Optimal cutoff scores of the Montreal Cognitive Assessment to detect mild cognitive impairment and dementia in Costa Rican older adults.

BACKGROUND: The burden of Alzheimer's disease and related dementias (AD/ADRD) in Costa Rica is expected to become one of the highest in the region. Early detection will help optimize resources and improve primary care interventions. The Montreal Cognitive Assessment (MoCA) has shown good sensitivity for detecting mild cognitive impairment (MCI), but specificity varies depending on the population. This motivated the analysis of different cutoffs to minimize false-positive classifications in a Costa Rican sample for its use in clinical settings. METHODS: Data was analyzed from 516 memory clinic outpatients (148 cognitively normal, 260 MCI, 108 mild AD/ADRD; mean age 66.3 ± 10.8 years) who underwent complete neurological and neuropsychological assessment and were diagnosed by consensus. Optimal MoCA cutoff scores were identified using a multiple cutoff approach. RESULTS: Overall, a cutoff score of ≥ 23 showed better accuracy to distinguish between normal cognition (NC) and MCI (sensitivity 73%, specificity 83%). When analyzed by educational levels, a cutoff score of ≥ 21 showed better accuracy for ≤ 6 years (sensitivity 80%, specificity 76%), ≥23 for 7-12 years (sensitivity 86%, specificity 76%) and ≥ 24 for > 12 years (sensitivity 70%, specificity 85%). For distinguishing MCI from mild AD/ADRD, the optimal overall cutoff score was ≥ 15 (sensitivity 66%, specificity 85%). When stratified by years of education, cutoff scores of ≥ 14 showed better accuracy for ≤ 6 years (sensitivity 70%, specificity 88%), ≥15 for 7-12 years (sensitivity 46%, specificity 95%) and ≥ 17 for > 12 years (sensitivity 67%, specificity 93%). CONCLUSIONS: A MoCA cutoff score of ≥ 23 in the Costa Rican population showed better diagnostic accuracy for detecting MCI and may reduce the false positive rate. Our findings may be helpful for primary care clinical settings and further referral criteria.

Unstable angina secondary to left main coronary artery vasculitis as a rare initial manifestation of systemic lupus erythematosus. A case report.

We present the case of a woman in her third decade of life, known to have difficult-to-control mixed headaches and polycystic ovary syndrome, under hormonal treatment. Without any other manifestation, the patient debuted with an acute coronary syndrome classified as unstable angina. Electrocardiogram showed anterior and lateral ST segment depression and ST elevation in aVR. Coronary computer tomography and coronary angiography showed evidence of significant obstruction of the left main coronary artery. The patient was diagnosed with systemic lupus erythematosus (SLE), and was classified as vasculitis secondary to SLE as an unusual initial manifestation.

Se presenta el caso de una mujer en la tercera década de la vida, con cefalea mixta de difícil control y síndrome de ovario poliquístico bajo tratamiento hormonal, sin ninguna otra manifestación, la cual debutó con un síndrome coronario agudo tipo angina inestable. El electrocardiograma mostró infradesnivel en cara anterior y lateral, así como supradesnivel del ST en aVR. La angiotomografia de coronarias y la coronariografía mostraron evidencia de obstrucción importante del tronco de la coronaria izquierda. Tras el abordaje se llegó al diagnóstico de vasculitis secundaria a lupus eritematoso sistémico como manifestación inicial poco habitual.

Phytotherapeutic potential of Artemisia ludoviciana and Cordia boissieri extracts against the dermatophyte Microsporum canis.

Introduction: Microsporum canis is a dermatophyte that mainly affects dogs and cats. However, it can be transmitted to humans by direct contact. This makes it one of the most frequent causative agents of dermatophytosis in humans, reflecting the frequent human close relationships with pets. Conventional treatment relies on antifungal pharmacological agents. However, errors in application have led to the occurrence of fungal resistance and toxic effects. Consequently, new therapeutic alternatives are needed for M. canis infections. Plant extracts have been explored as phytotherapeutics for the treatment of dermatophyte infections, which prompted an attempt to apply extracts of the ethnopharmacologically important plants Artemisia ludoviciana and Cordia boissieri. Material and Methods: Methanolic extracts of these two plants were obtained using a Soxhlet method and were characterised by phytochemical screening. Extracts were evaluated against a M. canis commercial strain (ATCC-11621) using the microdilution method described in the Clinical and Laboratory Standards Institute protocol M38-A, determining its minimal inhibitory concentration (MIC) and minimal fungicidal concentration (MFC). Subsequently, these concentrations were tested in a human keratinocyte human cell line. Results: Artemisia ludoviciana and C. boissieri extracts showed MIC values of 2,500 and 1,250 µg/mL, and MFC values of 5,000 and 2,500 µg/mL against M. canis, respectively. These extracts did not inhibit HaCaT cell proliferation in vitro. Conclusion: The evaluated extracts showed potential for the treatment of M. canis fungal infections. However, further studies on their phytochemical characterisation, purification, clinical safety and formulation are required.

