High-resolution density assessment assisted by deep learning of Dendrophyllia cornigera (Lamarck, 1816) and Phakellia ventilabrum (Linnaeus, 1767) in rocky circalittoral shelf of Bay of Biscay.

This study presents a novel approach to high-resolution density distribution mapping of two key species of the 1170 "Reefs" habitat, Dendrophyllia cornigera and Phakellia ventilabrum, in the Bay of Biscay using deep learning models. The main objective of this study was to establish a pipeline based on deep learning models to extract species density data from raw images obtained by a remotely operated towed vehicle (ROTV). Different object detection models were evaluated and compared in various shelf zones at the head of submarine canyon systems using metrics such as precision, recall, and F1 score. The best-performing model, YOLOv8, was selected for generating density maps of the two species at a high spatial resolution. The study also generated synthetic images to augment the training data and assess the generalization capacity of the models. The proposed approach provides a cost-effective and non-invasive method for monitoring and assessing the status of these important reef-building species and their habitats. The results have important implications for the management and protection of the 1170 habitat in Spain and other marine ecosystems worldwide. These results highlight the potential of deep learning to improve efficiency and accuracy in monitoring vulnerable marine ecosystems, allowing informed decisions to be made that can have a positive impact on marine conservation.

Takayasu's arteritis presenting as acute STEMI.

An 18-year-old man with past medical history of secondary arterial hypertension diagnosed at age 15 presented with an abdominal magnetic resonance imaging (MRI) that exhibited left renal artery stenosis.

Tuberous Sclerosis Associated With Aortic Stenosis and Endocarditis: A Case Report.

Tuberous sclerosis (TS) is a multisystem neurocutaneous disorder with an autosomal dominant pattern of inheritance. It is characterized by hamartomas that damage the skin, kidneys, lungs, heart, and central nervous system, among other organs. Rhabdomyomas, benign tumors of aberrant myocytes, are common in affected patients at birth. Depending on their size and location, these lesions might create valvopathies, which can cause heart failure or malignant arrhythmias, or they can cause obstruction of the outlet or inlet tract. Before making the diagnosis, a long time-even years-often passes. Early diagnosis can help prevent permanent irreversible complications. Differential diagnoses may include neurofibromatosis type 1, Sturge-Weber syndrome, and von Hippel-Lindau disease, among others. Diagnostic aids, such as MRI, CT scans, and genetic testing, can be useful in confirming a diagnosis of TS. Histological findings may include the presence of hamartomas, which are benign tumors composed of abnormal cells. Treatment for TS is mainly supportive and may involve medications to manage symptoms, and surgery to remove tumors. We present the case of a 23-year-old woman with TS who was admitted with macroscopic hematuria and fever, with further workup revealing tumor-like cardiac lesions associated with infective endocarditis.

Estudios del despoblamiento rural en Chile: aproximaciones hacia un marco analítico desde la ecología política latinoamericana / Estudos do despovoamento rural no Chile: abordagens para um quadro analítico da ecologia política latino-americana / Studies of rural depopulation in Chile: approaches towards an analytical framework from Latin American political ecology

Resumen El objetivo de este este trabajo fue hacer una revisión documental sobre el despoblamiento rural para ubicar sus principales antecedentes, corrientes y visiones de estudio en Latinoamérica y otros espacios geográficos, con énfasis en Chile para exponer la forma en que la relación entre extractivismo y despoblamiento rural ha sido tratada con la intención de contrastar los resultados con los insumos teóricos de la ecología política latinoamericana y de plantear un análisis integral de este fenómeno. Los resultados muestran que en Chile los factores que han impulsado históricamente el despoblamiento de zonas rurales fueron la dictadura militar, los planes de ordenamiento territorial, industrialización y urbanización, la transformación de la estructura agraria, el cambio climático y el extractivismo. Se constató que los estudios sobre este último factor han omitido la forma en que se produce el despoblamiento, en general en contextos de estructuras de poder desigual y de tensiones territoriales entre distintos modelos de desarrollo y de formas de habitar el espacio. Se propone el campo de la ecología política latinoamericana para abordar los procesos de despoblamiento rural vinculados al extractivismo, cuyos insumos teóricos pueden contribuir a la comprensión más amplia del problema y a la construcción de respuestas con y desde los propios territorios.

