Euthanasia Attitudes Questionnaire in Medical Personnel (AHE-PM) / Cuestionario de actitudes hacia la eutanasia en personal médico (AHE-PM)

Abstract The right to die is an international dilemma. Some countries and states already have laws regulating one of the most common applications of this right, the active voluntary euthanasia. The evidence from these countries highlights the importance of a bioethical framework to limit some of its applications. In this regard, the evaluation of attitudes towards euthanasia in medical personnel will allow to understand the attitudes of these professionals and how they can deal with such requests, whether this assisted death is decided by the patients or their surroundings. Consequently, the aim of this study was to develop a brief scale to evaluate attitudes, as well as to determine their significance according to the gender and seniority of the professionals in this situation. A double design strategy was followed. On the one hand, a psychometric design with an exploratory and confirmatory factor analysis and, on the other, a descriptive analytical design for the comparison of groups. A six-item scale (AE-PM) and two factors were extracted. The first focuses on attitudes towards euthanasia to alleviate suffering for medical reasons and the second one to alleviate the patient's emotional suffering. The scale (AHE-PM) is useful for the rapid exploration of attitudes towards euthanasia in physicians, a professional group with limited free time, who may also encounter relatively frequent requests for active voluntary euthanasia. The two factors obtained allow attitudes to be assessed from a bioethical perspective, providing information on the application under apparent medical justification and in situations based on the patient's subjective emotional suffering.

Resumen La eutanasia voluntaria activa se define como la petición de un paciente que quiere morir y la acción que es llevada a cabo por otra persona para provocar dicha muerte. El derecho a morir es un dilema sobre el que se debate a nivel internacional. Algunos países y estados ya cuentan con leyes que regulan una de las aplicaciones más comunes de este derecho. Los datos aportados por estos países ponen de manifiesto la importancia de un marco bioético que permita limitar algunas de sus aplicaciones. En este sentido, la evaluación de las actitudes hacia la eutanasia en personal médico permitirá conocer las actitudes de estos profesionales y cómo estos pueden enfrentarse a dichas solicitudes, o no, sea de muerte asistida por parte de los pacientes o su entorno. Además, se ha reportado en la bibliografía diferentes actitudes según la experiencia o el sexo de los trabajadores, por lo que es de relevancia su exploración diferencial. Por ello, el objetivo del presente trabajo un instrumento de evaluación de actitudes hacia la eutanasia diseñado y validado por y para profesionales médicos en ejercicio. En esta línea, los objetivos de este estudio son obtener una escala corta con propiedades psicométricas adecuadas, que proporcione información relevante sobre las actitudes hacia la eutanasia, así como la posible evaluación de algunas prácticas médicas relacionadas con ésta que pueden ser bioéticamente dudosas. La muestra estaba compuesta por 419 profesionales de la medicina procedentes de tres provincias del sur de España. Se siguió una doble estrategia en el diseño. Por un lado, un diseño psicométrico con un análisis factorial exploratorio y confirmatorio. Se dividió la muestra en dos submuestras aleatorias para realizar de forma paralela ambos análisis. Se utilizaron los estadísticos KMO, Bartlett, RMSEA, RMRS, CFI, NNFI, GFI y AGFI para explorar el ajuste de modelos. Po otro lado, se utilizó un diseño asociativo descriptivo para la comparación de grupos mediante la t de Student, ANOVA, Tukey y la prueba d de Cohen. Se extrae una escala de seis ítems (AE-PM) y dos factores. El primero de ellos está centrado en las actitudes hacia la eutanasia para aliviar el sufrimiento por cuestiones médicas y el segundo para aliviar el sufrimiento emocional del paciente. Respecto al estudio de las diferencias, no se observaron diferencias significativas según el sexo del profesional ni la antigüedad en la profesión. La escala (AHE-PM) es útil para la exploración rápida de las actitudes hacia la eutanasia en médicos, un grupo profesional con limitado tiempo libre que, además, puede encontrarse con relativa frecuencia ante solicitudes de eutanasia voluntaria activa. Los dos factores obtenidos permiten evaluar, por un lado, las actitudes desde una perspectiva bioética. Es de especial relevancia en estas situaciones el conocimiento de las actitudes del personal médico hacia la eutanasia, exponiéndolo a un dilema bioético y personal. La autoconciencia de estos profesionales sobre sus propias actitudes hacia la eutanasia y su adaptación a los códigos éticos vigentes podría minimizar el impacto generado por estas situaciones y, por tanto, mejorar la relación terapéutica y la calidad asistencial. Por otro lado, el instrumento aporta información sobre la posible recomendación de estas prácticas bajo aparente justificación médica y/o en situaciones basadas en el sufrimiento emocional subjetivo del paciente. Estudios previos indican que los profesionales se ven afectados emocionalmente cuando se enfrentan a los conceptos de muerte y eutanasia en pacientes terminales. En este sentido, la escala también podría servir de evaluación de actitudes y el trabajo en planes de prevención de salud laboral en los centros sanitarios.