Treatment of Symptomatic Carotid Webs.

BACKGROUND: The present study aims to describe the clinical characteristics and treatment outcomes of patients with symptomatic carotid web treated at a single institution in South America. METHODS: Retrospective study of a single-center experience of patients with carotid webs surgically treated from September 2019 to September 2023. RESULTS: Ten patients had carotid webs, 6 (60%) were females. Median age was 54.5 years (range: 35-77 years). All patients were symptomatic. Diagnosis was made in 90% (n = 9) of the patients with either computed tomography angiography or magnetic resonance alone. One (10%) patient underwent angiography for definite diagnosis. The median interval from the first neurological event to intervention was 90 months (range: 3 days-108 months). Four (40%) patients underwent surgical treatment within 1 month from symptom onset and carotid web diagnosis, with a median of 3.5 days (range: 3-9 days). Six (60%) patients underwent delayed surgical treatment since the cause of the neurological event was uncertain, with a median of 54 months (range: 6-108 months). These 6 patients had recurrent neurological events. Three (30%) patients underwent carotid endarterectomies with polyurethane patch and 3 (30%) by eversion technique. Three (30%) patients underwent segmental resection and reanastomosis of the internal carotid artery. One underwent internal carotid artery plasty with saphenous vein. At a median follow-up of 30 months (range: 6-46 months), 1 patient persists with mild aphasia, another patient has severe aphasia and right hemiparesis, both as sequelae of their initial strokes, and another patient has suffered 3 nonischemic episodes of brief transient right hemiparesis attributed to epileptic seizures. The other 7 patients remain without new neurological events. CONCLUSIONS: Neurological events of carotid distribution deserve accurate imaging work up, keeping in mind the diagnosis of carotid web. Surgical treatment for carotid web seems effective for preventing recurrences; nevertheless, further studies are warranted to define the best management for these patients.

Coexistencia y fuentes de alimentación de mosquitos adultos (Diptera: Culicidae) en un centro de salud rural en Piura, Perú 2024 / Coexistence and food sources of adult mosquitoes (Diptera: Culicidae) in a rural health center in Piura, Peru 2024

RESUMEN Con el objetivo del estudio fue determinar la coexistencia y fuentes de alimentación de mosquitos adultos (Diptera: Culicidae) en un centro de salud rural de Piura en Perú, se realizó un estudio descriptivo transversal. Se usaron técnicas entomológicas para capturar e identificar mosquitos, y técnicas de biotecnología molecular para identificar las fuentes de alimentación. Un total de 793 ejemplares de los géneros Culex y Aedes se encontraron coexistiendo, 789 (99,5%) corresponden a Culex quinquefasciatus, 607 (76,9%) fueron machos y 182 (23,1%) hembras. Así mismo, 4 (100%) corresponden a Aedes aegypti hembras. Las fuentes de alimentación de Aedes aegypti fueron Homo sapiens sapiens, y de Culex quinquefasciatus fueron Homo sapiens sapiens y Canis familiaris. Este estudio proporciona evidencia de que los centros de salud rurales estarían actuando como focos de arbovirosis, existiendo el riesgo de que personas que acuden por distintas dolencias, puedan contraer enfermedades transmitidas por C. quinquefasciatus y A. aegypti.

