Psychiatric diagnoses are common after liver transplantation and are associated with increased health care utilization and patient financial burden.

Psychiatric disorders after liver transplantation (LT) are associated with worse patient and graft outcomes, which may be amplified by inadequate treatment. We aimed to characterize the burden of psychiatric disorders, treatment patterns, and associated financial burden among liver transplantation recipients (LTRs). IQVIA PharMetrics (R) Plus for Academics-a large health plan claims database representative of the commercially insured US population-was used to identify psychiatric diagnoses among adult LTRs and assess treatment. Multivariable logistic regression analysis identified factors associated with post-LT psychiatric diagnoses and receipt of pharmacotherapy. Patient financial liability was estimated using adjudicated medical/pharmacy claims for LTRs with and without psychiatric diagnoses. Post-LT psychiatric diagnoses were identified in 395 (29.5%) of 1338 LTRs, of which 106 (26.8%) were incident cases. Treatment varied, with 67.3% receiving pharmacotherapy, 32.1% psychotherapy, 21.0% combination therapy, and 21.5% no treatment. Among 340 LTRs on psychotropic medications before transplant, 24% did not continue them post-LT. Post-LT psychiatric diagnoses were independently associated with female sex, alcohol-associated liver disease (ALD), prolonged LT hospitalization (>2 wk), and pre-LT psychiatric diagnosis. Incident psychiatric diagnoses were associated with female sex, ALD, and prolonged LT hospitalization. Patients with a post-LT psychiatric diagnosis had higher rates of hospitalization (89.6% vs. 81.5%, p <0.001) and financial liability (median $5.5K vs. $4.6K USD, p =0.006). Having a psychiatric diagnosis post-LT was independently associated with experiencing high financial liability >$5K. Over 1 in 4 LTRs had a psychiatric diagnosis in a large national cohort, yet nearly a quarter received no treatment. LTRs with psychiatric diagnoses experienced increased health care utilization and higher financial liability. Sociodemographic and clinical risk factors could inform high-risk subgroups who may benefit from screening and mitigation strategies.

Effect of hydrochar-doping on the performance of carbon felt as anodic electrode in microbial fuel cells.

In this study, the feasibility of using hydrochars as anodic doping materials in microbial fuel cells (MFCs) was investigated. The feedstock used for hydrochar synthesis was metal-polluted plant biomass from an abandoned mining site. The hydrochar obtained was activated by pyrolysis at 500 °C in N2 atmosphere. Under steady state conditions, the current exerted by the MFCs, as well as the cyclic voltammetry and polarization curves, showed that the activated hydrochar-doped anodes exhibited the best performance in terms of power and current density generation, 0.055 mW/cm2 and 0.15 mA/cm2, respectively. These values were approximately 30% higher than those achieved with non-doped or doped with non-activated hydrochar anodes which can be explained by the highly graphitic carbonaceous structures obtained during the hydrochar activation that reduced the internal resistance of the system. These results suggest that the activated hydrochar materials could significantly enhance the electrochemical performance of bioelectrochemical systems. Moreover, this integration will not only enhance the energy generated by MFCs, but also valorize metal polluted plant biomass within the frame of the circular economy.

The financial burden after liver transplantation is significant among commercially insured adults: A large US National Cohort.

Liver transplantation (LT) is lifesaving for patients with cirrhosis; however, the resultant financial burden to patients has not been well characterized. We aimed to provide a nationally representative portrayal of patient financial burden after LT. Adult recipients of LT from 2006 to 2021 were identified using IQVIA PharMetrics® Plus for Academics-a large nationally representative claims database of commercially insured Americans. Patient financial liability (ie, what patients owe) was estimated using the difference between allowed and paid costs for adjudicated medical/pharmacy claims. Descriptive statistics were provided stratified by the financial liability group within 1 year after LT. Multivariable logistic regression modeling identified factors associated with high/extreme liability adjusting for covariates. Potential indirect costs of post-LT care were estimated based on hourly wages lost for care. Among 1412 recipients of LT, financial liability was heterogeneous-~3% had no liability and 21% had extreme liability > $10K for 1-year post-LT care; most (69%) paid between $1 and 10K, with 48% having liability >$5K. Factors associated with >$5K liability included older age, insurance/enrollment type, US region, history of HCC, and simultaneous liver-kidney transplant (for liability >$10K). Medication costs comprised ~30% of outpatient financial liability. Potential indirect costs from wages lost were $2,201-$6,073 per person, depending on an hourly wage. In a large national cohort of commercially insured recipients of LT, financial liability was highly variable across sociodemographic and clinical characteristics; nearly 1 out of 2 recipients of LT owed >$5K for 1 year of post-LT care. Transplant programs should help patients anticipate potential costs and identify vulnerable populations who would benefit from enhanced financial counseling.

A paradigm for fostering patient-centered research in liver disease: The liver transplant patient-engagement program.

BACKGROUND: Many federal funding and regulatory agencies require patient engagement to conduct patient-centered research and drug development. We developed a liver transplantation patient-engagement program, which can serve as a model for bringing the patient perspective to digestive diseases research. METHODS: Six liver transplantation patient-engagement program advisors completed training in patient engagement; participated in several virtual sessions; and completed postsession surveys. RESULTS: Qualitative and quantitative results elucidated patient-centered liver transplantation study outcomes and barriers/facilitators to conducting clinical research. Group satisfaction was very high. CONCLUSIONS: The liver transplantation patient-engagement program model provides a paradigm for how to engage patients in the formative steps of patient-centered clinical research.

Active coping, resilience, post-traumatic growth, and psychiatric symptoms among early and late liver transplant survivors.