Enfermedad de Huntington en población panameña, 2007-2021

Introducción: La enfermedad de Huntington (EH) es un desorden neurodegenerativo autosómico dominante caracterizado por disfunción progresiva motora, cognitiva y psiquiátrica1. No se conoce la prevalencia de EH en Centro América (2-11). En Panamá no se han reportado estudios sobre esta Enfermedad. El objetivo es estimar la prevalencia de EH en población panameña. Metodología: Se realizó un estudio descriptivo de casos con EH entre 2007 y 2021 en un hospital de tercer nivel. Se incluyeron individuos panameños, mayores de 15 años, un caso por familia, con cuadro clínico sugestivo, con o sin antecedentes familiares, resonancia magnética cerebral y prueba genética HTT positiva. Estos casos fueron incluidos en el Registro Nacional de Enfermedad de Huntington. Resultados: Presentamos 11 casos índice, 6 femeninos.  Se estima una prevalencia de 0.25 x 100000 habitantes, edad promedio 40 años (rango 23-63), media 43±12.4, la edad de inicio 29 años (rango 14-43), media 27±11.13, presentación juvenil 3 casos. Se detectaron 91 sintomáticos de 185 familiares, transmisión predominante paterna, todos heterocigóticos. Alelo normal entre 13-23 repeticiones de CAG, mientras que alelo mutante oscila entre 41 y 59 repeticiones de CAG. Conclusión: Este es el primer reporte de la EH en población panameña, la prevalencia estimada es baja de 0.25 x 100000 habitantes. Estudios futuros deberán realizarse para conocer la prevalencia en Panamá y Centro América además de determinar el origen ancestral de esta población. (provisto por Infomedic International)

Introduction: Huntington´s disease (HD) is an autosomal dominant neurodegenerative disorder characterized by progressive motor, cognitive and psychiatric dysfunction. HD prevalence in Panama or in Central America is unknown. This will be the first report in Panamá about HD. Metodology: The objective is to estimate HD prevalence in Panamanian population. A retrospective, descriptive study of patients with HD between 2007 and 2021 was conducted. Panamanians > 15 years, 1 case per family, with typical clinical symptoms, with or without family history, brain magnetic resonance and positive genetic test and then included in the National registry of Huntington Disease. Results: Eleven index cases were presented, 6 women. The mean age was 40 years (range 23-63), median 43±12.4, sex ratio was 5:6, the onset age was 29 years (range 14-43), median 27±11.13. 3 cases in young patients. 91 symptomatic cases out of 185 relatives, with a dominant paternal transmission, all heterozygous. Normal allele between 13-23 CAG repetitions, while the mutant allele ranges between 41 and 59 CAG repetitions. Conclusions: This is the first HD report in Panamanian population, with a low estimated prevalence of 0.25 x 100,000. The aim of this study is to promote HD research in Panama and Central America and determine the ancestral origin of this population. (provided by Infomedic International)

Case Report: Splanchnic Vein Thrombosis as a Complication of Necrotizing Acute Pancreatitis in a Pediatric Patient.

Splanchnic vein thrombosis is an unusual manifestation of venous thromboembolism and includes portal vein thrombosis, mesenteric veins thrombosis, splenic vein thrombosis, and the Budd-Chiari syndrome. The most common risk factors include hematologic and autoimmune disorders, hormonal therapy, liver cirrhosis, solid abdominal cancer, recent abdominal surgery, and abdominal infections or inflammatory conditions, such as pancreatitis. Splanchnic vein thrombosis in acute pancreatitis is most commonly associated with the severe form of the disease and pancreatic necrosis. This report describes a case of splanchnic vein thrombosis as a complication of necrotizing acute pancreatitis in a pediatric patient. Splanchnic vein thrombosis was incidentally detected on contrast-enhanced computed tomography to assess the pancreas. There was no evidence of prior risk factors for the thrombotic condition. The patient was treated with anticoagulation and showed complete resolution after recovery from necrotizing acute pancreatitis, at a 16-month follow-up. The complication of necrotizing acute pancreatitis with splanchnic vein thrombosis in pediatric age is a rare presentation.

