Hepatitis C virus infection and Parkinson's disease: insights from a joint sex-stratified BioOptimatics meta-analysis.

Hepatitis C virus (HCV) infection poses a significant public health challenge and often leads to long-term health complications and even death. Parkinson's disease (PD) is a progressive neurodegenerative disorder with a proposed viral etiology. HCV infection and PD have been previously suggested to be related. This work aimed to identify potential biomarkers and pathways that may play a role in the joint development of PD and HCV infection. Using BioOptimatics-bioinformatics driven by mathematical global optimization-, 22 publicly available microarray and RNAseq datasets for both diseases were analyzed, focusing on sex-specific differences. Our results revealed that 19 genes, including MT1H, MYOM2, and RPL18, exhibited significant changes in expression in both diseases. Pathway and network analyses stratified by sex indicated that these gene expression changes were enriched in processes related to immune response regulation in females and immune cell activation in males. These findings suggest a potential link between HCV infection and PD, highlighting the importance of further investigation into the underlying mechanisms and potential therapeutic targets involved.

SARS-CoV-2 infection during pregnancy: clinical characteristics and vertical transmission in a referral hospital in Peru. / Infección por SARS-CoV-2 en el embarazo: características clínicas y trasmisión vertical en un hospital de referencia de Perú.

Motivation for the study. There is a gap in knowledge about vertical transmission of SARS- CoV-2 and its implications for maternal and neonatal health, despite evidence of multisystem involvement in pregnant women with COVID-19. Main findings. The study results suggest low incidence of vertical transmission during pregnancy, with only one PCR-positive case in the placenta and one asymptomatic neonate. Implications. Our results can inform strategies for prevention and management of COVID-19 in pregnant women, as well as guide the development of health policies aimed at protecting maternal and neonatal health during the pandemic. The aim of this study was to analyze the vertical transmission of SARS-CoV-2 in pregnant women with COVID-19 in the Gynecology and Obstetrics Department of the Edgardo Rebagliati Martins National Hospital (HNERM). Twelve pregnant women who met the inclusion criteria were included. Real-time PCR (RT-PCR) tests for SARS-CoV-2 were performed when each woman was admitted to the hospital, placenta samples were collected for pathological evaluation as well. The results showed that vertical transmission of the virus was rare, with an overall low positivity rate in newborns. Although the study has limitations, such as the small number of cases and the lack of electron microscope analysis, it is the first attempt to evaluate vertical transmission in Peru. It is concluded that more research is needed to better understand the relationship between COVID-19 infection and complications during pregnancy.

Se realizó un estudio en el departamento de Ginecología y Obstetricia del Hospital Nacional Edgardo Rebagliati Martins (HNERM) con el objetivo analizar la transmisión vertical del SARS-CoV-2 en mujeres embarazadas con COVID-19. Se incluyeron 12 gestantes que cumplían con los criterios de inclusión. Se realizaron pruebas diagnósticas de PCR en tiempo real (RT-PCR) para SARS-CoV-2 durante la admisión de cada gestante y se recolectaron muestras de placenta para su evaluación anatomopatológica. Los resultados mostraron que la transmisión vertical del virus fue poco común, con una tasa general de positividad baja en los recién nacidos. Aunque el estudio presenta limitaciones, como el número reducido de casos y la falta de análisis con microscopio electrónico, constituye el primer intento en Perú de evaluar la transmisión vertical. Se concluye que se necesita más investigación para comprender mejor la relación entre la infección por la COVID-19 y las complicaciones durante el embarazo. Motivación para realizar el estudio. A pesar de la evidencia de una afectación multisistémica en mujeres embarazadas con la COVID-19, existe un vacío de conocimiento sobre la transmisión vertical del virus y sus implicancias en la salud materna y neonatal. Principales hallazgos. Los resultados del estudio sugieren una baja incidencia de transmisión vertical durante el embarazo, con solo un caso positivo de PCR en la placenta y un neonato asintomático. Implicancias. Este resultado pueden informar las estrategias de prevención y manejo de la COVID-19 en mujeres embarazadas, así como guiar el desarrollo de políticas sanitarias dirigidas a proteger la salud materna y neonatal durante la pandemia.

