The impact of adverse childhood experiences on mental health, sexual risk behaviors, and alcohol consumption in adulthood.

The purpose of the study was to determine how Adverse Childhood Experiences (ACE) relate to adulthood flourishing, symptoms of depression, anxiety, somatization, self-reported health, sexual risk behaviors, and alcohol consumption. A quantitative cross-sectional methodology was used. A total of 452 adults completed the survey. The most prevalent ACE include physical abuse (44.69%), separation/divorce of parents (41.81%), living with someone with alcohol problems (39.38%), and being sworn, insulted, or humiliated by adults at home (35.62%). Almost one out of every four respondents (24.34%) reported being touched by an adult, 17.92% reported that an adult tried to manipulate the respondent into touching them, and 8.19% were forced to have sexual intercourse. Results indicate that women reported a higher number of ACE than men. The number of ACE is inversely related to flourishing and self-reported health; while being positively associated with participant's scores in depression, anxiety, somatization, sexual risk behaviors, and alcohol use. The regression model, including the eleven ACE and respondents' sex and age, achieved medium effect sizes for somatization, depression, and anxiety symptoms and small effect sizes for flourishing, self-reported health, sexual risk behaviors, and alcohol consumption. Specific ACE have a particularly significant negative impact on mental health outcomes: forced intercourse, witnessing familial violence, verbal humiliation, and living with individuals struggling with mental health issues and drug consumption or who were incarcerated. In conclusion, the study highlights the alarming prevalence of ACE among the Honduran population and their significant negative impact on mental health outcomes during adulthood.

Enhanced antimicrobial efficacy of biogenic ZnO nanoparticles through UV-B activation: A novel approach for textile garment.

Zinc oxide nanoparticles (ZnO NP) are characterized by novel properties which have been attracting the attention of different lines of research due to their wide applicability. Obtaining this nanomaterial is strongly linked to biogenic synthesis methods, which have also been developed in this research, using Coriandrum sativum extract as a reducing agent. ZnO NPs have been properly characterized by techniques to evaluate their morphology by transmission electron microscopy (TEM) and elemental analysis by EDX. The evaluation of the antimicrobial and antifungal effects is linked to the use of a system provided by "locker sanitizer" equipment, which has been designed and built as part of this research, and is intended to treat textile garments by nebulizing the ZnO NP colloid (99.08 µg/mL) + UV-B, water + UV-B, and UV-B only, and also to evaluate the influence of the treatment time for 1, 2 and 3 min. In this sense, it is known that the nanomaterial used shows a better response to UV light because more hydroxyl radicals are produced, leading to a higher reaction rate, which results in greater efficiency in inhibitory processes. The results show that the use of the locker sanitizer is more efficient when using ZnO NP + UV-B light since it achieved 100 % growth inhibition against E. coli, C. albicans, and A. brasiliensis, and >99 % against S. aureus, after 3 min of treatment.

Optimization of the biosynthesis of silver nanoparticles using bacterial extracts and their antimicrobial potential.

In the present study, silver nanoparticles (AgNPs) were biosynthesized using the supernatant and the intracellular extract of Cupriavidus necator, Bacillus megaterium, and Bacillus subtilis. The characterization of the AgNPs was carried out using UV-Vis spectroscopy, FTIR, DLS and TEM. Resazurin microtiter-plate assay was used to determine the antimicrobial action of AgNPs against Escherichia coli. UV-Visible spectra showed peaks between 414 and 460 nm. TEM analysis revealed that the synthesized AgNPs showed mostly spherical shapes. DLS results determined sizes from 20.8 to 118.4 nm. The highest antimicrobial activity was obtained with the AgNPs synthesized with supernatant rather than those using the intracellular extract. Therefore, it was determined that the bacterial species, temperature, pH, and type of extract (supernatant or intracellular) influence the biosynthesis. This synthesis thus offers a simple, environmentally friendly, and low-cost method for the production of AgNPs, which can be used as antibacterial agents.