Understanding survivorship experiences at different stages postliver transplantation (poat-LT) is essential to improving care. Patient-reported concepts including coping, resilience, post-traumatic growth (PTG), and anxiety/depression, have been implicated as important predictors of quality of life and health behaviors after LT. We aimed to descriptively characterize these concepts at different post-LT survivorship stages. This cross-sectional study featured self-reported surveys measuring sociodemographic, clinical characteristics, and patient-reported concepts including coping, resilience, PTG, anxiety, and depression. Survivorship periods were categorized as early (1 y or below), mid (1-5 y), late (5-10 y), and advanced (10 y or above). Univariable and multivariable logistic and linear regression modeling examined factors associated with patient-reported concepts. Among 191 adult LT survivors, the median survivorship stage was 7.7 years (interquartile range: 3.1-14.4) and median age was 63 years (range: 28-83); most were male (64.2%) and Caucasian (84.0%). High PTG was more prevalent in the early survivorship period (85.0%) than late survivorship (15.2%). High trait resilience was only reported by 33% of survivors and associated with higher income. Lower resilience was seen among patients with longer LT hospitalization stays and late survivorship stages. About 25% of survivors had clinically significant anxiety and depression, which was more frequent among early survivors and females with pre-LT mental health disorders. In multivariable analysis, factors associated with lower active coping included survivors ≥65 years, non-Caucasian race, lower levels of education, and nonviral liver disease. In a heterogeneous cohort including early and late LT survivors, there was variation in levels of PTG, resilience, anxiety, and depression at different survivorship stages. Factors associated with positive psychological traits were identified. Understanding determinants of LT survivorship has important implications for how we should monitor and support LT survivors.

Evaluation of the management of marine protected areas. Comparative study in Costa Rica.

Costa Rica is one of the most biodiverse countries in the world, and stands out for its commitment to conservation. Along its two coasts, it presents a great heterogeneity of ecosystems and social realities. Social factors, more than physical-natural factors, determine the success or failure of an MPA, so they must be urgently incorporated into all phases of MPA management. The objective of this work is to analyze the management of three marine protected areas, to establish improvements. These areas are Santa Rosa National Park, Marino Ballena National Park and Cahuita National Park. The methodology used assesses 26 indicators grouped into 4 key factotres: management body, planning subprocess, public participation, and implementation subprocess. The results of this evaluation are 5 possible scenarios. These scenarios have been termed (from the ideal situation to the least favourable): proactive (1), learning (2), interactive (3), centralized (4) and formal (5) management. The results of this study show that both Santa Rosa and Cahuita present a proactive scenario (1), with high citizen participation, although in practice the way the two MPAs are managed is very different. Marino Ballena, on the other hand, is in scenario 5 (formal), and a series of measures are presented that can move it towards scenario 2 (learning). In general, MPA management in Costa Rica tends to be adaptive, with high public participation, as determined by its public policies. However, the existence of a public policy favors but does not guarantee success in MPA management, as can be seen in the difference in results. Therefore, the periodic evaluation of its management, allowing for feedback, is essential.

A fjord-like tropical ecosystem, Pacific coast of Costa Rica: overview of research in Golfo Dulce / Un ecosistema tropical similar a un fiordo, costa del Pacífico de Costa Rica: panorama de la investigación en el Golfo Dulce

Abstract Introduction: Coastal ecosystems worldwide are under the influence of local, regional and global stressors, such as pollution, eutrophication and climate change. Golfo Dulce is a relatively pristine and accessible deep tropical ecosystem that provides opportunities for comparative and collaborative research. Objective: To summarize published reports on past research conducted in this ecosystem, identify topics for further study, and suggest new research issues. Methods: A search was made on the web for reports based on research conducted in Golfo Dulce and published in scientific journals. Reports focusing on environmental parameters and on the biota were included. Results: A total of 123 studies that include data from Golfo Dulce are cited. The four topics more frequently addressed were reports based on the results of the R/V Victor Hensen expedition (1993-1994) and follow-up work on microbiology, studies on water parameters, research on vertebrates, and zooplankton studies. The reports focusing on vertical profiles of oxygen and temperature are discussed in detail, followed by those on the biota. Conclusions: Golfo Dulce has low oxygen concentrations below 50 m and is frequently anoxic at the 200 m deep basin with occasional formation of H2S. However, the ecosystem contains a relatively high diversity of identified organisms, from bacteria to whales. Of particular relevance for future studies are multidisciplinary surveys aiming at obtaining data on primary productivity, the diversity and biomass of the main groups of planktonic, demersal and benthic organisms, and the frequency and magnitude of the influx of deep offshore waters over the sill into the basin. These data, as well as the information gathered in the past, are essential for updating the trophic model developed more than 25 years ago and in support of new predictive models on the functioning of the ecosystem.

Resumen Introducción: Los ecosistemas costeros alrededor del mundo están bajo la influencia de tensores locales, regionales y globales, como la contaminación, la eutroficación y el cambio climático. El Golfo Dulce es un profundo ecosistema tropical relativamente inalterado y accesible, que provee oportunidades para la investigación comparativa y colaborativa. Objetivo: Resumir los informes publicados sobre investigaciones pasadas realizadas en el ecosistema, identificar tópicos para estudios futuros y sugerir nuevas áreas de investigación. Métodos: Se hizo una búsqueda en la red de informes basados en investigaciones hechas en Golfo Dulce y publicadas en revistas científicas. Fueron incluidos aquellos informes sobre parámetros ambientales y la biota. Resultados: Un total de 123 estudios que incluyen datos sobre Golfo Dulce son citados. Los cuatro tópicos citados con más frecuencia fueron: Los resultados de la expedición del R/V Victor Hensen (1993-1994) y estudios de seguimiento sobre microbiología, informes sobre parámetros acuáticos, investigaciones sobre vertebrados y estudios sobre zooplancton. Los informes sobre perfiles de oxígeno y temperatura son presentados con mayor detalle, seguidos por aquellos sobre la biota. Conclusiones: Golfo Dulce tiene bajas concentraciones de oxígeno por debajo de 50 m y es usualmente anóxico a 200 m en el fondo, con formación ocasional de H2S. Sin embargo, el ecosistema contiene una diversidad de organismos identificados relativamente alta, desde bacterias hasta ballenas. De relevancia particular para futuros estudios es, entre otros, la conducción, de muestreos multidisciplinarios orientados a obtener datos sobre productividad primaria, la diversidad y biomasa de los principales grupos de organismos planctónicos, demersales y bénticos, así como la frecuencia y magnitud del flujo de agua oceánica hacia el interior. Estos datos, así como los obtenidos en el pasado, son esenciales para actualizar el modelo trófico desarrollado hace más de 25 años, o en apoyo de nuevos modelos predictivos de funcionamiento del ecosistema.