Estudio Observacional Descriptivo de Pacientes Hemodializados Sospechosos de Nefritis Intersticial Crónica en Comunidades Agrícolas de Asunción y el Departamento Central / Descriptive Observational Study of Hemodialyzed Patients Suspected of Chronic Interstitial Nephritis in Agricultural Communities of Asunción and Central Department

Introducción: La Enfermedad Renal Crónica ha cobrado interés debido a su alta tasa de morbimortalidad. Además de las causas vasculares y de la diabetes mellitus, se ha identificado una causa de Origen Desconocido en jóvenes agricultores. Objetivo: El objetivo del estudio es determinar la prevalencia de la población en hemodiálisis, sospechosa de la Nefritis Intersticial Crónica en Comunidades Agrícolas, para categorizar la verdadera etiología de su patología renal. Metodología: Se aplicó un diseño observacional descriptivo durante los meses de diciembre de 2022, enero y febrero de 2023; y se encuestó a 684 pacientes de ambos sexos en 8 centros de hemodiálisis de la Capital y el Departamento Central del Paraguay. Resultados: La prevalencia de casos sospechosos por la exposición a factores de riesgo resultó ser del 18.1%. Esta cifra podría ser mayor, ya que 22.6% de los pacientes con diabetes mellitus tipo 2, no presentó retinopatía clínica ni otros signos clínicos de la enfermedad al momento del diagnóstico de la falla renal. Este panorama nos advierte de un probable diagnóstico desacertado en una cantidad considerable de pacientes. Conclusión: La importancia de esta investigación se sustenta en generar acciones preventivas en la población agrícola y concientizar a la sociedad médica de la relevancia diagnóstica de esta patología para mejorar la calidad y pronóstico de vida en la población paraguaya.

Introduction: Chronic Kidney Disease has gained interest due to its high morbidity and mortality rate. In addition to vascular causes and diabetes mellitus, an unknown cause has been identified in young farmers. Objective: This study aims to determine the prevalence of the population on hemodialysis, suspected of Chronic Interstitial Nephritis in agricultural communities, to categorize the true etiology of their renal pathology. Methodology: A descriptive observational design was applied during December 2022, January, and February 2023; and 684 patients of both sexes were surveyed in 8 hemodialysis centers in the Capital and the Central Department of Paraguay. Results: The prevalence of suspected cases due to the exposure to risk factors was 18.1%. This figure could be higher since 22.6% of patients with type 2 diabetes mellitus did not present clinical retinopathy or other clinical signs of the disease at the time of the diagnosis of kidney failure. This scenario warns us of a probable misdiagnosis in a considerable number of patients. Conclusion: The importance of this research lies in generating preventive actions in the agricultural population and raising awareness in the medical community about the diagnostic relevance of this pathology to improve the quality and prognosis of life in the Paraguayan population.

Infección por SARS-CoV-2 en el embarazo: características clínicas y trasmisión vertical en un hospital de referencia de Perú / SARS-CoV-2 infection in pregnancy: clinical characteristics and vertical transmission in a reference hospital in Peru

Se realizó un estudio en el departamento de Ginecología y Obstetricia del Hospital Nacional Edgardo Re-bagliati Martins (HNERM) con el objetivo analizar la transmisión vertical del SARS-CoV-2 en mujeres embarazadas con COVID-19. Se incluyeron 12 gestantes que cumplían con los criterios de inclusión. Se realizaron pruebas diagnósticas de PCR en tiempo real (RT-PCR) para SARS-CoV-2 durante la admi-sión de cada gestante y se recolectaron muestras de placenta para su evaluación anatomopatológica. Los resultados mostraron que la transmisión vertical del virus fue poco común, con una tasa general de posi-tividad baja en los recién nacidos. Aunque el estudio presenta limitaciones, como el número reducido de casos y la falta de análisis con microscopio electrónico, constituye el primer intento en Perú de evaluar la transmisión vertical. Se concluye que se necesita más investigación para comprender mejor la relación entre la infección por la COVID-19 y las complicaciones durante el embarazo.

A Cost Model for Neurological Diseases in Puerto Rico: Parkinson's Disease, Alzheimer's Disease and Huntington's Disease.

OBJECTIVE: This article proposes an engineering-economics model to determine the total cost of a neurological disease along its temporal progression. The objective was to develop a planning tool faithful to the reality of this type of ailment as well as to that of Puerto Rico (PR). METHODS: The proposed model organizes a given neurological disease into 3 progressive phases of deterioration; in each, the model collects the typical associated costs and adjusts them based on their value over time. This way, the total cost of the ailment is calculated and its present day dollar value expressed. Model verification was carried out using data from Puerto Rico related to Parkinson's, Alzheimer's, and Huntington's diseases. RESULTS: The method demonstrated here considered Parkinson's disease in PR. Our model calculated a total annual cost of $64,915 for a patient at the medium stage. This figure is larger than estimates from other authors, which fall between $41,689 and $51,600 for the USA. This difference is partially due to the proposed model considering the individual's opportunity cost of the loss of productive years, an original contribution of our work. CONCLUSION: A neurological disease is one in which an individual goes through progressive phases of deterioration that will require significant economic resources. The model proposed here is designed across the commonalities between Alzheimer's, Parkinson's, and Huntington's diseases and illustrated using costs from PR. As an additional contribution, it allows the consideration of the opportunity cost of lost productivity, a characteristic that makes it more realistic.