ABSTRACT This study aimed to determine the coexistence and food sources of adult mosquitoes (Diptera: Culicidae) in a rural health center in Piura, Peru by using a descriptive cross-sectional design. Entomological techniques were used to capture and identify mosquitoes, and molecular biotechnology techniques were used to identify food sources. A total of 793 specimens of the Culex and Aedes genera were found coexisting, 789 (99.5%) were Culex quinquefasciatus, 607 (76.9%) were males and 182 (23.1%) were females. Likewise, 4 (100%) corresponded to Aedes aegypti females. The food sources of Aedes aegypti were Homo sapiens sapiens, and Homo sapiens sapiens and Canis familiaris were the food sources of Culex quinquefasciatus. This study provides evidence that rural health centers could be acting as foci of arbovirosis, with the risk that people who come for different ailments could contract diseases transmitted by C. quinquefasciatus and A. aegypti.

Improving medication safety in a Latin American hospital: Examination of medication errors and the role of pharmacists.

DISCLAIMER: In an effort to expedite the publication of articles, AJHP is posting manuscripts online as soon as possible after acceptance. Accepted manuscripts have been peer-reviewed and copyedited, but are posted online before technical formatting and author proofing. These manuscripts are not the final version of record and will be replaced with the final article (formatted per AJHP style and proofed by the authors) at a later time. PURPOSE: Prospective medication order review by a clinical pharmacist is uncommon in many South and Central American countries. Voluntary error reporting and analysis are similarly uncommon. This paper describes the results of pharmacist prospective order review, medication error reporting, and quality improvement activities in a Latin American hospital. METHODS: On January 1, 2020, the hospital initiated prospective review of all medication orders in both the hospital and clinic setting by pharmacists. Health professionals were encouraged to report errors identified to the hospital's voluntary reporting program. Data collected included the medication name and dose, stage of the medication use process, error severity, and error cause. Error reports were periodically reviewed by pharmacy staff. RESULTS: In the 402,100 orders reviewed, errors were found in 605 inpatient orders and 405 clinic orders (0.25%). Most errors were identified before they reached the patient (69.9% of inpatient errors and 81.0% of clinic errors). The prescribing phase was associated with the highest proportion of errors (50.8% of inpatient errors and 41.7% of clinic errors). The most common reasons for prescribing errors were confusing orders and wrong doses. Analgesics (22.7%) and antibiotics (21.3%) were the medication classes most frequently identified. After aggregated review, pharmacists generated 19 clinical alerts leading to system changes and staff education. CONCLUSION: This study demonstrates the impact of prospective order review by pharmacists on patient safety. In addition to preventing errors from reaching the patient, voluntary error reporting and evaluation led to system changes intended to reduce the likelihood that similar errors would occur again.

Daily rhythm in feeding behavior and digestive processes in totoaba (Totoaba macdonaldi) under commercial farming conditions.

To identify daily changes in the digestive physiology of Totoaba macdonaldi, the feed intake, activity (pepsin, trypsin, chymotrypsin, lipase, amylase, and L-aminopeptidase), and gene expression (aminopeptidase and maltase-glucoamylase) of key digestive enzymes were measured in the intestine and the pyloric caeca. Fish were fed for three weeks every four hours during the light period to apparent satiation, and samples were taken every four hours throughout a 24-h cycle under a 12:12 L:D photoperiod. The feed consumption steadily increased until the third feeding (16:00 h, ZT-8) and decreased significantly towards the end of the day. The activity of pepsin and alkaline enzymes (trypsin, chymotrypsin, lipase, amylase, and L-aminopeptidase) exhibited a pattern dependent on the presence of feed, showing a significant reduction during the hours of darkness (ZT-12 to ZT-24). Expression of the intestinal brush border enzyme (L-aminopeptidase) increased during the darkness period in anticipation of the feed ingestion associated with the subsequent light period. The cosinor analysis used to estimate the feed rhythms for all tested enzymes showed that activity in the intestine and pyloric caeca exhibited significant rhythmicity (p < 0.05). However, no rhythmicity was observed in the intestinal expression of maltase-glucoamylase. Our results demonstrate that some of the behavioral and digestive physiology features of totoaba directly respond to rhythmicity in feeding, a finding that should be considered when establishing optimized feeding protocols.

Analysis of the swine movement network in Mexico: A perspective for disease prevention and control.

