Efficacy of delafloxacin alone and in combination with cefotaxime against cefotaxime non-susceptible invasive isolates of Streptococcus pneumoniae.

OBJECTIVE: We assessed the in vitro activity of delafloxacin and the synergy between cefotaxime and delafloxacin among cefotaxime non-susceptible invasive isolates of Streptococcus pneumoniae (CNSSP). METHODS: A total of 30 CNSSP (cefotaxime MIC > 0.5 mg/L) were studied. Serotyping was performed by the Pneumotest-Latex and Quellung reaction. Minimum inhibitory concentrations (MICs) of delafloxacin, levofloxacin, penicillin, cefotaxime, erythromycin and vancomycin were determined by gradient diffusion strips (GDS). Synergistic activity of delafloxacin plus cefotaxime against clinical S. pneumoniae isolates was evaluated by the GDS cross method. RESULTS: Delafloxacin showed a higher pneumococcal activity than its comparator levofloxacin (MIC50, 0.004 versus 0.75 mg/L and MIC90, 0.047 versus >32 mg/L). Resistance to delafloxacin was identified in 7/30 (23.3%) isolates, belonging to serotypes 14 and 9V. Synergy between delafloxacin and cefotaxime was detected in 2 strains (serotypes 19A and 9V). Antagonism was not observed. Addition of delafloxacin increased the activity of cefotaxime in all isolates. Delafloxacin susceptibility was restored in 5/7 (71.4%) strains. CONCLUSIONS: CNSSP showed a susceptibility to delafloxacin of 76.7%. Synergistic interactions between delafloxacin and cefotaxime were observed in vitro among CNSSP by GDS cross method.

The percentage of CD39+ monocytes is higher in pregnant COVID-19+ patients than in nonpregnant COVID-19+ patients.

Current medical guidelines consider pregnant women with COVID-19 to be a high-risk group. Since physiological gestation downregulates the immunological response to maintain "maternal-fetal tolerance", SARS-CoV-2 infection may constitute a potentially threatening condition to both the mother and the fetus. To establish the immune profile in pregnant COVID-19+ patients, a cross-sectional study was conducted. Pregnant women with COVID-19 (P-COVID-19+; n = 15) were analyzed and compared with nonpregnant women with COVID-19 (NP-COVID-19+; n = 15) or those with physiological pregnancy (P-COVID-19-; n = 13). Serological cytokine and chemokine concentrations, leucocyte immunophenotypes, and mononuclear leucocyte responses to polyclonal stimuli were analyzed in all groups. Higher concentrations of serological TNF-α, IL-6, MIP1b and IL-4 were observed within the P-COVID-19+ group, while cytokines and chemokines secreted by peripheral leucocytes in response to LPS, IL-6 or PMA-ionomicin were similar among the groups. Immunophenotype analysis showed a lower percentage of HLA-DR+ monocytes in P-COVID-19+ than in P-COVID-19- and a higher percentage of CD39+ monocytes in P-COVID-19+ than in NP-COVID-19+. After whole blood polyclonal stimulation, similar percentages of T cells and TNF+ monocytes between groups were observed. Our results suggest that P-COVID-19+ elicits a strong inflammatory response similar to NP-COVID19+ but also displays an anti-inflammatory response that controls the ATP/adenosine balance and prevents hyperinflammatory damage in COVID-19.

Extending Brain-Computer Interface Access with a Multilingual Language Model in the P300 Speller.

Brain-computer interfaces (BCI) such as the P300 speller have the potential to restore communication to advanced-stage neuromuscular disease patients. Research has improved typing speed and accuracy through innovations including the use of language models. While significant advances have been made, implementations have largely been restricted to a single language, primarily English. It is unclear whether these improvements would extend to other languages that present potential technical hurdles due to different alphabets and grammatical structures. Here, we adapt a language model-based classifier designed for English to two other languages, Spanish and Greek, to demonstrate the generalizability of these methods. Online experimental trials with 30 healthy native English, Spanish, and Greek speakers showed no significant difference between performances using the different versions of the system (66.20 vs. 61.97 vs. 60.89 bits/minute). Extending these methods across languages allows for expanding access to BCI systems to other populations, particularly in the developing world.

Impact of the implementation of a Sepsis Code Program in medical patient management: a cohort study in an Internal Medicine ward.