Individual emergency response and recovery: What people worried about during and after Hurricane Maria.

Hurricane Maria was a disastrous weather event that devastated Puerto Rico (PR) in September 2017. Yet, little is known about people's perceptions of this event. In this investigation, we offer insight about Hurricane Maria's impact on PR's inhabitants. More specifically, we study a sample (n = 542 responses) of individuals' worry levels through four time points during the aftermath of Hurricane Maria: their variation through time, their relationship to decision making, and if and how certain demographic variables may influence them. For these purposes, we designed and implemented the Individual Emergency Response and Recovery Questionnaire, a web-based survey that measured several aspects of the objective and subjective experiences of individuals who underwent Hurricane Maria in PR. Results of a statistical analysis using nonparametric tests show that some of the demographic variables selected as factors of interest influence the worry levels reported by respondents. Most significant results coincide with conclusions drawn by literature: that time, age group, and the level of information influence worry levels. Another key finding is that the worry level may influence individual decision-making frequency. Understanding principal factors in people's behavior and perceptions during hurricanes is crucial to help us learn how to better prepare for and respond to natural disasters in the future.

Multiple Criteria Optimization (MCO): A gene selection deterministic tool in RStudio.

Identifying genes with the largest expression changes (gene selection) to characterize a given condition is a popular first step to drive exploration into molecular mechanisms and is, therefore, paramount for therapeutic development. Reproducibility in the sciences makes it necessary to emphasize objectivity and systematic repeatability in biological and informatics analyses, including gene selection. With these two characteristics in mind, in previous works our research team has proposed using multiple criteria optimization (MCO) in gene selection to analyze microarray datasets. The result of this effort is the MCO algorithm, which selects genes with the largest expression changes without user manipulation of neither informatics nor statistical parameters. Furthermore, the user is not required to choose either a preference structure among multiple measures or a predetermined quantity of genes to be deemed significant a priori. This implies that using the same datasets and performance measures (PMs), the method will converge to the same set of selected differentially expressed genes (repeatability) despite who carries out the analysis (objectivity). The present work describes the development of an open-source tool in RStudio to enable both: (1) individual analysis of single datasets with two or three PMs and (2) meta-analysis with up to five microarray datasets, using one PM from each dataset. The capabilities afforded by the code include license-free portability and the possibility to carry out analyses via modest computer hardware, such as personal laptops. The code provides affordable, repeatable, and objective detection of differentially expressed genes from microarrays. It can be used to analyze other experiments with similar experimental comparative layouts, such as microRNA arrays and protein arrays, among others. As a demonstration of the capabilities of the code, the analysis of four publicly-available microarray datasets related to Parkinson´s Disease (PD) is presented here, treating each dataset individually or as a four-way meta-analysis. These MCO-supported analyses made it possible to identify MMP9 and TUBB2A as potential PD genetic biomarkers based on their persistent appearance across each of the case studies. A literature search confirmed the importance of these genes in PD and indeed as PD biomarkers, which evidences the code´s potential.

Valor predictivo prequirúrgico del EuroSCORE I, EuroSCORE II y STS score en pacientes sometidos a cirugía cardíaca: informe preliminar / Pre-surgical predictive value of the EuroSCORE I, EuroSCORE II and STS score in patients undergoing cardiac surgery: preliminary report

RESUMEN Introducción: en cirugía cardiovascular, el EuroSCORE I, EuroSCORE II y STS score son herramientas que brindan pronóstico e información para la toma de decisiones. Es imperativo evaluar el valor predictivo real de los mismos en nuestro medio. Objetivo: evaluar el valor predictivo de los citados scores en pacientes sometidos a cirugía cardíaca en el área de cardiología del Hospital Nacional. Metodología: estudio de cohortes, retrospectivo, con muestreo no probabilístico de casos consecutivos. La población estuvo constituida por pacientes sometidos a cirugía cardiaca en el periodo comprendido entre enero 2020 a julio 2021. Fueron evaluadas 60 historias clínicas, excluidas 6, quedando finalmente 54 expedientes. Resultado: predominó el sexo masculino 57,14 %, la edad media fue de 60 ± 12 años (rango 26 - 82 años). El EuroSCORE II presentó un riesgo relativo de 10 (IC 95 % 1,3 ­ 90), p=0,004, sensibilidad 80 %, especificidad 78,43 %, VPP 26,67 % (IC 95 % 0,95 a 52,38) y VPN 97,56 % (IC 95 % 91,62 a 100 %). El EuroSCORE I presentó riesgo relativo de 1,6 (IC 95 % 0,2 ­ 10,9) p=0,50, sensibilidad 60 %, especificidad 52,94 %, VPP 11,11 % (IC 95 % 0,00 a 24,82) y VPN 93,10 % (IC 95 % 82,16 a 100 %). El STS score arrojó un riesgo relativo de 3,5 (IC 95 % 0,07 ­ 35), p=0,10, sensibilidad del 20 %, especificidad 93,33 %, valor predictivo positivo del 25 % (IC 95 % 0,00 a 79,93) y valor predictivo negativo 91,30 % (IC 95 % 82,07 a 100 %). La mortalidad global fue 8,93 % y morbilidad 93 %. Conclusión: se demostró un alto valor predictivo negativo en los scores, lo que determinó que pacientes con riesgo bajo e intermedio tuvieran una mortalidad baja.

