Review of the concept of Profilicollis Meyer, 1931 with a description of Profilicollis rancoensis n. sp. (Acanthocephala: Polymorphidae) from the freshwater crab, Aegla abtao Schmitt, 1942 (Decapoda: Anomura) in Chile, with a key to congeneric species.

Profilicollis rancoensis n. sp. is the tenth species of Profilicollis Meyer, 1931 which includes 9 other species mostly known from marine decapod crabs and shore birds. Cystacanths of P. rancoensis are described from the dominant freshwater crab Aegla abtao in Ranco Lake, Chile and are morphologically distinguished from cystacanths of the 9 other species based on a combination of 4 characters. These are body size, number of proboscis hook rows, number of hooks per row, and length of the largest anterior 2-4 hooks. Male and female cystacanths of P. rancoensis are 2.10-3.33 mm long having an ovoid proboscis with 14 rows of 6-7 hooks per row, with the largest anterior 2-4 hooks being 105-110 micrometers long; the anterior trunk has many small spines in 70-80 concentric rings, each with 50-60 spines around them; hook roots are simple, directed posteriorly, about as long as the blades anteriorly with unremarkable anterior manubria; the cephalic ganglion are in mid-receptacle just anterior to the level of the anterior trunk; the lemnisci are long and slender; the testes are in the anterior trunk, posterior trunk, or one in each; the primordia of 2 tubular cement glands are evident; strong bundles of fibers link the anterior and posterior trunk; and the posterior trunk has a corrugated surface cuticula. Molecular analysis (COI and 18S) sequences coincided with the morphology and support its taxonomy. The phylogenetic profile revealed that P. rancoensis n. sp. fell into the Profilicollis clade. Both sequences showed low genetic variation, and three different haplotypes were found. The new species was more closely related to P. botulus (Van Cleave, 1916) Witenberg, 1932 than to other Profilicollis species.

Title: Révision du concept de Profilicollis Meyer, 1931 avec la description de Profilicollis rancoensis n. sp. (Acanthocephala, Polymorphidae) du crabe d'eau douce Aegla abtao Schmitt, 1942 (Decapoda, Anomura) au Chili, avec une clé des espèces congénères. Abstract: Profilicollis rancoensis n. sp. est la dixième espèce de Profilicollis Meyer, 1931 qui comprend neuf autres espèces principalement connues de crabes décapodes marins et d'oiseaux de rivage. Les cystacanthes de P. rancoensis sont décrits chez le crabe d'eau douce dominant Aegla abtao dans le lac Ranco, au Chili et se distinguent morphologiquement des cystacanthes des neuf autres espèces sur la base d'une combinaison de quatre caractères. Il s'agit de la taille du corps, du nombre de rangées de crochets du proboscis, du nombre de crochets par rangée et de la longueur des 2 à 4 crochets antérieurs les plus grands. Les cystacanthes mâles et femelles de P. rancoensis mesurent de 2,10 à 3,33 mm de long et ont une trompe ovoïde avec 14 rangées de 6 à 7 crochets par rangée, les 2 à 4 crochets antérieurs les plus grands mesurant 105 à 110 micromètres de long ; le tronc antérieur a de nombreuses petites épines en 70-80 anneaux concentriques chacun avec 50-60 épines ; les racines des crochets sont simples, dirigées vers l'arrière, à peu près aussi longues que les lames vers l'avant avec une manubrie antérieure sans particularité ; les ganglions céphaliques sont au milieu du réceptacle juste en avant du niveau du tronc antérieur ; les lemnisques sont longs et minces ; les testicules sont dans le tronc antérieur, le tronc postérieur ou un dans chacun ; les ébauches des 2 glandes cémentaires tubulaires sont évidentes ; de solides faisceaux de fibres relient le tronc antérieur et postérieur ; le tronc postérieur a une cuticule à surface ondulée. Les séquences d'analyse moléculaire (COI et 18S) coïncidaient avec la morphologie et confirmaient sa taxonomie. Le profil phylogénétique a révélé que P. rancoensis n. sp. appartient au clade Profilicollis. Les deux séquences ont montré une faible variation génétique et trois haplotypes différents ont été trouvés. La nouvelle espèce était plus proche de P. botulus (Van Cleave, 1916) Witenberg, 1932 que des autres espèces de Profilicollis.