OBJECTIVE: Sepsis is the main cause of death in hospitals and the implementation of diagnosis and treatment bundles has shown to improve its evolution. However, there is a lack of evidence about patients attended in conventional units. METHODS: A 3-year retrospective cohort study was conducted. Patients hospitalized in Internal Medicine units with sepsis were included and assigned to two cohorts according to Sepsis Code (SC) activation (group A) or not (B). Baseline and evolution variables were collected. RESULTS: A total of 653 patients were included. In 296 cases SC was activated. Mean age was 81.43 years, median Charlson comorbidity index (CCI) was 2 and 63.25% showed some functional disability. More bundles were completed in group A: blood cultures 95.2% vs 72.5% (p <0.001), extended spectrum antibiotics 59.1% vs 41.4% (p < 0.001), fluid resuscitation 96.62% vs 80.95% (p < 0.001). Infection control at 72 hours was quite higher in group A (81.42% vs 55.18%, odds ratio 3.55 [2.48-5.09]). Antibiotic was optimized more frequently in group A (60.77% vs 47.03%, p 0.008). Mean in-hospital stay was 10.63 days (11.44 vs 8.53 days, p < 0.001). Complications during hospitalization appeared in 51.76% of patients, especially in group B (45.95% vs 56.58%, odds ratio 1.53 [1.12-2.09]). Hospital readmissions were higher in group A (40% vs 24.76%, p < 0.001). 28-day mortality was significantly lower in group A (20.95% vs 42.86%, odds ratio 0.33 [0.23-0.47]). CONCLUSIONS: Implementation of SC seems to be effective in improving short-term outcomes in IM patients, although therapy should be tailored in an individual basis.

Alterations in epididymal sperm maturation caused by ageing.

The epididymis is an organ that performs all the biochemical changes responsible for sperm maturation. During ageing, histological alterations in the epididymis and decreased protein synthesis have been found. This might affect the sperm maturation process. The aim of this study was to determine if the changes in the epididymis during ageing might cause alterations in sperm maturation. Wistar rats of 3-4months old (young) and 18-21months old (old) were used. The testosterone concentration was determined and the epididymides were dissected and divided in three regions: caput, corpus, and cauda. The tissues were used for histological processing and sperm extraction. Testosterone concentration decreased 34% in the old animals compared to the young ones. The distribution of mannose, sialic acid, and N-acetylglucosamine in the glycocalyx of the sperm membrane of old animals was different from that of young animals. The same occurred with phosphatidylserine externalisation and protein phosphorylation at tyrosine residues. Epididymis histology in old animals showed tubular and cellular degeneration. Our results suggest that ageing affects maturational markers, likely due to alterations in the epididymis as a result of the testosterone decrease associated with ageing.

Perfil epidemiológico del dolor secundario a neuropatía periférica moderada diabética / Epidemiological profile of pain secondary to moderate diabetic peripheral neuropathy

Antecedentes y objetivo: La neuropatía diabética es una complicación de la diabetes tipo 2. Afecta el entorno individual, familiar y social. El objetivo es identificar el perfil epidemiológico del dolor secundario a neuropatía periférica moderada diabética. Materiales y métodos: Estudio transversal descriptivo del dolor utilizando como fuente de información el paciente con neuropatía periférica moderada secundaria a diabetes tipo 2. La severidad de la neuropatía periférica diabética fue establecida con la escala de Michigan. El tamaño de la muestra fue 145. El perfil epidemiológico del dolor evaluado con el cuestionario multidimensional de McGill, alfa de Cronbach de 0,88, evalúa la intensidad de dolor en tres categorías independientes (índice de valoración total -dimensión sensorial, afectiva y evolutiva-, intensidad total general e intensidad total actual) y al interior identifica las características específicas del dolor. El análisis estadístico incluyó promedios, desviación estándar, intervalo de confianza para promedios y porcentajes. Resultados: Índice de valoración total de dolor 9,74 ± 1,40 (IC 95 %; 9,51-9,97), dimensión sensorial 5,02 ± 0,84 (IC 95 %; 4,88-5,16), dimensión afectiva 3,75 ± 0,94 (IC 95 %; 3,59-3,90) y dimensión evolutiva 0,96 ± 0,18 (IC 95 %; 0,93-1,00). Las características de la valoración total de dolor identifican sacudida 35,2 %, ardiente/quemante 31,0 %, sofocante 40,0 %, agotador 33,1 %, deprimente 29,7 % y constante 35,2 %. Intensidad total general de dolor 7,70 ± 1,29 (IC 95 %; 7,49-7,91). Intensidad total actual 40,7 % "intenso". Conclusión: El perfil epidemiológico del dolor es de intensidad elevada, quemante, penetrante, tirante fijo o difuso, acompañado de picor generalmente constante, con repercusión emocional negativa, entre ellas sentimiento de ansiedad, secundario a dolor deprimente, agotador, sofocante y mortificante.(AU)

