Combination of error-prone PCR (epPCR) and Circular Polymerase Extension Cloning (CPEC) for improving the coverage of random mutagenesis libraries.

Random mutagenesis, such as error-prone PCR (epPCR), is a technique capable of generating a wide variety of a single gene. However, epPCR can produce a large number of mutated gene variants, posing a challenge in ligating these mutated PCR products into plasmid vectors. Typically, the primers for mutagenic PCRs incorporate artificial restriction enzyme sites compatible with chosen plasmids. Products are cleaved and ligated to linearized plasmids, then recircularized by DNA ligase. However, this cut-and-paste method known as ligation-dependent process cloning (LDCP), has limited efficiency, as the loss of potential mutants is inevitable leading to a significant reduction in the library's breadth. An alternative to LDCP is the circular polymerase extension cloning (CPEC) method. This technique involves a reaction where a high-fidelity DNA polymerase extends the overlapping regions between the insert and vector, forming a circular molecule. In this study, our objective was to compare the traditional cut-and-paste enzymatic method with CPEC in producing a variant library from the gene encoding the red fluorescent protein (DsRed2) obtained by epPCR. Our findings suggest that CPEC can accelerate the cloning process in gene library generation, enabling the acquisition of a greater number of gene variants compared to methods reliant on restriction enzymes.

Ultrasound Cut-Off Values for Rectus Femoris for Detecting Sarcopenia in Patients with Nutritional Risk.

BACKGROUND: A nationwide, prospective, multicenter, cohort study (the Disease-Related caloric-protein malnutrition EChOgraphy (DRECO) study) was designed to assess the usefulness of ultrasound of the rectus femoris for detecting sarcopenia in hospitalized patients at risk of malnutrition and to define cut-off values of ultrasound measures. METHODS: Patients at risk of malnutrition according to the Malnutrition Universal Screening Tool (MUST) underwent handgrip dynamometry, bioelectrical impedance analysis (BIA), a Timed Up and Go (TUG) test, and rectus femoris ultrasound studies. European Working Group on Sarcopenia in Older People (EWGSOP2) criteria were used to define categories of sarcopenia (at risk, probable, confirmed, severe). Receiver operating characteristic (ROC) and area under the curve (AUC) analyses were used to determine the optimal diagnostic sensitivity, specificity, and predictive values of cut-off points of the ultrasound measures for the detection of risk of sarcopenia and probable, confirmed, and severe sarcopenia. RESULTS: A total of 1000 subjects were included and 991 of them (58.9% men, mean age 58.5 years) were evaluated. Risk of sarcopenia was detected in 9.6% patients, probable sarcopenia in 14%, confirmed sarcopenia in 9.7%, and severe sarcopenia in 3.9%, with significant differences in the distribution of groups between men and women (p < 0.0001). The cross-sectional area (CSA) of the rectus femoris showed a significantly positive correlation with body cell mass of BIA and handgrip strength, and a significant negative correlation with TUG. Cut-off values were similar within each category of sarcopenia, ranging between 2.40 cm2 and 3.66 cm2 for CSA, 32.57 mm and 40.21 mm for the X-axis, and 7.85 mm and 10.4 mm for the Y-axis. In general, these cut-off values showed high sensitivities, particularly for the categories of confirmed and severe sarcopenia, with male patients also showing better sensitivities than women. CONCLUSIONS: Sarcopenia in hospitalized patients at risk of malnutrition was high. Cut-off values for the better sensitivities and specificities of ultrasound measures of the rectus femoris are established. The use of ultrasound of the rectus femoris could be used for the prediction of sarcopenia and be useful to integrate nutritional study into real clinical practice.

Recommendations on the use of the flash continuous glucose monitoring system in hospitalized patients with diabetes in Latin America.

BACKGROUND: Continuous glucose monitoring can improve glycemic control for hospitalized patients with diabetes, according to current evidence. However, there is a lack of consensus-established recommendations for the management of hospitalized patients with diabetes using flash continuous glucose monitoring system (fCGM) in Latin America. Therefore, this expert consensus exercise aimed to establish guidelines on the implementation of fCGM in the management of hospitalized patients with diabetes in Latin America. METHODS: The modified Delphi method was applied on a panel of nine specialists, establishing consensus at 80%. A twenty-two-question instrument was developed to establish recommendations on the use of fCGM in hospitalized patients living with diabetes. RESULTS: Based on consensus, experts recommend the use of fCGM in hospitalized patients with diabetes starting at admission or whenever hyperglycemia (> 180 mg/dl) is confirmed and continue monitoring throughout the entire hospital stay. The recommended frequency of fCGM scans varies depending on the patient's age and diabetes type: ten scans per day for pediatric patients with type 1 and 2 diabetes, adult patients with type 1 diabetes and pregnant patients, and seven scans for adult patients with type 2 diabetes. Different hospital services can benefit from fCGM, including the emergency room, internal medicine departments, intensive care units, surgery rooms, and surgery wards. CONCLUSIONS: The use of fCGM is recommended for patients with diabetes starting at the time of admission in hospitals in Latin America, whenever the necessary resources (devices, education, personnel) are available.