Prevalencia y caracterización de la sobrecarga del cuidador primario de pacientes al final de la vida / Prevalence and characterization of overload of the primary caregiver of patients at the end of life

Introducción: El objetivo del presente estudio fue determinar la prevalencia de la sobrecarga del cuidador primario de pacientes al final de la vida que acuden al servicio de urgencias de este hospital y determinar sus características sociodemográficas. Pacientes y métodos: Se realizó un estudio de tipo observacional, descriptivo y prospectivo; se incluyeron 264 cuidadores principales de pacientes que se encontraban en la fase final de la vida, quienes recibieron atención médica por complicaciones de su patología de base en el servicio de urgencias del Hospital General de México “Dr. Eduardo Liceaga”, en un periodo de 6 meses, del 1 de abril de 2021 al 31 de septiembre de 2021, con los siguientes criterios de inclusión: ser el cuidador principal, tener un lazo familiar con un enfermo, con participación voluntaria, tener más de 18 años de edad. Los participantes, previa firma del consentimiento informado, contestaron los cuestionarios de datos demográficos, escala de Zarit abreviada, escala de Katz. Dentro de la valoración multidimensional del paciente con enfermedad terminal, la valoración biológica es fundamentada por la situación funcional del enfermo; para valorar la dependencia para las actividades de la vida diaria se puede emplear el índice de Katz. Resultados: Se incluyeron 264 cuidadores primarios, 187 (70,8 %) fueron del género femenino y 77 (29,2 %) del género masculino; la edad mínima fue de 18 años y máxima de 80 años, con una mediana de 44 años. Del total de cuidadores analizados 219 (83 %) presentaban sobrecarga del cuidador en el momento de la entrevista. De los sujetos estudiados, 138 (52,3 %) eran cuidadores únicos, de los cuales más de la mitad (57 %) padecían sobrecarga del cuidador. (AU)

Introduction: The objective of this study was to determine the prevalence of overload among the primary caregivers of patients at the end of life who attended the emergency department of this hospital, and to determine their sociodemographic characteristics. Patients and methods: An observational, descriptive and prospective study was carried out, including 264 main caregivers of patients who were in the final phase of life, who received medical care for complications of their underlying condition in the emergency department of the General Hospital of Mexico “Dr. Eduardo Liceaga” over a period of 6 months, from April 1, 2021 to September 31, 2021, with the following inclusion criteria: being the main caregiver, having a family relationship with the patient, voluntary participation, being more than 18 years old. The participants, after signing an informed consent, completed the demographic data questionnaires, the abbreviated Zarit scale, and the Katz scale. Within the multidimensional assessment of the terminally ill patient, the biological assessment is based on the patient’s functional status; to assess dependence on activities of daily living, the Katz index can be used. Results: A total of 264 primary caregivers were included, 187 (70,8%) were female and 77 (29,2%) were male; the minimum age was 18 years and the maximum age was 80 years, with a median of 44 years. Of the total number of caregivers analyzed, 219 (83%) presented caregiver collapse syndrome at the time of the interview. Of the subjects studied, 138 (52,3%) were sole caregivers, of which more than half (57%) suffered from caregiver collapse syndrome. (AU)

Quantitative STEM: A method for measuring temperature and thickness effects on thermal diffuse scattering using STEM/EELS, and for testing electron scattering models.

In the last two decades, advances in the dark field detectors and microscopes of scanning transmission electron microscopy (STEM) have inspired a resurgence of interest in quantitative STEM analysis. One promising avenue is the use of STEM as a nanothermometric probe. In this application, thermal diffuse scattering, captured by a CCD camera or an annular dark field detector, acts as an indirect measurement of the specimen temperature. One challenge with taking such a measurement is achieving adequate sensitivity to quantify a change in scattered electron signal on the order of 1% or less of the full electron beam. Another difficulty is decoupling the thermal effect on electron scattering from scattering changes due to differing specimen thicknesses and materials. To address these issues, we have developed a method using STEM, combined with electron energy loss spectroscopy (EELS), to produce a material-specific calibration curve. On silicon, across the range 89 K to 294 K, we measured a monotonically increasing HAADF signal ranging from 4.0% to 4.4% of the direct beam intensity at a thickness-to-mean-free-path ratio of 0.5. This yielded a calibration curve of temperature versus full-beam-normalized, thickness-normalized HAADF signal. The method enables thermal measurements on a specimen of varying local thickness at a spatial resolution of a few nanometers. We demonstrated the potential of the technique for testing electron scattering models by applying single-electron scattering theory to the data collected to extract a measurement of the mean atomic vibration amplitude in silicon at 294 K. The measured value, 0.00738 ± 0.00002 nm, agrees well with reported measurement using X-rays.