Resumo O objetivo deste artigo é realizar uma revisão documental sobre o despovoamento rural para localizar os principais antecedentes, correntes e visões de estudo na América Latina e outros espaços geográficos. A ênfase foi colocada no Chile para expor a forma como tem sido tratada a relação entre extrativismo e despovoamento rural, com a intenção de contrastar os resultados com os aportes teóricos da ecologia política latino-americana e propor uma análise abrangente desse fenômeno. Os resultados mostram que no Chile os fatores que historicamente impulsionam o despovoamento das áreas rurais têm sido a ditadura militar, os planos de ordenamento territorial, a industrialização e a urbanização, a transformação da estrutura agrária, as mudanças climáticas e o extrativismo. Constatou-se que os estudos sobre este último fator têm omitido a forma como ocorre o despovoamento, regularmente em contextos de estruturas de poder desiguais e tensões territoriais entre diferentes modelos de desenvolvimento e formas de habitar o espaço. O campo da ecologia política latino-americana se propõe a abordar os processos de despovoamento rural vinculados ao extrativismo, cujos aportes teóricos podem contribuir para uma compreensão mais ampla do problema e a construção de respostas com e a partir dos próprios territórios.

Abstract The goal was to conduct a documentary review on rural depopulation in order to identify the main antecedents, trends and visions in studies in Latin America and other geographical spaces. Emphasis was placed on Chile to expose the way in which the relationship between extractivism and rural depopulation has been treated, with the intention of contrasting the results with the theoretical inputs of Latin American political ecology and proposing a comprehensive analysis of this phenomenon. Results show that, in Chile, factors historically driving the depopulation of rural areas include the military dictatorship, the territorial ordering plans, industrialization and urbanization, the transformation of the agrarian structure, climate change and extractivism. It was found that studies on this last factor have omitted the way in which depopulation occurs, regularly in contexts of unequal power structures and territorial tensions between different development models and ways of inhabiting space. The field of Latin American political ecology is proposed in order to address the processes of rural depopulation linked to extractivism, since its theoretical inputs can contribute to a broader understanding of the problem and to the construction of responses with and from the territories themselves.

Economic burden of osteoporotic fractures in US managed care enrollees.

OBJECTIVES: To examine healthcare resource utilization (HRU) and costs in a population of managed care enrollees who experienced an osteoporotic fracture. STUDY DESIGN: Retrospective cohort study using the Optum Research Database (January 2007 to May 2017). METHODS: All-cause and osteoporosis-related HRU and costs were analyzed in patients 50 years and older with a qualifying index fracture and continuous enrollment with medical and pharmacy benefits for 12 months preindex (baseline period). RESULTS: Of 1,841,263 patients with fractures during the identification period, 302,772 met eligibility criteria. Two-thirds (66.6%) were 65 years and older, 71.6% were women, and 41.2% were commercial (not Medicare Advantage) enrollees. The most common fracture sites were spine (21.9%), radius/ulna (19.5%), and hip (13.7%). Mean (SD) total all-cause healthcare cost was $34,855 ($56,094), with most paid by health plans ($31,863 [$55,025]) versus patients ($2992 [$2935]). Most healthcare costs were for medical ($31,766 [$54,943]) versus pharmacy ($3089 [$6799]) services. Approximately 75% of patients received rehabilitation services (mean [SD] cost = $18,025 [$41,318]). Diagnosis of index fracture during an inpatient stay versus an outpatient visit (cost ratio, 2.16; 95% CI, 2.13-2.19) and fractures at multiple sites (cost ratio, 1.23; 95% CI, 1.21-1.26) were the leading predictors of cost. Kaplan-Meier estimated cumulative second-fracture rates were 6.6% at 1 year, 12.3% at 2 years, 16.9% at 3 years, and 20.9% at 4 years after index fracture. CONCLUSIONS: These findings suggest a significant economic burden associated with fractures, including a high total all-cause cost of care. Early identification and treatment of patients at high risk of fractures are of paramount importance to reduce fracture risk and associated healthcare costs.

Implementing the Clean Clinic Approach Improves Water, Sanitation, and Hygiene Quality in Health Facilities in the Western Highlands of Guatemala.

