 5 years of age in Chimborazo-Ecuador: multicausal analysis of its determinants.

BACKGROUND: Despite the multiple initiatives implemented to reduce stunting in Ecuador, it continues to be a public health problem with a significant prevalence. One of the most affected groups is the rural indigenous population. This study aimed to analyze the prevalence of chronic malnutrition in indigenous children under 5 years of age and its association with health determinants, focusing on one of the territories with the highest prevalence of stunting. METHODS: A cross-sectional study in 1,204 Kichwa indigenous children under the age of five, residing in rural areas of the counties with the highest presence of indigenous in the province of Chimborazo-Ecuador. A questionnaire on health determinants was applied and anthropometric measurements were taken on the child and the mother. Stunting was determined by the height-for-age z-score of less than 2 standard deviations, according to the World Health Organization´s parameters. Data were analyzed using bivariate and multivariate Poisson regression. RESULTS: 51.6% (n = 646) of the children are stunted. Height-for-age z-scores were significantly better for girls, children under 12 months, families without overcrowding, and families with higher family income. The variables that were significantly and independently associated with stunting were: overcrowding (PR 1.20, 95% CI 1-1.44), the mother required that the father give her money to buy medicine (PR 1.33, 95% CI 1.04-1.71), the father did not give her money to support herself in the last 12 months (1.58, 95% CI 1.15-2.17), mother's height less than 150 cm (PR 1.42, 95% CI 1.19-1.69) and the child was very small at birth (PR 1.75, 95% CI 1.22-2.5). CONCLUSION: One out of every two rural indigenous children included in this study is stunted. The high prevalence of stunting in the indigenous and rural population is multicausal, and requires an intersectoral and multidisciplinary approach. This study identified three fundamental elements on which public policy could focus: (a) reduce overcrowding conditions, improving economic income in the rural sector (for example, through the strengthening of agriculture), (b) provide prenatal care and comprehensive postnatal care, and (c) promote strategies aimed at strengthening the empowerment of women.

Commercial Vaccines Do Not Confer Protection against Two Genogroups of Piscirickettsia salmonis, LF-89 and EM-90, in Atlantic Salmon.

In Atlantic salmon, vaccines have failed to control and prevent Piscirickettsiosis, for reasons that remain elusive. In this study, we report the efficacy of two commercial vaccines developed with the Piscirickettsia salmonis isolates AL100005 and AL 20542 against another two genogroups which are considered highly and ubiquitously prevalent in Chile: LF-89 and EM-90. Two cohabitation trials were performed to mimic field conditions and vaccine performance: (1) post-smolt fish were challenged with a single infection of LF-89, (2) adults were coinfected with EM-90, and a low level coinfection of sea lice. In the first trial, the vaccine delayed smolt mortalities by two days; however, unvaccinated and vaccinated fish did not show significant differences in survival (unvaccinated: 60.3%, vaccinated: 56.7%; p = 0.28). In the second trial, mortality started three days later for vaccinated fish than unvaccinated fish. However, unvaccinated and vaccinated fish did not show significant differences in survival (unvaccinated: 64.6%, vaccinated: 60.2%, p = 0.58). Thus, we found no evidence that the evaluated vaccines confer effective protection against the genogroups LF-89 and EM-90 of P. salmonis with estimated relative survival proportions (RPSs) of -9% and -12%, respectively. More studies are necessary to evaluate whether pathogen heterogeneity is a key determinant of the lack of vaccine efficacy against P. salmonis.

Successful treatment of cardiac sarcoidosis based on clinical suspicion and advanced cardiac imaging: A case report.

INTRODUCTION: Confirming the diagnosis of cardiac sarcoidosis (CS) is a challenging task as we often do not count with histopathologic evidence. However, prompt initiation of treatment is sometimes necessary, and advanced cardiac imaging along with key clinical findings can play a crucial role in the diagnostic workup. PATIENT CONCERNS: A 77-year-old male with a history of heart failure presented with chest pain and shortness of breath. He was found to have an acute drop in left ventricular ejection fraction associated with frequent premature ventricular contractions and nonsustained ventricular tachycardia. Coronary angiogram was negative for acute coronary syndrome. Advanced cardiac imaging with cardiac magnetic resonance raised suspicion of CS, and steroids were started empirically. Endomyocardial biopsy was attempted but was not successful. DIAGNOSIS: The patient's presentation was highly suggestive of cardiac sarcoidosis. INTERVENTIONS: Corticosteroids, diuresis, guideline-directed medical therapy for heart failure. OUTCOMES: The patient's symptoms and ventricular arrhythmias improved on steroids. Subsequent FDG-PET revealed increased uptake in a pattern consistent with CS. CONCLUSION: This clinical scenario highlights the importance of advanced cardiac imaging and clinical findings for the diagnosis of CS and exposes the practical need for a standardized, noninvasive strategy to the diagnosis of CS.

