Mediation effect of body mass index on the association between serum magnesium level and insulin resistance in children from Mexico City.

BACKGROUND/OBJECTIVES: Reduced serum magnesium (Mg) levels have been associated with obesity, insulin resistance (IR), type 2 diabetes, and metabolic syndrome in adults. However, in the children population, the evidence is still limited. In this cross-sectional study, we aimed to analyze the association of serum Mg levels with the frequency of overweight and obesity and cardiometabolic traits in 189 schoolchildren (91 girls and 98 boys) between 6 and 12 years old from Mexico City. SUBJECTS/METHODS: Anthropometrical data were collected and biochemical parameters were measured by enzymatic colorimetric assay. Serum Mg level was analyzed by inductively coupled plasma mass spectrometry (ICP-MS). The triglyceride-glucose (TyG) index was used as a surrogate marker to evaluate IR. RESULTS: Serum Mg level was negatively associated with overweight (Odds ratio [OR] = 0.377, 95% confidence interval [CI] 0.231-0.614, p < 0.001) and obesity (OR = 0.345, 95% CI 0.202-0.589, p < 0.001). Serum Mg level resulted negatively associated with body mass index (BMI, ß = -1.16 ± 0.26, p < 0.001), BMI z-score (ß = -0.48 ± 0.10, p < 0.001) and TyG index (ß = -0.04 ± 0.04, p = 0.041). Through a mediation analysis was estimated that BMI z-score accounts for 60.5% of the negative association of serum Mg level with IR (Sobel test: z = 2.761; p = 0.005). CONCLUSION: Our results evidence that BMI z-score mediate part of the negative association of serum Mg level and IR in Mexican schoolchildren.

Overweight, Obesity, Hypertriglyceridemia, and Insulin Resistance Are Positively Associated with High Serum Copper Levels in Mexican Adults.

Recently, the role of trace elements in the pathophysiology of obesity, insulin resistance (IR), and metabolic diseases has been explored. In this cross-sectional study, we aimed to assess the association of overweight, obesity, and cardiometabolic traits with serum copper (Cu) levels in 346 Mexican adults. Serum Cu level was measured by inductively coupled plasma mass spectrometry (ICP-MS). Anthropometrical data were collected, and biochemical parameters were measured. The triglyceride-glucose (TyG) index was used as a surrogate marker to evaluate IR. Overweight and obesity status was positively associated with the serum Cu level (ß = 19.434 ± 7.309, p = 0.008). Serum Cu level was observed to have a positive association with serum triglycerides level (ß = 0.160 ± 0.045, p < 0.001) and TyG (ß = 0.001 ± 0.001, p < 0.001). Additionally, high serum Cu level was positively associated with overweight and obesity status (odds ratio [OR] = 1.9, 95% confidence interval [95% CI] 1.1-3.4, p = 0.014), hypertriglyceridemia (OR = 3.0, 95% CI 1.7-5.3, p < 0.001), and IR (OR = 2.6, 95% CI 1.4-4.6, p = 0.001). In conclusion, our results suggest that overweight, obesity, hypertriglyceridemia, and IR are positively associated with serum Cu levels in Mexican adults.

Imaging and Quantitative Analysis on the Etching of Diatom Frustules via Digital Holographic Microscopy.

Frustules, whose length spans from a few micrometers to more than a hundred micrometers, have been the subject of various modifications to improve their physical properties because of their complex porous silica structure. However, three-dimensional measurements of these changes can be challenging because of the complex 3D architecture and limitations of known methods. In this study, we present a new method that applies digital holographic microscopy (DHM) to analyze controlled etched frustules and observe real-time degradation of frustules at the single-cell level. Frustules obtained from Craspedostauros sp. diatoms were etched in 1 N NaOH for 5 min at 25 and 60 °C, respectively, and the frustule's valve was analyzed using DHM. DHM uses a combination of holography and tomography to reconstruct a 3D refractive index image of the frustule. Measurements of the width, volume, and surface area are achieved. Results showed that at 60 °C of etching, a significant difference with the unetched frustule was observed for all measurements but with high fluctuation values. Finally, real-time observation of the degradation of the frustule is observed when immersed in a high concentration of NaOH. This is the first time the real-time etching of the frustule is observed at the single-cell level. This research provides an easy estimation of the 3D measurements of frustules that may provide new fundamental information and applications.

Effectiveness of Virtual Reality and Feedback to Improve Gait and Balance in Patients with Diabetic Peripheral Neuropathies: Systematic Review and Meta-Analysis.

