Selenium serum levels in patients with SARS-CoV-2 infection: a systematic review and meta-analysis.

The nutritional status is a determinant of the immune response that promotes a cellular homeostasis. In particular, adequate selenium levels lead to a better antioxidant and immune response. The aim of this work is to assess whether blood selenium levels, at time of SARS-CoV-2 infection, have an impact on the development and severity of COVID-19. A systematic review and meta-analysis of comparative and descriptive studies using MeSH terms, selenium and COVID-19 was performed. We searched bibliographic databases up to 17 July 2022 in PubMed and ScienceDirect. Studies that reported data on blood selenium levels were considered. A total of 629 articles were examined by abstract and title, of which 595 abstracts were read, of which 38 were included in the systematic review and 11 in the meta-analysis. Meta-analysis was conducted to mean difference (MD) with a 95 % confidence interval (CI), and heterogeneity was tested by I2 with random factors with a MD between selenium levels, mortality, morbidity and healthy subjects with a P-value of 0⋅05. Selenium levels were higher in healthy people compared to those in patients with COVID-19 disease (six studies, random effects MD: test for overall effect Z = 3⋅28 (P = 0⋅001), 97 % CI 28⋅36 (11⋅41-45⋅31), P < 0⋅00001), but without difference when compared with the degree of severity in mild, moderate or severe cases. In conclusion, the patients with active SARS-CoV-2 infection had lower selenium levels than the healthy population. More studies are needed to evaluate its impact on clinical severity through randomised clinical trials.

Evaluación de la sensibilidad a organofosforados en poblaciones de Aedes aegypti (L. ) (Diptera: Culicidae) del departamento de La Guajira, Colombia / Evaluation of susceptibility to organophosphates in populations of Aedes aegypti (L. ) (Diptera: Culicidae) in La Guajira, Colombia

Introducción. El dengue es un problema de salud pública para el departamento de La Guajira. El control se ha enfocado en el vector con el uso de insecticidas, entre ellos los organofosforados. Objetivo. Evaluar el estado de la sensibilidad a insecticidas organofosforados de quince poblaciones de Aedes aegypti (L.) en el departamento de La Guajira, Colombia. Materiales y métodos. Se realizaron bioensayos para temefos, malatión y pirimifos- metil en larvas de tercer estadio y mosquitos adultos de Ae. aegypti en los municipios de Albania, Barrancas, Dibulla, Distracción, El Molino, Fonseca, Hatonuevo, La Jagua del Pilar, Maicao, Manaure, Riohacha, San Juan del Cesar, Uribia, Urumita y Villanueva, siguiendo la metodología de la Organización Mundial de la Salud (OMS) y la técnica de botellas usando la guía de los de los Centers for Disease Control and Prevention, respectivamente. Se determinó la sensibilidad por medio de la relación de resistencia a CL50 y CL95 (RRCL50, RRCL95) para temefos y a dosis y tiempo diagnóstico para temefos, malatión y pirimifos-metil en las poblaciones de campo evaluadas, usando como control la cepa sensible Rockefeller. Resultados. Las 15 poblaciones del departamento de La Guajira son sensibles a: temefos (relación de la resistencia a CL50<5,0; relación de resistencia a CL95<5,0; 98 a 100 % de mortalidad); pirimifos-metil (99 a 100 % de mortalidad) y malatión (100 % de mortalidad). Conclusión. Con base en los resultados obtenidos, es factible el uso de temefos, malatión y pirimifos-metil para el control de Ae. aegypti en las poblaciones evaluadas.

Introduction. Dengue is a public health problem in La Guajira region. Control has focused on the vector using insecticides, including organophosphates. Objective. To evaluate the state of susceptibility to organophosphates insecticides in fifteen Aedes aegypti (L.) populations in La Guajira, Colombia. Materials and methods. We collected samples of third-instar larvae and adult mosquitoes of Ae. aegypti in the municipalities of Albania, Barrancas, Dibulla, Distracción, El Molino, Fonseca, Hatonuevo, La Jagua del Pilar, Maicao, Manaure, Riohacha, San Juan del Cesar, Uribia, Urumita, Villanueva. Bioassays for temefos, malathion, and pirimiphos-methyl were carried out following the methodology of the World Health Organization, and the bottle technique using the guidance of the Centers for Disease Control and Prevention. Susceptibility to temefos was determined through the resistance ratio between lethal concentration 50 and lethal concentration 95; for the compounds temefos, malathion and pirimiphos-methyl, susceptibility was calculated using diagnostic dose and diagnostic time in the populations evaluated. Rockefeller susceptible strain was used as a control. Results. All evaluated populations of Ae. aegypti from La Guajira were found to be susceptible to temefos (ratio resistance to CL50<5.0; ratio resistance to CL95<5.0; 98 - 100 % mortality); pirimiphosmethyl (99 - 100 % mortality), and malathion (100 % mortality). Conclusion. Based on the results, the use of temefos, malathion, and pirimiphosmethyl is feasible for the control of Ae. aegypti in the evaluated populations.