An Upgrade on the Surveillance System of SARS-CoV-2: Deployment of New Methods for Genetic Inspection.

SARS-CoV-2 variants surveillance is a worldwide task that has been approached with techniques such as Next Generation Sequencing (NGS); however, this technology is not widely available in developing countries because of the lack of equipment and limited funding in science. An option is to deploy a RT-qPCR screening test which aids in the analysis of a higher number of samples, in a shorter time and at a lower cost. In this study, variants present in samples positive for SARS-CoV-2 were identified with a RT-qPCR mutation screening kit and were later confirmed by NGS. A sample with an abnormal result was found with the screening test, suggesting the simultaneous presence of two viral populations with different mutations. The DRAGEN Lineage analysis identified the Delta variant, but there was no information about the other three mutations previously detected. When the sequenced data was deeply analyzed, there were reads with differential mutation patterns, that could be identified and classified in terms of relative abundance, whereas only the dominant population was reported by DRAGEN software. Since most of the software developed to analyze SARS-CoV-2 sequences was aimed at obtaining the consensus sequence quickly, the information about viral populations within a sample is scarce. Here, we present a faster and deeper SARS-CoV-2 surveillance method, from RT-qPCR screening to NGS analysis.

Recomendaciones de la Asociación Colombiana de Neurología para el uso de anticuerpos monoclonales antiCGRP en la profilaxis de migraña / Recommendations on the use of the antiCGRP monoclonal antibodies for migraine prophylaxis on behalf of the Colombian Association of Neurology

RESUMEN INTRODUCCIÓN: El desarrollo de anticuerpos monoclonales (mAbs) contra el péptido relacionado con el gen de la calcitonina (CGRP) ha determinado una nueva era terapéutica en la profilaxis de migraña, demostrando su efectividad en pacientes con migraña episódica (ME) y migraña crónica (MC), con respuesta desde pacientes naïve hasta refractarios a múltiples medicamentos. La disminución del 50% de los ataques de migraña al mes (DMM) durante los primeros 3 meses de uso es el desenlace aproximado en el 50% de los pacientes que reciben esta terapia. OBJETIVO: Este consenso de la Asociación Colombiana de Neurología (ACN) tiene el objetivo de guiar la selección y uso racional de los mAbs antiCGRP en pacientes con ME y MC. MATERIALES Y MÉTODOS: El comité de cefalea de la ACN mediante la aplicación de la metodología Delphi y discusiones en reuniones posteriores desarrolló un documento en formato de consenso soportado en literatura y recomendaciones de expertos. RESULTADOS: Se obtuvieron respuestas de 14 expertos en cefalea sobre moléculas utilizadas en profilaxis de migraña, analizando su aplicabilidad en situaciones clínicas frecuentes. DISCUSIÓN: Los mAbs antiCGRP han demostrado efectividad con adecuado soporte fisiopatológico, considerando que son moléculas de alto precio en una enfermedad de alta prevalencia, existe la necesidad de guíar la selección del paciente que mejor puede beneficiarse de su administración CONCLUSIONES: Los mAbs antiCGRP están recomendados en pacientes con ME y MC que presentan falla terapéutica a otras moléculas profilácticas.

ABSTRACT INTRODUCTION: The development of monoclonal antibodies (mAbs) against Calcitonin Gene Related Peptide (CGRP) has determined a new therapeutic era in migraine prophylaxis, demonstrating its effectiveness in patients with episodic migraine (EM) and chronic migraine (CM), obtaining a response in naive patients and in those who are refractory to multiple medications. A 50% decrease in migraine attacks per month during the first 3 months of use is the approximate outcome in 50% of patients receiving this therapy. OBJECTIVE: This consensus from the Colombian Association of Neurology (ACN) has the objective of serving as a guide for the rational use of antiCGRP mAbs in patients with EM and CM. METHODS AND MATERIALS: The headache committee through the application of the Delphi methodology and discussions in subsequent meetings, develops this consensus, supported in the published literature and expert recommendations. RESULTS: Fourteen answers from headache experts were received regarding the use of drugs for migraine prophylaxis, analyzing their applicability in frequent clinical situations. DISCUSSION: AntiCGRP mAbs have proved their effectiveness with adequate pathophysiological support, but with a high price in a highly prevalent disease, there is then a need to select the patient who best benefits from this therapy. CONCLUSIONS: AntiCGRP mAbs are recommended in patients with EM and CM that have previously failed to other prophylactic drugs.