ABSTRACT Introduction: in cardiovascular surgery, the EuroSCORE I, EuroSCORE II and STS score are tools that provide prognosis and information for decision making. It is imperative to evaluate their real predictive value in our environment. Objective: to evaluate the predictive value of the aforementioned scores in patients undergoing cardiac surgery in the Hospital Nacional cardiology area. Methodology: retrospective cohort study, with non-probabilistic sampling of consecutive cases. The population consisted of patients undergoing cardiac surgery in the period from January 2020 to July 2021. 60 medical records were evaluated, 6 excluded, finally leaving 54 records. Result: male sex predominated 57,14 %, the mean age was 60 ± 12 years (range 26 - 82 years old). The EuroSCORE II presented a relative risk of 10 (95 % CI 1.3 - 90), p = 0.004, sensitivity 80 %, specificity 78,43 %, PPV 26,67 % (95 % CI 0,95 to 52,38) and NPV 97,56 % (95 % CI 91,62 to 100 %). The EuroSCORE I presented a relative risk of 1.6 (95 % CI 0.2 - 10.9) p = 0.50, sensitivity 60 %, specificity 52,94 %, PPV 11,11 % (95 % CI 0.00 a 24,82) and NPV 93,10 % (95 % CI 82.16 to 100 %). The STS score yielded a relative risk of 3,5 (95 % CI 0.07 - 35), p = 0.10, sensitivity of 20 %, specificity 93,33 %, positive predictive value of 25 % (CI 95 % 0 .00 to 79.93) and negative predictive value 91,30 % (95 % CI 82.07 to 100 %). Overall mortality was 8,93 % and morbidity 93 %. Conclusion: a high negative predictive value was demonstrated in the scores, which determined that patients with low and intermediate risk had a low mortality.

Frecuencia de lesiones coronarias epicárdicas en pacientes con cardiopatía dilatada en un Departamento de Cardiología en el periodo 2015 - 2021 / Frequency of epicardial coronary lesions in patients with Dilated Heart Disease in a Department of Cardiology in the period from 2015 to 2021

RESUMEN Introducción: la cardiopatía dilatada definida como la dilatación de cavidades cardiacas de múltiples etiologías tiene una prevalencia en adultos de alrededor de 1/2.500 individuos. La ecocardiografía transtorácica determina la dilatación de cavidades y evalúa la función ventricular mientras que la cinecoronariografía permite identificar la etiología principalmente isquémica por afección de arterias coronarias epicárdicas. La utilización de la cinecoronariografía como primera línea para el diagnóstico etiológico, implica riesgos propios de un método invasivo con un alto costo en recursos económicos, por lo cual es imperioso determinar el posible resultado de dicho procedimiento. Objetivo: determinar la frecuencia de lesiones coronarias epicárdicas en pacientes con Cardiopatía Dilatada en un Departamento de Cardiología en el periodo del 2015 ­ 2021. Metodología: estudio observacional, descriptivo, retrospectivo y de corte transversal con muestreo no probabilístico por conveniencia, mediante la revisión en la base de datos en un Departamento de Cardiología. Resultados: este estudio incluyó a 88 pacientes, con disnea en clase funcional II-IV de la NYHA y cardiopatía dilatada por ecocardiografía, de etiología no filiada. De éste grupo, 66 % eran varones y 34 % mujeres, la media de edad fue de 56 ± 11,19 años. Al ser sometidos a cinecoronariografía diagnostica, se constató que el 23 % presentó lesiones coronarias epicárdicas, siendo la más frecuente la lesión de un vaso (55 %), predominando el sexo masculino en aquellos con o sin lesiones coronarias epicárdicas. Conclusiones: la frecuencia de lesiones coronarias epicárdicas en pacientes con cardiopatía dilatada, es baja.