Suppression of Midgut Microbiota Impact Pyrethroid Susceptibility in Aedes aegypti.

Aedes aegypti is a mosquito that transmits viral diseases such as dengue, chikungunya, Zika, and yellow fever. The insect's microbiota is recognized for regulating several biological processes, including digestion, metabolism, egg production, development, and immune response. However, the role of the bacteria involved in insecticide susceptibility has not been established. Therefore, the objective of this study was to characterize the resident microbiota in a field population of A. aegypti to evaluate its role associated with susceptibility to the insecticides permethrin and deltamethrin. Mosquitoes were fed 10% sucrose mixed with antibiotics and then exposed to insecticides using a diagnostic dose. DNA was extracted, and sequencing of bacterial 16S rRNA was carried out on Illumina® MiSeq™. Proteobacteria (92.4%) and Bacteroidetes (7.6%) were the phyla, which are most abundant in mosquitoes fed with sucrose 10%. After exposure to permethrin, the most abundant bacterial species were Pantoea agglomerans (38.4%) and Pseudomonas azotoformans-fluorescens-synxantha (14.2%). Elizabethkingia meningoseptica (38.4%) and Ps. azotoformans-fluorescens-synxantha (26.1%) were the most abundant after exposure to deltamethrin. Our results showed a decrease in mosquitoes' survival when exposed to permethrin, while no difference in survival when exposed to deltamethrin when the microbiota was modified. We found that the change in microbiota modifies the response of mosquitoes to permethrin. These results are essential for a better understanding of mosquito physiology in response to insecticides.

Determination of Knockdown Resistance (kdr) Allele Frequencies (T929I mutation) in Head Louse Populations from Mexico, Canada, and Peru.

The head louse Pediculus humanus capitis (De Geer) is a hematophagous ectoparasite that inhabits the human scalp. The infestations are asymptomatic; however, skin irritation from scratching occasionally may cause secondary bacterial infections. The present study determined the presence and frequency of the knockdown resistance (kdr) mutation T929I in 245 head lice collected from Mexico, Peru, and Canada. Head lice were collected manually using a comb in the private head lice control clinic. Allele mutation at T9291 was present in 100% of the total sampled populations (245 lice) examined. In addition, 4.89% of the lice were homozygous susceptible, whereas 6.93% heterozygous and 88.16% homozygous were resistant, respectively. This represents the second report in Mexico and Quebec and fist in Lima.

Outcomes in Temporary ICUs Versus Conventional ICUs: An Observational Cohort of Mechanically Ventilated Patients With COVID-19-Induced Acute Respiratory Distress Syndrome.

Throughout the COVID-19 pandemic, thousands of temporary ICUs have been established worldwide. The outcomes and management of mechanically ventilated patients in these areas remain unknown. OBJECTIVES: To investigate mortality and management of mechanically ventilated patients in temporary ICUs. DESIGN SETTING AND PARTICIPANTS: Observational cohort study in a single-institution academic center. We included all adult patients with severe COVID-19 hospitalized in temporary and conventional ICUs for invasive mechanical ventilation due to acute respiratory distress syndrome from March 23, 2020, to April 5, 2021. MAIN OUTCOMES AND MEASURES: To determine if management in temporary ICUs increased 30-day in-hospital mortality compared with conventional ICUs. Ventilator-free days, ICU-free days (both at 28 d), hospital length of stay, and ICU readmission were also assessed. RESULTS: We included 776 patients (326 conventional and 450 temporary ICUs). Thirty-day in-hospital unadjusted mortality (28.8% conventional vs 36.0% temporary, log-rank test p = 0.023) was higher in temporary ICUs. After controlling for potential confounders, hospitalization in temporary ICUs was an independent risk factor associated with mortality (hazard ratio, 1.4; CI, 1.06-1.83; p = 0.016).There were no differences in ICU-free days at 28 days (6; IQR, 0-16 vs 2; IQR, 0-15; p = 0.5) or ventilator-free days at 28 days (8; IQR, 0-16 vs 5; IQR, 0-15; p = 0.6). We observed higher reintubation (18% vs 12%; p = 0.029) and readmission (5% vs 1.6%; p = 0.004) rates in conventional ICUs despite higher use of postextubation noninvasive mechanical ventilation (13% vs 8%; p = 0.025). Use of lung-protective ventilation (87% vs 85%; p = 0.5), prone positioning (76% vs 79%; p = 0.4), neuromuscular blockade (96% vs 98%; p = 0.4), and COVID-19 pharmacologic treatment was similar. CONCLUSIONS AND RELEVANCE: We observed a higher 30-day in-hospital mortality in temporary ICUs. Although both areas had high adherence to evidence-based management, hospitalization in temporary ICUs was an independent risk factor associated with mortality.