Reinforced Concrete Structure Performance in Marine Structures: Analyzing Durability Indexes to Obtain More Accurate Corrosion Initiation Time Predictions.

This paper presents a comparison of six index properties collected during durability inspections of five Mexican seaports. Typical durability indicators such as compressive strength, saturated electrical resistivity, ultrasonic pulse velocity, percent total void content, capillary porosity, and chloride concentration profiles were analyzed to obtain empirical correlations with the non-steady-state chloride diffusion coefficient. These indices were compared to determine correlation coefficients that are the most important for obtaining better corrosion initiation forecasting. Two models of corrosion initiation time (ti) were used: Fick's second law of diffusion and the reported UNE-83994-2 (Spanish Association for Standardization, UNE) in which electrical resistivity was used to calculate concrete service life. The data from both models were cleaned using correlated variables, and the initial variables were compared with ti. The main result achieved was the verification of the feasibility of using correlations of variables to clean unnecessary data in order to calculate ti. Additionally, electrical resistivity was identified as one of the main durability indexes for in-service concrete structures exposed to marine environments. This is important because electrical resistivity is a non-destructive and reliable test that can be measured both in the laboratory and in the field very easily.

Effect of the Addition of Agribusiness and Industrial Wastes as a Partial Substitution of Portland Cement for the Carbonation of Mortars.

The present research work shows the effect on the carbonation of Portland cement-based mortars (PC) with the addition of green materials, specifically residues from two groups: agricultural and industrial wastes, and minerals and fibres. These materials have the purpose of helping with the waste disposal, recycling, and improving the durability of concrete structures. The specimens used for the research were elaborated with CPC 30R RS, according to the Mexican standard NMX-C-414, which is equivalent to the international ASTM C150. The aggregates were taken from the rivers Lerma and Huajumbaro, in the State of Michoacan, Mexico, and the water/cement relation was 1:1 in weight. The carbonation analyses were performed with cylinder specimens in an accelerated carbonation test chamber with conditions of 65 +/- 5% of humidity and 25 +/- 2 °C temperature. The results showed that depending on the PC substitutions, the carbonation front advance of the specimens can increase or decrease. It is highlighted that the charcoal ashes, blast-furnace slags, and natural perlite helped to reduce the carbonation advance compared to the control samples, consequently, they contributed to the durability of concrete structures. Conversely, the sugarcane bagasse ash, brick manufacturing ash, bottom ash, coal, expanded perlite, metakaolin, and opuntia ficus-indica dehydrated fibres additions increased the velocity of carbonation front, helping with the sequestration of greenhouse gases, such as CO2, and reducing environmental pollution.

Phylogenomics and population genomics of SARS-CoV-2 in Mexico during the pre-vaccination stage reveals variants of interest B.1.1.28.4 and B.1.1.222 or B.1.1.519 and the nucleocapsid mutation S194L associated with symptoms.

Understanding the evolution of the SARS-CoV-2 virus in various regions of the world during the Covid-19 pandemic is essential to help mitigate the effects of this devastating disease. We describe the phylogenomic and population genetic patterns of the virus in Mexico during the pre-vaccination stage, including asymptomatic carriers. A real-time quantitative PCR screening and phylogenomic reconstructions directed at sequence/structure analysis of the spike glycoprotein revealed mutation of concern E484K in genomes from central Mexico, in addition to the nationwide prevalence of the imported variant 20C/S:452R (B.1.427/9). Overall, the detected variants in Mexico show spike protein mutations in the N-terminal domain (i.e. R190M), in the receptor-binding motif (i.e. T478K, E484K), within the S1-S2 subdomains (i.e. P681R/H, T732A), and at the basis of the protein, V1176F, raising concerns about the lack of phenotypic and clinical data available for the variants of interest we postulate: 20B/478K.V1 (B.1.1.222 or B.1.1.519) and 20B/P.4 (B.1.1.28.4). Moreover, the population patterns of single nucleotide variants from symptomatic and asymptomatic carriers obtained with a self-sampling scheme confirmed the presence of several fixed variants, and differences in allelic frequencies among localities. We identified the mutation N:S194L of the nucleocapsid protein associated with symptomatic patients. Phylogenetically, this mutation is frequent in Mexican sub-clades. Our results highlight the dual and complementary role of spike and nucleocapsid proteins in adaptive evolution of SARS-CoV-2 to their hosts and provide a baseline for specific follow-up of mutations of concern during the vaccination stage.