Background and objective: Diabetic neuropathy is a complication of type 2 diabetes, it´s present in 95 % of patients, affecting the individual, family and social environment. The objective is to identify the epidemiological profile of pain secondary to moderate diabetic peripheral neuropathy. Materials and methods: Descriptive cross-sectional study of pain using as a source of information the patient with moderate peripheral neuropathy secondary to type 2 diabetes. The severity of diabetic peripheral neuropathy was established with the Michigan scale. The sample size was 145 patients. The epidemiological profile of pain evaluated with the McGill multidimensional questionnaire, Cronbach's alpha 0.88; it is assesses the intensity of pain in three independent categories (total pain assessment index [sensory, affective and evolutionary dimension], overall total intensity and current total intensity) and within each of them identifies the specific characteristics of pain. Statistical analysis included means, standard deviation, confidence interval for means, and percentages. Results: Total pain assessment index 9.74 ± 1.40 (95 % CI; 9.51-9.97), sensory dimension 5.02 ± 0.84 (95 % CI; 4.88-5.16), affective dimension 3.75 ± 0.94 (95 % CI; 3.59-3.90), and evolutionary dimension 0.96 ± 0.18 (95 % CI; 0.93-1.00). Specific characteristics of the total pain assessment Index identify shaking 35.2 %, burning 31.0 %, suffocating 40.0 %, exhausting 33.1 %, depressing 29.7 % and constant 35.2 %. Total general intensity of pain 7.70 ± 1.29 (95 % CI;7.49-7.91). Current total intensity 40.7 % "intense". Conclusion: The epidemiological profile of pain is of high intensity, burning, penetrating, fixed or diffuse, accompanied by generally constant itching, with negative emotional repercussions, including feelings of anxiety, secondary to depressing, exhausting, suffocating and mortifying pain.(AU)

Seguridad del paciente: percepción de estudiantes de una universidad pública / Patient safety: Perceptions of students in a public university / Segurança do paciente: percepção de estudantes de uma universidade pública

RESUMEN Introducción: La seguridad del paciente es una prioridad mundial para los sistemas de salud. Las instituciones educativas formadoras de recursos humanos deben incluir la temática en su currículo. Objetivo: Identificar la percepción sobre la seguridad del paciente en los estudiantes de licenciatura en enfermería. Metodología: Estudio descriptivo y transversal. Población total de 516 alumnos de licenciatura en enfermería de la Universidad Autónoma de Tamaulipas, México. Se utilizó el cuestionario APQS-III y se diseñó una cédula con variables sociodemográficas. Resultados: La mayoría de los participantes son mujeres, edad promedio: 20 años. La mitad de los alumnos no tiene cursos que avalen sus conocimientos sobre seguridad del paciente. En la dimensión entrenamiento recibido, 63.5 % concuerda que la formación de pregrado los capacita para entender las causas de un evento adverso por enfermería, los habilita para prevenir errores y desarrollar una adecuada comprensión en materia de seguridad. 50.3 % está totalmente de acuerdo en la dimensión confianza en el reporte del error y es semejante la proporción en la dimensión horas de trabajo como causas de error. Discusión: La identificación positiva de la percepción que se tiene acerca de la seguridad del paciente por parte de los estudiantes, favorece desde el pregrado la creación de una cultura de seguridad que fomenta la confianza y el interés de estos para desarrollar un enfoque integrado en el tema estudiado. Conclusiones: Los estudiantes en su mayoría refieren actitudes positivas confiados en que su entrenamiento sobre seguridad los prepara para entender y prevenir las causas de errores en seguridad del paciente.

ABSTRACT Introduction: Patient safety is a priority of health systems worldwide and therefore, the education institutions responsible for the formation of human resources for health must address this goal in detail. Objective: To identify the perceptions of baccalaureate nursing students regarding patient safety. Methodology: This is a descriptive and transversal study on 516 baccalaureates in nursing students from the Universidad Autónoma de Tamaulipas, Mexico. The APQS-III and a specific social-demographic data questionnaire were used. Results: The majority of the participants were female. The average age was 20 years old. Nearly half of the students do not have enough courses to strengthen their knowledge on patient safety. Regarding the training received, 63.5 % of the participants agree that the baccalaureate level formation prepares them to understand the causes of adverse events in nursing, to prevent errors, and to have an adequate understanding of security. 50.3 % of the participants approved the dimension's confidence approach regarding error reporting. Many participants considered that the excessive long hours working dimension is a cause of errors. Discussion: The perception of patient safety as being very important favors and further promotes a culture of security. Conclusions: The majority of the students trust their training regarding patient safety and know how to prevent possible causes of errors.