Sepsis 3-hour bundle compliance and prognosis in emergency department patients aged 65 years or older. / Cumplimiento del paquete de medidas en las primeras tres horas en urgencias y su relación con el pronóstico de los pacientes mayores de 65 años con sepsis.

OBJECTIVES: To analyze 3-hour bundle compliance in for patients aged 65 years or older with sepsis treated in our emergency department (ED) and to explore the association between compliance and mortality. MATERIAL AND METHODS: Retrospective observational study in patients aged 65 years or older treated in our ED between January 1, 2020 and December 31, 2022. Factors associated with mortality at the end of the episode were also analyzed. RESULTS: Data for 190 patients were analyzed; 98 (51%) were men. Eighty-five (45%) were aged between 65 and 79 years, and 105 (55%) were aged 80 years or older. Mortality was higher in the patients over 80 years of age (62%) vs 33% of the patients under 80 years of age (P = .001). Overall mean survival time was 38 days (95% CI, 28-48 days). Cox regression analysis showed that 3-hour bundle compliance was associated with longer survival (HR, 0.56; 95% CI, 0.34-0.95; P = .03). Mean survival in patients older than 80 years was 21 days (95% CI, 13-30 days), and 3-hour bundle compliance was associated with longer survival (hazard ratio, 0.51; 95% CI, 0.3-0.9; P = .02). CONCLUSION: Three-hour sepsis bundle compliance in the ED was associated with longer survival in patients aged 65 years or older.

OBJETIVO: Analizar el cumplimiento del paquete de medidas de tratamiento de la sepsis en las primeras 3 horas de asistencia en urgencias y su relación con la mortalidad en una cohorte de pacientes $ 65 años. METODO: Estudio observacional retrospectivo. Se seleccionaron los pacientes con una edad $ 65 años visitados en urgencias del 1 de enero de 2020 al 31 de diciembre de 2022 diagnosticados de sepsis o shock séptico. Se determinaron los factores asociados a mortalidad al final del episodio. RESULTADOS: Se incluyeron 190 pacientes, 98 (51%) varones y 85 (45%) tenían una edad 65­79 años (añosos) y 105 (55%) $ 80 años (muy añosos). La mortalidad al final del episodio fue mayor en el grupo de pacientes muy añosos (62% vs 33%, p = 0,001). La media de supervivencia fue de 38 días (IC 95%: 28-48). Mediante regresión de Cox se determinó que el cumplimiento del paquete de medidas en las primeras tres horas se asoció a mayor supervivencia (HR: 0,56, IC 95%: 0,34-0,95 p = 0,03). En el grupo de pacientes muy añosos, la media de supervivencia fue de 21 días (IC 95%: 1-30); el cumplimiento de las medidas dentro de las primeras 3 horas se asoció a mayor supervivencia (HR: 0,51, IC 95%: 0,3-0,9 p = 0,02). CONCLUSIONES: El cumplimiento del paquete de medidas en las primeras 3 horas se asoció con una mayor supervivencia en los pacientes mayores de 65 años con sepsis en urgencias.

Assessment of postoperative morbidity in Spanish hospitals: Results from a national survey.

BACKGROUND: The methodology used for recording, evaluating and reporting postoperative complications (PC) is unknown. The aim of the present study was to determine how PC are recorded, evaluated, and reported in General and Digestive Surgery Services (GDSS) in Spain, and to assess their stance on morbidity audits. METHODS: Using a cross-sectional study design, an anonymous survey of 50 questions was sent to all the heads of GDSS at hospitals in Spain. RESULTS: The survey was answered by 67 out of 222 services (30.2%). These services have a reference population (RP) of 15 715 174 inhabitants, representing 33% of the Spanish population. Only 15 services reported being requested to supply data on morbidity by their hospital administrators. Eighteen GDSS, with a RP of 3 241 000 (20.6%) did not record PC. Among these, 7 were accredited for some area of training. Thirty-six GDSS (RP 8 753 174 (55.7%) did not provide details on all PC in patients' discharge reports. Twenty-four (37%) of the 65 GDSS that had started using a new surgical procedure/technique had not recorded PC in any way. Sixty-five GDSS were not concerned by the prospect of their results being audited, and 65 thought that a more comprehensive knowledge of PC would help them improve their results. Out of the 37 GDSS that reported publishing their results, 27 had consulted only one source of information: medical progress records in 11 cases, and discharge reports in 9. CONCLUSIONS: This study reflects serious deficiencies in the recording, evaluation and reporting of PC by GDSS in Spain.

Adapted Original Music as an Environmental Enrichment in an Intensive Pig Production System Reduced Aggression in Weaned Pigs during Regrouping.