Asphalt Mixes Processed with Recycled Concrete Aggregate (RCA) as Partial Replacement of the Natural Aggregate.

Materials play a fundamental role in any branch of civil engineering. From ancient times to the present day, society has required enormous amounts of construction materials, which implies an excessive exploitation of the natural environment. The present research work consisted in the design and development of asphalt mixes with a partial substitution of the natural aggregate (NA) by means of recycled concrete aggregate (RCA). The mix was designed with the Marshall methodology, considering the next percentages of substitution and addition by mass: 90% NA and 10% RCA; 80% NA and 20% RCA; 70% NA and 30% RCA. The mixtures were elaborated and analysed under the international standards and the Mexican regulation of the Communications and Transport Ministry, to determine the best option regarding their performance. The materials were characterized according to the current regulations and later employed in the mixes design. A total of 38 specimens were elaborated for each mixture, determining the optimum asphalt content; after that, mechanical tests were performed to analyse and determine the best results. In the aftermath of the examination of all mixtures, we concluded that the 70%AN/30%RCA is the best alternative option according to its performance and numeric results, complying with the cited regulations, and allowing a lower content of asphalt during the process.

RT-qPCR Assays for Rapid Detection of the N501Y, 69-70del, K417N, and E484K SARS-CoV-2 Mutations: A Screening Strategy to Identify Variants With Clinical Impact.

Background: Several variants of the SARS-CoV-2 have been documented globally during the current COVID-19 pandemic. The N501Y, 69-70del, K417N, and E484K SARS-CoV-2 mutations have been documented among the most relevant due to their potential pathogenic biological effects. This study aimed to design, validate, and propose a fast real-time RT-qPCR assay to detect SARS-CoV-2 mutations with possible clinical and epidemiological relevance in the Mexican population. Methods: Targeting spike (S) gene mutations of SARS-CoV-2 (N501Y, 69-70del, K417N, and E484K), specific primers, and probes for three specific quantitative reverse transcription PCR (RT-qPCR) assays were designed, and validated using Sanger sequencing. These assays were applied in clinical samples of 1060 COVID-19 patients from Jalisco Mexico. Results: In silico analyzes showed high specificity of the three assays. Amplicons of samples were confirmed through sequencing. The screening of samples of COVID-19 patients allowed the identification of the E484K mutation in nine individuals and the identification of P.2 Brazilian variant in Mexico. Conclusion: This work provides low-cost RT-qPCR assays for rapid screening and molecular surveillance of mutations with potential clinical impact. This strategy allowed the detection of E484K mutation and P.2 variant for the first time in samples from the Mexican population.

Border Mexico and the United States: a perspective from the imaginary, media and art / Frontera méxico y estados unidos: una perspectiva desde los imaginarios, los medios y el arte

RESUMEN Sin duda, la frontera entre Estados Unidos y México es un espacio territorial de la mayor relevancia en la geopolítica en América. En este artículo se hace una mirada a esta frontera desde la perspectiva de los imaginarios, los medios y el arte, que complemente aquella centrada en la geopolítica, que es la manera en que tradicionalmente se ha estudiado. Se indaga en la percepción de los ciudadanos de frontera, particularmente en los que habitan en El Paso, Texas, y en Ciudad Juárez, México, con el objetivo de ubicar los imaginarios que tienen sobre este territorio de separación y de encuentro de manera simultánea, y en espacial sobre tres objetos que definen esta frontera: el muro, el río Bravo y el desierto. Asimismo, se analizan diversas producciones artísticas y mediáticas para ampliar la perspectiva de configuración de los imaginarios fronterizos.