Pigmentación violácea dolorosa, reto clínico y enfoque diagnóstico en un país tropical / Painful violaceous pigmentation, a clinical challenge and diagnostic approach in a tropical country

RESUMEN Contrario a lo que se cree, los milpiés no se consideran animales venenosos, su mecanismo de defensa puede resultar perjudicial para el ser humano, manifestándose como lesiones de carácter eritematoso, purpúrico y cianótico, concomitante dolor local y parestesia; Según la exposición, el cuadro clínico puede evolucionar a lesiones moderadas y severas, ampollas y úlceras. Describimos el caso de un paciente pediátrico de sexo masculino de la región andina de Colombia, con temperaturas diarias que oscilan entre 15° y 30°C y una humedad promedio de 72 %, quien accidentalmente pisó un milpiés, lo cual fue un desafío diagnóstico entre el personal de salud que generó su atención.

ABSTRACT Millipedes are not considered poisonous animals, although in some cases their chemical defense mechanisms may be deleterious for human beings, manifesting as erythematous, purpuric and/ or cyanotic lesions alongside local pain and paresthesia. According to the exposure, the clinical condition may progress to moderate and severe lesions such as ulcers and blisters. We describe a case of a male child from the Andean region in Colombia, an area with daily temperatures between 15° and 30° C and 72% average humidity. The boy accidentally stepped on a millipede, and this occurrence became a challenge for its diagnosis amongst staff who provided emergency health care.

Aspectos epidemiológicos, clínicos y paraclínicos del accidente escorpiónico en el Hospital Universitario de Neiva, Colombia / Epidemiological, clinical and paraclinical aspects of the scorpion accident at the University Hospital of Neiva, Colombia

RESUMEN Objetivo: describir las características sociodemográficas, clínicas y paraclínicas de los pacientes atendidos en el Hospital Universitario de Neiva, entre los años 2014 y 2018 e identificar los factores de riesgo que se asocien con la mortalidad. Materiales y métodos: estudio observacional analítico retrospectivo. Se calcularon las medias, la desviación estándar, frecuencias absolutas y relativas. Se realizó un análisis de normalidad con el Test de Shapiro-Wilk. Se evaluó la asociación de diferentes variables sociodemográficas y clínicas con el riesgo de mortalidad usando regresión logística. Resultados: se registraron 305 eventos, predominantemente leves (117 casos). El 2018 fue el año con mayor número de reportes (35,45 %). La mayoría eran personas jóvenes con una edad media de 17 años, principalmente de los 0 a 11 años (61 %). Más del 90% eran pacientes residentes del departamento Huila y más de la mitad (67 %) pertenecían al régimen subsidiado. La mayoría de las picaduras ocurrieron durante el día, siendo las extremidades la ubicación más frecuentemente reportada (82 %). Se encontró una asociación estadísticamente significativa entre un cuadro grave y la mayor necesidad de UCI. Conclusiones: el escorpionismo es un problema de salud pública infravalorado en Colombia. La población pediátrica tiene mayor riesgo de desarrollar complicaciones y síntomas graves en la escorpiotoxicosis. Un cuadro grave en cualquier edad aumenta la probabilidad de ingreso a una UCI, requerimiento frecuente de soporte hídrico e inotrópico y la necesidad de antihipertensivos, al igual que dosis elevadas de antiveneno.