In intensive swine production systems,, the practice of regrouping unfamiliar pigs is common, often leading to aggressive behavior. Although the effect of different musical genres composed for humans has been evaluated in pigs to mitigate aggression, there have been few attempts to create music specifically for pigs. Here, we assess whether sensory stimulation through music, created by adapting the acoustic parameters in the sound mix, induces changes in the aggressive behaviors of pigs during regrouping. Six litters of 10-week-old piglets were randomly selected and assigned to different treatments. The control group (Group A) received no intervention, while Group B was exposed to music for two continuous hours in the morning and afternoon from the time of regrouping. Group C received musical stimulation for one continuous hour in the morning following regrouping. A significant reduction in the frequency and duration of aggressive behaviors was observed in the groups that received musical stimulation during regrouping. Additionally, social, and individual play behaviors showed a decrease in the musical stimulation groups. These findings provide evidence for the effectiveness of created music as a strategy in reducing aggressive behavior during pig regrouping, which can enhance the welfare of pigs and offer a practical solution for pig producers to minimize aggression and its associated negative impacts.

Red Fluorescent Protein Variant with a Dual-Peak Emission of Fluorescence.

The marine environment is a rich reservoir of diverse biological entities, many of which possess unique properties that are of immense value to biotechnological applications. One such example is the red fluorescent protein derived from the coral Discosoma sp. This protein, encoded by the DsRed gene, has been the subject of extensive research due to its potential applications in various fields. In the study, a variant of the red fluorescent protein was generated through random mutagenesis using the DsRed2 gene as a template. The process employed error-prone PCR (epPCR) to introduce random mutations, leading to the isolation of twelve gene variants. Among these, one variant stood out due to its unique spectral properties, exhibiting dual fluorescence emission at both 480 nm (green) and 550 nm (red). This novel variant was expressed in both Escherichia coli and zebrafish (Danio rerio) muscle, confirming the dual fluorescence emission in both model systems. One of the immediate applications of this novel protein variant is in ornamental aquaculture. The dual fluorescence can serve as a unique marker or trait, enhancing the aesthetic appeal of aquatic species in ornamental settings.

TMEM106B is a receptor mediating ACE2-independent SARS-CoV-2 cell entry.

SARS-CoV-2 is associated with broad tissue tropism, a characteristic often determined by the availability of entry receptors on host cells. Here, we show that TMEM106B, a lysosomal transmembrane protein, can serve as an alternative receptor for SARS-CoV-2 entry into angiotensin-converting enzyme 2 (ACE2)-negative cells. Spike substitution E484D increased TMEM106B binding, thereby enhancing TMEM106B-mediated entry. TMEM106B-specific monoclonal antibodies blocked SARS-CoV-2 infection, demonstrating a role of TMEM106B in viral entry. Using X-ray crystallography, cryogenic electron microscopy (cryo-EM), and hydrogen-deuterium exchange mass spectrometry (HDX-MS), we show that the luminal domain (LD) of TMEM106B engages the receptor-binding motif of SARS-CoV-2 spike. Finally, we show that TMEM106B promotes spike-mediated syncytium formation, suggesting a role of TMEM106B in viral fusion. Together, our findings identify an ACE2-independent SARS-CoV-2 infection mechanism that involves cooperative interactions with the receptors heparan sulfate and TMEM106B.

A new automatic method for tracking rats in the Morris water maze.

Morris water maze (MWM) test is widely used to evaluate the learning and memory deficits in rodents. Image processing and pattern recognition can be used to analyse videos and recognize automatically the tracking in MWM. There are several commercial and free access software that allows analyzing the behavioral tasks although they also have limitations such as automation, cost, user intervention among other things. The aim of this paper was to develop a new image processing technique to automatically analyse the track of the rat in the MWM, which we called RatsTrack. The MWM test was performed with an animal model for Alzheimer, and the videos were recorded to measure the distance, time, and speed. The segmentation method based on the projection of the video frames was made for pool identification, eliminating the rat, while conserving the shape of the pool. Then, the Hough transformation was used to recognize the position and radius of the pool. Finally, the frame in which the rat is released into the pool was established automatically using mathematical morphology techniques and added as a plugin on free access ImageJ software. The new image processing technique, RatsTrack, successfully detected and located the pool and rat without user intervention, significantly decreasing operational time and providing results for distance, time, speed, and acceleration parameters of the MWM test. Alzheimer's rats compared with the control group presented significant data measured with the RatsTrack. RatsTrack is a plugin of ImageJ software and will be made freely available for public use.

Role of Bladder Functional Testing Prior to Surgeries for Benign Prostatic Obstruction.