Diabetic peripheral neuropathy (DPN) is the primary complication in patients with diabetes mellitus, characterized by loss of sensation and function in the lower limbs. Virtual reality (VR) and/or sensory feedback (FB) therapy has shown positive effects in other neurologic conditions such as stroke. However, consensus regarding their effectiveness in the DPN population is lacking. This study aims to analyze existing scientific evidence about the effects of VR and/or FB on improving gait and balance and reducing the risk of falls in patients with DPN (pwDPN). A thorough search was conducted in scientific databases including PubMed, Scopus, and EMBASE, up until November 2023. CMSQ, the PEDro scale, and the Cochrane Collaboration's tool were used to assess the methodological quality and risk of bias of the studies. A total of 10 studies were selected for qualitative analysis, with three contributing information to the meta-analysis. The combined results suggest a positive trend in favor of VR and FB rehabilitation; however, significant differences were not observed in balance (SMD = -0.81, 95% CI = -1.90, 0.29; p = 0.15; I2 = 86%) or gait speed improvements (MD = -1.05, 95% CI = -2.96, 0.85; p = 0.28; I2 = 89%). Therefore, further randomized controlled studies are still needed to achieve stronger conclusions regarding the benefits of VR and/or FB in pwDPN.

Molecular Detection and Characterization of Mycoplasma spp. in Marine Mammals, Brazil.

Mycoplasma spp. are wall-less bacteria able to infect mammals and are classified as hemotropic (hemoplasma) and nonhemotropic. In aquatic mammals, hemoplasma have been reported in California sea lions (Zalophus californianus) and river dolphins (Inia spp.). We investigated Mycoplasma spp. in blood samples of West Indian manatees (Trichechus manatus), pinnipeds (5 species), and marine cetaceans (18 species) that stranded or were undergoing rehabilitation in Brazil during 2002-2022. We detected Mycoplasma in blood of 18/130 (14.8%) cetaceans and 3/18 (16.6%) pinnipeds. All tested manatees were PCR-negative for Mycoplasma. Our findings indicate that >2 different hemoplasma species are circulating in cetaceans. The sequences from pinnipeds were similar to previously described sequences. We also detected a nonhemotropic Mycoplasma in 2 Franciscana dolphins (Pontoporia blainvillei) that might be associated with microscopic lesions. Because certain hemoplasmas can cause disease and death in immunosuppressed mammals, the bacteria could have conservation implications for already endangered aquatic mammals.

Analysis of Physical-Cognitive Tasks Including Feedback-Based Technology for Alzheimer's Disorder in a Randomized Experimental Pilot Study.

INTRODUCTION: Alzheimer's disease causes great changes, with the prefrontal cortex being the most frequently damaged zone; these changes affect physical and cognitive behavior and compromise autonomy. OBJECTIVE: The objective of this study was to evaluate the effects of physical-cognitive tasks on memory, attention, balance, gait, and risk of falling in Alzheimer's by using feedback-based technology. METHODS: Forty patients with Alzheimer's were recruited from an Alzheimer's Association; of these, 15 met the inclusion criteria and were included in the pilot RCT (eight in the control group; seven in the experimental group). ASSESSMENT TOOLS: The Cognitive Mini-Examination Scale, Oddball Test and Attention Network, Berg Scale, Tinetti, Timed Up and Go, and Geriatric Deterioration Scale. The experimental group was treated with physical-cognitive tasks by using combined feedback-based technology (visual, acoustic, simultaneous, immediate, and terminal feedback, as well as knowledge of the results and performance) under the supervision of physiotherapists twice per week for 16 thirty-minute sessions. The control group underwent their usual care (pharmacological treatment, mobility exercises, and cognitive stimulation sessions). RESULT: In the experimental group, the contrast tests showed differences for the re-test (except in attention), with the significative Timed Up and Go test being significant (p = 0.020). The interaction between groups showed significant differences for the experimental group according to the MEC (p = 0.029; d = 0.14) and Tinetti (p = 0.029; d = 0.68). DISCUSSION/CONCLUSION: Memory, balance, gait, and risk of falling improved in the Alzheimer's patients through the use of physical-cognitive tasks involving combined feedback-based technology. The effects on attention were inconclusive. The outcomes should be treated with caution due to the sample. This can promote intergenerational bonds, use at home, and adherence to treatment.

Serum levels of anti-inflammatory/proinflammatory adipocytokines, and copper levels in overweight and obese women in an adult Mexican population.

BACKGROUND: An imbalance between adipokines and micronutrient concentrations, such as those of copper (Cu), has been linked to dysregulation of energy homeostasis leading to weight gain and the development of other comorbidities; however, information on this issue remains limited. Our aim was to investigate the correlation between Cu status and serum adipokine levels and their relationship in normal-weight, overweight, and obese adult women. METHODS: Sixty patients were evaluated and classified according to their body mass index (BMI) and biochemical parameters; adipokines and Cu were measured at fasting. RESULTS: Leptin (Lep) and resistin (Res) levels were elevated, whereas adiponectin (Adpn) and ghrelin (Ghr) values were decreased in overweight and obese women (p = 0.001). The mean Adpn/Lep ratio was <0.5 in overweight and obese subjects, while the Lep/Ghr ratio increased significantly in relation to weight gain, suggesting an inverse link between the ratios of these hormones in the regulation of obesity. The analysis revealed a positive association between BMI and Cu levels in obese women. Moreover, a negative association between Cu and Res in normal-weight subjects was found. CONCLUSIONS: Circulating fasting Res levels are negatively associated with serum Cu concentration in normal-weight adult women. We also observed a close relationship between Adpn/Lep and Lep/Ghr ratios with obesity. However, more observational studies are required to confirm these results in future research.