Respuestas del mesozooplancton a condiciones oceanográficas en diferentes escalas en Bahía Salinas, Pacífico Norte de Costa Rica, durante 2011-2013

Introducción: El Pacífico Norte de Costa Rica se caracteriza por presentar una variación de la temperatura subsuperficial del mar (TSSM) modulada por vientos superficiales de componente este, con variaciones estacionales e intra-estacional. La TSSM es fundamental para las interacciones de la interfase océano-atmósfera y de gran influencia en los procesos biológicos marinos. Los estudios de zooplancton en el Pacífico Norte son escasos y se han enfocado en la composición, abundancia y biomasa de macro y mesozooplanctonen en Bahía Culebra. No se han realizado trabajos sobre zooplancton al norte del Golfo de Papagayo. Objetivo: Analizar la variación del zooplancton de Bahía Salinas a diferentes escalas como respuesta a condiciones oceanográficas-atmosféricas. Métodos: durante algunos meses de los años 2011, 2012 y 2013, el mesozooplancton fue muestreado en siete estaciones siguiendo un gradiente costero-oceánico para determinar su abundancia, biomasa y composición de la comunidad. Se realizaron lances de CTD en cada estación, y se recopilaron datos horarios de la TSSM desde junio de 2003 a diciembre de 2017. Resultados: La temperatura superficial anual en Bahía Salinas es menor en diciembre-abril con un mínimo secundario en julio y mayor en mayo-junio, y agosto-octubre. Los eventos fríos, neutros y cálidos determinados por anomalías en la TSSM, presentaron una distribución de la temperatura en la columna de agua con estratificación horizontal, de mezcla vertical y homogénea, respectivamente. La distribución espacial del zooplancton no presentó diferencias significativas y la variación del promedio total de abundancia y biomasa mostró un comportamiento similar durante el período de estudio, con menor variación en el primer año en comparación con el segundo, siendo los copépodos la categoría predominante para todas las fechas. A escala estacional no se observó un patrón general de variación entre estación seca y lluviosa y, copépodos y otros grupos del zooplancton fueron las categorías que presentaron diferencias. A escala intra-estacional la abundancia y biomasa presentaron una relación inversa con la TSSM y se vieron afectadas de manera diferencial. Los copépodos y zooplancton gelatinoso se diferenciaron en todos los eventos. Conclusiones: El zooplancton de Bahía de Salinas responde de manera diferencial en las diferentes escalas a las condiciones climáticas que afectan la TSSM de la región. La clasificación de las fechas de muestreo en eventos permite caracterizar diferentes perfiles en la columna de agua, así como permite definer patrones de variación para el mesozooplancton, que refleja la adaptación a corto plazo en función de la variación de las condiciones ambientales. El conocimiento generado ayuda a comprender mejor los fenómenos oceanográficos y su efecto sobre las poblaciones de plancton y la biota en general, especialmente en el escenario de cambio climático y las manifestaciones modernas de su impacto, p. e. la acidificación oceánica y pérdida de biodiversidad marina.

Introduction: The North Pacific of Costa Rica is characterized by presenting a variation of the subsurface temperature of the sea (SSST) modulated by surface winds with east component, with seasonal and intra-seasonal variations. The SSST is fundamental for the interactions of the ocean-atmosphere interface and influence marine biological processes. Zooplankton studies in the North Pacific are scarce and have been focused on the composition, abundance and biomass of macro and mesozooplankton in Culebra Bay. No works on zooplankton has been carried out northward of Papagayo Gulf. Objective: To analyze the variation of the zooplankton in Bahía Salinas at different scales in response to oceanographic-atmospheric conditions. Methods: during 2011, 2012 and 2013, mesozooplankton was collected in seven stations following a coastal-ocean gradient to determine abundance, biomass, and community composition. CTD casts were also carried out in each station. Hourly data of the Sea Subsurface Temperature (SSST) were obtained from June 2003 to December 2017. Results: The annual surface temperature in Bahía Salinas was lower in December-April with a secondary minimum in July and higher in May-June and August-November. The cold, neutral and warm events determined by anomalies in the SSST, presented a distribution of the temperature in the water column with horizontal stratification, vertical mixture and homogeneous, respectively. The spatial distribution of zooplankton did not show significant differences and the variation of the total average abundance and biomass showed a similar behavior during the study period, with less variation in the first year compared to the second one, being the copepods the predominant category for all the dates. On a seasonal scale, a general pattern of variation between dry and rainy seasons was not observed, and copepods and others zooplankton groups were the categories that presented differences. On an intra-seasonal scale, abundance and biomass showed an inverse relationship with SST. Copepods and gelatinous zooplankton (GZ) were differentiated in all events. Conclusions: The zooplankton of Bahía Salinas respond differentially at different scales to the climatic conditions that affect the SSST of the region. The classification of the sampling dates into events allows characterizing different profiles in the water column it also allows to define the variation patterns for mesozooplankton that reflects short-term adaptation as a function of variation in environmental conditions. These findings help to understand how oceanographic processes determine plankton community composition and biota in general. This is relevant in times of climate change and the manifestation of its impact through processes such as ocean acidification and loss of marine biodiversity.

Community structure of coral reef zooplankton in Isla del Coco National Park, a natural World Heritage site in the Eastern Tropical Pacific

Introduction: Zooplankton is a major link between primary producers and the following trophic levels, and in coral reefs they represent an energy source for corals and involve complex assemblies integrating a wide variety of species form different functional groups. Objective: To define interannual changes in zooplankton assemblies in coral reefs of Isla del Coco. Methods: Three coral reefs system were sampled. Two or three samples were taken by surface horizontal trawls in each coral reef from 2009 to 2012, using conical zooplankton nets of 200 and 500 µm mesh sizes at different times of the day. Physical and chemical variables were measured before zooplankton sampling. Results: We identified 24 taxonomic groups of macrozooplankton and 22 of mesozooplankton. Copepods were the most abundant taxa (87.1%) of the total abundance of mesozooplankton and macrozooplakton (58.9%); however, chaetognaths (35.6%) exceeded copepods (35.4%) in abundance in macrozooplankton samples during 2011. Mesozooplankton samples showed higher abundance (68753.2±9123.2 ind m-3) and biomass (85.14±11.3 mg DW m-3) than macrozooplankton samples (4454.9±751.0 ind m-3, 22.8±3.8 mg DW m-3). The interannual macrozooplankton community structure did not change significantly (ANOVA, p=0.368), but did change for mesozooplankton (ANOVA, p=0.001). Variations in physical and chemical variables influenced the community structure for both meso and macrozooplankton, increasing or decreasing organism abundance. Conclusions: Coral reef zooplankton of Isla del Coco resembles that of other coral reefs under the influence of oceanic conditions, with a fauna formed mainly by calanoid copepods, chaetognaths and appendicularians, and depending on oceanographic conditions, the abundance of these groups can change.