Strengthening the role of science and technology in disaster risk reduction: the Chilean strategy.

This paper presents an integrative case study of Chile's national strategy of research, development, and innovation (R&D+i) for disaster resilience and progress towards developing the institutional conditions necessary for its successful implementation. The paper covers the period between 2016 and 2021, concentrating on the work of the Chilean Commission of R&D+i for Resilience to Disasters of Natural Origin (CREDEN). Through an analysis of the official records of the initiative at all of its stages, and 29 semi-structured interviews with CREDEN members and stakeholders, we aim to present a successful example of strengthening the role of science and technology in disaster risk reduction. Chile's experience is particularly interesting because its strategy focused on R&D+i and proposed developing an industry of scientific-based technological solutions for disaster resilience. The study also illustrates how strategic interaction between academia, state, and industry can be a key factor in aligning knowledge production to tackle current socio-technical challenges.

Critical Analysis of the Evaluation Methods of Extended Reality (XR) Experiences for Construction Safety.

The construction industry has high accident rates. The sector is exploring various tools to improve safety management, training, and awareness to achieve zero accidents. This work focuses on extended reality (XR), which encompasses virtual reality (VR), augmented reality (AR), and mixed reality (MR) technologies. Several authors have developed training experiences for construction safety in XR environments with positive conclusions about their effectiveness. However, there is no standardization regarding the evaluation methods used in the sector, and many experiences do not use any method. This lack is critical, as whenever the aim is to evaluate the degree of awareness of security issues, the implementation of evaluation systems is indispensable to make known the methods used in the literature to evaluate the effectiveness of the experiences and represent support for future research. This research identifies developments in XR experiences and analyzes the validation methods through a systematic review using the PRISMA methodology. It identifies two evaluation methods, objective and subjective, which are each broken down into four categories. The results show the types of evaluation, safety-related purposes, and safety application objectives used by the database classification.

A comparative assessment of the morphology of Profilicollis altmani (Acanthocephala, Polymorphidae) from crustaceans and shore birds in Peru, with special notes on hook elemental analysis (EDXA), SEM imaging, histopathology, and molecular profile.

The morphology of cystacanths and adults of Profilicollis altmani (Perry, 1942) Van Cleave, 1947 (Polymorphidae) were studied from the Pacific mole crab Emerita analoga (Stimpson) (Crustacea, Hippidae) and Belcher's gull Larus belcheri (Vigors) (Aves, Laridae), respectively, in Peru. Comparative morphometrics with accounts of other populations of P. altmani from elsewhere off the Pacific and Atlantic coasts of North and South America revealed marked intraspecific population variations. We report scanning electron micrographs (SEM) of new features, not before noted or captured in line drawings by earlier observers. We further present microscope images that reveal internal details not previously reported or possible to see with SEM. Energy dispersive X-ray analysis (EDXA) revealed unusual patterns in the chemistry of proboscis hooks especially the high sulfur and diminished phosphorous and calcium in hook tips and low sulfur and high levels of phosphorous and calcium at mid hooks. The size and shape of all hooks of the cystacanths are reported for the first time. Histopathological studies in L. belcheri from Peru are also included. Cystacanths of P. altmani from California were also analyzed for molecular patterns and compared with other sequences reported from other locations. The molecular data and the analysis of our new sequences of cytochrome oxidase I (COI) showed that haplotypes of P. altmani had low genetic variation; the species is not geographically structured, and within its clade no monophyletic group is formed.