SUMMARY Objective: To describe the sociodemographic, clinical and paraclinical characteristics of the patients treated at the Neiva University Hospital between 2014 and 2018, and identify risk factors that are associated with mortality. Materials and Methods: Observational, analytic retrospective, study. Absolute and relative frequencies were calculated. Normality analysis was performed with the Shapiro-Wilk Test. The relationship of different sociodemographic and clinical variables and the risk of mortality were evaluated using logistic regression. Results: 305 events were registered, predominantly mild (117 cases), being 2018 the year with the highest number of reports (35.45%). Most were young people, with a mean age of 17 years, mainly between 0-11 years (61%). More than 90% resided in the Huila department and more than half (67%) belonged to the subsidized regime. Most bites occurred during the day, with the extremities being the most frequently reported location (82%). A statistically significant association was found between a severe condition and an increased need for an ICU. Conclusions: Scorpionism is an undervalued public health problem in Colombia. The pediatric population is at increased risk of developing severe complications and symptoms in scorpiotoxicosis. A severe condition at any age increases the probability of ICU admission, more frequent requirement for inotropic and liquids supply, and the use of antihypertensive drugs and high doses of anti-venom.

Losartan-induced DRESS syndrome

Abstract Introduction: drug reactions with eosinophilia and systemic symptoms, known as DRESS syndrome, are a hypersensitivity reaction to medications which can lead to skin lesions and internal organ involvement. This syndrome has typically been associated with a wide variety of medications, including aromatic anticonvulsants, allopurinol and antibiotics as the main culprits. Objective: we present the case of a patient with DRESS syndrome secondary to losartan, manifesting skin symptoms and mild hepatic involvement. Up until now, there have been no reports of losartan as the cause of this condition. Prompt treatment was instated including the withdrawal of the offending medication and initiation of oral systemic steroids, with a satisfactory response. Conclusion: caregivers should be alert to the appearance of skin lesions with the use of different groups of medications, not just those typically reported, since any medication could potentially cause a hypersensitivity reaction. (Acta Med Colomb 2021; 46. DOI:https://doi.org/10.36104/amc.2021.2081).

Molecular Characterization of Associated Pathogens in Febrile Patients during Inter-Epidemic Periods of Urban Arboviral Diseases in Tapachula Southern Mexico.

Emerging and re-emerging vector-borne infections are a global public health threat. In endemic regions, fever is the main reason for medical attention, and the etiological agent of such fever is not usually identified. In this study, non-specific febrile pathogens were molecularly characterized in serum samples from 253 patients suspected of arbovirus infection. The samples were collected in the southern border region of Mexico from April to June 2015, and February to March 2016. ZIKV, CHIKV, DENV, leptospirosis, and rickettsiosis were detected by qPCR and nested PCR to identify flavivirus and alphavirus genera. The results indicated that 71.93% of the samples were positive for CHIKV, 0.79% for ZIKV, and 0.39% for DENV, with the number positive for CHIKV increasing to 76.67% and those positive for ZIKV increasing to 15.41% under the nested PCR technique. Leptospira Kmetyi was identified for the first time in Mexico, with a prevalence of 3.16%. This is the first report of ZIKV in Mexico, as well the first detection of the virus in early 2015. In conclusion, the etiological agent of fever was determined in 94% of the analyzed samples.

Field Effectiveness of Drones to Identify Potential Aedes aegypti Breeding Sites in Household Environments from Tapachula, a Dengue-Endemic City in Southern Mexico.

Aedes aegypti control programs require more sensitive tools in order to survey domestic and peridomestic larval habitats for dengue and other arbovirus prevention areas. As a consequence of the COVID-19 pandemic, field technicians have faced a new occupational hazard during their work activities in dengue surveillance and control. Safer strategies to monitor larval populations, in addition to minimum householder contact, are undoubtedly urgently needed. Drones can be part of the solution in urban and rural areas that are dengue-endemic. Throughout this study, the proportion of larvae breeding sites found in the roofs and backyards of houses were assessed using drone images. Concurrently, the traditional ground field technician's surveillance was utilized to sample the same house groups. The results were analyzed in order to compare the effectiveness of both field surveillance approaches. Aerial images of 216 houses from El Vergel village in Tapachula, Chiapas, Mexico, at a height of 30 m, were obtained using a drone. Each household was sampled indoors and outdoors by vector control personnel targeting all the containers that potentially served as Aedes aegypti breeding sites. The main results were that the drone could find 1 container per 2.8 found by ground surveillance; however, containers that were inaccessible by technicians in roofs and backyards, such as plastic buckets and tubs, disposable plastic containers and flowerpots were more often detected by drones than traditional ground surveillance. This new technological approach would undoubtedly improve the surveillance of Aedes aegypti in household environments, and better vector control activities would therefore be achieved in dengue-endemic countries.