PURPOSE OF REVIEW: There is no consensus on preoperative functional testing prior to surgeries for benign prostatic obstruction causing lower urinary tract symptoms (LUTS). RECENT FINDINGS: Surgical management offers definite benefits, but the results are not always satisfactory. The urodynamic study (UDS) is the gold standard for assessing bladder outlet obstruction (BOO) which is the best predictor of surgical success. Yet, it is not recommended by our urologic societies as standard testing prior to surgery. In this narrative review of the literature, we report recent findings and controversies regarding the benefits and downside of UDS, and the use of other less-invasive approaches to achieve this goal. The lack of strong evidence for or against performing UDS was surprising. Prospective UDS data may not predict surgical outcomes if there is no consensus on criteria that directs surgical intervention. However, confirming the presence of BOO and characterizing the bladder function to identify detrusor over- and underactivity may help counselling and setting patient's post-operative expectations. Urocuff, a non-invasive testing offers promising results to address this problem with a less-invasive assessment of BOO. We emphasize better pre-operative characterization of patients to confirm BOO and better define subgroups to improve surgical decision-making.

Correlation Between Hemoglobin Glycation Index Measured by Continuous Glucose Monitoring With Complications in Type 1 Diabetes.

OBJECTIVE: HbA1C is the "gold standard" parameter to evaluate glycemic control in diabetes; however, its correlation with mean glucose is not always perfect. The objective of this study was to correlate continuous glucose monitoring (CGM)-derived hemoglobin glycation index (HGI) with microvascular complications. METHODS: We conducted a cross-sectional study including permanent users of CGM with type 1 diabetes mellitus or latent autoimmune diabetes of the adult. HGI was estimated, and presence of microvascular complications was compared in subgroups with high or low HGI. A logistic regression analysis to assess the contribution of high HGI to chronic kidney disease (CKD) was performed. RESULTS: In total, 52 participants who were aged 39.7 ± 14.7 years, with 73.1% women and 15.5 years (IQR, 7.5-29 years) since diagnosis, were included; 32.7% recorded diabetic retinopathy, 25% CKD, and 19.2% neuropathy. The median HbA1C was 7.6% (60 mmol/mol) and glucose management indicator (GMI) 7.0% (53 mmol/mol). The average HGI was 0.55% ± 0.66%. The measured HbA1C was higher in the group with high HGI (8.1% [65 mmol/mol] vs 6.9% [52 mmol/mol]; P < .001), whereas GMI (7.0% [53 mmol/mol] vs 7.0% [53 mmol/mol]; P = .495) and mean glucose were similar in both groups (153 mg/dL vs 153 mg/dL; P = .564). In the high HGI group, higher occurrence of CKD (P = .016) and neuropathy were observed (P = .025). High HGI was associated with increased risk of CKD (odds ratio [OR]: 5.05; 95% CI: 1.02-24.8; P = .04) after adjusting for time since diagnosis (OR: 1.09; 95% CI: 1.02-1.16; P = .008). CONCLUSION: High HGI measured by CGM may be a useful marker for increased risk of microvascular diabetic complications.

Alopecia Areata in Latin America: Where are We and Where are We Going?

Alopecia areata (AA) represents an underrecognized burden in Latin America (LA), severely impacting quality of life (QoL). This impact is exacerbated by limited access to specialized dermatologic care and therapies for AA within and among nations. Many of the unmet needs for AA globally also exist in LA. The region has geographic, ethnic, cultural, and economic conditions. With new AA medicines targeting immunologic pathways on the horizon, LA must prepare regarding regulatory issues, reimbursement, awareness, and education to give adequate and timely treatment for patients with AA. To address these issues, the Americas Health Foundation convened a panel of six dermatologists from Argentina, Brazil, Colombia, and Mexico who are experts in AA and its comorbidities for a 3-day virtual meeting to discuss AA diagnosis and treatment in LA and create a manuscript offering recommendations to address discussed barriers. This publication examines unmet AA needs in LA, treatment, and innovative therapies and recommends improving AA care. Access constraints to conventional and novel medicines hinder appropriate treatments for patients. Therapy initiation delays can affect QoL, mental health, and disease progression. People with AA face stigmas, discrimination, and misconceptions owing to a lack of disease awareness. With promising new treatments for AA on the horizon, all stakeholders must coordinate efforts to enhance LA's AA management landscape and improve patient outcomes.

Necesidades reproductivas de hombres transgénero: revisión bibliográfica / Reproductive choices of transgender men: literature review

Actualmente se han hecho visibles casos de hombres transgénero que han logrado el embarazo, lo que pone de manifiesto la posibilidad de concebir y, por tanto, la existencia de necesidades reproductivas en este grupo. Objetivo: Explorar las necesidades en salud reproductiva de hombres transgénero. Metodología: Se realizó una búsqueda bibliográfica durante los meses de abril a junio de 2022 en las bases de datos PubMed, WOS, Scopus, CINAHL y PsycInfo, usando diferentes estrategias de búsqueda. Los criterios de inclusión han sido: artículos publicados en los últimos 10 años; en inglés o español; relacionados con los objetivos del estudio y adecuados a la metodología. Además, se realizó una revisión secundaria de los estudios seleccionados. Resultados: Se seleccionaron un total de 28 artículos tras aplicarse los criterios de inclusión y exclusión, además de seleccionarse 2 artículos en la búsqueda secundaria. La mayoría de los artículos son estudios cualitativos, realizados en Estados Unidos. Los hombres transgénero desean y pueden formar la familia que esperan a través del propio embarazo, independientemente del tratamiento hormonal empleado. El modo en el que experimentan su periodo de decisión y embarazo varía a lo largo de un continuo de vivencias. Conclusiones: El embarazo en hombres transgénero es un proceso complejo a nivel biopsicosocial. Estos hombres tienen unas necesidades reproductivas muy variadas, por lo que resulta difícil describir un único perfil y se requiere una atención individualizada de cada caso. (AU)