TITLE: Évaluation comparative de la morphologie de Profilicollis altmani (Acanthocephala, Polymorphidae) de crustacés et d'oiseaux de rivage au Pérou, en particulier l'analyse élémentaire des crochet (EDXA), l'imagerie SEM, l'histopathologie et le profil moléculaire. ABSTRACT: La morphologie des cystacanthes et des adultes de Profilicollis altmani (Perry, 1942) Van Cleave, 1947 (Polymorphidae) a été étudiée, respectivement, à partir du crustacé Emerita analoga (Stimpson) (Crustacea, Hippidae) et du Goéland Siméon Larus belcheri (Vigors) (Aves, Laridae), au Pérou. La morphométrie comparative avec des données d'autres populations de P. altmani d'autres localités au large des côtes du Pacifique et de l'Atlantique de l'Amérique du Nord et du Sud a révélé des variations intraspécifiques marquées des populations. Nous rapportons des nouvelles observations de microscopie électronique à balayage, non notées auparavant ou non capturées dans des dessins au trait par des observateurs antérieurs. Nous présentons en outre des images au microscope qui révèlent des détails internes qui n'ont pas été signalés auparavant ni possibles à voir avec MET. L'analyse aux rayons X à dispersion d'énergie (EDXA) a révélé des modèles inhabituels dans la chimie des crochets de la trompe, en particulier la teneur élevée en soufre et une diminution du phosphore et du calcium dans les pointes des crochets et des niveaux faibles en soufre et en phosphore et en calcium au milieu des crochets. La taille et la forme de tous les crochets des cystacanthes sont décrites pour la première fois. Des études histopathologiques sur L. belcheri du Pérou sont également incluses. Les cystacanthes de P. altmani de Californie ont également été analysés pour les modèles moléculaires et comparés à d'autres séquences rapportées d'autres endroits. Les données moléculaires et l'analyse de nos nouvelles séquences de cytochrome oxydase I (COI) ont montré que les haplotypes de P. altmani avaient une faible variation génétique. L'espèce n'est pas structurée géographiquement, et au sein de son clade aucun groupe monophylétique n'est formé.

Parámetros Cardiovasculares y su Variación Posterior a una Atención de Urgencia Odontológica

RESUMEN: La atención de urgencia dental se desenvuelve en un contexto de estrés que afecta el comportamiento cardiovascular de los pacientes, expresado como cambios en Frecuencia Cardiaca y Presión Arterial. Se espera que posterior a la atención, estos parámetros varíen conforme se controla el cuadro clínico o se presenten complicaciones. Un estudio observacional retrospectivo recopiló los registros de Frecuencia Cardiaca y Presión Arterial de pacientes atendidos en la urgencia dental del Complejo Asistencial Barros Luco en dos ocasiones, estando la segunda consulta vinculada al primer ingreso, tanto como control post tratamiento o complicaciones derivadas. Datos fueron registrados en Microsoft Excel™ y analizados en SciStat™. 466 pacientes consultaron en dos ocasiones, concentrados entre tercera y quinta década. Los mayores registros de Presión Arterial fueron reportados en controles post atención de Pericoronaritis, infecciones de espacios anatómicos faciales y en complicaciones post tratamiento por Pulpitis, TDA e Infección de espacios anatómicos faciales. En segundas consultas por control de Pulpitis, Alveolitis, TDA, Fracturas faciales y Hemorragias post exodoncia hubo disminución. Frecuencia Cardiaca fue el parámetro con mayor variación existiendo disminución en controles y complicaciones entre consultas. El papel exacto del dolor en la respuesta cardiovascular no está bien delimitado, la interpretación de las investigaciones destinadas a estudiar esto resulta difícil, pues estímulos nociceptivos son sólo uno de los activadores de la respuesta sistémica al estrés. En el postoperatorio el dolor juega un papel importante estudiado a 48 horas, más no, en mediano y largo plazo. Existen variaciones estadísticamente significativas en algunos parámetros estudiados, los cuales pueden presentar significancia clínica a considerar en pacientes hipertensos o cardiópatas. Son necesarios estudios sobre la incidencia particular que tienen los procedimientos odontológicos en la expresión de otros marcadores del estado sistémico.