Relationship of Serum Zinc Levels with Cardiometabolic Traits in Overweight and Obese Schoolchildren from Mexico City.

Zinc (Zn) participates as a cofactor for many enzymes in the cellular metabolism, and its serum levels have been associated with different metabolic diseases, especially obesity (OB). Nevertheless, its associations are not clear in the children population. The objective of this study is to evaluate the association between serum Zn levels (SZn) with overweight/obesity status (OW/OB), as well as its cardiometabolic traits in a population of children in Mexico City. Anthropometrical data (body mass index z score (BMIz)), demographic variables (age and sex), and cardiometabolic traits (total cholesterol (TC), high-density lipoprotein cholesterol (HDLc), low-density lipoprotein cholesterol (LDLc), triglycerides (TG), fasting plasma glucose (FPG), and insulin) were analyzed in this cross-sectional study. SZn were measured by inductively coupled plasma mass spectrometry (ICP-MS). The population included 210 children from Mexico City (girls (n = 105) and boys (n = 105)) between ages 6 and 10 years. Normal-weight (NW) schoolchildren had higher SZn concentrations (66 µg/dL; IQR: 48 to 91) compared to OW or OB schoolchildren (61 µg/dL; IQR: 45 to 76). The data showed a significant negative association between SZn and BMIz without sex exclusion (r = - 0.181 and p = 0.009). The boy's population did not show an association between the SZn and BMIz compared to the girl's population which showed a significant negative association (r = - 0.277 and p = 0.004). In addition, other associations were found between SZn and TC (boys (r = 0.214 and p = 0.025), LDLc (boys (r = 0.213 and p = 0.029), and TG (girls (r = - 0.260 and p = 0.007)). Moreover, 38.6% of the total children in our population study had Zn deficiency (ZnD). NW schoolchildren had higher SZn concentrations compared to OW or OB schoolchildren. A diet low in Zn can be a factor to evaluate in the development of childhood OB in Mexico. However, further studies need to be performed on the children Mexican population to replicate and confirm our findings.

Overweight and Obesity Are Positively Associated with Serum Copper Levels in Mexican Schoolchildren.

Due to its relationship with oxidative stress and inflammation responses, obesity and its cardiometabolic implications have been related with serum copper (Cu). Hence, we analyzed the association of overweight (OW) and obesity (OB) status and cardiometabolic traits with serum Cu level in Mexican schoolchildren. Anthropometrical data and cardiometabolic traits were analyzed in this cross-sectional study. Serum Cu level was measured by inductively coupled plasma mass spectrometry. The study involved 191 schoolchildren (93 girls and 98 boys) with a mean age of 8.054 ± 1.170 years. Children with OW and OB had higher serum Cu levels than children with normal weight (NW) (mean difference: OW vs NW = 51.85 µg dL-1, OB vs NW = 47.22 µg dL-1, p < 0.001). In a multiple linear regression model, OW and OB status were positively associated with serum Cu levels (ßOW = 49.85, 95% confidence interval (95% CI) 35.84-63.87, p < 0.001; ßOB = 44.38, 95% CI 27.70-61.05, p < 0.001). We did not identify any significant association between cardiometabolic traits and serum Cu level. In conclusion, our results show an association of the presence of OW and OB with higher serum Cu levels, for the first time in Mexican schoolchildren. However, further functional studies are needed to better understand the role of Cu in the pathophysiology of obesity.

SANT esplénico: tumoración infrecuente / Splenic SANT: Uncommon tumor

La Transformación Nodular Angiomatoide Esclerosante del bazo (SANT) es una patología poco común, que afecta a vasos sanguíneos de forma benigna con esclerosis extensa de la pulpa roja. Paciente masculino, 24 años, consulta en centro privado (Paraguay) por un cuadro de 7 meses de evolución de disnea paroxística y sudoración fría. Al examen físico y laboratorial sin datos de valor. La ecografía abdominal demuestra bazo con parénquima inhomogéneo con imagen pseudonodular 48x41 mm de diámetro, la RMN con contraste confirma hallazgo por nódulo irregular, con realce que predomina en la periferia de la fase arterial, con aspecto radiado y relleno centrípeto en fase venosa y tardía, la histopatología confirma diagnóstico clínico-imagenológico de SANT. Esta tumoración es frecuente entre los 45 a 48 años, manifestada con esplenomegalia, poca sintomatología, llama la atención la presentación del caso que se contrapone con la bibliografía. Considerando la falta de métodos auxiliares para descartar la malignidad, se aplica esplenectomía como conducta terapéutica.