Nowadays there are many cases of transgender pregnancy. This situation brings to light the possibility of these men to conceive and also exposes the reproductive necessities of this group. Objective: Exploring transgender men’s choices related to reproductive health. Methodology: During April to June 2022, different search strategies were used to obtain an exhaustive literature search within the following databases: PubMed, WOS, Scopus, CINAHL and PsycInfo. The inclusion criteria are: last 10 years-published articles, even English or Spanish ones, related to the main objective of the study and suitable for the methodology. Moreover, these articles were reviewed in a second time. Results: 28 articles were selected after applying the inclusion and exclusion criteria. In addition, two more articles were included in the second review. Most articles are qualitative studies from the USA. Transgender men desire and are able to form the family they hope through their own pregnancy, regardless of the hormonal treatment used. The way in which they experience their decision period and pregnancy vary along a continuum of experiences. Conclusions: Pregnancy in transgender men is a complex process at the biopsychosocial level. These men have highly varied reproductive needs, making it difficult to describe a single outline, which is why an individual attention is required for each case. (AU)

Role of the arts in the life and mental health of young people that participate in artistic organizations in Colombia: a qualitative study.

BACKGROUND: Adolescents and young adults are vulnerable to developing mental distress. However, evidence suggests that more than half of the young people with symptoms of depression and anxiety overcome their distress within a year. However, there is little research on the exact resources that young people use and help them to recover. The aim of this study was to explore how arts activities can support the recovery of young people engaged with arts organizations in Bogota. METHODS: We recruited 38 participants from two arts organizations in Bogotá and conducted six focus groups embedded within artistic workshops. The type of activities in the workshops varied reflecting the different teaching methods of the two organizations. The focus group discussions were recorded and analyzed using thematic analysis. RESULTS: Five themes explained how arts activities can help young people participating in artistic organizations to overcome mental distress: i) allowing the expression of emotions; ii) helping to manage and transform emotions; iii) distracting from problems; iv) facilitating social support and relationships; and v) contributing to the identity of young people. CONCLUSIONS: For young people who participate in artistic organizations, the arts are a resource for overcoming negative emotions such as anxiety, depression, and sadness. The beneficial role of arts activities includes different process of managing, expressing, and distracting from distress, and it differs depending on whether arts are perceived as a professional vocation or a hobby.

COVID-19 Pandemic Response Preparedness and Risk Perceptions Among Peruvian Veterinarians and Animal Care Workers.

Peruvian veterinarians and animal care workers (VACW) are primary responders in the event of disasters or emergencies, yet they face unique concerns that could impede or block their essential functions in public health preparedness in comparison with VACWs in other countries. In this study, we used the Ready, Willing, and Able model via electronic survey to evaluate the perception of risks and barriers that Peruvian VACWs faced when deciding whether to continue working during the COVID-19 pandemic between July and December 2020. We used logistic regression models to evaluate associations between demographic characteristics, perceived role, and contact scores with 8 outcomes: knowledge of COVID-19; confidence in safety protocols; perceived threat; perceived job efficacy; perceived barriers; and readiness, willingness, and ability to respond to the COVID-19 pandemic. Less than 50% of respondents reported barriers to report to work during the pandemic. Respondents who reported higher contact with coworkers had an increased confidence in safety protocols (OR 5.16; 95% CI, 1.36 to 19.61) and willingness (OR 3.76; 95% CI, 1.14 to 12.47) to respond to the pandemic. Close contacts with essential workers and higher economic income were associated with higher reported knowledge of COVID-19. Respondents with higher perceived job efficacy had higher odds of reporting being ready, willing, and able to respond to COVID-19, while those who identified more barriers to report to work had lower odds of being ready, willing, and able to respond. The findings from this study, which showed differences from VACWs in the United States, can be used by individuals designing programs to improve pandemic and disaster preparedness in this essential, yet understudied and vulnerable, workforce.