BACKGROUND: Water, sanitation, and hygiene (WASH) services are cornerstones to providing safe health care services and improving patient satisfaction and care seeking. The Clean Clinic Approach (CCA) uses a 10-step process to support health care facilities (HCFs) in making incremental, effective cleanliness and infection prevention and control (IPC) improvements, without relying on external investments. We piloted the CCA in Guatemala and assessed the extent to which it contributed to quality improvements in WASH for IPC. METHODS: After developing an assessment tool tailored to the Guatemalan context, we assessed 11 HCFs in 8 technical areas and scored the facilities on 79 criteria with a total of 100 points. We conducted a baseline assessment (September to October 2018), second assessment (January 2019), and final assessment (February to March 2019). RESULTS: The 11 HCFs improved their average emergency/general ward scores from 41 points at baseline to 87 points at end line, based on a 100-point scale. For delivery wards, the scores increased from 50 to 91 points and for postnatal wards from 46 to 90 points. CONCLUSIONS: The CCA process and tools facilitated a systematic way for HCFs to identify, prioritize, make, and measure WASH quality of care improvements. Training facility staff was fundamental to improving quality standards, and involving medical and administration staff in joint analysis, coordination, and planning sessions was key to integration and teamwork. Further work is needed to increase involvement of local government and community members and to further adapt the process and tools.

Genotyping of Malassezia pachydermatis disclosed genetic variation in isolates from dogs in Colombia / Genotipagem de Malassezia pachydermatis revelou variação genética em isolados de cães na Colômbia

Malassezia pachydermatis is a lipophilic and lipid-dependent yeast mostly isolated from animals' skin; hence, it is regarded as a zoophilic species causing otitis externa in dogs. Aspects associated with its epidemiology and pathogenicity is a matter of interest. This study aimed to conduct a molecular characterization of 43 isolates of M. pachydermatis obtained from dogs with otitis externa. For this purpose, the 5.8S internal transcribed spacer 2 (ITS2) and D1/D2 26S rRNA regions were amplified, sequenced and analyzed using restriction fragment length polymorphism (RFLP) with AluI, CfoI, and BstF5I endonucleases. Phylogenetic analyses revealed that these isolates grouped with the sequence types I, IV and V, previously proposed for M. pachydermatis. Interestingly, we found a new polymorphic RFLP pattern using BstF5I, these isolates were associated with the sequence types IV and V, nevertheless an association between polymorphic RFLP patterns, and fosfolipase activity or canine population data was not observed. These findings underline the genetic diversity of M. pachydermatis and provide new insights about the epidemiology of this species in the analyzed population.(AU)

Malassezia pachydermatis é uma levedura lipofílica e dependente de lipídios, principalmente da pele de animais. Sendo, por essa razão, considerada uma espécie zoofílica e causadora de otite externa em cães. Neste sentido, aspectos associados à sua epidemiologia e patogenicidade constituem um tema de interesse científico. O objetivo deste estudo foi realizar a caracterização molecular de 43 isolados de M. pachydermatis obtidos a partir de cães com otite externa. Para esta propósito, foram amplificadas, sequenciadas e analisadas com enzimas de restrição as regiões do gene 5.8S, do espaçador interno transcrito 2 (ITS2) e D1/D2 do 26S do rRNA pelo método RFLP, com as endonucleases AluI, CfOI e BstF5I. Análises filogenéticas revelaram que os isolados se agruparam com as sequências tipo I, IV e V de M. pachydermatis como já descrito anteriormente. De maneira interessante, se observou um novo RFLP polimórfico utilizando BstF5I. Os isolados que mostraram esse padrão foram associados com os padrões IV e V. No entanto, não foi observada associação entre padrões polimórficos de RFLP e atividade de fosfolipase ou dados da população canina. Estes resultados demonstram a diversidade genética de M. pachydermatis e fornecem novas perspectivas sobre a epidemiologia destas espécies na população analisada.(AU)

Choque hipovolémico / Hypovolemic shock

Se realiza una revisión del tema choque hipovolémico, haciendo énfasis en los cambios fisiopatológicos que se suceden en cada sistema y las manifestaciones clínicas que se generan como consecuencia de dichos cambios. Además se presenta un esquema de tratamiento, basados principalmente en la reposición del espacio vascular mediante las diferentes soluciones de coloides y cristaloides disponibles en la actualidad.

Dermatopolimiositis / Dermatopolimyositis

Se presenta un caso de dermatopolimiositis de 3 meses de evolucion en un paciente de sexo masculino, de 55 anos de edad. Se comenta la evolucion, resultados de los examenes paraclinicos y la respuesta al tratamiento durante la hospitalizacion