Nodular Angiomatoid Sclerosing Transformation of the Spleen (SANT) is a rare pathology, which affects blood vessels benignly with extensive sclerosis of the red pulp. A 24-year-old man consulted in a private center (Paraguay) for a 7-month course of paroxysmal dyspnea and cold sweating. Physical examination and laboratory evaluation show no abnormalities. Abdominal ultrasound shows a spleen with heterogeneous parenchyma and a pseudonodular image that is 48mm x 41mm in diameter. Contrasted MRI confirms the finding of an irregular nodule, with enhancement that predominates in the periphery of the arterial phase, with radiated appearance and centripetal filling in venous and late phase. Histopathology confirms diagnosis of SANT. SANT is frequent between 45 and 48 years of age, manifested with splenomegaly and scarce symptomatology. The presentation of this case differs with literature. Considering the lack of auxiliary methods to rule out malignancy, a splenectomy is performed.

Effectiveness of feedback-based technology on physical and cognitive abilities in the elderly.

Aging raises a social and health challenge because the passing of time causes changes in cognitive and physical functions that impair functionality and quality of life. In addition, advancements in technology and information technology have led to the development of new techniques for retraining based on the feedback technology provides. To solve the negative consequences of aging, a randomized clinical trial was carried out to assess the effectiveness of a protocol using feedback-based technology to improve physical and cognitive functions in older adults. For the purpose of this study, 200 patients were selected from a Social and Community Services Center in the province of Seville and only 46 of them became participants of the study (after applying the inclusion criteria). These patients were divided into two groups: control and experimental. Physical and cognitive abilities were assessed using the Miniexamen cognoscitivo Test (an adaptation of the MiniMental examination test), Yesevage's Depression Scale, Oddball Test, Attention Network Test, Berg Scale, Tinetti Scale, and Timed Up and Go Test. The intervention applied to the experimental group consisted of a supervised protocol using the Nintendo® Wii video game console and the Wii-Fit© video game during 16 sessions, 2 times a week with a duration of 30 min per session. The control group did not receive any treatment. The experimental group showed statistically significant improvements in all the physical variables (balance, gait, autonomy, and fall risk), as other authors had proven, and in memory and reaction times; there were no improvements in attention networks. The control group (placebo) even showed a decrease in their functions, with worse results on the Timed up and Go test Scale. The intervention using feedback-based technology has been proven effective in improving physical and cognitive abilities and in preventing and promoting healthy aging.

Relationship of thorium, uranium isotopes and uranium isotopic ratios with physicochemical parameters in cenote water from the Yucatán Peninsula.

Uranium (U) and Thorium (Th) concentrations are normally low in the water (<30 and 5 ng mL-1, respectively). However, we performed a direct analysis of 232Th, 234U, 235U and 238U in cenote water from the Yucatán Peninsula using Inductively Coupled Plasma Mass Spectrometry (ICP-MS) as a rapid response technique to perform environmental radioactivity monitoring. Water samples were collected in 2021 from the cenotes and these were certificated by zones (PYNO, PYNE and PYSE) and monitoring depth [surface water (n = 52) and depth water (n = 48)]. Moreover, physicochemical parameters such as pH, electrical conductivity (EC), total dissolved solids (TDS), and temperature were measured in situ. Results obtained were total U and Th levels below permissible for human consumption. However, physicochemical parameters must be considered before use because it is outside the permissible limits in most cenotes. The median concentration value for 234U, 235U, 238U and 232Th in surface + depth water were 0.0001 ng mL-1, 0.0130 ng mL-1, 1.76 ng mL-1, and 0.062 ng mL-1, respectively. In addition, isotopic ratio of 235U/238U in surface + depth water was 0.00730. In addition, the PYNO zone showed a correlation between 232Th with EC and TDS. The PYSE zone showed a correlation between 232Th and temperature, and 235U/234U with pH, while PYEN did not show correlations. In conclusion, the first time evaluated U isotope concentrations and isotopic ratios of U and 232Th in cenote water from the Yucatán Peninsula, where U and Th concentrations were found below the permissible limits mentioned by guidelines for drinking-water quality. The average of 235U/238U is similar to isotopic ratios in "natural" water.

Sex-Specific Association between Fasting Plasma Glucose and Serum Selenium Levels in Adults from Southern Mexico.

Selenium (Se) is an essential trace element that by its antioxidant properties has been studied to elucidate its participation in the development of obesity and type 2 diabetes. We evaluated the association between cardiometabolic traits and serum Se levels in a sample of adults from southern Mexico. In 96 nondiabetic individuals, anthropometric data and clinical biochemistry measurements were analyzed. Serum total Se levels were measured with inductively coupled plasma mass spectrometry (ICP-MS). Serum Se level in the whole sample was 10.309 ± 3.031 µg mL-1 and no difference between the women and men was observed (p = 0.09). Additionally, fasting plasma glucose (FPG) was significantly associated with serum Se level (ß = -0.07 ± 0.03, p = 0.02, analysis adjusted for age, sex and BMI). Furthermore, sex shows significant interaction with FPG on the serum Se levels (p = 0.01). A follow-up analysis revealed the particular association between FPG and Se levels in women (ß = -0.10 ± 0.04, p = 0.01). In conclusion, our data evidenced a women-specific association between FPG and serum Se levels in a sample of adults from southern Mexico.