ABSTRACT Undoubtedly the border between the United States and Mexico is a territorial space of the greatest relevance in geopolitics in America. This article takes a look at this frontier from the perspective of imaginaries, the media and art, which complements the one focused on geopolitics, which is the way it has traditionally been studied. It investigates the perception of border citizens, particularly those who live in El Paso, Texas, and Ciudad Juárez, Mexico, with the aim of locating the imaginaries they have on this territory of separation and encounter simultaneously, and spatially on three objects that define this border: the wall, the Rio Grande and the desert. Likewise, various artistic and media productions are analyzed to broaden the perspective of configuration of border imaginary.

Late Frontal Negativity Discriminates Outcomes and Intentions in Trust-Repayment Behavior.

Altruism (a costly action that benefits others) and reciprocity (the repayment of acts in kind) differ in that the former expresses preferences about the outcome of a social interaction, whereas the latter requires, in addition, ascribing intentions to others. Interestingly, an individual's behavior and neurophysiological activity under outcome- versus intention-based interactions has not been compared directly using different endowments in the same subject and during the same session. Here, we used a mixed version of the Dictator and the Investment games, together with electroencephalography, to uncover a subject's behavior and brain activity when challenged with endowments of different sizes in contexts that call for an altruistic (outcome-based) versus a reciprocal (intention-based) response. We found that subjects displayed positive or negative reciprocity (reciprocal responses greater or smaller than that for altruism, respectively) depending on the amount of trust they received. Furthermore, a subject's late frontal negativity differed between conditions, predicting responses to trust in intentions-based trials. Finally, brain regions related with mentalizing and cognitive control were the cortical sources of this activity. Thus, our work disentangles the behavioral components present in the repayment of trust, and sheds light on the neural activity underlying the integration of outcomes and perceived intentions in human economic interactions.

No association between genetic variants in MAOA, OXTR, and AVPR1a and cooperative strategies.

The effort to understand the genetic basis of human sociality has been encouraged by the diversity and heritability of social traits like cooperation. This task has remained elusive largely because most studies of sociality and genetics use sample sizes that are often unable to detect the small effects that single genes may have on complex social behaviors. The lack of robust findings could also be a consequence of a poor characterization of social phenotypes. Here, we explore the latter possibility by testing whether refining measures of cooperative phenotypes can increase the replication of previously reported associations between genetic variants and cooperation in small samples. Unlike most previous studies of sociality and genetics, we characterize cooperative phenotypes based on strategies rather than actions. Measuring strategies help differentiate between similar actions with different underlaying social motivations while controlling for expectations and learning. In an admixed Latino sample (n = 188), we tested whether cooperative strategies were associated with three genetic variants thought to influence sociality in humans-MAOA-uVNTR, OXTR rs53576, and AVPR1 RS3. We found no association between cooperative strategies and any of the candidate genetic variants. Since we were unable to replicate previous observations our results suggest that refining measurements of cooperative phenotypes as strategies is not enough to overcome the inherent statistical power problem of candidate gene studies.

El paciente con dolor ocular en urgencias / Patient with ocular pain in emergency department

RESUMEN La región ocular es una zona que puede ser origen de patologías dolorosas por compromiso primario del ojo que produzcan cefalea como síntoma asociado. A su vez, puede ser la localización de dolor referido por patologías neurológicas. De allí que su evaluación se realice usualmente en forma multidisciplinaria por neurología y oftalmología. Los pacientes con examen oftalmológico anormal suelen tener una aproximación clínica más simple, lo que permite un diagnóstico más rápido y un tratamiento más eficaz; el reto es la aproximación al paciente con dolor ocular y examen normal. Por lo general, los oftalmólogos se refieren a este como "ojo blanco o tranquilo" y los pacientes son diferidos a valoración por neurología.

SUMMARY The ocular region is an area that can be the origin of painful pathologies due to primary involvement of the eye that produce headache as an associated symptom and in turn be the location for referred pain in neurological pathologies, its evaluation is usually performed by neurologist and ophthalmologist. Patients with an abnormal ophthalmologic examination usually have a simpler clinical approach allowing a faster diagnosis and a more effective treatment, the challenge is the approach to the patient with eye pain but with normal examination, ophthalmologists usually refer to this condition as "white or quiet eye" and those patients are deferred to assessment by neurology to rule out organicity.