First Record of Aedes podographicus in Nuevo León State, Mexico.

In Mexico, Aedes podographicus is one of the most common species within the subgenus Protomacleaya of Aedes. This species has been collected in 12 states close to the coastal regions; however, few records confirm the presence of Ae. podographicus inland. During a mosquito-survey using ovitraps in the state of Nuevo León, Mexico, Ae. podographicus was collected in association with Ae. albopictus and Culex quinquefasciatus. This is the first record of the presence of Ae. podographicus in Nuevo León. With the addition of Ae. podographicus to the mosquito fauna of Nuevo León, there are currently 66 species in the state, 19 within the genus Aedes and 6 within the subgenus Protomacleaya, the genus Aedes being the group with the major number of species in Nuevo León. Specimens collected during this study were deposited in the collection of insects and mites of medical importance of the Laboratory of Medical Entomology of the Autonomous University of Nuevo León, Mexico.

Correlación entre las fórmulas de medición de filtrado glomerular Cockcroft-Gault, MDRD-4 y CKD-EPI, y la depuración de creatinina de 24 horas / Relation between Cockcroft-Gault, MDRD-4 and CKD-EPI formulas, compared with the 24-hour creatinin depuration

Resumen Introducción: es evidente que en los últimos tiempos la pirámide poblacional ha tenido cambios significativos, siendo cada vez más estrecha su base. El aumento en el número de personas adultas mayores trae consigo nuevos retos a nivel del ámbito médico, tales como la adaptación y la adecuación de fórmulas y parámetros que permitan prestar una atención medica eficiente y efectiva. De este modo, la determinación de la tasa de filtración glomerular se vuelve un parámetro de vital importancia dada su relación con el aumento del riesgo cardiovascular y la morbilidad general en este grupo de pacientes. Objetivo: comparar las diferentes fórmulas para calcular la tasa de filtrado glomerular con el estándar diagnóstico de depuración de creatinina de 24 horas en pacientes mayores de 85 años de edad, sin enfermedad renal crónica conocida, a fin de establecer la mejor correlación entre las fórmulas MDRD, CKD-EPI y Cockcroft-Gault. Materiales y métodos: estudio prospectivo, observacional, descriptivo y transversal realizado en 25 pacientes que ingresaron al servicio de Geriatría del Hospital Juárez de México entre Junio de 2017 y Junio de 2018. Al ingreso se midieron los niveles séricos de creatinina, se recolectó la orina de 24 horas y se realizaron los diferentes cálculos de tasa de filtrado con las fórmulas MDRD, CKD-EPI y Cockcroft-Gault. Resultados: la tasa de filtrado glomerular promedio medida por depuración de creatinina en 24 horas fue 48,35 mL/min/1,73 m2; según la fórmula de Cockcroft-Gault, 41,49 mL/min/1,73 m2; según MDRD, 64,98 mL/min/1,73 m2, y según CKD-EPI, 57,0 mL/min/1,73 m2, siendo significativamente menores estas dos últimas. De esta forma, se estableció que hay una correlación directa entre los distintos tipos de fórmulas; sin embargo, la que tiene mayor poder estadístico y reciprocidad es la Cockcroft-Gault, siendo estadísticamente significativa. Conclusiones: en pacientes mayores de 85 años de edad las estimaciones medidas por las diferentes tasas de filtrado glomerular no son intercambiables, pero la fórmula Cockcroft-Gault tiene gran ventaja al mostrar resultados estadísticamente significativos (p<0,05); sin embargo, es necesario realizar estudios más amplios en población geriátrica para tener una estimación más precisa.