Frecuencia de complicaciones neurológicas de hemorragia subaracnoidea

RESUMEN Introducción: las complicaciones neurológicas más frecuentes de la hemorragia subaracnoidea son el vasoespasmo cerebral, el resangrado y la hidrocefalia. Las convulsiones que pueden asociarse son generalmente secundarias a las anteriores. La aparición de éstas influye en la morbimortalidad de los pacientes afectados. Objetivo: determinar la frecuencia de complicaciones clínicas de la hemorragia subaracnoidea Material y métodos: se aplicó un estudio observacional, descriptivo, de corte transversal, retrospectivo. Se incluyeron 105 pacientes adultos con hemorragia subaracnoidea que acudieron al Hospital Nacional, Itauguá, Paraguay, en el periodo 2020-2021. Resultados: la edad media fue 52 ±15 años. La mayoría de los pacientes fue del sexo femenino (59,05%) y provenía del Departamento Central. La hipertensión arterial fue la principal comorbilidad. La mayoría de los pacientes presentó Fisher 4 en la tomografía simple de cráneo y la presentación clínica fue el Hunt y Hess 2. El vasoespasmo fue la complicación neurológica más frecuente. La mortalidad fue 54,29%. Conclusión: la escala de Fisher 4 y la de Hunt y Hess 2 fueron los grados de presentación imagenológica y afectación clínica más frecuentes. La complicación neurológica predominante fue el vasoespasmo, aislado o asociado a otras complicaciones como hidrocefalia o resangrado. La mortalidad fue 54,29%.

ABSTRACT Introduction: The most frequent neurological complications of subarachnoid hemorrhage are cerebral vasospasm, rebleeding and hydrocephalus. The seizures that may be associated are generally secondary to these complications. Their appearance influences the morbidity and mortality of affected patients. Objective: To determine the frequency of clinical complications of subarachnoid hemorrhage Material and methods: An observational, descriptive, cross-sectional, retrospective study was used. One hundred five adult patients with subarachnoid hemorrhage who attended the Hospital Nacional of Itauguá, Paraguay, in the period 2020-2021 were included. Results: The mean age was 52±15 years. Most of the patients were female (59.05%) and came from the Central Department. Arterial hypertension was the main comorbidity. Most of the patients presented Fisher grade 4 in the simple skull tomography and the clinical presentation was Hunt and Hess grade 2. Vasospasm was the most frequent neurological complication while mortality was 54.29%. Conclusion: The Fisher grade 4 and the Hunt and Hess grade were the most frequent grades of imaging presentation and clinical involvement. The predominant neurological complication was vasospasm, isolated or associated with other complications such as hydrocephalus or rebleeding. Mortality was 54.29%.

Complicaciones vasculares en pacientes hipertensos jóvenes de un hospital de Paraguay

RESUMEN Introducción: la hipertensión arterial es una enfermedad que se caracteriza por la elevación sostenida de la presión arterial. Su aparición a temprana edad se ha duplicado en los últimos años, por lo que se espera un incremento de las complicaciones vasculares relacionadas a ella, como la manifestación de accidente cerebrovascular isquémico o hemorrágico, infarto agudo de miocardio, nefropatía hipertensiva, preeclampsia, eclampsia. Los factores de riesgos asociados de gran influencia como el antecedente patológico familiar entre otros se encuentran relacionados a su aparición. Objetivo: determinar las características clínicas de pacientes hipertensos menores de 50 años en el Hospital Nacional, Itauguá, Paraguay, en el periodo 2020-2021. Metodología: estudio observacional, descriptivo, retrospectivo de corte transversal, analítico que incluyo 150 pacientes con hipertensión arterial, de ambos sexos, menores de 50 años. Resultados: la edad media de la muestra fue 39 años, con rango entre 15-50 años, la mayoría provenía del área urbana, con nivel educativo secundario. Hubo predominio del sexo femenino (52%), sin embargo, las complicaciones vasculares fueron más frecuentes en el sexo masculino. Las complicaciones vasculares se detectaron en 89%, predominando el accidente cerebrovascular (26%), la retinopatía hipertensiva (24%) y la nefropatía de origen hipertensivo (22,6%). La mayoría de los pacientes presentaba factores de riesgo cardiovascular asociados, los principales fueron el sedentarismo y la diabetes mellitus tipo 2, así como el antecedente patológico familiar de hipertensión arterial. Conclusión: las principales complicaciones fueron el accidente cerebro vascular (26%), la retinopatía hipertensiva (24%) y la nefropatía de origen hipertensivo (22,6%). Se recomienda la detección precoz y el tratamiento oportuno de los hipertensos jóvenes.