Guideline on the preventive treatment of chronic migraine, chronic tension type headache, hemicrania continua and new daily persistent headache on behalf of the Colombian Association of Neurology / Guía de la Asociación Colombiana de Neurología para el tratamiento preventivo de la migraña crónica, cefalea tipo tensión crónica, hemicránea continua y cefalea diaria persistente de novo

SUMMARY INTRODUCTION: Chronic daily headache is a high impact entity in the general population. Although chronic migraine and tension-type headache are the most frequent conditions, it is necessary to consider hemicrania continua and new daily persistent headache as part of the differential diagnoses to perform a correct therapeutic approach. OBJECTIVE: To make recommendations for the treatment of chronic daily headache of primary origin METHODOLOGY: The Colombian Association of Neurology, by consensus and Grade methodology (Grading of recommendations, assessment, development and evaluation), presents the recommendations for the preventive treatment of each of the entities of the daily chronic headache of primary origin group. RESULTS: For the treatment of chronic migraine, the Colombian Association of Neurology recommends onabotulinum toxin A, erenumab, topiramate, flunarizine, amitriptyline, and naratriptan. In chronic tension-type headache the recommended therapeutic options are amitriptyline, imipramine, venlafaxine and mirtazapine. Topiramate, melatonin, and celecoxib for the treatment of hemicrania continua. Options for new daily persistent headache include gabapentin and doxycycline. The recommendations for inpatient treatment of patients with chronic daily headache and the justifications for performing neural blockades as a therapeutic complement are also presented. CONCLUSION: The therapeutic recommendations for the treatment of chronic daily headache based on consensus methodology and Grade System are presented.

RESUMEN INTRODUCCIÓN: La cefalea crónica diaria es una entidad de alto impacto en la población general. Aunque la migraña crónica y la cefalea tipo tensión son las condiciones más frecuentes, es necesario considerar la hemicránea continua y la cefalea diaria persistente de novo como parte de los diagnósticos diferenciales para realizar un enfoque terapéutico correcto. OBJETIVO: Hacer recomendaciones para el tratamiento de la cefalea crónica diaria de origen primario METODOLOGÍA: La Asociación Colombiana de Neurología, mediante consenso y metodología GRADE (Grading of Reccomendations, Assesment, Development and Evaluation), presenta las recomendaciones para el tratamiento preventivo de cada una de las entidades del grupo de la cefalea crónica diaria de origen primario. RESULTADOS: Para el tratamiento de la migraña crónica, la Asociación Colombiana de Neurología recomienda onabotulinum toxina A, erenumab, galcanezumab, fremanezumab, topiramato, flunarizina, amitriptilina y naratriptan. En cefalea tipo tensional crónica las opciones terapéuticas recomendadas son amitriptilina, imipramina, venlafaxina y mirtazapina. Para el tratamiento de la hemicránea continua topiramato, melatonina y celecoxib. Las opciones para cefalea diaria persistente de novo incluyen gabapentin y doxiciclina. Se presentan adicionalmente las recomendaciones para el tratamiento intrahospitalario de los pacientes con cefalea crónica diaria y las justificaciones para la realización de bloqueos neurales como complemento terapéutico. CONCLUSIÓN: se presentan las recomendaciones terapéuticas para el tratamiento de la cefalea crónica diaria basado en metodología de consenso y sistema GRADE.

Acute Disseminated Encephalomyelitis with Baló-like Lesion by Scorpion Sting: Case Report.

Acute disseminated encephalomyelitis (ADEM) has been linked to immunizations, viral infections, and occasionally to arthropods stings. Its association with scorpion stings has not been described. A 29-year-old man, who after being stung by a scorpion presented right hemiparesis and language impairment. Brain MRI showed subcortical bihemispheric lesion characteristics of ADEM and a bigger one compatible with Baló concentric sclerosis (BCS). Patient was managed with steroids, showing complete clinical improvement. Magnetic resonance imaging (MRI) after 6 months showed cavitation of the bigger lesion with no new findings. In 2 years of follow-up, there is no clinical relapse or new lesions in MRI. Although cases of ADEM have been reported due to venom of chilopoda and hymenoptera, the scorpion sting can be considered as another new cause; this case being even more relevant due to present a Baló-like lesion in MRI.

Reduction Over Condensation of Carbonyl Compounds Through a Transient Hemiaminal Intermediate Using Hydrazine.

Reduction of carbonyl moieties to the corresponding alcohol using simply hydrazine hydrate has been considerably unfeasible until now due to the well-known condensation reaction. However, herein, we report that using an excess of 20-fold equivalents, the reduction proceeds in excellent yields. 1H NMR study of the reaction and density functional theory (DFT) calculations indicate that the final fate of the hemiaminal intermediate is crucial to obtain the alcohol or the hydrazone.