Pig farming in Mexico is critical to the economy and food supply. Mexico has achieved advancements in swine health and established an electronic database that records swine movements (Sistema Nacional de Avisos de Movilización, SNAM). In this study, we characterized swine movement patterns in México between 2017 and 2019 to identify specific areas and periods that require concentrated efforts for effective epidemiological surveillance and disease control. We employed a Social Network Analysis (SNA) methodology to comprehensively describe and analyze the intricate patterns of pig movement. In addition, we sought to integrate swine population density into the analysis. We used metrics to characterize the network structure and identify the most critical nodes in the movement network. Cohesion metrics were used to identify commercial communities characterized by a high level of interconnectivity in swine movements between groups of nodes. Of a cumulative count of 662,255 pig shipments, 95.9% were attributed to slaughterhouse shipments. We observed that 54% of all Mexican municipalities were part of the network; however, the density of the movement network was less than 0.14%. We identified four Swine Production Centers in Mexico with high interconnectivity in the movement network. We detected moderate positive correlations (ρ ≥0.4 and <0.6, p < 0.001) between node metrics and swine population indicators, whereas the number of commercial swine facilities showed weak correlations with the node metrics. We identified six large, geographically clustered commercial communities that aligned with the Swine Production Centers. This study provides a comprehensive overview of swine movement patterns in Mexico and their close association with swine production centers, which play a dual role as producers and traders within the swine industry of Mexico. Our research offers valuable insights for policymakers in developing disease prevention and control strategies.

SEOM clinical guidelines on venous thromboembolism (VTE) and cancer (2023).

The Spanish Society of Medical Oncology (SEOM) last published clinical guidelines on venous thromboembolism (VTE) and cancer in 2019, with a partial update in 2020. In this new update to the guidelines, SEOM seeks to incorporate recent evidence, based on a critical review of the literature, to provide practical current recommendations for the prophylactic and therapeutic management of VTE in patients with cancer. Special clinical situations whose management and/or choice of currently recommended therapeutic options (low-molecular-weight heparins [LMWHs] or direct-acting oral anticoagulants [DOACs]) is controversial are included.

Proximal Jejuno-Ileal Bypass as Revision of Roux-en-Y Gastric Bypass.

INTRODUCTION: Bariatric surgery is established as a possibility for the treatment of obesity, allowing weight reduction and remission of obesity comorbidities. Reported suboptimal clinical response rates are as high as 30-60% (insufficient weight loss or gain, defined as BMI greater than 35 kg/m2 or excess weight loss less than 50%). Proximal jejuno-ileal bypass (PJIBP) is a promising option when re-intervention is required. OBJECTIVES: To describe the standardization of a proprietary technique of modified PJIBP as a management procedure in patients with post-gastric bypass recurrent weight gain or insufficient post-intervention weight loss. METHODS: This study evaluated a case series of 10 Latin American patients requiring post-bariatric re-intervention, between February 2018 and 2023, in a single-metabolic surgery center in Cali-Colombia. RESULTS: Median age was 45 years (26-70 RIC), 60% female, and 40% male. Mean BMI at conversion was 36.7 kg/m2 (6.4 SD). Median follow-up was 22 months (RIC 16-30). Mean percentage of excess weight lost was 78% (22.4 SD). One hundred percent achieved glycemia control, only one patient persisted with dyslipidemia, and no patient presented hypoalbuminemia. At the end of follow-up, 100% received vitamin supplementation. CONCLUSION: PJIBP could be an effective procedure, associated with positive results in relation to weight loss and resolution of obesity comorbidities. Deficiencies of fat-soluble vitamins and protein malnutrition represent the main concern in the long term, so multidisciplinary management and continuous follow-up are required.

Effects of clinical interventions through a comprehensive medication management program: A retrospective study among outpatients in a private hospital.