ABSTRACT Introduction: Hypertension is a disease characterized by sustained elevation of blood pressure. Its appearance at an early age has doubled in recent years, therefore an increase in vascular complications related to it is expected, such as the manifestation of ischemic or hemorrhagic stroke, acute myocardial infarction, hypertensive nephropathy, preeclampsia, eclampsia. Associated risk factors of great influence, such as family pathological history, among others, are related to its appearance. Objective: To determine the clinical characteristics of hypertensive patients under 50 years of age at the Hospital Nacional of Itauguá, Paraguay, in the period 2020-2021. Methodology: Observational, descriptive, retrospective, cross-sectional, analytical study that included 150 male and female patients with arterial hypertension under 50 years of age. Results: The average age of the sample was 39 years, with a range between 15-50 years, the majority came from the urban area, and had secondary education level. There was a predominance of women (52%), however, vascular complications were more frequent in men. Vascular complications were detected in 89%, predominantly stroke (26%), hypertensive retinopathy (24%) and hypertensive nephropathy (22.6%). Most of the patients had associated cardiovascular risk factors, the main ones being sedentary lifestyle and type 2 diabetes mellitus, as well as a family pathological history of high blood pressure. Conclusion: The main complications were cerebrovascular accident (26%), hypertensive retinopathy (24%) and hypertensive nephropathy (22.6%). Early detection and timely treatment of young hypertensive patients is recommended.

Caracterización de la hipertensión arterial en adultos menores de 30 años de edad de un hospital del Paraguay

RESUMEN Introducción: la hipertensión arterial constituye el principal factor de riesgo para el desarrollo de enfermedades cardiovasculares. Su detección en adultos jóvenes obliga a buscar una causa secundaria y potencialmente corregible. Objetivo: determinar las características clínicas de la hipertensión arterial en adultos menores de 30 años de edad que acuden al Hospital Nacional, Itauguá, Paraguay, en el periodo 2019-2021. Sujetos y métodos: estudio descriptivo observacional retrospectivo de corte transversal donde se incluyó 50 pacientes entre 18 y 30 años de edad con hipertensión arterial. La investigación fue aprobada por el Comité de Ética de la Universidad Nacional de Itapúa, Paraguay. Resultados: la edad media fue 23 ± 4 años, en su mayoría eran provenientes de la zona urbana, siendo 58% del sexo masculino y con un bajo nivel educativo. La media de índice de masa corporal fue 23,5 ± 5 k/m2 y 58% no tenía antecedente familiar de hipertensión arterial. La media de cifras de presión arterial fueron 150 mmHg para la sistólica y 100 mmHg para la diastólica. La hipertensión arterial secundaria se detectó en 86% de la muestra. La etiología más frecuente fue la enfermedad renal parenquimatosa (86%), de los cuales 89% padecía enfermedad renal crónica y nefritis lúpica. La frecuencia de daño de órgano blanco fue de 86%, el fondo de ojo era anormal en 8%, 46% tenía hipertrofia ventricular izquierda por electrocardiograma y 58% por ecocardiograma, 78% tenía alteración de la arquitectura normal renal por ecografía, 57% presentaba creatininemia elevada, 76% trazas de proteínas en orina tomada al azar y 80% proteinuria de 24 hs elevada. Conclusión: la forma prevalente de hipertensión arterial en los adultos jóvenes estudiados fue la secundaria, con leve predominio del sexo masculino, con normopeso y sin antecedente familiar. La principal causa fue la enfermedad renal parenquimatosa. Más de la mitad de los casos presentó hipertrofia ventricular izquierda y proteinuria elevada.

ABSTRACT Introduction: High blood pressure is the main risk factor for the development of cardiovascular diseases. Its detection in young adults makes necessary to look for a secondary and potentially correctable cause. Objective: To determine the clinical characteristics of arterial hypertension in adults under 30 years of age who attended the Hospital Nacional of Itauguá, Paraguay, in the period 2019-2021. Subjects and methods: Retrospective observational cross-sectional descriptive study which included 50 patients between 18 and 30 years of age with arterial hypertension. The research was approved by the Ethics Committee of the National University of Itapúa, Paraguay. Results: The mean age was 23±4 years, most patients were from urban areas, 58% was male and had a low educational level. The mean body mass index was 23.5±5 k/m2 and 58% had no family history of arterial hypertension. The mean blood pressure values were 150 mmHg for systolic and 100 mmHg for diastolic. Secondary arterial hypertension was detected in 86% of the sample. The most frequent etiology was parenchymal kidney disease (86%), of which 89% had chronic kidney disease and lupus nephritis. The frequency of target organ damage was 86%, the eye fundus was abnormal in 8%, 46% had left ventricular hypertrophy by electrocardiogram and 58% by echocardiogram, 78% had abnormal renal architecture by ultrasound, 57% had elevated creatininemia, 76% trace protein in randomly collected urine, and 80% elevated 24-hour proteinuria. Conclusion: The prevalent form of arterial hypertension in the young adults studied was secondary, with a slight predominance of males, with normal weight and without family history. The main cause was renal parenchymal disease. More than half of the cases presented left ventricular hypertrophy and high proteinuria.