RESUMO Introdução: A segurança do paciente é uma prioridade mundial para os sistemas de saúde. As instituições educacionais formadoras de recursos humanos devem incluir a temática em seu currículo. Objetivo: Identificar a percepção sobre a segurança do paciente nos estudantes de graduação em enfermagem. Metodologia: Estudo descritivo e transversal. População total de 516 alunos de graduação em enfermagem da Universidad Autónoma de Tamaulipas, México. Foi utilizado o questionário APQS-III e realizou-se um questionário com variáveis sociodemográficas. Resultados: A maioria dos participantes são mulheres, idade média: 20 anos. Metade dos estudantes não tem cursos que avaliem seus conhecimentos sobre segurança do paciente. Na dimensão do treinamento recebido, 63,5 % concordam que a formação de graduação os treina para entender as causas de um evento de enfermagem adverso, lhes permite prevenir erros e desenvolver uma compreensão adequada da segurança. 50,3 % concordam fortemente sobre a dimensão de confiança no relatório dos erros e a proporção e da mesma forma sobre a dimensão das horas de trabalho como causa dos erros. Discussão: A identificação positiva da percepção que se tem sobre a segurança do paciente por parte dos alunos, favorece desde a graduação a criação de uma cultura de segurança que fomente a confiança e o interesse destes em desenvolver uma abordagem integrada na o assunto estudado. Conclusões: A maioria dos alunos relata atitudes positivas, confiantes de que seu treinamento em segurança os prepara para compreender e prevenir as causas dos erros na segurança do paciente.

Cirugía bariátrica en adolescentes con obesidad severa: recomendaciones de la Rama de Nutrición, Sociedad Chilena de Pediatría / Bariatric surgery in adolescents with severe obesity: recommendations of the Nutrition Branch, Chilean Pediatric Society

Resumen: En los últimos años, la obesidad severa en adolescentes ha aumentado a nivel mundial y Chile no es la excepción a este fenómeno. Es conocido que esta condición aumenta exponencialmente los riesgos para la salud y se asocia a mortalidad prematura. Desde el año 2008, diversas guías de tratamiento de obesidad pediátrica han incluido a la cirugía bariátrica como una estrategia de tratamiento para adolescentes obesos severos seleccionados. Estos procedimientos han mostrado ser seguros y eficaces en adultos. Un cuerpo emergente de evidencia demuestra que, en centros especializados, en el corto y mediano plazo se obtendrían resultados similares en adolescentes. Sin embargo, en este grupo de pacientes, la cirugía bariátrica tiene implícitos otros riesgos inherentes a la etapa de desarrollo en que se encuentran, y los resultados y complicaciones especialmente de largo plazo en gran medida son aún desconocidos. Por lo anterior y para el logro de los resultados esperados, es muy importante que la selección de pacientes, la cirugía y el seguimiento, sean realizados por equipos multidisciplinarios calificados, en centros hospitalarios que cuenten con la infraestructura adecuada, siendo imprescin dible la adherencia de por vida al seguimiento médico y nutricional. El objetivo de este documento es presentar la postura de la Rama de Nutrición de la Sociedad Chilena de Pediatría (SOCHIPE) frente a las diversas aristas a considerar para la adecuada indicación de estos procedimientos en adolescentes obesos severos.

Abstract: In recent years, severe obesity in adolescents has been rising worldwide, and Chile is no exception to this phenomenon. This condition exponentially increases health risks and it is associated with prema ture mortality. Since 2008, several guidelines on pediatric obesity treatment have included bariatric surgery as a treatment strategy for certain severely obese adolescents. These procedures have proven to be safe and efficient in adults. Recent evidence shows that, when done in specialized centers, the re sults would be similar in adolescents in the short and medium term. Nonetheless, in this group of pa tients, bariatric surgery has risks related to their stage of development, and data on long-term results and complications are still lacking. Therefore, to achieve the expected results, the patient selection, surgery, and follow-up must be carried out by qualified multidisciplinary teams, in hospitals centers that have the appropriate infrastructure, It is essential for the patients a life-long adherence to medi cal and nutritional monitoring. The objective of this document is to present the position statement of the Nutrition Branch of the Chilean Society of Pediatrics on the different issues to be considered for the adequate indication of these procedures in severely obese adolescents.