ABSTRACT Introduction: dilated heart disease defined as the dilation of cardiac cavities of multiple etiologies has a prevalence in adults of around 1/2.500 individuals. Transthoracic echocardiography determines chamber dilation and evaluates ventricular function, while coronary angiography can identify the mainly ischemic etiology due to involvement of the epicardial coronary arteries. The use of coronary angiography as the first line for the etiological diagnosis implies risks of an invasive method with a high cost in economic resources, for which it is imperative to determine the possible result of said procedure. Objective: to determine the frequency of epicardial coronary lesions in patients with Dilated Heart Disease in a Departmento de Cardiología in the period 2015-2021. Methodology: observational, descriptive, retrospective and cross-sectional study with non-probabilistic convenience sampling, by reviewing the database in a Departmento de Cardiología. Results: this study included 88 patients, with dyspnea in NYHA functional class II-IV and dilated heart disease by echocardiography, of unknown etiology. Out of this group, 66% were men and 34 % women, the mean age was 56 ± 11.19 years. When undergoing diagnostic cinecoronariography, it was found that 23 % had epicardial coronary lesions, the most frequent being a lesion of a vessel (55 %), with the male sex predominating in those with or without epicardial coronary lesions. Conclusions: the frequency of epicardial coronary lesions in patients with dilated heart disease is low.

Características clínicas y angiográficas de pacientes fumadores y no fumadores sometidos a cinecoronariografía - Servicio de Clínica Médica. Hospital Central del Instituto de Previsión Social. Enero 2018 a octubre del 2019

Resumen Introducción: El tabaquismo es considerado uno de los factores de riesgo más importantes en las enfermedades cardiovasculares. La incidencia de pacientes con infarto sigue en aumento, sobre todo en adultos jóvenes en quienes el único factor de riesgo presente es el tabaquismo. Objetivo: Determinar las características clínicas y angiográficas de pacientes fumadores y no fumadores sometidos a cinecoronariografía internados en el servicio de clínica médica de enero 2018 a octubre 2019. Metodología: Estudio observacional, descriptivo, transversal. Se incluirá a todos los pacientes con diagnóstico de infarto de miocardio, que se realizaron cateterismo cardiaco. Resultados: Se incluyó a 100 pacientes, con edad promedio de 67,9± 10,2 años, 39,0% entre 68 y 77 años. 60,0% de sexo masculino. 91,0% presentó hipertension arterial, 42,0% diabetes mellitus, 20,0% dislipidemias, 14,0% obesidad. 62,0% de los pacientes presento sin elevación del segmento ST. En el grupo de pacientes fumadores el 39,1% presentó lesiones de 2 vasos coronarios, entre los no fumadores el 35,0% presentó lesión de 1 vaso. 53,0% se realizó angioplastia con colocacion de stent coronario. Conclusión: Los pacientes fumadores presentan tendencia a la lesión de más de un vaso coronario, el sexo masculino fue predominante, casi todos los pacientes presentaron hipertensión arterial.

Abstract Introduction: Smoking is considered one of the most important risk factors in cardiovascular ediseases. The incidence of heart attack patients continues to increase, especially in young adults in whom the only risk factor present is smoking. Objective: To determine the clinical and angiographic characteristics of smokers and non-smokers patients undergoing coronary angiography admitted to the medical clinic service from January 2018 to October 2019. Methodology: Observational, descriptive, cross-sectional study. All patients diagnosed with myocardial infarction who underwent cardiac catheterization will be included. Results: 100 patients were included, with an average age of 67.9 ± 10.2 years, 39.0% between 68 and 77 years. 60.0% male. 91.0% presented high blood pressure, 42.0% diabetes mellitus, 20.0% dyslipidemia, 14.0% obesity. 62.0% of the patients presented without ST segment elevation. In the group of smoking patients 39.1% presented lesions of 2 coronary vessels, among non-smokers 35.0% presented lesion of 1 vessel. Angioplasty with coronary stent placement was performed 53.0%. Conclusion: Smoking patients have a tendency to damage more than one coronary vessel, the male sex was predominant, almost all patients presented high blood pressure.