ABSTRACT: Emergency dental care develops in a context of stress that affects the cardiovascular behavior of patients, expressed as changes in heart rate and blood pressure. After care, these parameters are expected to vary as the clinical picture is controlled or complications occur. A retrospective observational study compiled the heart rate and blood pressure records of patients seen in the dental emergency of the Barros Luco Care Complex on two occasions, the second consultation being linked to the first admission, as well as post-treatment control or derived complications. Data was recorded in Microsoft Excel ™ and analyzed in SciStat ™. 466 patients consulted on two occasions, concentrated between the third and fifth decade. Higher Blood Pressure records were reported in post-care controls for Pericoronitis, infections of facial anatomical spaces and in post-treatment complications due to Pulpitis, ADD and Infection of facial anatomical spaces. In second consultations for control of Pulpitis, Alveolitis, ADT, facial fractures and post- extraction hemorrhages there was a decrease. Heart rate was the parameter with the greatest variation, with a decrease in controls and complications between consultations. The exact role of pain in the cardiovascular response is not well defined, the interpretation of the research aimed at studying this is difficult, since nociceptive stimuli are only one of the activators of the systemic response to stress. In the postoperative period, pain plays an important role, studied at 48 hours, but not in the medium and long term. There are statistically significant variations in some parameters studied which may present clinical significance to be considered in hypertensive or heart disease patients. Studies are needed on the particular incidence that dental procedures have on the expression of other markers of the systemic state.

Implementation of Facility Management for Port Infrastructure through the Use of UAVs, Photogrammetry and BIM.

The maintenance of port infrastructures presents difficulties due to their location: an aggressive environment or the variability of the waves can cause progressive deterioration. Maritime conditions make inspections difficult and, added to the lack of use of efficient tools for the management of assets, planning maintenance, important to ensure operability throughout the life cycle of port infrastructures, is generally not a priority. In view of these challenges, this research proposes a methodology for the creation of a port infrastructure asset management tool, generated based on the Design Science Research Method (DSRM), in line with Building Information Modeling (BIM) and digitization trends in the infrastructure sector. The proposal provides workflows and recommendations for the survey of port infrastructures from UAVs, the reconstruction of digital models by photogrammetry (due to scarce technical documentation), and the reconstruction of BIM models. Along with this, the bidirectional linking of traditional asset management spreadsheets with BIM models is proposed, by visual programming, allowing easy visualization of the status and maintenance requirements. This methodology was applied to a port infrastructure, where the methodology demonstrated the correct functionality of the asset management tool, which allows a constant up-dating of information regarding the structural state of the elements and the necessary maintenance activities.

Barriers and facilitators to answering clinical questions in the Americas: a cross-sectional study of surgical trauma care providers.

BACKGROUND: We aimed to understand how surgical trauma providers in the Americas acquire answers to clinical questions and what barriers and facilitators they face in efforts to practice according to recommendations for common surgical cases. We hypothesized that increased English proficiency and country income improved providers' acquisition and application of clinical knowledge. METHODS: A 23-question survey evaluated reported confidence in interpretation of evidence, perceived language fluency, and access to and application of recommendations on sepsis and appendicitis. Electronic surveys were distributed across the Americas to Pan American Trauma Society members. RESULTS: 108 participants from 21 countries completed this survey. 59% had ≥21 years of provider experience. 38% reported their English reading comprehension as less than or equal to "limited working proficiency." 44% endorsed using Google Translate; 35% reported they did not need translation tools to evaluate medical literature. 59% felt uncertainty regarding clinical care at least weekly. 65% reported inability to answer their clinical questions at least once per month. 86% felt confident in their ability to interpret and apply evidence for their practice. To answer clinical questions, participants listed guidelines (76%), full-text peer-reviewed journal articles (61%), and meta-analyses (49%) as their most used resources. 25% answered all five clinical questions correctly, whereas 43% answered three or fewer correctly. 79% felt they had adequate access to resources to answer the five clinical questions. When controlling for individual demographic characteristics, decreased age (p<0.01) and increased country income level (p=0.03) positively impacted correct answers to questions. DISCUSSION: Uncertainties in clinical care are unavoidable. Language, age, and country income level impacted provider acquisition and application of knowledge relevant to select clinical scenarios. These findings highlight disparities in access and training and add urgency to the movement for improved dissemination and implementation approaches for evidence-based practice in surgery. LEVEL OF EVIDENCE: IV.

Factors Influencing Safety on Construction Projects (fSCPs): Types and Categories.