[Bariatric surgery in adolescents with severe obesity: Recommendations of the Nutrition Branch, Chilean Pediatric Society]. / Cirugía bariátrica en adolescentes con obesidad severa: Recomendaciones de la Rama de Nutrición, Sociedad Chilena de Pediatría.

In recent years, severe obesity in adolescents has been rising worldwide, and Chile is no exception to this phenomenon. This condition exponentially increases health risks and it is associated with prema ture mortality. Since 2008, several guidelines on pediatric obesity treatment have included bariatric surgery as a treatment strategy for certain severely obese adolescents. These procedures have proven to be safe and efficient in adults. Recent evidence shows that, when done in specialized centers, the re sults would be similar in adolescents in the short and medium term. Nonetheless, in this group of pa tients, bariatric surgery has risks related to their stage of development, and data on long-term results and complications are still lacking. Therefore, to achieve the expected results, the patient selection, surgery, and follow-up must be carried out by qualified multidisciplinary teams, in hospitals centers that have the appropriate infrastructure, It is essential for the patients a life-long adherence to medi cal and nutritional monitoring. The objective of this document is to present the position statement of the Nutrition Branch of the Chilean Society of Pediatrics on the different issues to be considered for the adequate indication of these procedures in severely obese adolescents.

Costo efectividad de insulina lispro protamina (NPL) vs. combinación de insulina NPH + insulina rápida / Cost effectiveness of lispro protamine insulin (NPL) vs combination of NPH insulin + rapid insulin

OBJETIVO: La estrategia farmacológica en el manejo de la diabetes tipo 2 incluye la insulina lispro protamina (NPL) vs. combinación de insulina NPH + insulina rápida. El análisis costo efectividad aborda el aspecto económico y el epidemiológico en el proceso de elección entre dos o más alternativas. El objetivo fue determinar el costo efectividad de la insulina lispro protamina (NPL) vs. combinación de insulina NPH + insulina rápida. MÉTODOS: Estudio de costo efectividad en pacientes con diabetes tipo 2. Alternativa 1, usuarios de insulina lispro protamina (NPL), y 2, usuarios de insulina NPH + insulina rápida. Tamaño de muestra de 62 por grupo, técnica muestral aleatoria simple. El costo incluyó, costo unitario, intensidad de uso del servicio, costo promedio por insumo, costo promedio por servicio, y costo por tipo de alternativa (incluyó medicina familiar, laboratorio y medicamentos). La efectividad se determinó con el promedio de los resultados de glucosa realizados durante todo el año. El plan de análisis incluyó análisis costo efectividad y análisis costo efectividad incremental. RESULTADOS: Costo promedio (estimado en pesos mexicanos) de la alternativa lispro protamina (NPL) $6,146.30 y NPH + insulina rápida $2,671.02. La NPH + insulina rápida tiene menor costo y mayor efectividad. El costo efectividad incremental identifica que con la alternativa NPH + insulina rápida existe ahorro de $158.98 por cada miligramo de glucosa por decilitro en relación a la alternativa  lispro protamina (NPL). CONCLUSION: El resultado, bajo nuestras limitantes, sugiere mejor relación costo efectividad en insulina NPH + insulina rápida

OBJECTIVE: Pharmacological strategies for the management of patients with type 2 diabetes include lispro protamine insulin (NPL) and NPH insulin + rapid insulin. The cost-effectiveness study addresses the economic and epidemiological aspects in the process of choosing between two or more alternatives. The objective is to determine the cost effectiveness of lispro protamine insulin (NPL) vs combination of NPH insulin + rapid insulin. METHODS: Cost effectiveness study in patients with type 2 diabetes. Alternative 1: lispro protamine insulin (NPL) and alternative 2: NPH insulin + rapid insulin. Sample size 62 per group, simple random sampling technique. Cost (estimated in Mexican pesos) included, unit cost, intensity of use of the service, average cost per input, average cost per service, and cost per type of alternative (including family medicine, laboratory and medication.) Effectiveness was determined with the average glucose results carried out throughout the year. Analysis plan included cost effectiveness analysis and incremental cost effectiveness analysis. RESULTS: The total average cost of lispro protamine insulin (NPL) and NPH insulin + rapid insulin mixture was $6,146.30 and $2,671.02, respectively. The NPH insulin + rapid insulin mixture alternative has lower cost and greater effectiveness. According to the cost effectiveness analysis, with the NPH insulin + rapid insulin mixture alternative, there was a saving of $159.98 for each milligram of glucose per deciliter comparing to the lispro protamine insulin (NPL) alternative. CONCLUSION: According with our results, a better cost-effectiveness ratio was obtained in NPH insulin + rapid insulin

Variational reduced density matrix method in the doubly-occupied configuration interaction space using four-particle N-representability conditions: Application to the XXZ model of quantum magnetism.