Factores de Riesgo de Mortalidad en Pacientes Hematológicos con Aspergilosis Pulmonar en Clínica Médica Instituto de Previsión Social - Hospital Central. Año 2016 A 2018

ResumenIntroducción: Es una de las infecciones oportunistas de mayor impacto en el paciente con patologías hematooncológicas, su detección precoz y tratamiento oportuno impide su diseminación. Objetivo: Determinar factores de riesgo de mortalidad en pacientes hematológicos con aspergilosis pulmonar de pacientes internados en clínica médica en el Instituto de Previsión Social del Hospital Central durante 2016 a 2018. Metodología: Estudio observacional, descriptivo, transversal, se incluyó a pacientes con patologías hematooncológicas e infección por aspergillus internados por un periodo de tres años. Resultados: Se incluyó a 55 pacientes, con edad promedio de 57,2±19,5 años. El 36,3% con edades comprendidas entre 40 a 59 años. 52,8% fue sexo femenino. 56,3% presentó hipertensión arterial. 27,2% linfoma no Hodking. 34,5% se encontraba en fase de mantenimiento al momento del diagnóstico de aspergilosis pulmonar. Respecto al grado de neutropenia el 34,7% presentó neutropenia severa. El 83,6% fue diagnosticado a traves de TACAR y galactomanano. El tiempo de inicio de síntomas hasta el momento del diagnóstico en promedio de días fue de 12,4±4,7 días. 38,1% presentó esputo con aislamiento positivo. Del tratamiento antifúngicos el 78,2% recibió anfotericina B y 21,8% Voriconazol. En relación a la evolución clínica 50,9% fueron alta, el 25,45% requirieron de Unidad de cuidados intensivos, 23,6%obitaron. Conclusión: Las aspergilosis pulmonar se presentó con predominio femenino, la mayoría se encontraba con neutropenia severa en fase de mantenimiento quimioterápico, dos tercios fue tratado con anfotericina B y la mitad fue dado de alta médica.

AbstractIntroduction: It is one of the opportunistic infections with the greatest impact on the patient with hemato-oncological pathologies, its early detection and timely treatment prevents its spread. Objective: To determine risk factors for mortality in hematological patients with pulmonary aspergillosis of patients hospitalized in a medical clinic at the Social Security Institute of the Central Hospital during 2016 to 2018. Methodology: Observational, descriptive, cross-sectional study included patients with hemato-oncological pathologies and infection by aspergillus hospitalized for a period of three years. Results: 55 patients were included, with an average age of 57.2 ± 19.5 years. 36.3% with ages between 40 to 59 years. 52.8% were female. 56.3% presented hypertension. 27.2% non-Hodking lymphoma. 34.5% were in the maintenance phase at the time of pulmonary aspergillosis diagnosis. Regarding the degree of neutropenia, 34.7% presented severe neutropenia. 83.6% were diagnosed through TACAR and galactomannan. Symptom onset time until diagnosis on average days was 12.4 ± 4.7 days. 38.1% presented sputum with positive isolation. Of the antifungal treatment, 78.2% received amphotericin B and 21.8% Voriconazole. In relation to the clinical evolution, 50.9% were high, 25.45% required an intensive care unit, 23.6% obliged. Conclusion: Pulmonary aspergillosis presented with a female predominance, the majority were with severe neutropenia in the phase of chemotherapy maintenance, two thirds were treated with amphotericin B and half were discharged medically.

Luxación glenohumeral posterior traumática: Reporte de caso / Traumatic posterior glenohumeral dislocation: A case report

Introducción. La luxación glenohumeral posterior (LGHP) es una lesión de diagnóstico poco frecuente que se asocia a traumatismos de alta energía, deporte, convulsiones y electrocuciones. Con frecuencia el diagnóstico es omitido debido a que en la mayoría de veces no se observa deformidad llamativa en la articulación lesionada y las radiografías iniciales son similares a la del hombro ileso. Presentamos el caso de un varón de 30 años que ingresó al servicio de emergencia tras una caída sobre el hombro izquierdo sin deformidad articular observable. Se le realizó un radiografía anteroposterior y transtorácica concluyendo en el diagnóstico de LGHP. La lesión fue tratada mediante reducción incruenta bajo anestesia general. Alos 4 años de seguimiento no presenta secuelas y conserva movilidad articular sin dolor.

Introduction. The posterior glenohumeral dislocation (PGD) is misdiagnosed frequently. This is associated withhigh-energy trauma, sports, seizures and electrocutions. The diagnosis is often omitted because of in most of the cases a striking deformity is not seen in the injured joint. Also, initial x-ray images are very similar to those from an uninjured shoulder. A30-year-old man was admitted to the emergency room after falling onto his left shoulder, no joint deformity was observed. Anteroposterior and transthoracic X-ray showed PGD. Closed reduction was performed under general anesthesia. At 4-year follow-up, the patient has no sequels and preserves joint mobility without pain.

Hyper-phosphorylation of Rb S249 together with CDK5R2/p39 overexpression are associated with impaired cell adhesion and epithelial-to-mesenchymal transition: Implications as a potential lung cancer grading and staging biomarker.