Introducción: El zooplancton es el principal enlace entre los productores primarios y los siguientes niveles de la cadena trófica, en los arrecifes de coral representa una importante fuente de alimento, en estos ambientes comprende una amplia variedad de especies de diferentes grupos funcionales. Métodos: En el presente trabajo se analiza la estructura de la comunidad del zooplancton asociado a los sistemas arrecifales de la Isla del Coco, sus variaciones interanuales y como las variables físicas y químicas en diferentes épocas influencian la composición de especies. Las muestras se colectaron sobre los parches de arrecife de Bahía Weston, Bahía Wafer y Bahía Chatham en el sector norte de la Isla, en cuatro periodos, en 2009 a 2012, se realizaron arrastres horizontales con redes cilindro cónicas de 200 y 500 µm tamaño de poro, durante tres e cinco minutos respectivamente a diferentes horas del día. Resultados: Se identificaron 24 grupos taxonómicos dentro del Macrozooplancton y 22 dentro del Mesozooplancton. Mayores abundancias y biomasas se registraron en el Mesozooplancton. Copépodos, apendicularias e quetognatos fueron los grupos más abundantes, siendo afectadas sus abundancias por las variaciones en las variables físicas y químicas. Conclusiones: La comunidad zooplanctónica de los arrecifes coralinos en la Isla del Coco es semejante a aquellos sistemas arrecifales de zonas oceánicas bajo la influencia de aguas oceánicas, con una fauna conformada principalmente por copépodos, quetognatos y apendicularias y que dependiendo de las características oceanográficas imperantes las abundancias de estos grupos pueden cambiar.

Nocturnal variation of the zooplankton community in coral reef substrates at Isla del Coco National Park (Eastern Tropical Pacific)

Introduction: Zooplankton is a major link in coral reef food webs and a source of nutrients for corals. Demersal zooplankton in coral reefs makes diel migrations at night to avoid predation by fish and corals, increasing abundance and biomass at night. Objectives: To study the composition and variation of the demersal and pelagic zooplankton community at night and to increase the taxonomic knowledge of the benthic copepod fauna over different substrates of a coral reef. Methods: Traps made of plastic, with a 100 μm mesh size collector cup attached, were placed for 12 hours between 5-10 m depth over four substrates: (1) sand, (2) small and (3) big colonies of Porites lobata, and (4) dead and alive corals. Sampling started at dusk (1800 h), and the collector cups were collected and replaced at 2100 and 0000, and the last samples removed at down (0600 h). Results: The highest abundance of zooplankton was capture over P. lobata colonies between 0000 to 0600 h. Copepods (adults, copepodites, and nauplii) dominated the community structure and were more abundant during all the time intervals and substrates. Pelagic copepods were more abundant than the benthic, however, not more diverse. Among the benthic copepods, 20 new records of harpacticoids and calanoids were registered for Isla del Coco and Costa Rican waters. Appendicularians and decapod larvae were also abundant. Changes in coral reef community structure were related with time and not with the kind of substrate, although some taxa were found only in a specific time interval or substrate. Conclusions: Community structure and abundance of demersal and pelagic coral reef zooplankton in Chatham Bay were dominated by copepods, larvaceans and decapod larvae, similar to other coral reefs around the world. The highest abundance peak of organisms in the water column between 0000 to 0600 h could be related to diel migration.

Introducción: El zooplancton demersal en los arrecifes de coral diariamente realiza migraciones diarias durante la noche para evitar ser depredados, su abundancia y su biomasa aumentan durante la noche. Objetivos: Registrar la composición y la variación del zooplancton pelágico-demersal durante la noche y aumentar el conocimiento taxonómico de la fauna de copépodos bénticos sobre diferentes sustratos de un arrecifes de coral. Métodos: El zooplancton asociado a diferentes sustratos fue colectado usando trampas en forma de cono confeccionadas con una bolsa plástica y un copo colector de zooplancton de 100 μm, las trampas se ubicaron sobre cuatro tipos de sustratos en un arrecife de coral: (1) arena, (2) colonias pequeñas y (3) grandes de Porites lobata, y (4) coral vivo y muerto ubicadas entra 5 y 10 m de profundidad. El muestreo fue realizado durante 12 horas, las trampas fueron colocadas a las 1800 h y los copos colectores se cambiaron a las 2100, 0000 y 0600 h. Resultados: Los copépodos (adultos, copepoditos y nauplios) dominaron la composición y fueron más abundantes en todos los intervalos de tiempo y cada uno de los sustratos. Los copépodos pelágicos fueron más abundantes pero no más diversos que los bentónicos. Dentro de los copépodos bénticos recolectados, 20 nuevos registros fueron identificados para las aguas de la Isla del Coco y Costa Rica. Los cambios en la estructura de la comunidad del zooplancton de los arrecifes de coral se relacionaron con el intervalo tiempo de muestreo y no con el tipo de sustrato en que fue colocado la red. Conclusiones: La composición de la comunidad y la abundancia de zooplancton pelágico-demersal en los arrecifes de coral de Bahía Chatham fueron dominadas por copépodos, larvaceos y larvas de decápodos, similar a otros arrecifes de coral alrededor del mundo. El intervalo de tiempo con la mayor abundancia de organismos fue el de 0000 a 0600 h, este pico de abundancia puede estar relacionado con la migración vertical.

Varicela, afectación palmo-plantar y neumonía / Varicella, palmoplantar involvement and pneumonia

La varicela es una enfermedad propia de la infancia; su presentación en adultos es muy poco frecuente y suele asociarse a cuadros de mayor gravedad y afectación sistémica. Se presenta como un exantema generalizado de diseminación centrípeta, pruriginoso y pleomórfico, de predominio facial y troncular, que respeta las extremidades. La neumonía es la complicación extracutánea más frecuente y la principal causa de hospitalización en este grupo etario. La afectación palmo-plantar es excepcional y suele estar asociada a enfermedad diseminada en pacientes con importante comorbilidad o algún tipo inmunosupresión. Presentamos el caso de un paciente de 71 años que presenta enfermedad varicelosa diseminada, caracterizada por neumonía y afectación palmo-plantar, en el contexto de tratamiento con corticoides

Varicella is a childhood disease; it occurs very rarely in adults, usually associated with more severe cases and systemic involvement. It presents as a generalized rash of centripetal spread, pruritic and pleomorphic, occurring in the face and trunk but not in the limbs. Pneumonia is the most frequent extracutaneous complication and the leading cause of hospitalization among this age group. Palmoplantar involvement is uncommon, usually associated with disseminated disease in patients with significant comorbidity or some kind of immunosuppression. We present the case of a 71-year-old patient with disseminated varicella infection, characterized by pneumonia and palmoplantar involvement, and treated with corticosteroids

Trade-off between tolerance and resistance to infections: an experimental approach with malaria parasites in a passerine bird.