Lightweight Authentication Protocol for M2M Communications of Resource-Constrained Devices in Industrial Internet of Things.

The Industrial Internet of Things (IIoT) consists of sensors, networks, and services to connect and control production systems. Its benefits include supply chain monitoring and machine failure detection. However, it has many vulnerabilities, such as industrial espionage and sabotage. Furthermore, many IIoT devices are resource-constrained, which impedes the use of traditional security services for them. Authentication allows devices to be confident of each other's identity, preventing some security attacks. Many authentication protocols have been proposed for IIoT; however, they have high computing requirements not viable to resource-constrained devices, or they have been found insecure. In this paper, an authentication protocol for resource-constrained IIoT devices is proposed. It is based on the lightweight operations xor, addition, and subtraction, and a hash function. Also, only four messages are exchanged between the principals to authenticate. It has a low execution-time and communication-cost. Its security was successfully assessed with the formal methods Automated Validation of Internet Security Protocols and Applications (AVISPA) tool and Burrows-Abadi-Needham (BAN) logic, together with an informal analysis of its resistance to known attacks. Its performance and security were compared with state-of-the-art protocols, resulting in a good performance for resource-constrained IIoT devices, and higher security similar to computational expensive schemes.

Vessel-specific quantification of absolute myocardial blood flow, myocardial flow reserve and relative flow reserve by means of fused dynamic 13NH3 PET and CCTA: Ranges in a low-risk population and abnormality criteria.

OBJECTIVES: The goal of the present work is to present a novel methodology for the extraction of MBF, MFR and RFR along coronary arteries by means of multimodality image fusion of dynamic PET and CCTA images. BACKGROUND: FFR is the reference standard to identify flow-limiting lesions, but its invasiveness limits broad application. New noninvasive methodologies are warranted to stratify patients and guide treatment. METHODS: A group of 16 low-risk CAD subjects who underwent both 13NH3 PET and CCTA were analyzed. Image fusion techniques were employed to align the studies and CCTA-derived anatomy used to identify coronaries trajectories. MBF was calculated by means of a 1-tissue compartmental model for the standard vascular territories and along patient-specific vessel paths from the base to the apex of the heart. RESULTS: Low-risk ranges for MBF. MFR and RFR for LAD, LCX and rPDA were computed for the entire cohort and separated by gender. Computed low-risk ranges were used to assess a prospective patient with suspected CAD. CONCLUSIONS: Our vessel-specific functional indexes and 3D displays offer promise to more closely replicate what is commonly performed during a catheterization session and have the potential of providing effective noninvasive tools for the identification of flow-limiting lesions and image-guided therapy.

An approach on the implementation of full batch, online and mini-batch learning on a Mamdani based neuro-fuzzy system with center-of-sets defuzzification: Analysis and evaluation about its functionality, performance, and behavior.

Due to the rapid technological evolution and communications accessibility, data generated from different sources of information show an exponential growth behavior. That is, volume of data samples that need to be analyzed are getting larger, so the methods for its processing have to adapt to this condition, focusing mainly on ensuring the computation is efficient, especially when the analysis tools are based on computational intelligence techniques. As we know, if you do not have a good control of the handling of the volume of the data, some techniques that are based on learning iterative processes could represent an excessive load of computation and could take a prohibitive time in trying to find a solution that could not come close to desired. There are learning methods known as full batch, online and mini-batch, and they represent a good strategy to this problem since they are oriented to the processing of data according to the size or volume of available data samples that require analysis. In this first approach, synthetic datasets with a small and medium volume were used, since the main objective is to define its implementation and in experimentation phase through regression analysis obtain information that allows us to assess the performance and behavior of different learning methods under distinct conditions. To carry out this study, a Mamdani based neuro-fuzzy system with center-of-sets defuzzification with support of multiple inputs and outputs was designed and implemented that had the flexibility to use any of the three learning methods, which were implemented within the training process. Finally, results show that the learning method with best performances was Mini-Batch when compared to full batch and online learning methods. The results obtained by mini-batch learning method are as follows; mean correlation coefficient [Formula: see text] with 0.8268 and coefficient of determination [Formula: see text] with 0.7444, and is also the method with better control of the dispersion between the results obtained from the 30 experiments executed per each dataset processed.