Due to the fact of activity, environment and work dynamics, the construction industry is characterised by high accident rates. Different initiatives have emerged to reduce these figures, which focus on using new methodologies and technologies for safety management. Therefore, it is essential to know the key factors and their influence on safety in construction projects (fSCPs) to focus efforts on these elements. Through a systematic literature review, based on PRISMA methodology, this article identifies, describes and categorises 100 factors that affect construction safety. It thus contributes by providing a comprehensive general framework, unifying previous studies focused on specific geographic areas or case studies with factors not considered or insufficiently disaggregated, along with an absence of classifications focused on understanding where and how factors affect the different dimensions of construction projects. The 100 factors identified are described and categorised according to the dimensions and aspects of the project in which these have an impact, along with identifying whether they are shaping or immediate factors or originating influences for the generation of accidents. These factors, their description and classification are a key contribution to improving the systematic creation of safety and generating training and awareness materials to fully develop a safety culture in organisations.

Unmanned Aerial Vehicles (UAVs) for Physical Progress Monitoring of Construction.

The physical progress of a construction project is monitored by an inspector responsible for verifying and backing up progress information, usually through site photography. Progress monitoring has improved, thanks to advances in image acquisition, computer vision, and the development of unmanned aerial vehicles (UAVs). However, no comprehensive and simple methodology exists to guide practitioners and facilitate the use of these methods. This research provides recommendations for the periodic recording of the physical progress of a construction site through the manual operation of UAVs and the use of point clouds obtained under photogrammetric techniques. The programmed progress is then compared with the actual progress made in a 4D BIM environment. This methodology was applied in the construction of a reinforced concrete residential building. The results showed the methodology is effective for UAV operation in the work site and the use of the photogrammetric visual records for the monitoring of the physical progress and the communication of the work performed to the project stakeholders.

The Age-AST-D Dimer (AAD) Regression Model Predicts Severe COVID-19 Disease.

AIM: Coronavirus disease (COVID-19) ranges from mild clinical phenotypes to life-threatening conditions like severe acute respiratory syndrome (SARS). It has been suggested that early liver injury in these patients could be a risk factor for poor outcome. We aimed to identify early biochemical predictive factors related to severe disease development with intensive care requirements in patients with COVID-19. METHODS: Data from COVID-19 patients were collected at admission time to our hospital. Differential biochemical factors were identified between seriously ill patients requiring intensive care unit (ICU) admission (ICU patients) versus stable patients without the need for ICU admission (non-ICU patients). Multiple linear regression was applied, then a predictive model of severity called Age-AST-D dimer (AAD) was constructed (n = 166) and validated (n = 170). RESULTS: Derivation cohort: from 166 patients included, there were 27 (16.3%) ICU patients that showed higher levels of liver injury markers (P < 0.01) compared with non-ICU patients: alanine aminotrasnferase (ALT) 225.4 ± 341.2 vs. 41.3 ± 41.1, aspartate aminotransferase (AST) 325.3 ± 382.4 vs. 52.8 ± 47.1, lactic dehydrogenase (LDH) 764.6 ± 401.9 vs. 461.0 ± 185.6, D-dimer (DD) 7765 ± 9109 vs. 1871 ± 4146, and age 58.6 ± 12.7 vs. 49.1 ± 12.8. With these finding, a model called Age-AST-DD (AAD), with a cut-point of <2.75 (sensitivity = 0.797 and specificity = 0.391, c - statistic = 0.74; 95%IC: 0.62-0.86, P < 0.001), to predict the risk of need admission to ICU (OR = 5.8; 95% CI: 2.2-15.4, P = 0.001), was constructed. Validation cohort: in 170 different patients, the AAD model < 2.75 (c - statistic = 0.80 (95% CI: 0.70-0.91, P < 0.001) adequately predicted the risk (OR = 8.8, 95% CI: 3.4-22.6, P < 0.001) to be admitted in the ICU (27 patients, 15.95%). CONCLUSIONS: The elevation of AST (a possible marker of early liver injury) along with DD and age efficiently predict early (at admission time) probability of ICU admission during the clinical course of COVID-19. The AAD model can improve the comprehensive management of COVID-19 patients, and it could be useful as a triage tool to early classify patients with a high risk of developing a severe clinical course of the disease.