Avian malaria parasites are known to have negative effects on their hosts, including consequences for reproductive success and survival. However, the outcome of disease may vary greatly among individuals, due to their particular genetic background, their past history of exposure to infections, or the way they respond to infections at the physiological level. We experimentally reduced parasitemia in naturally infected birds to examine individual-level variation in physiological parameters involved in anti-parasite defense, focusing specifically on disease resistance and tolerance. As a measure of disease resistance, we used circulating levels of IgY, and as a measure of disease tolerance, we estimated haptoglobin concentrations. Our results show individual consistency in the physiological parameters studied during the experiment, that was statistically significant for body condition, and marginally significant for IgY levels, and a trade-off between physiological mechanisms involved in resistance and tolerance that seem to be mediated by parasitemia. The medication experiment with primaquine was successful in reducing parasite intensity, but was not sufficient to clear the infection, and there was a generalized improvement in body condition in all birds maintained in captivity during the experiment. We suggest that the observed changes in the association between resistance and tolerance estimates may be due to the decrease in parasitemia attained through medication, to the improved nutritional status observed during the experiment or to the combined effect of both. Our study adds to the understanding of how wild animals cope with the diseases they are exposed to in their natural environment, and ultimately the consequences of parasitism at the individual level.

Efecto de un programa lúdico de actividad física general de corta duración y moderada intensidad sobre las cifras de presión arterial y otros factores de riesgo cardiovascular en hipertensos mayores de 50 años / Effects of a recreational general physical activity program with short term and moderate intensity of blood pressure and other cardiovascular risk factors in hypertensive patients over 50 years old

Objetivo: Evaluar los efectos de un programa recreativo de actividad física general, de intensidad moderada y corta duración, sobre las cifras de hipertensión arterial y otros factores de riesgo cardiovascular (FRCV) en hipertensos mayores de 50 años. Diseño: Estudio cuasi-experimental no aleatorizado con diseño pre-post. Emplazamiento: Íllora (Granada). Participantes: Sesenta sujetos sedentarios de 50-75 años pertenecientes al programa de hipertensos del Centro de Salud. Intervención: Programa lúdico de actividad física general donde predomina la capacidad aeróbica, 3días/semana, durante 4 semanas, y una intensidad del 45-55% de la FC Reserva. Mediciones principales: PAS, PAD, FC, IMC, colesterol total, HDL, LDL, TG y glucosa. Resultados y conclusiones: Disminuciones estadísticamente significativas (p < 0,05) en el IMC (-0,51%; IC95%: 30,26-31,93 unid), la FC (-5,57 lat/min; IC95%: 68,76-71,73 lat/min), la PAS (-14,82 mmHg; IC95%: 131,57-137,52 mmHg), la PAD (-5,33 mmHg; IC95%: 78,94-83,68 mmHg), la glucosa (-7,63 mg/dl; IC95%: 125,06-153,73 mg/dl) y el riesgo REGICOR (-20,46%; IC95%: 5,45-6,90%). Aumentos estadísticamente significativos en el HDL (+2,82mg/dl; IC95%: 46,78-52,11 mg/dl) y los TG (+8,27 mg/dl; IC95% 133,89-152,60 mg/dl). Según el sexo, los hombres presentaron la mayor variación en la FC y la PAD, y las mujeres en la PAS (p < 0,05). Sujetos con valores iniciales de PAS≥160mmHg experimentaron mayores descensos de FC, PAS, PAD, glucosa y TG (-(-10,67lat/min, -31mmHg, -8,27mmHg, -10,86mg/dl y 34,66mg/dl, respectivamente) que aquellos con PAS inicial < 160 mmHg, donde aumentó el HDL y disminuyó el LDL. Tras este programa se obtuvieron mejoras en la presión arterial y otros FRCV en sujetos hipertensos mayores de 50 años (AU)

Objectives: To evaluate the effects of a recreational general physical activity program with moderate intensity and short duration on blood pressure and other cardiovascular risk factors (BMI, cholesterol, Rest Heart Rate, HDL, LDL, Triglycerides) in hypertensive patients older than 50 years. Design: Non-randomised pre-post design, quasi-experimental study. Location: Íllora, Granada, Spain. Participants: A total of 60 subjects aged 50-75 years taking part in the Health Hypertensive Program in the Medical Centre were selected. Intervention: A recreational general physical activity program, mainly aerobic capacity, of 4weeks duration, 3days/week, and an intensity of 45-55% HR Reserve. Main measurements: SBP, DBP, HR, BMI, total cholesterol, HDL, LDL, TG, and Glucose. Results and conclusions: Statistically significant decreases (P < .05) were observed in BMI (-0.51%; 95%CI: 30.26 to 31.93 units), HR (-5.57 beats/min; 95% CI: 68.76 to 71.73 beats/min), SBP (-14.82 mmHg; 95%CI: 131.57 to 137.52 mmHg), DBP (-5.33 mmHg; 95%CI: 78.94 to 83.68 mmHg), Glucose (-7.63 mg/dL; 95%CI: 125.06 to 153.73 mg/dL) and REGICOR risk (-20.46%; 95%CI: 5.45 to 6.90%). Statistically significant increases were observed in HDL (+2.82 mg/dl; 95%CI: 46.78 to 52.11 mmHg), and TG (+8.27 mg/dl; 95%CI: 133.89 to 152.60 mg/dL). Men had a wider variation in HR and DBP, and women in SBP (P<.05). Subjects with baseline SBP≥160 mmHg experienced greater declines in HR, SBP, DBP, Glucose and TG (-10.67 beats/min, -31 mmHg, -8.27 mmHg, -10.86mg/dL, and 34.66mg/dL, respectively) than those with an initial SBP<160 mmHg, where there was an increase in HDL and a decrease in LDL. After this program, improvements in BP and other cardiovascular risk factors were obtained in hypertensive subjects over 50 years (AU)

[Effects of a recreational general physical activity program with short term and moderate intensity of blood pressure and other cardiovascular risk factors in hypertensive patients over 50 years old]. / Efecto de un programa lúdico de actividad física general de corta duración y moderada intensidad sobre las cifras de presión arterial y otros factores de riesgo cardiovascular en hipertensos mayores de 50 años.