This work deals with the variational determination of the two-particle reduced density matrix (2-RDM) and the energy corresponding to the ground state of N-particle systems within the doubly occupied configuration interaction (DOCI) space. Here, we impose for the first time up to four-particle N-representability constraint conditions in the variational determination of the 2-RDM matrix elements using the standard semidefinite programming algorithms. The energies and 2-RDMs obtained from this treatment and the corresponding computational costs are compared with those arisen from previously reported less restrictive variational methods [D. R. Alcoba et al., J. Chem. Phys. 149, 194105 (2018)] as well as with the exact DOCI values. We apply the different approximations to the one-dimensional XXZ model of quantum magnetism, which has a rich phase diagram with one critical phase and constitutes a stringent test for the method. The numerical results show the usefulness of our treatment to achieve a high degree of accuracy.

Encuesta de Percepción en Capacidad Instalada para la Formación de Médicos Residentes en Ortopedia (Traumatología) y Necesidades de la Atención en Patología Musculoesquelética Aguda y Crónica en México. Primera Parte / Installed Capacity Perception Survey for the Training of Resident's Program in Orthopedics and Care Needs in Acute and Chronic Musculoskeletal Pathology in Mexico

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Abstract: Introduction: It is essential that orthopaedic resident physicians be highly proficient in all aspects, considering the balance between supply, demand, need and context. Fundamental to identify the capacity and quality installed for their training in Mexico. Material and methods: Observational Study, transverse, non-probabilistic sampling-conglomerates, in two phases. The instrument has 8 domains, 57 variables and 4,867 items. 60 graduate professors of 20 states, 50 hospital sites, 22 university programs. Results: 1,038 years of experience (collective intelligence), 17 years of experience/teacher (01 to 50 years). Identified: acute pathology 30 (2 to 90%), chronic pathology 30 (5 to 96%), patients ˂ 15 years, 10 (3 to 30%), patients between 15 and 65 years, 47 (2 to 78%), patients ˃ 65 years, 20 (2 to 60%), number of beds/seat 20 (2 to 510), number of clinics 3 (1 to 48), number of surgical procedures/headquarters per year at the national level, was 960 (50 to 24,650). The national average per resident doctor is 362 surgeries/year with 1,450 surgical times/year. Conclusions: The needs and resources for the training of physicians specializing in orthopedics/traumatology are highly heterogeneous, so it should be adapted to the epidemiological needs of the region of influence, in an area of epidemiological transition. 62.2% expressed not having or have bad academic and scientific infrastructure at its headquarters, more than 50% without rotation overseas and ˃ 90% without regular scientific production.

[Bariatric surgery in adolescents]. / Cirugía bariátrica en adolescentes.

The obesity epidemic affects transversally the entire life cycle. Particularly in recent decades, an in crease in severe obesity has been observed in adolescents. At this stage of life, characterized by deep physical and emotional changes, and great vulnerability, severe obesity has few effective treatment options. In adolescents, the treatment results focused on lifestyle modifications are poor and the pharmacological options are very limited and ineffective. Bariatric Surgery (BS) has emerged as a via ble therapeutic option for a selected group of adolescents. The objective of this review is to update the current view regarding indications, contraindications, complications, and results of these procedures in the adolescent population.

[Installed Capacity Perception Survey for the Training of Residents Program in Orthopedics and Care Needs in Acute and Chronic Musculoskeletal Pathology in Mexico]. / Encuesta de Percepción en Capacidad Instalada para la Formación de Médicos Residentes en Ortopedia (Traumatología) y Necesidades de la Atención en Patología Musculoesquelética Aguda y Crónica en México. Primera Parte.