Abstract Introduction: It is currently evident that the population pyramid has undergone significant changes in recent times. The increase in the number of older adults brings with it new challenges at the medical level, such as the adaptation and adaptation of formulas and parameters that allow efficient and effective medical care to be provided. Among them, the determination of the glomerular filtration rate becomes a parameter of vital importance given its relationship with increased cardiovascular risk and general morbidity in this group of patients. Objective: To compare, in patients over 85 years without known chronic kidney disease, different formulas for calculating the glomerular filtration rate with diagnostic standard 24-hour creatinine clearance, in order to establish the best correlation between MDRD, CKD-EPI and Cockcroft-Gault. Materials and methods: A prospective, descriptive, cross-sectional observational study including 25 patients admitted to the Geriatrics service of the Juarez Hospital in Mexico, in the period from June 2017 to June 2018, serum creatinine levels were measured upon arrival, with 24-hour urine collection and performed filtering rate calculations with the CKDEPI, MDRD and Cockcroft Gault formulas. Results: the average glomerular filtration rate measured by creatinine clearance in 24 hours was 48.35 ml / min / 1.73 m2; according to the formula of Cockcroft and Gault was 41.49 ml / min / 1.73 m2, significantly lower than with MDRD and CKD-EPI 64.98 ml / min / 1.73 m2-57.0 / ml / min / 1.73 m2 respectively. There is a direct correlation between the different types of formulas; however, the one with the greatest statistical power and reciprocity is Cockcroft and Gault being statistically significant. Conclusions: In elderly patients, the formulas for the measurement of glomerular filtration rate are not interchangeable, showing an advantage for Cockcroft and Gault, being statistically significant (P <0.05), however, it is necessary to perform more extensive studies in geriatric population, to have a more accurate estimate.

Identifying urban hotspots of dengue, chikungunya, and Zika transmission in Mexico to support risk stratification efforts: a spatial analysis.

BACKGROUND: Effective Aedes aegypti control is limited, in part, by the difficulty in achieving sufficient intervention coverage. To maximise the effect of vector control, areas with persistently high numbers of Aedes-borne disease cases could be identified and prioritised for preventive interventions. We aimed to identify persistent Aedes-borne disease hotspots in cities across southern Mexico. METHODS: In this spatial analysis, geocoded cases of dengue, chikungunya, and Zika from nine endemic Mexican cities were aggregated at the census-tract level. We included cities that were located in southern Mexico (the arbovirus endemic region of Mexico), with a high burden of dengue cases (ie, more than 5000 cases reported during a 10-year period), and listed as high priority for the Mexican dengue control and prevention programme. The Getis-Ord Gi*(d) statistic was applied to yearly slices of the dataset to identify spatial hotspots of each disease in each city. We used Kendall's W coefficient to quantify the agreement in the distribution of each virus. FINDINGS: 128 507 dengue, 4752 chikungunya and 25 755 Zika clinical cases were reported between Jan 1, 2008, and Dec 31, 2016. All cities showed evidence of transmission heterogeneity, with a mean of 17·6% (SD 4·7) of their total area identified as persistent disease hotspots. Hotspots accounted for 25·6% (SD 9·7; range 12·8-43·0) of the population and 32·1% (10·5; 19·6-50·5) of all Aedes-borne disease cases reported. We found an overlap between hotspots of 61·7% for dengue and Zika and 53·3% for dengue and chikungunya. Dengue hotspots in 2008-16 were significantly associated with dengue hotspots detected during 2017-20 in five of the nine cities. Heads of vector control confirmed hotspot areas as problem zones for arbovirus transmission. INTERPRETATION: This study provides evidence of the overlap of Aedes-borne diseases within geographical hotspots and a methodological framework for the stratification of arbovirus transmission risk within urban areas, which can guide the implementation of surveillance and vector control. FUNDING: USAID, the US Centers for Disease Control and Prevention, the Canadian Institutes of Health Research, International Development Research Centre, Fondo Mixto CONACyT (Mexico)-Gobierno del Estado de Yucatan, and the US National Institutes of Health. TRANSLATION: For the Spanish translation of the abstract see Supplementary Materials section.

miRNAs of Aedes aegypti (Linnaeus 1762) conserved in six orders of the class Insecta.

Aedes aegypti L. is the most important vector of arboviruses such as dengue, Zika, chikungunya, Mayaro, and yellow fever, which impact millions of people's health per year. MicroRNA profile has been described in some mosquito species as being important for biological processes such as digestion of blood, oviposition, sexual differentiation, insecticide resistance, and pathogens dissemination. We identified the miRNAs of Ae. aegypti females, males and eggs of a reference insecticide susceptible strain New Orleans and compared them with those other insects to determine miRNA fingerprint by new-generation sequencing. The sequences were analyzed using data mining tools and categorization, followed by differential expression analysis and conservation with other insects. A total of 55 conserved miRNAs were identified, of which 34 were of holometabolous insects and 21 shared with hemimetabolous insects. Of these miRNAs, 32 had differential expression within the stages analyzed. Three predominant functions of miRNA were related to embryonic development regulation, metamorphosis, and basal functions. The findings of this research describe new information on Ae. aegypti physiology which could be useful for the development of new control strategies, particularly in mosquito development and metamorphosis processes.