OBJECTIVES: To evaluate the effects of a recreational general physical activity program with moderate intensity and short duration on blood pressure and other cardiovascular risk factors (BMI, cholesterol, Rest Heart Rate, HDL, LDL, Triglycerides) in hypertensive patients older than 50years. DESIGN: Non-randomised pre-post design, quasi-experimental study. LOCATION: Íllora, Granada, Spain. PARTICIPANTS: A total of 60 subjects aged 50-75years taking part in the Health Hypertensive Program in the Medical Centre were selected. INTERVENTION: A recreational general physical activity program, mainly aerobic capacity, of 4weeks duration, 3days/week, and an intensity of 45-55% HR Reserve. MAIN MEASUREMENTS: SBP, DBP, HR, BMI, total cholesterol, HDL, LDL, TG, and Glucose. RESULTS AND CONCLUSIONS: Statistically significant decreases (P<.05) were observed in BMI (-0.51%; 95%CI: 30.26 to 31.93units), HR (-5.57beats/min; 95%CI: 68.76 to 71.73beats/min), SBP (-14.82mmHg; 95%CI: 131.57 to 137.52mmHg), DBP (-5.33mmHg; 95%CI: 78.94 to 83.68mmHg), Glucose (-7.63mg/dL; 95%CI: 125.06 to 153.73mg/dL) and REGICOR risk (-20.46%; 95%CI: 5.45 to 6.90%). Statistically significant increases were observed in HDL (+2.82mg/dl; 95%CI: 46.78 to 52.11mmHg), and TG (+8.27mg/dl; 95%CI: 133.89 to 152.60mg/dL). Men had a wider variation in HR and DBP, and women in SBP (P<.05). Subjects with baseline SBP≥160mmHg experienced greater declines in HR, SBP, DBP, Glucose and TG (-10.67beats/min, -31mmHg, -8.27mmHg, -10.86mg/dL, and 34.66mg/dL, respectively) than those with an initial SBP<160mmHg, where there was an increase in HDL and a decrease in LDL. After this program, improvements in BP and other cardiovascular risk factors were obtained in hypertensive subjects over 50years.

Changes in abundance and composition of a Caribbean coral reef zooplankton community after 25 years / Cambios en abundancia y composición de una comunidad de zooplancton arrecifal en el Caribe 25 años después

Abstract:Coral reef zooplankton represents a key community in coral ecosystems, as they are involved in trophic and biogeochemical dynamics, and recruitment processes. Zooplankton abundance, composition and biomass were surveyed at six stations within the coral reef at Cahuita National Park, Limon, Costa Rica, in order to compare with the only previous study conducted during 1984. Samples were collected monthly (September 2010-August 2011). Seston biomass (0.49-85.87 mg/m3) and total abundance (1 145-112 422 ind./ m3) fluctuated among the months and the stations. Higher values of these two variables were found in the rainiest months (November 2010 and May 2011). A total of 38 taxa were identified, of which calanoid copepods abundance dominated year round (66 %), followed by appendicularians (12 %). Zooplankton mean abundance in this survey resulted 20 times higher (13 184 ± 4 104 ind./m3) than in 1984 (645 ± 84 ind./m3). Copepods and appendicularians were the groups that differed the most, relative to the 1984 study, resulting in 63 and 170 times more abundant overall, respectively. An increase in terrestrial runoff and nutrient input during the past 30 years could explain these differences. High abundances of zooplankton may constitute an important food source for coral reef organisms in Cahuita ecosystem. In addition, zooplankton abundances here reported for Cahuita are among the worldwide highest coral reef zooplankton abundances, and further trophic models can help elucidate its role in coral reef resilience in the Caribbean Coast of Central America.

ResumenEl grupo de zooplancton representa una comunidad clave en los arrecifes de coral. Está involucrado en dinámicas tróficas y biogeoquímicas, y en procesos de reclutamiento. La abundancia, composición y biomasa del zooplancton fueron estudiadas en seis estaciones dentro del arrecife coralino del Parque Nacional Cahuita, para compararlas con el único estudio realizado durante 1984. Las muestras se recolectaron mensualmente (Septiembre 2010-Agosto 2011). La biomasa del seston (0.49-85.87 mg/m3) y la abundancia total (1 145-112 422 ind./m3) fluctuaron entre meses y estaciones. Los valores más altos se encontraron durante los meses más lluviosos (Noviembre 2010 y Mayo 2011). Treinta y ocho taxones fueron identificados, copépodos calanoidos (66 %) y apendicularias (12 %) dominaron la abundancia durante todo el año. La abundancia promedio en este estudio fue 20 veces más alta (13 184 ± 4 104 ind./m3) que en 1984 (645 ± 84 ind./m3). Copépodos y apendicularias fueron los grupos con mayor discrepancia con respecto al estudio de 1984. Un aumento en la descarga de nutrientes de origen terrestre, podría explicar estas grandes diferencias. Abundancias tan altas de zooplancton podrían constituir una importante fuente de alimento para los organismos del arrecife en Cahuita. Las abundancias aquí reportadas colocan al arrecife de Cahuita entre los arrecifes de coral con mayor abundancia de zooplancton en el mundo y estudios futuros en redes tróficas podrían elucidar el papel de esta comunidad en procesos de resiliencia en los arrecifes del Caribe centroamericano.

Changes in abundance and composition of a Caribbean coral reef zooplankton community after 25 years.