Meta-Analysis Comparing Venoarterial Extracorporeal Membrane Oxygenation With or Without Impella in Patients With Cardiogenic Shock.

Cardiogenic shock is associated with high short-term mortality. Venoarterial extracorporeal membrane oxygenation (VA-ECMO) is increasingly used as a mechanical circulatory support strategy for patients with refractory cardiogenic shock. A drawback of this hemodynamic support strategy is increased left ventricular (LV) afterload, which is mitigated by concomitant use of Impella (extracorporeal membrane oxygenation with Impella [ECPELLA]). However, data regarding the benefits of this approach are limited. We conducted a systematic search of Medline, EMBASE, and Cochrane databases to identify studies including patients with cardiogenic shock reporting clinical outcomes with Impella plus VA-ECMO compared with VA-ECMO alone. Primary outcome was short-term all-cause mortality (in-hospital or 30-day mortality). Secondary outcomes included major bleeding, hemolysis, continuous renal replacement therapy, weaning from mechanical circulatory support, limb ischemia, and transition to destination therapy with LV assist device (LVAD) or cardiac transplant. Of 2,790 citations, 7 observational studies were included. Of 1,054 patients with cardiogenic shock, 391 were supported with ECPELLA (37%). Compared with patients on only VA-ECMO support, patients with ECPELLA had a lower risk of short-term mortality (risk ratio [RR] 0.89 [0.80 to 0.99], I2 = 0%, p = 0.04) and were significantly more likely to receive a heart transplant/LVAD (RR 2.03 [1.44 to 2.87], I2 = 0%, p <0.01). However, patients with ECPELLA had a higher risk of hemolysis (RR 2.03 [1.60 to 2.57], I2 = 0%, p <0.001), renal failure requiring continuous renal replacement therapy (RR 1.46 [1.23 to 174], I2 = 11%, p <0.0001), and limb ischemia (RR 1.67 [1.15 to 2.43], I2 = 0%, p = 0.01). In conclusion, among patients with cardiogenic shock requiring VA-ECMO support, concurrent LV unloading with Impella had a lower likelihood of short-term mortality and a higher likelihood of progression to durable LVAD or heart transplant. However, patients supported with ECPELLA had higher rates of hemolysis, limb ischemia, and renal failure requiring continuous renal replacement therapy. Future prospective randomized are needed to define the optimal treatment strategy in this high-risk cohort.

Inflammatory-Metal Profile as a Hallmark for COVID-19 Severity During Pregnancy.

Pregnancy makes women more susceptible to infectious agents; however, available data on the effect of SARS-CoV-2 on pregnant women are limited. To date, inflammatory responses and changes in serum metal concentration have been reported in COVID-19 patients, but few associations between metal ions and cytokines have been described. The aim of this study was to evaluate correlations between inflammatory markers and serum metal ions in third-trimester pregnant women with varying COVID-19 disease severity. Patients with severe symptoms had increased concentrations of serum magnesium, copper, and calcium ions and decreased concentrations of iron, zinc, and sodium ions. Potassium ions were unaffected. Pro-inflammatory cytokines IL-6, TNF-α, IL-8, IL-1α, anti-inflammatory cytokine IL-4, and the IP-10 chemokine were induced in the severe presentation of COVID-19 during pregnancy. Robust negative correlations between iron/magnesium and zinc/IL-6, and a positive correlation between copper/IP-10 were observed in pregnant women with the severe form of the disease. Thus, coordinated alterations of serum metal ions and inflammatory markers - suggestive of underlying pathophysiological interactions-occur during SARS-CoV-2 infection in pregnancy.

Deterministic and Probabilistic Dietary Exposure Assessment to Deoxynivalenol in Spain and the Catalonia Region.

Deoxynivalenol (DON) remains one of the most concerning mycotoxins produced by the Fusarium genus due to the wide occurrence in highly consumed cereal-based food and its associated toxicological effects. Previous studies conducted in Spain and other European countries suggested that some vulnerable groups such as children could be exceeding the tolerable daily intakes. Thus, the aim of this study was to conduct a comprehensive and updated dietary exposure assessment study in Spain, with a specific analysis in the region of Catalonia. Cereal-based food samples collected during 2019 were analysed using liquid chromatography coupled to tandem mass spectrometry for multi-mycotoxin detection including DON and its main metabolites and derivatives. Consumption data were gathered from the nation-wide food surveys ENALIA and ENALIA2 conducted in Spain, and a specific survey conducted in Catalonia. The data were combined using deterministic and semi-parametric probabilistic methods. The results showed that DON was widely present in cereal-based food highly consumed in Spain and the Catalonia region. Exposure to DON among the adult population was globally low; however, among infants aged 3-9 years, it resulted in the median of 192 ng/kg body weight/day and the 95th percentiles of 604 ng/kg body weight/day, that would exceed the most conservative safety threshold for infants. Bread and pasta were the main contributing foodstuffs to the global exposure to DON, even among infants; thus, those foods should be considered a priority for food control or to develop strategies to reduce the exposure. In any case, further toxicological and epidemiological studies are required in order to refine the safety thresholds accounting for the sensitivity of the infant population.