Expanded Hemodialysis and Its Effects on Hospitalizations and Medication Usage: A Cohort Study.

INTRODUCTION: Expanded hemodialysis (HDx) effectively removes large middle molecular uremic toxins (>25 kDa) while still retaining albumin, potentially reducing their adverse effects. We compare the clinical laboratory parameters, hospitalization rates, and medication use in a cohort of patients switched from high-flux HD to HDx. METHODS: This is a multicenter, observational cohort study of 81 adult patients, across 3 clinics, with end-stage kidney disease (ESKD) on chronic hemodialysis (HD). Patients received high-flux HD for at least 1 year and then switched to HDx and were followed up for 1 year. Patients were excluded if they discontinued therapy, changed provider, underwent kidney transplant, recovered kidney function, or changed to peritoneal dialysis, another dialyzer, or renal clinic. RESULTS: Twelve months after switching to HDx, the rate of hospitalization events per patient-year decreased from 0.77 (95% CI: 0.60-0.98, 61 events) to 0.71 (95% CI: 0.55-0.92, 57 events) (p = 0.6987). The hospital day rate per patient-year was significantly reduced from 5.94 days in the year prior to switching compared with 4.41 days after switching (p = 0.0001). The mean dose of erythropoiesis-stimulating agent (SC epoetin-α) and intravenous iron also significantly decreased (p = 0.0361 and p = 0.0003, respectively). CONCLUSION: Switching to HDx was associated with reductions in hospital day rate and medication use, suggesting HDx has the potential to reduce the burden of ESKD on patients and healthcare systems.

Dimensions of social and political capital in interventions to improve household well-being: Implications for coffee-growing areas in southern Colombia.

This paper studies the influence of community capitals on well-being through a Community Capital Index (CCI) within coffee-growing families in southern Colombia. Our results show different farm typologies, with different levels of capital endowment translated into well-being that, in our case, were represented in the CCI. Specifically, social and political capitals positively affect coffee-growing families' decisions in terms of life strategies. The results of this study increase our understanding of welfare enhancement and its relationship with capital endowment according to the type of coffee producer, having implications for the planning of more effective programs towards the improvement of quality of life.

An initial evaluation of expanded hemodialysis on hospitalizations, drug utilization, costs, and patient utility in Colombia.

To examine new evidence linking expanded hemodialysis (HDx) using a medium cut-off (MCO) membrane with hospitalizations, hospital days, medication use, costs, and patient utility. This retrospective study utilized data from Renal Care Services medical records database in Colombia from 2017 to 2019. Clinics included had switched all patients from high flux hemodialysis (HD HF) to HDx and had at least a year of data on HD HF and HDx. Data included demographic characteristics, comorbidities, years on dialysis, hospitalizations, medication use, and quality of life measured by the 36 item and Short Form versions of the Kidney Disease Quality of Life survey at the start of HDx, and 1 year after HDx, which were mapped to EQ-5D utilities. Generalized linear models were run on the outcomes of interest with an indicator for being on HDx. Annual cost estimates were also constructed. The study included 81 patients. HDx was significantly associated with lower dosing of erythropoietin stimulating agents, iron, hypertension medications, and insulin. HDx was also significantly associated with lower hospital days per year (5.94 on HD vs. 4.41 on HDx) although not with the number of hospitalizations. Estimates of annual hospitalization costs were 23.9% lower using HDx and patient utilities did not appear to decline. HDx was statistically significantly associated with reduced hospitalization days and lower medication dosages. Furthermore, this preliminary analysis suggested potential for HDx being a dominant strategy in terms of costs and utility and should motivate future work with larger samples and better controls.

Designing Structural Electrochemical Energy Storage Systems: A Perspective on the Role of Device Chemistry.

Structural energy storage devices (SESDs), designed to simultaneously store electrical energy and withstand mechanical loads, offer great potential to reduce the overall system weight in applications such as automotive, aircraft, spacecraft, marine and sports equipment. The greatest improvements will come from systems that implement true multifunctional materials as fully as possible. The realization of electrochemical SESDs therefore requires the identification and development of suitable multifunctional structural electrodes, separators, and electrolytes. Different strategies are available depending on the class of electrochemical energy storage device and the specific chemistries selected. Here, we review existing attempts to build SESDs around carbon fiber (CF) composite electrodes, including the use of both organic and inorganic compounds to increase electrochemical performance. We consider some of the key challenges and discuss the implications for the selection of device chemistries.