Consenso Colombiano para la prevención, diagnóstico y manejo de condiciones trombóticas en pacientes adultos con COVID-19: aplicando el Marco de la Evidencia a la Decisión (EtD) GRADE / Colombian consensus for the prevention, diagnosis and treatment of thrombotic conditions in adult patients with COVID-19: applying GRADE Evidence to Decision (EtD) Frameworks

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Abstract Recent studies have reported the occurrence of thrombotic phenomena or coagulopathy in patients with COVID-19. There are divergent positions regarding the prevention, diagnosis, and treatment of these phenomena, and current clinical practice is based solely on deductions by extension from retrospective studies, case series, observational studies, and international guidelines developed prior to the pandemic. In this context, the aim was to generate a group of recommendations on the prevention, diagnosis and management of thrombotic complications associated with COVID-19. Methods: A rapid guidance was carried out applying the GRADE Evidence to Decision (EtD) frameworks and an iterative participation system, with statistical and qualitative analysis. Results: 31 clinical recommendations were generated focused on: a) Coagulation tests in symptomatic adults with suspected infection or confirmed SARS CoV-2 infection; b) Thromboprophylaxis in adults diagnosed with COVID-19 (Risk scales, thromboprophylaxis for outpatient, in-hospital management, and duration of thromboprophylaxis after discharge from hospitalization), c) Diagnosis and treatment of thrombotic complications, and d) Management of people with previous indication of anticoagulant agents. Conclusions: Recommendations of this consensus guide clinical decision-making regarding the prevention, diagnosis, and treatment of thrombotic phenomena in patients with COVID-19, and represent an agreement that will help decrease the dispersion in clinical practices according to the challenge imposed by the pandemic.

Impact of liver enzymes on SARS-CoV-2 infection and the severity of clinical course of COVID-19.

BACKGROUND AND AIM: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the virus responsible for the current pandemic, can have multi-organ impact. Recent studies show that liver injury could be a manifestation of the disease, and that liver disease could also be related to a worse prognosis. Our aim was to compare the characteristics of patients with severe coronavirus disease 2019 (COVID-19) due to SARS-CoV-2 who required intubation versus stable hospitalized patients to identify the early biochemical predictive factors of a severe course of COVID-19 and subsequent requirement for intubation, specifically in Mexican. METHODS: This was an observational case-control study nested in a cohort study. Complete medical records of patients admitted for confirmed COVID-19 at a tertiary level center in Mexico City were reviewed. Clinical and biochemical data were collected, and the characteristics of patients who required invasive mechanical ventilation (IMV) (cases) were compared with stable hospitalized patients without ventilation (controls). RESULTS: We evaluated 166 patients with COVID-19 due to SARS-CoV-2 infection; 114 (68.7%) were men, the mean age was 50.6 ± 13.3 years, and 27 (16.3%) required IMV. The comparative analysis between cases and controls showed (respectively) significantly lower blood oxygen saturation (SpO2) (73.5 ± 12.0% vs. 83.0 ± 6.8%, P < 0.0001) and elevated alanine aminotransferase (ALT) (128 (14-1123) IU/L vs. 33 (8-453) IU/L, P = 0.003), aspartate aminotransferase (AST) (214 (17-1247) vs. 44 (12-498) IU/L, P = 0.001), lactic dehydrogenase (LDH) (764.6 ± 401.9 IU/L vs. 461.0 ± 185.6 IU/L, P = 0.001), and D-dimer (3463 (524-34,227) ng/mL vs. 829 (152-41,923) ng/mL, P = 0.003) concentrations. Patients in the cases group were older (58.6 ± 12.7 years vs. 49.1 ± 12.8 years, P=0.001). Multivariate analysis showed that important factors at admission predicting the requirement for IMV during hospitalization for COVID-19 were AST ≥250 IU/L (odds ratio (OR) = 64.8, 95% confidence interval (CI) 7.5-560.3, P < 0.0001) and D-dimer ≥ 3500 ng/mL (OR = 4.1, 95% CI 1.2-13.7, P=0.02). CONCLUSIONS: Our study confirms the importance of monitoring liver enzymes in hospitalized patients with COVID-19; seriously ill patients have significantly elevated AST and D-dimer concentrations, which have prognostic implications in the SARS-CoV-2 disease course.

Boldine inhibits the alveolar bone resorption during ligature-induced periodontitis by modulating the Th17/Treg imbalance.