Coral reef zooplankton represents a key community in coral ecosystems, as they are involved in trophic and biogeochemical dynamics, and recruitment processes. Zooplankton abundance, composition and biomass were surveyed at six stations within the coral reef at Cahuita National Park, Limon, Costa Rica, in order to compare with the only previous study conducted during 1984. Samples were collected monthly (September 2010-August 2011). Seston biomass (0.49-85.87 mg/m3) and total abundance (1 145-112 422 ind./m3) fluctuated among the months and the stations. Higher values of these two variables were found in the rainiest months (November 2010 and May 2011). A total of 38 taxa were identified, of which calanoid copepods abundance dominated year round (66 %), followed by appendicularians (12 %). Zooplankton mean abundance in this survey resulted 20 times higher (13 184 ± 4 104 ind./m3)than in 1984 (645 ± 84 ind./m3). Copepods and appendicularians were the groups that differed the most, relative to the 1984 study, resulting in 63 and 170 times more abundant overall, respectively. An increase in terrestrial runoff and nutrient input during the past 30 years could explain these differences. High abundances of zooplankton may constitute an important food source for coral reef organisms in Cahuita ecosystem. In addition, zooplankton abundances here reported for Cahuita are among the worldwide highest coral reef zooplankton abundances, and further trophic models can help elucidate its role in coral reef resilience in the Caribbean Coast of Central America.

Rasgos oceanográficos en el Golfo Dulce, Pacífico de Costa Rica: una revisión para la toma de decisiones en conservación marina / Oceanographic features of Golfo Dulce, Costa Rican Pacific: a review for decision-making in marine conservation

Resumen Se indagó, de septiembre del 2005 a noviembre del 2007, las propiedades oceanográficas físicas, químicas y biológicas (zooplancton) más relevantes del Golfo Dulce, Pacífico Sur de Costa Rica, y las tipologías meteorológicas de la zona, con el objetivo de analizarlas y hacerlas disponibles como referencia en el establecimiento de actividades adecuadas para su conservación, dado que es un ecosistema acuático único en Costa Rica. El patrón de circulación de las aguas en el Golfo Dulce es el típico de estuarios tipo fiordo, con una estratificación de flujo en la columna de agua. Las corrientes marinas superficiales alcanzaron velocidades cercanas a los 18cm/s en la región de entrada al Golfo, que disminuyeron al ampliarse el área del golfo donde las velocidades llegaron a alcanzar poco más de 5cm/s en el extremo noroeste, Rincón. Predominó el flujo superficial de este-oeste, mientras que en la zona de Puerto Jiménez la velocidad fue moderada de 5.4cm/s con dirección sur. Se detectaron velocidades mayores cercanas al umbral de la entrada del golfo (17.8cm/s) y en el fondo el ámbito fue de 2.0cm/s a 4.8cm/s. Se establecieron cinco sitios de muestreo denominados GD1, GD2, GD3, GD4 y GD5, que se visitaron en cinco ocasiones, excepto en GD5 que se visitó solo una vez. No se detectó la ausencia de oxígeno disuelto en las aguas profundas del Golfo (70m a los 140m), aunque las concentraciones fueron bajas (0.25mg/L a 1.10mg/L). La distribución de las concentraciones de los nutrimentos reflejó los patrones usuales para sistemas estuarinos a nivel horizontal, y a nivel vertical las concentraciones de fosfato y silicato fueron mayores al descender en la columna de agua, tanto en la estación lluviosa como en la seca. La descomposición de la materia orgánica fue evidente puesto que las concentraciones de nitrato fueron incrementándose en las aguas profundas. De los datos de concentración de nutrimentos, se deduce que el Golfo Dulce puede ser considerado como un cuerpo de agua que se mantiene en un estado de muy buena calidad ambiental. El grupo zooplánctico dominante fue el de los copédodos (44%-83.6%). Los vientos oeste ecuatoriales se detectaron en junio y fueron más intensos entre septiembre y octubre, lo que correspondió con promedios altos de altura de las olas. A su vez, los vientos alisios de diciembre a abril disminuyeron la energía del oleaje que entra al golfo y por lo tanto la altura promedio de las olas. El ciclo anual de la precipitación fue un patrón bimodal típico del Pacífico de América Central, con máximos en mayo y octubre, con la interrupción debida al veranillo o canícula, y un mínimo de precipitación ocurrió en febrero. Golfo Dulce es un ambiente único en todo el Pacífico Este Tropical, y aunque parezca mostrar condiciones ambientales saludables, está amenazado por muchas actividades humanas; ante todo urge el establecimiento de políticas de ordenamiento y planificación de las mismas, para proteger el ecosistema bajo los principios de uso sostenible.

Abstract From September 2005 to November 2007 we studied the meteorological typologies and the physical, chemical and zooplankton oceanography of Golfo Dulce, a unique aquatic ecosystem in the South Pacific of Costa Rica. The water circulation pattern in Golfo Dulce is typical of fjord-type estuaries, with flux stratification within the water column. Surface water currents reached speeds near 18cm/s in the vicinity of the sill and diminished inward to the northwest at around 5cm/s. The east-west flux was predominant, whereas near Puerto Jiménez the speed was a moderated 5.4cm/s with a south direction. Higher speeds were found near the sill (17.8cm/s) and at the bottom (2.0cm/s to 4.8cm/s). One station was visited once, five were visited five times each. Dissolved oxygen was not absent in deep waters (70m to 140m), but concentrations were low (0.25mg/L to 1.10mg/L). Nutrient concentrations and distribution had the usual horizontal estuarine patterns and for the vertical level phosphate and silicate concentrations increased with depth. Decomposition of organic matter was evident because nitrate concentrations were higher in deep waters. Surface nutrient concentrations indicated the gulf has good environmental quality that sustains a variety of life. Copepods dominated zooplankton (44%83.6%). The strongest equatorial westerlies were detected between September and October, coincident with higher wave heights. The trade winds blowing from December to April reduced the energy of entering waves and therefore the mean wave height. The annual rainfall cycle was the typical bimodal pattern from the Central America Pacific, with maxima in May and October, except for the midsummer interruption, and minimum rain was on February. Golfo Dulce is a unique environment in the Eastern Tropical Pacific, shows healthy environmental conditions, and is threatened; therefore we urge the establishment of zoning policy for human activities, and to improve protection under the principles of sustainable use. Rev. Biol. Trop. 63 (Suppl. 1): 131-160. Epub 2015 April 01.