Trombosis venosa abdominal en una población adulta seguida en una clínica de anticoagulación / Abdominal venous thrombosis in an adult population followed in an anticoagulation clinic

Resumen Introducción: La trombosis venosa abdominal es inusual y es una de las formas menos estudiada de la enfermedad tromboembólica venosa. Objetivo: Describir las características epidemiológicas, los factores de riesgo, las complicaciones y el manejo anticoagulante en pacientes con diagnóstico de trombosis venosa abdominal, atendidos en una clínica de anticoagulación en Cali, Colombia. Materiales y método: Estudio descriptivo en el que se identificaron 83 pacientes con diagnóstico de trombosis venosa abdominal, manejados en la clínica de anticoagulación de la Fundación Valle del Lili, entre los años 2011 y 2019. La edad promedio fue de 53.3 ± 17.4 años y el 59% eran de sexo femenino. Fue más frecuente en las venas mesentéricas (19%), seguidas de la vena porta (18%). Los antecedentes incluyen cáncer, hipertensión arterial y estado hipercoagulable/trombofilia. Conclusiones: La trombosis venosa abdominal es una patología poco frecuente. El principal compromiso se presenta en la vena mesentérica. La enoxaparina es el manejo más frecuente. Los pacientes requieren en su mayoría anticoagulación extendida.

Abstract Introduction: Abdominal venous thrombosis is rare condition and is one of the least studied forms of venous thromboembolic disease. Objective: To describe the epidemiological characteristics, risk factors, complications and anticoagulant management in patients with a diagnosis of abdominal venous thrombosis, treated at an anticoagulation clinic in Cali, Colombia. Materials and method: Descriptive study, 83 patients with diagnosis of abdominal venous thrombosis were identified, managed in the anticoagulation clinic of Fundación Valle del Lili, between the years 2011 and 2019. The average age was 53.3 ± 17.4, and 59% female. More frequent in mesenteric veins (19%), followed by portal vein (18%). Personal antecedent includes cancer, high blood pressure, and hypercoagulable/thrombophilia status. Conclusions: Abdominal vein thrombosis is a rare disease. The main compromise occurs at the level of the mesenteric vein. Enoxaparin is the most common management. Most patients require extended anticoagulation.

Estudio médico-forense de la muerte bajo custodia durante el terrorismo de Estado en Uruguay / Medical-forensic study of deaths in police custody during the period of State terrorism in Uruguay / Estudo médico-forense de morte sob custódia durante o terrorismo de Estado no Uruguai

Resumen: Toda muerte bajo custodia es potencialmente ilícita por acción u omisión del Estado. Se presenta el reporte sistematizado desde la perspectiva forense de la muerte bajo custodia en la prisión política en Uruguay durante el terrorismo de Estado. Objetivos: a) conocer la magnitud del fenómeno; b) caracterizar a las víctimas; c) determinar causas, maneras y circunstancias de las muertes en los casos que aún no habían sido estudiados; d) sistematizar las causas, maneras y circunstancias de muerte en toda la población estudiada. Material y métodos: se empleó la nómina oficial de víctimas del período de terrorismo de Estado y se estudió la información pública y/o accesible para investigaciones académicas. Las muertes no estudiadas previamente fueron analizadas por una Junta Médica que dictaminó en base a la metodología de la autopsia histórica. Resultados: entre 27/06/1973 y 28/02/1985 murieron bajo custodia en Uruguay por motivos políticos 108 personas; 36 (33%) en un centro de detención clandestino o irregular, 34 (31%) en un establecimiento de detención regular, 19 (18%) continúan como detenidos desaparecidos y 19 (18%) murieron durante operativos de detención o represión. El 81% fueron hombres y la edad media fue 37 años. El 67% eran obreros o empleados y el 23% estudiantes. El 69% fueron muertes violentas y la tortura fue la causa principal de muerte. En nueve de las 32 muertes naturales se demostraron negligencias o fallas asistenciales con ostensible incidencia en el resultado letal. Conclusiones: los resultados obtenidos confirman plenamente el principio general de que se trata de muertes potencialmente ilícitas y la consecuente necesidad de una investigación exhaustiva.

Summary: All deaths in police custody are potentially illicit on account of the government's acts of commission or acts of omission. The study presents a systematized report from the forensic perspective, of deaths in police custody of political prisoners in Uruguay during the period of state terrorism. Objectives: a) to learn about the scale of the phenomenon; b) to characterize victims; c) to determine the causes, ways and circumstances of deaths in the cases that had not been studied yet; d) to systematize the causes, modes and circumstances of death in all the studied population. Method: the study used the official list of victims for the period of State terrorism and analyzed both public information and information that was available for academic research. The deaths that had not been previously studied were reviewed by a Medical Board that rendered a decision through a historic autopsy. Results: in Uruguay, 108 people died for political reasons in police custody from June 27, 1973 to February 28, 1985; 36 (33%) victims died in a clandestine or irregular detention center, 34 (31%) in a regular prison; 19 (18%) are still missing and 19 (18%) died during detention or repression operations. 81% of victims were male and average age was 37 years old. 67% were workers or employees and 23% were students. 69% accounted for violent deaths and torture was the main cause. Negligence and failures in care were seen in 9 out of the 32 natural deaths, what evidently impacts the lethal outcome. Conclusions: the results obtained fully confirm the general principle that these are potentially illicit.