Introduction: The intricate nature of certain diseases necessitates complex medication regimens, utilization including high-cost medications, and continual vigilance to avoid potential complications. To address these exigencies, numerous healthcare institutions have instituted multidisciplinary management teams, exemplified in pharmaceutical care through Comprehensive Medication Management (CMM) programs. These programs oversee diverse facets such as patient education, medication adherence promotion, clinical monitoring, dose adjustments, and scrutiny of prescribed drug therapies. Given the emphasized significance, it is relevant to possess evidence to continue endorsing these initiatives from management positions within health centers, and it is for this reason that this study aims to evaluate the clinical and economic benefits provided by a CMM program within a private hospital in Latin America, by analyzing the effects of clinical interventions. Methods: A retrospective examination was conducted involving documented pharmaceutical interventions in an outpatient setting from January 2019 to September 2022. To assess the interventions' repercussions, a retrospective analysis was undertaken. The collated data included patients' basic characteristics, a comprehensive pharmacist-generated description of interventions, potential associated complications, and avoided medical services. Multiple clinical projections, which were endorsed by internal medicine physicians, were developed to explore potential scenarios in the absence of pharmaceutical care. These projections were associated with conceivable complications, aligned with the most plausible circumstances. Subsequently, utilizing the average cost of healthcare within a private hospital in Latin America, the cumulative savings were quantified. These savings were then attributed to the intrinsic advantages offered by pharmaceutical care. Results: The study discloses demographic trends among patients within distinct age groups in the CMM program. Rheumatology predominated as the main referral source, and interventions centering on monitoring emerged as the pivotal drug-related concern. This encompassed a collaborative approach, involving interdisciplinary efforts toward patient education and critical parameter monitoring. Of the total 347 pharmaceutical interventions, 66.3% (N = 230) specialty office visits, 14.1% (N = 49) general practitioner consultations, 12.4% (N = 43) hospitalizations, and 7.2% (N = 25) ER visits were avoided. The economic analysis underscores cost savings ensuing from pharmaceutical interventions, amounting to a cumulative 603,792.82 USD. Extrapolating these findings to a patient cohort of 400 enrolled in the pharmaceutical care program approximates per-patient savings of 361.47 USD. Conclusion: This study reveals the significant clinical and economic benefits of CMM programs, led by multidisciplinary pharmaceutical professionals. The findings provide compelling evidence for hospital management to consider promoting such programs, drawing from the patient-centered care model in the United States applicable to Latin America.

Optimizing Heart Failure Management: A Review of the Clinical Pharmacist Integration to the Multidisciplinary Health Care Team.

Heart failure (HF) stands as a prevalent chronic ailment, imposing a substantial burden on global healthcare systems due to recurrent hospitalizations, intricate management, persistent symptoms, and polypharmacy challenges. The augmentation of patient safety and treatment efficacy across various care stages, facilitated by a multidisciplinary HF team inclusive of a clinical pharmacist, emerges as paramount. Evidence underscores that the collaborative engagement of a physician and a clinical pharmacist engenders proficient and secure management, forestalling avoidable adversities stemming from drug reactions and prescription inaccuracies. This synergistic approach tailors treatments optimally to individual patients. Post-discharge, the vulnerability of HF patients to re-hospitalization looms large, historically holding sway as the foremost cause of 30-day readmissions. Diverse strategies have been instituted to fortify patient well-being, leading to the formulation of specialized transitional care programs that shepherd patients effectively from hospital to outpatient settings. These initiatives have demonstrably curtailed readmission rates. This review outlines a spectrum of roles assumed by clinical pharmacists within the healthcare cohort, spanning inpatient care, transitional phases, and outpatient services. Moreover, it traverses a compendium of studies spotlighting the affirmative impact instigated by integrating clinical pharmacists into these fields.

Weather and electrical demand and consumption data of a small Mexican community.

The development of novel technologies to mitigate the effects of climate change through Smart Grids requires energy related data. Unfortunately, this type of data is not always available in Mexico, especially from non-large urban areas and at the household level. Therefore, we present a dataset that contains electrical demand and consumption time series of 5 households within a small community in Mexico, at various resolutions, as well as weather data. The electrical demand is given in 15 min resolution, while the electrical consumption is presented in both hourly and daily resolutions. The data is contained within 15 separate .csv files; one for each household's resolution. In turn, the weather data is given in two .csv files (for outdoor and indoor variables, respectively) that together contain 24 meteorological variables measured in a 5 min resolution that is not always consistent. The dataset comprises of two separate folders that contain either the electrical demand and consumption files or the weather files. This dataset could aid in the development of novel smart grid methods and algorithms that might be able to push the energy transition in Mexico and other developing countries forward.

Microbiome and plant cell transformation trigger insect gall induction in cassava.