INTRODUCTION: It is essential that orthopaedic resident physicians be highly proficient in all aspects, considering the balance between supply, demand, need and context. Fundamental to identify the capacity and quality installed for their training in Mexico. MATERIAL AND METHODS: Observational Study, transverse, non-probabilistic sampling-conglomerates, in two phases. The instrument has 8 domains, 57 variables and 4,867 items. 60 graduate professors of 20 states, 50 hospital sites, 22 university programs. RESULTS: 1,038 years of experience (collective intelligence), 17 years of experience/teacher (01 to 50 years). Identified: acute pathology 30 (2 to 90%), chronic pathology 30 (5 to 96%), patients 15 years, 10 (3 to 30%), patients between 15 and 65 years, 47 (2 to 78%), patients 65 years, 20 (2 to 60%), number of beds/seat 20 (2 to 510), number of clinics 3 (1 to 48), number of surgical procedures/headquarters per year at the national level, was 960 (50 to 24,650). The national average per resident doctor is 362 surgeries/year with 1,450 surgical times/year. CONCLUSIONS: The needs and resources for the training of physicians specializing in orthopedics/traumatology are highly heterogeneous, so it should be adapted to the epidemiological needs of the region of influence, in an area of epidemiological transition. 62.2% expressed not having or have bad academic and scientific infrastructure at its headquarters, more than 50% without rotation overseas and 90% without regular scientific production.

INTRODUCCIÓN: Es fundamental que los médicos residentes de ortopedia (traumatología) sean altamente competentes en todos los aspectos, considerando el equilibrio entre la oferta, demanda, necesidad y contexto. Es primordial identificar la capacidad y calidad instalada para su formación en México. MATERIAL Y MÉTODOS: Estudio observacional, transversal, muestreo no probabilístico-conglomerados, en dos fases. El instrumento tiene ocho dominios, 57 variables y 4,867 ítems. Sesenta profesores de postgrado de 20 estados, 50 sedes hospitalarias, 22 programas universitarios. RESULTADOS: 1,038 años de experiencia (inteligencia colectiva), 17 años de experiencia/profesor (01 a 50 años). Se identificó: patología aguda 30 (2 a 90%), patología crónica 30 (5 a 96%), pacientes 15 años, 10 (3 a 30%), pacientes entre 15 y 65 años, 47 (2 a 78%), pacientes 65 años, 20 (2 a 60%), número de camas/sede 20 (2 a 510), número de consultorios 3 (1 a 48), el número de procedimientos quirúrgicos/sede al año a nivel nacional fue de 960 (50 a 24,650). La media nacional por médico residente es de 362 cirugías/año con 1,450 momentos quirúrgicos/año. CONCLUSIONES: Las necesidades y recursos para la formación de médicos especialistas en ortopedia/traumatología son en alto grado heterogéneos, por lo cual se debería adaptar a las necesidades epidemiológicas de la región de influencia, en un ámbito de transición epidemiológica. Sesenta y dos punto dos por ciento expresó no tener o tener deficiente infraestructura académica y científica en su sede, más de 50% sin rotación al extranjero y 90% sin producción científica regular.

Abnormal calcium signalling and the caffeine-halothane contracture test.

BACKGROUND: The variable clinical presentation of malignant hyperthermia (MH), a disorder of calcium signalling, hinders its diagnosis and management. Diagnosis relies on the caffeine-halothane contracture test, measuring contraction forces upon exposure of muscle to caffeine or halothane (FC and FH, respectively). Patients with above-threshold FC or FH are diagnosed as MH susceptible. Many patients test positive to halothane only (termed 'HH'). Our objective was to determine the characteristics of these HH patients, including their clinical symptoms and features of cytosolic Ca2+ signalling related to excitation-contraction coupling in myotubes. METHODS: After institutional ethics committee approval, recruited patients undergoing contracture testing at Toronto's MH centre were assigned to three groups: HH, doubly positive (HS), and negative patients (HN). A clinical index was assembled from musculoskeletal symptoms and signs. An analogous calcium index summarised four measures in cultured myotubes: resting [Ca2+]cytosol, frequency of spontaneous cytosolic Ca2+ events, Ca2+ waves, and cell-wide Ca2+ spikes after electrical stimulation. RESULTS: The highest values of both indexes were found in the HH group; the differences in calcium index between HH and the other groups were statistically significant. The principal component analysis confirmed the unique cell-level features of the HH group, and identified elevated resting [Ca2+]cytosol and spontaneous event frequency as the defining HH characteristics. CONCLUSIONS: These findings suggest that HH pathogenesis stems from excess Ca2+ leak through sarcoplasmic reticulum channels. This identifies HH as a separate diagnostic group and opens their condition to treatment based on understanding of pathophysiological mechanisms.