Resumo: Toda morte sob custódia é potencialmente ilegal por ação ou omissão do Estado. O relatório sistematizado é apresentado desde a perspectiva forense da morte sob custódia na prisão política no Uruguai durante o terrorismo de Estado. Objetivos: a) Conhecer a magnitude do fenômeno; b) Caracterizar as vítimas; c) Determinar as causas, formas e circunstâncias dos óbitos em casos ainda não estudados. d) Sistematizar as causas, formas e circunstâncias de morte em toda a população estudada. Material e métodos: foi utilizada a lista oficial de vítimas do período do terrorismo de Estado e foram estudadas as informações públicas e/ou acessíveis para pesquisas acadêmicas. Os óbitos não estudados anteriormente foram analisados por uma Junta Médica que decidiu de acordo com a metodologia da autópsia histórica. Resultados: entre 27/06/1973 e 28/02/1985, 108 pessoas morreram sob custódia no Uruguai por motivos políticos; 36 (33%) em centro de detenção clandestino ou irregular, 34 (31%) em centro de detenção regular, 19 (18%) continuam como detentos desaparecidos e 19 (18%) morreram durante operações de detenção ou repressão. 81% eram homens e a média de idade foi de 37 anos. 67% eram trabalhadores ou empregados e 23% estudantes. 69% foram mortes violentas e a tortura foi a principal causa. Em 9 dos 32 óbitos naturais, foram demonstradas negligências ou falhas assistenciais, com incidência ostensiva no resultado letal. Conclusões: os resultados obtidos confirmam plenamente o princípio geral de que se trata de mortes potencialmente ilícitas e a consequente necessidade de uma investigação exaustiva.

Recomendaciones de la Asociación Colombiana de Neurología para el uso de anticuerpos monoclonales antiCGRP en la profilaxis de migraña / Recommendations on the use of the antiCGRP monoclonal antibodies for migraine prophylaxis on behalf of the Colombian Association of Neurology

RESUMEN INTRODUCCIÓN: El desarrollo de anticuerpos monoclonales (mAbs) contra el péptido relacionado con el gen de la calcitonina (CGRP) ha determinado una nueva era terapéutica en la profilaxis de migraña, demostrando su efectividad en pacientes con migraña episódica (ME) y migraña crónica (MC), con respuesta desde pacientes naïve hasta refractarios a múltiples medicamentos. La disminución del 50% de los ataques de migraña al mes (DMM) durante los primeros 3 meses de uso es el desenlace aproximado en el 50% de los pacientes que reciben esta terapia. OBJETIVO: Este consenso de la Asociación Colombiana de Neurología (ACN) tiene el objetivo de guiar la selección y uso racional de los mAbs antiCGRP en pacientes con ME y MC. MATERIALES Y MÉTODOS: El comité de cefalea de la ACN mediante la aplicación de la metodología Delphi y discusiones en reuniones posteriores desarrolló un documento en formato de consenso soportado en literatura y recomendaciones de expertos. RESULTADOS: Se obtuvieron respuestas de 14 expertos en cefalea sobre moléculas utilizadas en profilaxis de migraña, analizando su aplicabilidad en situaciones clínicas frecuentes. DISCUSIÓN: Los mAbs antiCGRP han demostrado efectividad con adecuado soporte fisiopatológico, considerando que son moléculas de alto precio en una enfermedad de alta prevalencia, existe la necesidad de guíar la selección del paciente que mejor puede beneficiarse de su administración CONCLUSIONES: Los mAbs antiCGRP están recomendados en pacientes con ME y MC que presentan falla terapéutica a otras moléculas profilácticas.

ABSTRACT INTRODUCTION: The development of monoclonal antibodies (mAbs) against Calcitonin Gene Related Peptide (CGRP) has determined a new therapeutic era in migraine prophylaxis, demonstrating its effectiveness in patients with episodic migraine (EM) and chronic migraine (CM), obtaining a response in naive patients and in those who are refractory to multiple medications. A 50% decrease in migraine attacks per month during the first 3 months of use is the approximate outcome in 50% of patients receiving this therapy. OBJECTIVE: This consensus from the Colombian Association of Neurology (ACN) has the objective of serving as a guide for the rational use of antiCGRP mAbs in patients with EM and CM. METHODS AND MATERIALS: The headache committee through the application of the Delphi methodology and discussions in subsequent meetings, develops this consensus, supported in the published literature and expert recommendations. RESULTS: Fourteen answers from headache experts were received regarding the use of drugs for migraine prophylaxis, analyzing their applicability in frequent clinical situations. DISCUSSION: AntiCGRP mAbs have proved their effectiveness with adequate pathophysiological support, but with a high price in a highly prevalent disease, there is then a need to select the patient who best benefits from this therapy. CONCLUSIONS: AntiCGRP mAbs are recommended in patients with EM and CM that have previously failed to other prophylactic drugs.