Severe Obesity and Heart Failure.

Obesity is associated with reduced mortality in some patients hospitalized for heart failure (HF). In this analysis, we determine if this nonlinear relation, referred to as the obesity paradox, extends to secondary outcomes in patients diagnosed with severe obesity. This is a retrospective cohort study using the 2017 and 2018 National Inpatient Sample that includes adults hospitalized for HF. Patients with diagnosis codes specifying severe obesity, nonsevere obesity, or without obesity are compared. The primary outcome is mortality. Secondary outcomes include the length of stay (LOS), total charges, and cardiogenic shock (CS). Multivariate regression is used to adjust for demographics and co-morbidities. A total of 2,439,845 hospitalizations are included. A decreased mortality is found in nonsevere obesity (odds ratio 0.74, 95% confidence interval 0.69 to 0.80, p = 0.000), affirming the obesity paradox. However, this decreased mortality is not found in severe obesity (odds ratio 1.01, 95% confidence interval 0.94 to 1.08, p = 0.766). Severe obesity and nonsevere obesity are also associated with less CS and increased LOS compared with non-obese patients. Severe obesity is associated with increased total charges. In conclusion, a nonlinear, U-shaped relation between obesity and mortality in patients hospitalized for HF is demonstrated, where those not obese and those severely obese experience greater mortality compared with the nonseverely obese. However, for secondary outcomes of CS, LOS, and total charges, the relation is linear and therefore not interpreted as paradoxical. More information is needed using the adiposity-based chronic disease model to characterize complex relations between obesity and mortality.

Clinically Ambiguous Hemorrhagic Cardiac Tamponade Associated with Apixaban.

Hemorrhagic cardiac tamponade in the setting of direct oral anticoagulants (DOACs) is rare but life-threatening. Presentation in subacute cases can also be nonspecific, which can potentially delay diagnosis. A 60-year-old female with a history of heart failure and chronic obstructive pulmonary disease presented with shortness of breath, chest pain, and cough while on treatment with apixaban after a recent hospitalization for pulmonary embolism. Clinical presentation was consistent with multiple diagnoses, including pneumonia and heart failure exacerbation. However, there were several risk factors for hemopericardium with DOACs such as elevated creatinine, hypertension, elevated international normalized ratio (INR), and concomitant use of medications with similar metabolic pathways as apixaban. In addition, subtle findings on examination such as oximetry paradoxus and electrical alternans were crucial for an early diagnosis and management. In this case, we discuss key characteristics of hemopericardium with DOACs, as well as considerations on its management.

Ethnoveterinary Medicine and Ethnopharmacology in the Main Transhumance Areas of Castilla-La Mancha (Spain).

In this study, we document the practices of ethnoveterinary medicine and ethnopharmacology in the context of traditional transhumance routes that cross Castilla La Mancha from north to south. Transhumance is a type of grazing system that allows advantage to be taken of winter pastures (wintering places) and summer pastures by seasonal movement, twice a year, of cattle and their shepherds. Our study is based on over 200 interviews (from 1994 to 2021) conducted in 86 localities along eight major transhumance routes "cañadas reales" and 25 other minor transhumance routes, and involved 210 informants, 89 single and 121 groups, and 562 individuals, of which the majority were men. Sixty-three recorded pathologies and their treatments are discussed. Two hundred and two species and substances, belonging to 92 different families, have been recorded from the interviews, of which most are plants. Amid the toxic plant species, the most cited in the interviews are Erophaca baetica (L.) Boiss., Lupinus angustifolius L., and Oenanthe crocata L. Some of the species reported as toxic were reservoirs of pathogens or markers for dangerous areas. One of the fields most widely covered in our study is that of prevention, protection, and control of endo- and ectoparasites. This control is carried out mainly by means of aromatic plants. As a polyvalent species, Daphne gnidium L. is outstanding, and it contributes one-tenth of the records of our study. Among the species of fundamentally therapeutic use, Cistus ladanifer L. stands out by far. Principal Coordinate Analysis (PCoA) based on the repertories of ingredients, separates the routes whose most important sections run through siliceous terrain with its characteristic flora, especially in the provinces of Ciudad Real and Toledo, from the routes that run through the limestone terrain of Albacete and Cuenca, and link the Eastern Mancha and the "Serranía de Cuenca" with Andalusia and the Spanish Levant.