Efecto del Phlebodium decumanum y de la coenzima q10 sobre el rendimiento deportivo en jugadores profesionales de voleibol / Effect of Phlebodium decumanun y de la coenzima q10 on sports performance in profesional volleyball players

Introducción: Los programas de entrenamiento físico, se basan en provocar estados de fatiga transitoria para inducir supercompensaciones de los sistemas biológicos implicados en la actividad, con el objeto mejorar el rendimiento del deportista a medio-largo plazo. La administración de suplementos nutricionales con propiedades antioxidantes e inmunomoduladoras, como Phlebodium decumanum y Coenzima Q10, constituyen medidas muy ventajosas para la recuperación de la inflamación y el daño tisular originados por el estrés del ejercicio intenso y mantenido. Metodología: Se llevó a cabo un diseño experimental, longitudinal, a doble ciego, con tres grupos randomizados a partir de una muestra de 30 jugadores varones de voleibol (22-32 años) de la Universidad de Granada, con un nivel de entrenamiento alto (17 horas por semana en los 6 meses previos a la investigación). Se evaluaron los efectos de un programa de entrenamiento físico de un mes de duración, común a todos los grupos de estudio, asociado a la administración simultánea de suplementos nutricionales a base de Phlebodium decumanum (4 cápsulas de 400 mg/ cáp. al día) el Grupo Experimental 1, Phlebodium decumanum(la misma dosis y posología que el grupo 1) más Coenzima Q10 (4 cápsulas de 30 mg/cáp al día) el Grupo Experimental 2, y sustancia placebo, el Grupo Control. Las variables dependientes sanguíneas para valorar los efectos de dicha intervención sobre el perfil endocrinometabólico e inmunológico basales fueron: cortisol e interleuquina 6 relacionados ambos con el eje del estrés inducido por el ejercicio, y ácido láctico y amonio, vinculados esencialmente, al metabolismo energético anaeróbio. Resultados: Todos los grupos del estudio manifestaron cambios adaptativos favorables sobre el perfil endocrihormonano- metabólico e inmunológico, que se objetivaron a través de un descenso significativo basal postest de las concentraciones de cortisol, interleuquina 6, ácido láctico y amoniaco, respecto a los valores previos a la intervención actividad física ± suplemención nutricional protocolizada. Los grupos que mostraron un perfil más favorable, fueron los que recibieron suplementación nutricional frente a placebo, y de entre los primeros, los sujetos que tomaron doble suplementación con Phlebodium decumanum más Coenzima Q10. Conclusiones: La ingesta de Phlebodium decumanum y de Coenzima Q10 durante 4 semanas, mostró efectos protectores sobre el perfil endocrino-metabólico e inmunológico basales, que atribuimos a las propiedades inmunomoduladoras y antioxidantes de ambas sustancias, lo que no sólo resulta altamente beneficioso para retrasar la fatiga y mejorar el rendimiento deportivo, sino también, para disminuir el riesgo de lesiones asociadas al ejercicio físico de alta intensidad (AU)

Introduction: Physical training programmes are based on provoking transitory states of fatigue in order to induce super compensation by the biological systems involved in the activity, in order to improve the athlete’s medium-long term performance. The administration of nutritional supplements with antioxidant and immunomodulatory properties, such as Phlebodium decumanum and coenzyme Q10, can be a very advantageous means of achieving recovery from the inflammation and tissue damage caused by the stress of prolonged, intense exercise. Methodology: An experimental, longitudinal, double- blind experiment was conducted, with three randomized groups obtained from a sample of 30 male volleyball players (aged 22-32 years) at the University of Granada, with a high level of training (17 hours a week during the 6 months preceding the study). The effects were then evaluated of a month-long physical training programme, common to all the study groups, associated with the simultaneous administration of the following nutritional supplements: Phlebodium decumanum (4 capsules of 400 mg/capsule, daily), Experimental Group 1; Phlebodium decumanum (same dose and schedule as Group 1) plus coenzyme Q10 (4 capsules of 30 mg/ capsule, daily), Experimental Group 2; a placebo substance, Control Group. The following dependent blood variables were examined to assess the effects of the intervention on the basal immune and endocrine-metabolic profile: cortisol and interleukin-6, both related to the axis of exercise-induced stress; and lactic acid and ammonium, related essentially to the anaerobic metabolism of energy. Results: All the study groups presented favourable adaptive changes with respect to the endocrine-metabolic and immune profile, as reflected by a significant decrease in the post-test concentrations of cortisol, interleukin 6, lactic acid and ammonium, compared to the values recorded before the physical activity with/without nutritional supplement, per protocol. The groups that achieved the most favourable profile were those which had received nutritional supplementation, rather than the placebo, and among the former, those which had received the double- strength supplement with Phlebodium decumanum plus coenzyme Q10. Conclusions: The intake of Phlebodium decumanum plus coenzyme Q10 for 4 weeks produced protective effects on the endocrine-metabolic and immune profile, which we attribute to the immunomodulatory and antioxidant properties of these substances, which are highly beneficial not only in terms of delaying fatigue and improving athletic performance, but also in reducing the risk of injuries associated with high intensity exercise (AU)

Influence of charge and metal coordination of meso-substituted porphyrins on bacterial photoinactivation.

The photodynamic effect of meso-substituted porphyrins with different charges and metal ions: meso-tetraphenylporphyrin tetrasulfonate 1, its nickel 2 and zinc complexes 3; meso-tetranaphthylporphyrin tetrasulfonate 4, and its zinc complex Zn 5; and tetra piridyl ethylacetate porphirins 6 and their nickel 7 and zinc 8 complexes, were synthesized and studied their antimicrobial activity against Escherichia coli. Fluorescence quantum yields (ΦF) were measured in water using reference TPPS4, obtaining higher values for complexes 3 and 4. The singlet oxygen ΦΔ were measured using histidine as trapping singlet oxygen and Rose Bengal as a reference standard. Complexes 1, 2 and 6 have the highest quantum yields of singlet oxygen formation, showing no relation with the peripheral charges and efficiency as Type II photosensitizers. Meanwhile complexes 3, 8 and 4 were the most efficient in producing radical species, determined with their reaction with NADH. The photoinduced antibacterial activity of complex was investigated at different concentrations of the photosensitizers with an irradiation time of 30 min. The higher antibacterial activities were obtained for the complexes 1-3 that are those with greater production of ROS and minor structural deformations. Complexes 7 and 8 had moderate activity, while 4-6 a low activity. Thus, in this work demonstrates that the production of ROS and structural deformations due to peripheral substituents and metal coordination, influence the activity of the complexes studied. Therefore, is important to perform comprehensive study physics and structurally when predicting or explain such activity.