BACKGROUND: During periodontitis, tooth-supporting alveolar bone is resorbed when there is an increased expression of the pro-osteolytic factor termed receptor activator of nuclear factor κB ligand (RANKL), which is responsible for osteoclast differentiation and activation. In periodontitis-affected tissues, the imbalance between T-helper type-17 (Th17) and T-regulatory (Treg) lymphocyte activity favors this RANKL overexpression. In this context, immunotherapeutic strategies aimed at modulating this Th17/Treg imbalance could eventually arrest the RANKL-mediated alveolar bone loss. Boldine has been reported to protect from pathological bone loss during rheumatoid arthritis and osteoporosis, whose pathogenesis is associated with a Th17/Treg imbalance. However, the effect of boldine on alveolar bone resorption during periodontitis has not been elucidated yet. This study aimed to determine whether boldine inhibits alveolar bone resorption by modulating the Th17/Treg imbalance during periodontitis. METHODS: Mice with ligature-induced periodontitis were orally treated with boldine (10/20/40 mg/kg) for 15 consecutive days. Non-treated periodontitis-affected mice and non-ligated mice were used as controls. Alveolar bone loss was analyzed by micro-computed tomography and scanning electron microscopy. Osteoclasts were quantified by histological identification of tartrate-resistant acid phosphatase-positive cells. Production of RANKL and its competitive antagonist osteoprotegerin (OPG) were analyzed by ELISA, quantitative polymerase chain reaction (qPCR), and immunohistochemistry. The Th17 and Treg responses were analyzed by quantifying the T-cell frequency and number by flow cytometry. Also, the expression of their signature transcription factors and cytokines were quantified by qPCR. RESULTS: Boldine inhibited the alveolar bone resorption. Consistently, boldine caused a decrease in the osteoclast number and RANKL/OPG ratio in periodontal lesions. Besides, boldine reduced the Th17-lymphocyte detection and response and increased the Treg-lymphocyte detection and response in periodontitis-affected tissues. CONCLUSION: Boldine, administered orally, inhibited the alveolar bone resorption and modulated the Th17/Treg imbalance during experimental periodontitis.

American Association for the Surgery of Trauma-World Society of Emergency Surgery guidelines on diagnosis and management of peripheral vascular injuries.

The peripheral arteries and veins of the extremities are among the most commonly injured vessels in both civilian and military vascular trauma. Blunt causes are more frequent than penetrating except during military conflicts and in certain geographic areas. Physical examination and simple bedside investigations of pulse pressures are key in early identification of these injuries. In stable patients with equivocal physical examinations, computed tomography angiograms have become the mainstay of screening and diagnosis. Immediate open surgical repair remains the first-line therapy in most patients. However, advances in endovascular therapies and more widespread availability of this technology have resulted in an increase in the range of injuries and frequency of utilization of minimally invasive treatments for vascular injuries in stable patients. Prevention of and early detection and treatment of compartment syndrome remain essential in the recovery of patients with significant peripheral vascular injuries. The decision to perform amputation in patients with mangled extremities remains difficult with few clear indicators. The American Association for the Surgery of Trauma in conjunction with the World Society of Emergency Surgery seeks to summarize the literature to date and provide guidelines on the presentation, diagnosis, and treatment of peripheral vascular injuries. LEVEL OF EVIDENCE: Review study, level IV.

American Association for the Surgery of Trauma-World Society of Emergency Surgery guidelines on diagnosis and management of abdominal vascular injuries.

Abdominal vascular trauma accounts for a small percentage of military and a moderate percentage of civilian trauma, affecting all age ranges and impacting young adult men most frequently. Penetrating causes are more frequent than blunt in adults, while blunt mechanisms are more common among pediatric populations. High rates of associated injuries, bleeding, and hemorrhagic shock ensure that, despite advances in both diagnostic and therapeutic technologies, immediate open surgical repair remains the mainstay of treatment for traumatic abdominal vascular injuries. Because of their devastating nature, abdominal vascular injuries remain a significant source of morbidity and mortality among trauma patients. The American Association for the Surgery of Trauma in conjunction with the World Society of Emergency Surgery seek to summarize the literature to date and provide guidelines on the presentation, diagnosis, and treatment of abdominal vascular injuries. LEVEL OF EVIDENCE: Review study, level IV.