Evolución clínica del tratamiento empírico versus dirigido de la infección relacionada a catéter de hemodiálisis

RESUMEN Introducción: las infecciones relacionadas a catéteres utilizados en hemodiálisis constituyen una de las causas de morbimortalidad más frecuentes. No se dispone de estudios previos en el Paraguay que demuestren la diferencia entre tratamiento empírico y dirigido de infección relacionada a catéter de hemodiálisis Objetivo: determinar la evolución clínica del tratamiento empírico de la infección relacionada a catéter versus el tratamiento dirigido en pacientes adultos. Material y métodos: se aplicó un diseño observacional, retrospectivo, de corte transversal que incluyó 128 pacientes internados en el Hospital Nacional, Itauguá, Paraguay, durante los años 2020 y 2021. Fueron divididos en grupos de tratamiento dirigido (64 pacientes) y empírico (64 pacientes). Resultados: la edad media fue 52 ± 14 años. El acceso vascular yugular fue el más utilizado (78,91%). Se observó que el transcurso de días entre la colocación de catéter de hemodiálisis hasta su infección fue 16 ± 7,6 días. El crecimiento microbiano predominante en ambos grupos fue de cocos gram positivos (84,37%). S. aureus se aisló en 84,31% del grupo tratamiento dirigido y en 15,68% del grupo con tratamiento empírico. El grupo antibiótico más utilizado en ambos grupos fueron los glucopéptidos (77,34%) y la combinación más utilizada fue ciprofloxacina con vancomicina tanto en el grupo dirigido (37,5%) como en el empírico (31,25%). El desenlace curación de infección se observó en 90,62% en el grupo de tratamiento empírico y en 82,81% en el grupo dirigido. La frecuencia de sepsis fue 17,18% en el grupo empírico y 32,8% en grupo dirigido. La mortalidad fue 9,37% en grupo empírico y 14,06% en grupo dirigido. Conclusión: el germen más prevalente fue S. aureus. La curación de infección relacionada a catéter fue más frecuente en el grupo empírico, la mortalidad y sepsis predominaron en el grupo dirigido.

ABSTRACT Introduction: Infections related to catheters used in hemodialysis are one of the most frequent causes of morbidity and mortality. There are no previous studies in Paraguay that demonstrate the difference between empirical and directed treatment of hemodialysis catheter-related infection. Objective: To determine the clinical course of empirical treatment versus targeted treatment of catheter-related infection in adult patients. Material and methods: An observational, retrospective, cross-sectional design was applied including 128 patients admitted to the Hospítal Nacional of Itauguá, Paraguay, during the years 2020 and 2021. They were divided into directed (64 patients) and empirical (64 patients) treatment groups. Results: The mean age was 52 ± 14 years. The jugular vascular access was the most used (78.91%). It was observed that the time between hemodialysis catheter placement and infection was 16±7.6 days. The predominant microbial growth in both groups was gram-positive cocci (84.37%). S. aureus was isolated in 84.31% of the directed treatment group and in 15.68% of the empirical treatment group. The most used antibiotic group in both groups were glycopeptides (77.34%) and the most used combination was ciprofloxacin with vancomycin, both in the targeted group (37.5%) and in the empirical group (31.25%). The outcome of infection cure was observed in 90.62% in the empirical treatment group and in 82.81% in the directed group. The frequency of sepsis was 17.18% in the empirical group and 32.8% in the directed group. Mortality was 9.37% in the empirical group and 14.06% in the directed group. Conclusion: The most prevalent germ was S. aureus. Cure of catheter-related infection was more frequent in the empiric group, while mortality and sepsis predominated in the directed group.

Complicaciones de la endocarditis infecciosa al momento del diagnóstico y su relación con los gérmenes aislados en pacientes adultos

RESUMEN Introducción: la endocarditis infecciosa es una enfermedad de una variada presentación clínica. Es cada vez más frecuente debido a los cuidados relacionados con la salud. Objetivo: determinar las complicaciones de los pacientes con endocarditis infecciosa bacteriana al momento del diagnóstico y su relación con el agente causal y ofrecer una descripción general de las características demográficas y clínicas presentes en pacientes del Hospital Nacional, Itauguá, Paraguay, en el periodo 2017-2021. Material y métodos: estudio descriptivo, observacional, retrospectivo que incluyo 37 pacientes con el diagnóstico de endocarditis infecciosa con germen aislado. Resultados: la edad media fue 45 ±14 años, la mayoría provenía del área urbana y era del sexo masculino (65%). La comorbilidad más frecuente fue enfermedad renal crónica (50%). Los procedimientos invasivos (catéter venoso central simple) fueron el foco de bacteriemia más frecuente (65,22%). La válvula más comprometida fue la aórtica, la complicación más frecuente fue la insuficiencia cardiaca (70,27%), hubieron 49% de desenlaces fatales. El germen más frecuente y causante de la mayor morbimortalidad fue Staphylococcus aureus (43,24%). Conclusión: la enfermedad renal crónica fue el principal factor de riesgo. Ser portador de catéter venoso simple de hemodiálisis estuvo relacionado al aislamiento del Staphylococcus aureus como agente causal más frecuente. Este germen estuvo relacionado a la alta tasa de complicaciones al momento del ingreso y con el alto porcentaje de desenlaces fatales.