Prediction of lung cancer metastasis relies on post-resection assessment of tumor histology, which is a severe limitation since only a minority of lung cancer patients are diagnosed with resectable disease. Therefore, characterization of metastasis-predicting biomarkers in pre-resection small biopsy specimens is urgently needed. Here we report a biomarker consisting of the phosphorylation of the retinoblastoma protein (Rb) on serine 249 combined with elevated p39 expression. This biomarker correlates with epithelial-to-mesenchymal transition traits in non-small cell lung carcinoma (NSCLC) cells. Immunohistochemistry staining of NSCLC tumor microarrays showed that strong phospho-Rb S249 staining positively correlated with tumor grade specifically in the squamous cell carcinoma (SCC) subtype. Strong immunoreactivity for p39 positively correlated with tumor stage, lymph node invasion, and distant metastases, also in SCC. Linear regression analyses showed that the combined scoring for phospho-Rb S249, p39 and E-cadherin in SCC is even more accurate at predicting tumor staging, relative to each score individually. We propose that combined immunohistochemistry staining of NSCLC samples for Rb phosphorylation on S249, p39, and E-cadherin protein expression could aid in the assessment of tumor staging and metastatic potential when tested in small primary tumor biopsies. The intense staining for phospho-Rb S249 that we observed in high grade SCC could also aid in the precise sub-classification of poorly differentiated SCCs.

A Selection of Important Genes and Their Correlated Behavior in Alzheimer's Disease.

In 2017, approximately 5 million Americans were living with Alzheimer's disease (AD), and it is estimated that by 2050 this number could increase to 16 million. In this study, we apply mathematical optimization to approach microarray analysis to detect differentially expressed genes and determine the most correlated structure among their expression changes. The analysis of GSE4757 microarray dataset, which compares expression between AD neurons without neurofibrillary tangles (controls) and with neurofibrillary tangles (cases), was casted as a multiple criteria optimization (MCO) problem. Through the analysis it was possible to determine a series of Pareto efficient frontiers to find the most differentially expressed genes, which are here proposed as potential AD biomarkers. The Traveling Sales Problem (TSP) model was used to find the cyclical path of maximal correlation between the expression changes among the genes deemed important from the previous stage. This leads to a structure capable of guiding biological exploration with enhanced precision and repeatability. Ten genes were selected (FTL, GFAP, HNRNPA3, COX1, ND2, ND3, ND4, NUCKS1, RPL41, and RPS10) and their most correlated cyclic structure was found in our analyses. The biological functions of their products were found to be linked to inflammation and neurodegenerative diseases and some of them had not been reported for AD before. The TSP path connects genes coding for mitochondrial electron transfer proteins. Some of these proteins are closely related to other electron transport proteins already reported as important for AD.

Biological signaling pathways and potential mathematical network representations: biological discovery through optimization.

Establishing the role that different genes play in the development of cancer is a daunting task. A step toward this end is the detection of genes that are important in the illness from high-throughput biological experiments. Furthermore, it is safe to say that it is highly unlikely that these show expression changes independently, even with a list of potentially important genes. A biological signaling pathway is a more plausible underlying mechanism as favored in the literature. This work attempts to build a mathematical network problem through the analysis of microarray experiments. A preselection of genes is carried out with a multiple criteria optimization framework previously published by our research group . Afterward, application of the Traveling Salesperson Problem and Minimum Spanning Tree network optimization models are proposed to identify potential signaling pathways via the most correlated path among the genes of interest. Biological evidencing is provided to assess the effectiveness of the proposed methods. The capability of our analysis strategy is also demonstrated through the undertaking of meta-analysis studies. Three important aspects are novel in this work: (1) our joint analyses of different groups of lung cancer states reveal new correlations, biologically evidenced, and previously undocumented; (2) computation of the correlation coefficients from expression differences leads to an effective use of network optimization methods; and (3) the methods yield mathematically optimal correlation structures: no other configuration is better correlated using the available information.

Supercritical impregnation of cinnamaldehyde into polylactic acid as a route to develop antibacterial food packaging materials.

Supercritical impregnation was used to incorporate a natural compound with antibacterial activity into biopolymer-based films to develop active food packaging materials. Impregnation tests were carried out under two pressure conditions (9 and 12MPa), and three depressurization rates (0.1, 1 and 10MPamin-1) in a high-pressure cell at a constant temperature equal to 40°C. Cinnamaldehyde (Ci), a natural compound with proven antimicrobial activity, was successfully incorporated into poly(lactic acid) films (PLA) using supercritical carbon dioxide (scCO2), with impregnation yields ranging from 8 to 13% w/w. Higher pressure and slower depressurization rate seem to favor the Ci impregnation. The incorporation of Ci improved thermal, structural and mechanical properties of the PLA films. Impregnated films were more flexible, less brittle and more resistant materials than neat PLA films. The tested samples showed strong antibacterial activity against the selected microorganisms. In summary, this study provides an innovative route to the development of antibacterial biodegradable materials, which could be used in a wide range of applications of active food packaging.