Cuando la memoria se hace opaca y solo el dolor fulgura: abordaje sanitario del fenómeno suicida en Las vírgenes suicidas (1999) de Sofia Coppola / When memories become opaque and only the pain glows: Sanitary approach of the suicidal phenomenon in The Virgin Suicides (1999) by Sofia Coppola

En la década de 1970, en una ciudad norteamericana, cinco hermanas entre los trece y los diecisiete años cometieron suicidio, comenzado por Cecilia, la menor de las hermanas Lisbon. Una ola de tristeza plagada de interrogantes inundó las mentes de aquellos que convivieron con ellas y de todos aquellos fueron testigos de cómo poco a poco fueron perdiendo su alegría, sus motivaciones y su esencia hasta convertirse en sombras inexpresivas de lo que una vez fueron. Ante las peculiaridades descritas entre las muertes de las hermanas en las Vírgenes suicidas de Sofía Coppola 1999, el espectador puede plantearse diversas cuestiones relacionadas con el manejo sanitario adecuado y el papel del personal de salud para abordar de manera óptima la salud mental durante la adolescencia y de las medidas de prevención recomendables tanto en lo individual como en lo colectivo. El presente artículo se ofrece como un análisis a propósito de las conductas suicidas ficticias reportadas en el filme, como si de algún modo, las hermanas Lisbon pudiesen atenderse con los recursos y conocimientos que tienen en la actualidad los médicos contemporáneos a través

In the 1970s, in the suburbs of a US city, five sisters between thirteen and seventeen years of age committed suicide, starting with Cecilia, the youngest of the Lisbon sisters. A wave of sadness plagued with questions invaded the minds of those who lived with them and of all those who witnessed how little by little they lost their joy, their motivations and their essence until they became inexpressive shadows of what they once were. Given the peculiarities described between the deaths of the sisters in the Suicide Virgins of Sofia Coppola 1999, the expectation may ask several questions related to proper health approach and the role of health personnel to optimally address mental health in adolescence and of preventive measures recommended in both, individual and collective levels. This article is offered as an analysis of the fictional suicidal behaviors reported in the film, as if in some way, the Lisbon sisters could be treated with the resources and knowledge that contemporary doctors have in present time through the healthcare system, without ignoring the conditions in which their tragic deaths occurred

Renal tubular acidosis associated with trimethoprim-sulfamethoxazole poisoning / Acidosis tubular renal asociada a intoxicación por trimetoprim-sulfametoxazol

Abstract The combination of trimethoprim-sulfamethoxazole (TMP-SMZ or cotrimoxazole) has a bactericidal effect on gram-positive cocci and gram-negative bacilli. It is used clinically for skin and soft tissue, respiratory and urinary tract infections, and is also relevant for prophylaxis and treatment of opportunistic infections in immunosuppressed patients. Its use at established doses in immunocompetent patients is safe, with a low rate of adverse events. However, in immunosuppressed individuals (human immunodeficiency virus [HIV], transplants, or steroid users), the adverse effects (AEs) of this medication reach 83%; and, when administered parenterally at high doses, lactic acidosis has been documented secondary to the polyethylene glycol vehicle. We present two cases of patients who ingested an overdose of TMP-SMZ and developed type 2 renal tubular acidosis (RTA), which has not been described with this medication, and whose hyperlactatemia is not explained by the polyethylene glycol excipient, as it was taken orally.

Resumen La combinación de trimetoprim-sulfametoxazol (TMP-SMZ o cotrimoxazol) tiene efecto bactericida sobre cocos gram positivos y bacilos gram negativos, con uso clínico en infecciones de piel y tejidos blandos, del tracto respiratorio y urinario, además con relevancia en la profilaxis y tratamiento de infecciones oportunistas en pacientes inmunosupresos. Su uso en pacientes inmunocompetentes a dosis establecidas es seguro, con una baja tasa de eventos adversos. Sin embargo, en población con inmunosupresión: virus de inmunodeficiencia humana (VIH), trasplante, o usuarios de esteroides; los efectos adversos (EA) por este medicamento alcanzan 83% y por administración parenteral en dosis elevadas se ha documentado acidosis láctica secundaria al vehículo polietilenglicol. Presentamos dos casos de pacientes que ingirieron TMP-SMZ en sobredosis, desarrollando acidosis tubular renal (ATR) tipo 2, la cual no se ha descrito en este medicamento y cuya hiperlactatemia no es explicable por el excipiente polietilenglicol debido a que el consumo fue oral.