Several specialised insects can manipulate normal plant development to induce a highly organised structure known as a gall, which represents one of the most complex interactions between insects and plants. Thus far, the mechanism for insect-induced plant galls has remained elusive. To study the induction mechanism of insect galls, we selected the gall induced by Iatrophobia brasiliensis (Diptera: Cecidomyiidae) in cassava (Euphorbiaceae: Manihot esculenta Crantz) as our model. PCR-based molecular markers and deep metagenomic sequencing data were employed to analyse the gall microbiome and to test the hypothesis that gall cells are genetically transformed by insect vectored bacteria. A shotgun sequencing discrimination approach was implemented to selectively discriminate between foreign DNA and the reference host plant genome. Several known candidate insertion sequences were identified, the most significant being DNA sequences found in bacterial genes related to the transcription regulatory factor CadR, cadmium-transporting ATPase encoded by the cadA gene, nitrate transport permease protein (nrtB gene), and arsenical pump ATPase (arsA gene). In addition, a DNA fragment associated with ubiquitin-like gene E2 was identified as a potential accessory genetic element involved in gall induction mechanism. Furthermore, our results suggest that the increased quality and rapid development of gall tissue are mostly driven by microbiome enrichment and the acquisition of critical endophytes. An initial gall-like structure was experimentally obtained in M. esculenta cultured tissues through inoculation assays using a Rhodococcus bacterial strain that originated from the inducing insect, which we related to the gall induction process. We provide evidence that the modification of the endophytic microbiome and the genetic transformation of plant cells in M. esculenta are two essential requirements for insect-induced gall formation. Based on these findings and having observed the same potential DNA marker in galls from other plant species (ubiquitin-like gene E2), we speculate that bacterially mediated genetic transformation of plant cells may represent a more widespread gall induction mechanism found in nature.

El papel de la Ivabradina y la titulación de los betabloqueadores en la insuficiencia cardíaca: una serie de casos y revisión de la literatura / The role of Ivabradine and beta-blocker titration in heart failure: a case series and literature review

RESUMEN Introducción y objetivos : La insuficiencia cardíaca (IC) es una preocupación creciente de salud pública. Si bien los betabloqueantes (BB) son la base del tratamiento, lograr reducciones objetivo de frecuencia cardíaca puede ser difícil debido a los efectos secundarios y la tolerancia limitada. La ivabradina, un inhibidor único de la corriente If, ofrece un enfoque complementario para controlar la frecuencia cardíaca sin afectar la contractilidad. El objetivo de este estudio fue evaluar la eficacia de agregar ivabradina a la terapia BB en pacientes con IC. Métodos: Se realizó un estudio observacional retrospectivo en un hospital privado en San José, Costa Rica se analizaron 7 casos de pacientes tratados con BB a los cuales posteriormente se les adicionó ivabradina. Se recopilaron datos demo- gráficos, las características clínicas, la frecuencia cardíaca previa y posterior a la ivabradina, la clase funcional NYHA y los valores de laboratorio seleccionados. Resultados: La ivabradina redujo significativamente la frecuencia cardíaca en reposo en un promedio de 26,87 latidos por minuto. El 42,86% alcanzó la dosis meta de su BB inicial después de agregar ivabradina. La clase funcional NYHA se mantuvo estable o mejoró en todos los casos. Conclusiones: Estos resultados sugieren que agregar ivabradina a la terapia BB puede ser una estrategia eficaz para optimizar el control de la frecuencia cardíaca en pacientes con IC. Este enfoque puede mejorar la tolerabilidad de BB, lo que lleva a un mayor manejo de la dosis meta y posiblemente mejores resultados clínicos.

ABSTRACT Introduction and objectives: Heart failure (HF) is a growing public health concern. While beta-blockers (BBs) are the cornerstone of treatment, achieving target heart rate reductions can be difficult due to side effects and limited tolerance. Ivabradine, a unique inhibitor of the If current, offers a complementary approach to controlling heart rate without affecting contractility. This study aimed to evaluate the effectiveness of adding ivabradine to BB therapy in patients with HF. Methods : A retrospective observational study was conducted at a private hospital in San José, Costa Rica. Seven cases of patients treated with BBs who were subsequently added to ivabradine were analyzed. Demographic data, clinical characteristics, heart rate before and after ivabradine, NYHA functional class, and selected laboratory values were collected. Results : Ivabradine significantly reduced resting heart rate by an average of 26.87 beats per minute. Forty-two-point eight-six percent (42.86%) achieved the target dose of their initial BB after adding ivabradine. NYHA functional class remained stable or improved in all cases. Conclusions: These results suggest that adding ivabradine to BB therapy may be an effective strategy to optimize heart rate control in patients with HF. This approach may improve BB tolerability, leading to greater target dose management and possibly better clinical outcomes.

Impact of the Five-Year Intervention of an Antimicrobial Stewardship Program on the Optimal Selection of Surgical Prophylaxis in a Hospital without Antibiotic Prescription Restrictions in Costa Rica: A Retrospective Study.