Multiple criteria optimization joint analyses of microarray experiments in lung cancer: from existing microarray data to new knowledge.

Microarrays can provide large amounts of data for genetic relative expression in illnesses of interest such as cancer in short time. These data, however, are stored and often times abandoned when new experimental technologies arrive. This work reexamines lung cancer microarray data with a novel multiple criteria optimization-based strategy aiming to detect highly differentially expressed genes. This strategy does not require any adjustment of parameters by the user and is capable to handle multiple and incommensurate units across microarrays. In the analysis, groups of samples from patients with distinct smoking habits (never smoker, current smoker) and different gender are contrasted to elicit sets of highly differentially expressed genes, several of which are already associated to lung cancer and other types of cancer. The list of genes is provided with a discussion of their role in cancer, as well as the possible research directions for each of them.

Identification of potential biomarkers from microarray experiments using multiple criteria optimization.

Microarray experiments are capable of determining the relative expression of tens of thousands of genes simultaneously, thus resulting in very large databases. The analysis of these databases and the extraction of biologically relevant knowledge from them are challenging tasks. The identification of potential cancer biomarker genes is one of the most important aims for microarray analysis and, as such, has been widely targeted in the literature. However, identifying a set of these genes consistently across different experiments, researches, microarray platforms, or cancer types is still an elusive endeavor. Besides the inherent difficulty of the large and nonconstant variability in these experiments and the incommensurability between different microarray technologies, there is the issue of the users having to adjust a series of parameters that significantly affect the outcome of the analyses and that do not have a biological or medical meaning. In this study, the identification of potential cancer biomarkers from microarray data is casted as a multiple criteria optimization (MCO) problem. The efficient solutions to this problem, found here through data envelopment analysis (DEA), are associated to genes that are proposed as potential cancer biomarkers. The method does not require any parameter adjustment by the user, and thus fosters repeatability. The approach also allows the analysis of different microarray experiments, microarray platforms, and cancer types simultaneously. The results include the analysis of three publicly available microarray databases related to cervix cancer. This study points to the feasibility of modeling the selection of potential cancer biomarkers from microarray data as an MCO problem and solve it using DEA. Using MCO entails a new optic to the identification of potential cancer biomarkers as it does not require the definition of a threshold value to establish significance for a particular gene and the selection of a normalization procedure to compare different experiments is no longer necessary.

Potential colon cancer biomarker search using more than two performance measures in a multiple criteria optimization approach.

OBJECTIVE: A new method using Multiple Criteria Optimization (MCO) proposed by our research group has shown evidence of being able to identify gene-based biomarkers for the detection of cancer using microarray data. Herein, we explore this method, considering more than two conflicting criteria for the MCO problem. Using this method would result in stronger outcomes when using different results from microarray analyses. It would also demonstrate that the method is suitable for carrying out meta-analysis. METHODS: Statistical comparisons between normal and cancer tissues were performed using a colon cancer microarray database. The different comparisons were carried out with a Mann-Whitney non-parametric test using partial permutations of the data. An MCO problem was built using the different p-values obtained. The associated solution was the set of genes reaching the best compromises between the p-values under consideration that were located in the so-called efficient frontier. Data Envelopment Analysis (DEA) was used to find the efficient frontier of the MCO problem. The capacity of DEA was explored using different numbers of p-values (criteria) in the model. RESULTS: The set of identified genes was consistent across the instances using different numbers of p-values in the DEA model, thereby providing evidence of the outcome stability of the proposed strategy. It was also observed that convergence to a larger number of potential biomarkers is faster with additional criteria, i.e., more p-values. CONCLUSION: The MCO problem proposed for the cancer biomarker search using microarray data can be solved efficiently with DEA using more than two conflicting criteria. This approach can result in robust results when using different analyses of microarray data and, indeed, in a faster convergence to highly potential biomarkers.

Two novel nonparametric methods for cancer diagnosis through microarray analysis.

Diagnosing cancer using microarray analysis to study differential gene expression has been a recent focus of intense research Although several very sophisticated analysis tools have been developed with this aim in mind, it still remains a challenge to keep these methods free of parametric adjustments as well as maintain their transparency for the final user. Nonparametric methods in general have been associated with these last two characteristics, thus becoming attractive tools for microarray analysis in cancer research. In particular, diagnosing cancer via microarray analysis is an exercise whereby tissue is characterized according to its differential gene expression levels. In this manuscript, two novel nonparametric methods for cancer diagnosis using microarray data are described and their performance assessed against a baseline approach that utilizes the Mann-Whitney test for median differences. Both methods show promising results in terms of their potential use in making diagnoses.