Cirugía bariátrica en adolescentes / Bariatric surgery in adolescents

Resumen: La epidemia de obesidad afecta en forma transversal a todo el ciclo vital. En particular, en las últimas décadas se ha observado un incremento de la obesidad severa en adolescentes. En esta etapa de la vida caracterizada por profundos cambios físicos, emocionales y gran vulnerabilidad, la obesidad severa tiene pocas opciones efectivas de tratamiento. En adolescentes, los resultados del tratamiento centrado en modificaciones del estilo de vida son modestos y el arsenal farmacológico muy acotado y de poca efectividad. La Cirugía Bariátrica (CB) ha surgido como una opción terapéutica viable para un grupo seleccionado de adolescentes. El objetivo de esta revisión es presentar una visión actualizada respecto a indicaciones, contraindicaciones, complicaciones y resultados de estos procedimientos en población adolescente.

Abstract: The obesity epidemic affects transversally the entire life cycle. Particularly in recent decades, an in crease in severe obesity has been observed in adolescents. At this stage of life, characterized by deep physical and emotional changes, and great vulnerability, severe obesity has few effective treatment options. In adolescents, the treatment results focused on lifestyle modifications are poor and the pharmacological options are very limited and ineffective. Bariatric Surgery (BS) has emerged as a via ble therapeutic option for a selected group of adolescents. The objective of this review is to update the current view regarding indications, contraindications, complications, and results of these procedures in the adolescent population.

Further contributions to the understanding of nitrogen removal in waste stabilization ponds.

A set of experiments were conducted in Brazil in a pilot-scale waste stabilization pond (WSP) system (a four-maturation-pond series) treating an upflow anaerobic sludge blanket (UASB) reactor effluent. Over a year and a half the pond series was monitored under two flow rate conditions, hence also different hydraulic retention times and surface loading rates. On-site and laboratory trials were carried out to assess: (i) ammonia losses by volatilization using acrylic capture chambers placed at the surface of the ponds; (ii) organic nitrogen sedimentation rates using metal buckets placed at the bottom of the ponds for collecting settled particulate matter; (iii) nitrogen removal by algal uptake based on the nitrogen content of the suspended particulate matter in samples from the ponds' water column. In addition, nitrification and denitrification rates were measured in laboratory-based experiments using pond water and sediment samples. The pond system achieved high nitrogen removal (69% total nitrogen and 92% ammonia removal). The average total nitrogen removal rates varied from 10,098 to 3,849 g N/ha·d in the first and the last ponds, respectively, with the following fractions associated with the various removal pathways: (i) 23.5-45.6% sedimentation of organic nitrogen; (ii) 13.1-27.8% algal uptake; (iii) 1.2-3.1% ammonia volatilization; and (iv) 0.15-0.34% nitrification-denitrification.

MPT64 patch test for the diagnosis of active pulmonary tuberculosis: a randomised controlled trial in Peru.

SETTING: There remains a lack of effective and inexpensive diagnostic tools for active tuberculosis (TB) disease. Testing immune responses to proteins secreted by Mycobacterium tuberculosis, such as MPT64, may be a diagnostic option. OBJECTIVE: To evaluate the sensitivity and specificity of a patch test using MPT64 for the diagnosis of active TB disease. DESIGN: This randomised, double-blind, placebo-controlled, prospective study in Lima, Peru, involved 55 healthy controls and 457 symptomatic individuals referred for routine TB testing by the National TB Control Programme. All subjects underwent a comprehensive diagnostic workup, and received an active patch on one arm and a placebo patch on the opposite arm, which were read after 4 days. RESULTS: Eighty-one (18%) of the symptomatic participants were classified as having definite TB, while an additional 98 (21%) had probable TB. The patch tests performed the same in both groups, with a sensitivity of 27% and specificity of 74%. The area under the receiver operating characteristic curve was 0.495 (95%CI 0.425-0.565). CONCLUSIONS: Contrary to existing literature, the MPT64 patch was not sensitive and specific to detect active TB. Given the potential of the test, understanding possible differences in the protein source or underlying genetic factors should be explored further.

Factorization and Criticality in Finite XXZ Systems of Arbitrary Spin.

We analyze ground state (GS) factorization in general arrays of spins s_{i} with XXZ couplings immersed in nonuniform fields. It is shown that an exceptionally degenerate set of completely separable symmetry-breaking GSs can arise for a wide range of field configurations, at a quantum critical point where all GS magnetization plateaus merge. Such configurations include alternating fields as well as zero-bulk field solutions with edge fields only and intermediate solutions with zero field at specific sites, valid for d-dimensional arrays. The definite magnetization-projected GSs at factorization can be analytically determined and depend only on the exchange anisotropies, exhibiting critical entanglement properties. We also show that some factorization-compatible field configurations may result in field-induced frustration and nontrivial behavior at strong fields.