This study aims to characterize the impact of the implementation of an antimicrobial stewardship program (AMS) on the optimal selection of surgical antibiotic prophylaxis in adult patients. This is a retrospective quasi-experimental study that compared the selection and duration of antibiotics for all surgical prophylaxis prescriptions over six months, both before (pre-AMS) and after a five-year intervention of AMS (post-AMS). In addition, data related to the consumption of antibiotics, adverse drug reactions, and surgical site infections throughout the years of the intervention were analyzed. The rate of appropriate selection of antibiotic prophylaxis in surgical procedures improved to 80% during the post-AMS period. The percentage of optimal duration increased from 69.1% (N = 1598) in the pre-AMS period to 78.0% (N = 841) in the post-AMS period (p < 0.001). The consumption of ceftriaxone significantly decreased, while the use of cefazolin increased more than nine times. No severe adverse reactions or increases in surgical site infections were detected after the intervention. The implementation of an AMS in the surgical ward demonstrated a trend towards a positive overall impact on the selection and duration of prophylactic antibiotics for surgery, with positive results also observed in other variables associated with the prescription of these antibiotics.

The role of TNF receptors as mediators of chronic vasculitis in possible milder forms of the CNS tuberculosis.

INTRODUCTION: Central nervous system (CNS) tuberculosis (TB) is the most severe form of TB due to its high mortality and functional sequelae. There are several differential diagnoses for TB; and, it can also cause secondary conditions, such as vasculitis. METHODOLOGY: 155 biopsies, corresponding to 155 different patients out of 5,386 registered biopsies from 2008-2013, met the criteria of unknown etiology vasculitis and evidence of cerebral vascular disease. These were analyzed to assess the presence of central nervous system TB. The selected cases were assessed with Suzaan Marais (SM) criteria for clinical tuberculosis. After that, Ziehl-Neelsen (ZN) staining and polymerase chain reaction (PCR) were performed to amplify a fragment of the insertion sequence IS6110 of M. tuberculosis. 21 patients met the criteria for definitive tuberculosis by ZN staining and PCR, and 2 met the criteria for possible tuberculosis. Tumor necrosis factor (TNF)-α, TNF-R1, and TNF-R2 were determined by immunohistochemistry in histological sections from formalin-fixed paraffin-embedded (FF-PE) tissues in the 23 selected patients. RESULTS: Granulomatous TB was present in almost half of the cases. TNF-R1 and TNF-R2 were expressed mainly in blood vessels, histiocytes, and macrophages. TNF-R2 expression was higher than the other markers, which suggests an anti-inflammatory response against M. tuberculosis. CONCLUSIONS: The histopathological presentation of TB is not always limited to granulomas, abscesses, or meningitis; there are also clinical presentations characterized only with chronic inflammation of nervous and vascular tissue.

Measuring and Energizing Sensor System for Digital Signal Monitoring of an Academic-Experimental CubeSat for Wireless Telemetry Purposes.

Space technology for small satellites has made significant progress in the academic and industrial fields, and an alternative focused on educational institutions is the CubeSat standard, created to promote various scientific projects of space exploration. In this context, a fundamental module of any satellite is the telemetry subsystem, which controls the communication with the Earth through electronic circuits dedicated to remote communication; also, the measurement and power supply modules are integrated into a CubeSat. Its construction costs range from USD 2500 to 55,000, with suppliers from Europe and the United States. This motivates the development of the present project, aimed at an academic-experimental CubeSat-1U prototype, to limit this technological dependence, focusing on the measurement generated by the acceleration sensors, angular velocity, magnetic fields, barometric pressure, temperature and ultraviolet light intensity, and the energization of each of them. For this, the main objective of the research is to identify the four basic subsystems of the CubeSat-1U: (a) energization subsystem, (b) sensing subsystem, (c) transmission and reception subsystem, and (d) control subsystem. To describe in detail the construction of (a) and (b), a set of diagrams is performed, defining their operation and its interaction. To explain the subsystem's construction, the components selection and integration are presented. As a result, the electrical measurements generated by the power system, the output of the sensors in laboratory conditions, and images of the developed circuits are presented, having as a contribution to the methodology of design, integration, and development of the four subsystems, the feasibility of construction and its implementation in an academic satellite.