ABSTRACT Introduction: Infective endocarditis is a disease with a varied clinical presentation. It is becoming more frequent due to health-related care. Objective: To determine the complications of patients with bacterial infective endocarditis at the time of diagnosis and their relationship with the causal agent and offer a general description of the demographic and clinical characteristics present in patients of the Hospital Nacional of Itauguá, Paraguay, in the period 2017- 2021. Material and methods: Descriptive, observational, retrospective study that included 37 patients diagnosed with infective endocarditis with isolated germ. Results: The mean age was 45±14 years, the majority came from the urban area and was male (65%). The most frequent comorbidity was chronic kidney disease (50%). Invasive procedures (simple central venous catheter) were the most frequent source of bacteremia (65.22%). The most compromised valve was the aortic, the most frequent complication was heart failure (70.27%) and there was 49% of fatal outcomes. The most frequent germ and cause of the highest morbidity and mortality was Staphylococcus aureus (43.24%). Conclusion: Chronic kidney disease was the main risk factor. Being a carrier of a simple venous hemodialysis catheter was related to the isolation of Staphylococcus aureus as the most frequent causal agent. This germ was related to the high rate of complications at the time of admission and the high percentage of fatal outcomes.

Effect of the side of presentation in the visual field on phase-locked and nonphase-locked alpha and gamma responses.

Recent studies have suggested that nonphase-locked activity can reveal cognitive mechanisms that cannot be observed in phase-locked activity. In fact, we describe a concomitant decrease in nonphase-locked alpha activity (desynchronization) when stimuli were processed (alpha phase-locked modulation). This desynchronization may represent a reduction in "background activity" in the visual cortex that facilitates stimulus processing. Alternatively, nonphase-locked gamma activity has been hypothesized to be an index of shifts in attentional focus. In this study, our main aim was to confirm these potential roles for nonphase-locked alpha and gamma activities with a lateralized Go/NoGo paradigm. The results showed that nonphase-locked alpha modulation is bilaterally represented in the scalp compared to the contralateral distribution of the phase-locked response. This finding suggests that the decrease in background activity is not limited to neural areas directly involved in the visual processing of stimuli. Additionally, gamma activity showed a higher desynchronization of nonphase-locked activity in the ipsilateral hemisphere, where the phase-locked activity reached the minimum amplitude. This finding suggests that the possible functions of nonphase-locked gamma activity extend beyond shifts in attentional focus and could represent an attentional filter reducing the gamma representation in the visual area irrelevant to the task.

Serum zinc levels are associated with obesity and low-density lipoprotein cholesterol in Mexican adults.

PURPOSE: Little is known about the association between serum zinc (Zn) levels and obesity in the Mexican population. Therefore, we tested the association between serum Zn levels, obesity status, and serum lipid levels in a sample of Mexican adults. METHODS: Anthropometric data and serum levels of total cholesterol, high- and low-density lipoprotein cholesterol (HDL-C and LDL-C, respectively), and triglycerides were analyzed in 96 Mexican adults. Serum Zn was measured with inductively coupled plasma mass spectrometry. An individual data meta-analysis of the association between serum Zn, overweight, and obesity status was performed in 172 adults from two different provinces in Mexico. RESULTS: Serum Zn was negatively associated with body mass index (BMI, ß = -0.034 ± 0.013, p = 2.0 ×10-6) and obesity (odds ratio [OR]= 0.990, 95% confidence interval [CI]= 0.980-0.999, p = 3.4 ×10-5). The association between Zn level and obesity in Mexican adults was confirmed with an individual data meta-analysis (OR= 0.977, 95% CI= 0.966-0.988, p = 3.4 ×10-5). In addition, a significant interaction effect between serum Zn level and sex was observed on LDL-C level (ß = 7.010 ± 3.295, p = 0.037). Serum Zn was negatively associated with LDL-C levels in women (ß = -0.188 ± 0.074, p = 0.016). CONCLUSION: Our results confirm the negative association of serum Zn level with obesity. For the first time, we show a sex-specific association between serum Zn and LDL-C levels in a Mexican population. However, further studies are needed in larger and more varied Mexican cohorts to replicate and confirm our findings.