Efectos de la COVID-19 en el embarazo / Effects of COVID-19 on pregnancy

Objetivo: Conocer el impacto que tiene la COVID-19 en el curso de la gestación y en el recién nacido, así como determinar los posibles efectos del uso de mascarilla por parte de la mujer embarazada. Metodología: Se realizó una revisión de la literatura en lengua española e inglesa de los últimos 5 años en las bases de datos PubMed, WoS, Cuiden y Cochrane Library. Las palabras clave fueron «embarazo/pregnancy», «COVID-19», «SARS-CoV-2» y «máscaras/masks», de las que surgieron distintas estrategias de búsqueda empleando los operadores booleanos AND y OR, y el operador de truncamiento (*).Resultados: De los 2421 artículos obtenidos en la búsqueda primaria, finalmente se seleccionaron 32 estudios tras aplicarse los criterios de inclusión y exclusión. De ellos, 19 se centraron en los efectos maternos y neonatales de la COVID-19, mientras que 13 recogían las consecuencias respiratorias del uso de mascarilla.Conclusiones: La literatura científica que aborda la temática de la COVID-19 en gestantes está en constante actualización debido a la aparición continua de nuevos hallazgos. Hasta el momento diversos estudios han demostrado que las gestantes deben considerarse personas de alto riesgo por su mayor susceptibilidad a presentar infecciones respiratorias debido a una respuesta inmune alterada, y más probabilidad de tener complicaciones respiratorias y perinatales que demanden un cuidado intensivo. Diversos estudios han demostrado que el uso de las mascarillas N95 en gestantes se relaciona con la resistencia al flujo de aire y el aumento de los volúmenes de espacio muerto estático, lo que puede afectar a la función cardiorrespiratoria y a la oxigenación fetal si se usan durante periodos prolongados. (AU)

Objective: Understanding the implication of COVID-19 between both pregnant women and newborn babies, also clarifying the possible effects that masks could cause in pregnant women. Methodology: It has been done a review of actual literature through the following databases: PubMed, WoS, Cuiden and Cochrane Library. The key words are «pregnancy/ pregnant women», «COVID-19», «SARS-CoV-2» and «masks», using different strategies of search, and applying the boolean operators OR and AND, and the truncation operator (*).Results: Of the total 2421 articles obtained in the first search, 32 of them were finally selected applying the inclusion and exclusion criteria. In one hand, 19 articles talk about both maternal and neonatal effects of COVID-19. On the other hand, the rest of the articles explain the respiratory symptoms that the use of face masks provoques. Conclusions: The scientific literature related to COVID-19 between pregnant women is always updating because of the constant research findings. These studies support that pregnant women should be considered high risk population because they are more susceptible to respiratory infections. Since their altered immune system, the pregnant women are more likely to have respiratory complications which need intensive care and also perineonatal complications. Some studies prove that the use of N95 face masks between pregnant women is related to air flow resistance and increased dead air static volume. These changes could affect both cardiopulmonary function and fetal oxygenation when it is used during long periods. (AU)

Epidemiologic features and burden of atopic dermatitis in adolescent and adult patients: A cross-sectional multicenter study.

BACKGROUND: Atopic dermatitis (AD) is considered as one of the most frequent chronic skin conditions. Previous AD epidemiologic studies have been mainly retrospective and/or have been performed through surveys instead of in-person visits. Epidemiological studies concerning AD in Latin American countries are scarce. OBJECTIVE: To describe sociodemographic and clinical features and the economic burden of AD on children and adult patients in Colombia through in-person visits. METHODS: This was a cross-sectional study of 212 patients that included sociodemographic and clinimetric data. The diagnostic criteria of Hanifin and Rajka was used and data relating to disease distribution, disease severity (through the BSA: Body surface area; EASI: Eczema Area and Severity Index; SCORAD: Scoring Atopic Dermatitis), Fitzpatrick's skin phototypes, personal and familiar history of allergic diseases, previous treatments, and personal history of comorbidities, was collected. RESULTS: Patient age range was 12-76, and 52.8% were female. Disease distribution was mainly flexural (19.6%). Early age start, Denni-Morgan fold, and infections tendency were more frequent in adolescents compared to adults. Mean age of diagnosis was 12 years old, AD diagnosis was made mostly by a dermatologist, 48.1% (102 patients) reported alcohol consumption, and 59% of consumers were heavy drinkers. Comorbidities found were: chronic rhinitis (68.9%) food allergy (32.5%), allergic conjunctivitis (29.7%), and asthma (28.8%). Around 81% earned less than $896 US dollars and 59% invested 6-30% of their monthly budget yearly, and 40% had work or school absenteeism. Mean scores of BSA, EASI, and SCORAD involvement were 32.6, 13.7, and 42.4, respectively. CONCLUSIONS: This study adds well-supported data through an in-depth clinical and economical characterization of Colombian adolescents and adult patients with atopic dermatitis and shows its high impact and burden on patients and their families. It also contributes to understand the burden of AD in Latin America.