Psychometric properties of the Spanish version of the Flourishing Scale in the Honduran population.

Studying Flourishing is important to understand wellbeing. The current study aimed to determine the psychometric properties of the Spanish version of the Flourishing Scale (FS) in the Honduran population. The primary sample consisted of 422 residents of the Central District of Honduras; this included 275 (65.17%) women and 147 men (34.83%). Their average age was 28.18 years (SD = 10.58). Findings from the Exploratory Factor Analysis and Confirmatory Factor Analysis support a unidimensional factor structure. The FS achieved a high internal consistency with McDonald's ω = 0.89, 95% CI [0.86, 0.91]. The average inter-item correlation was 0.48, 95% CI [0.43, 0.53]. Using Student's t-test for paired samples, results indicate that none of the FS items varied significantly between baseline and post-test. Additionally, Spearman's rho was used to correlate test-retest scores; this yielded a statistically significant correlation coefficient of 0.66. The Flourishing Scale had adequate convergent validity with the Subjective Happiness Scale (r = 0.70) and the PANAS-Positive Affect Subscale (r = 0.70) (p < 0.001). In contrast, it correlates inversely with the PANAS-Negative Affect Subscale (r = -0.34) and the PHQ-9 (r = -0.51). Strict measurement invariance for sex was supported. The results indicate that the Flourishing Scale has robust psychometric properties for the Honduran population. Practical implications for public policy are discussed.

Biogenic production of silver, zinc oxide, and cuprous oxide nanoparticles, and their impregnation into textiles with antiviral activity against SARS-CoV-2.

Nanotechnology is being used to fight off infections caused by viruses, and one of the most outstanding nanotechnological uses is the design of protective barriers made of textiles functionalized with antimicrobial agents, with the challenge of combating the SARS-CoV-2 virus, the causal agent of COVID-19. This research is framed within two fundamental aspects: the first one is linked to the proposal of new methods of biogenic synthesis of silver, cuprous oxide, and zinc oxide nanoparticles using organic extracts as reducing agents. The second one is the application of nanomaterials in the impregnation (functionalization) of textiles based on methods called "in situ" (within the synthesis), and "post-synthesis" (after the synthesis), with subsequent evaluation of their effectiveness in reducing the viral load of SARS-CoV-2. The results show that stable, monodisperse nanoparticles with defined geometry can be obtained. Likewise, the "in situ" impregnation method emerges as the best way to adhere nanoparticles. The results of viral load reduction show that 'in situ' textiles with Cu2O NP achieved a 99.79% load reduction of the SARS-CoV-2 virus.

Evaluation of the antiviral activity of ultraviolet light and zinc oxide nanoparticles on textile products exposed to Avian coronavirus.

This research has developed a piece of sanitizing locker-model equipment for textiles exposed to avian coronavirus, which has been put under the influence of UV light, UV + zinc oxide nanoparticles (phytosynthesized ZnONP), and water + UV, and, in turn, under the influence of the exposure time (60, 120, 180 s). The results linked to the phytosynthesis of ZnONP indicate a novel method of fabricating nanostructured material, nanoparticles with spherical morphology and an average size of 30 nm. The assays were made based on the viral viability of avian coronavirus according to the mortality of SPF embryonated eggs and a Real-Time PCR for viral load estimation. This was a model to evaluate the sanitizing effects against coronaviruses since they share a very similar structure and chemistry with SAR-CoV-2. The influence of the type of textile treatment evidenced the potential effect of the sanitizing UV light, which achieved 100% of embryo viability. The response of the ZnONP + UV nebulization showed a notorious influence of photoactivation according to the exposure time, and the 60-s treatment achieved a decrease of 88.9% in viral viability, compared to 77.8% and 55.6% corresponding to the 120 and 180-s treatments, respectively. Regarding the decrease in viral load between the types of treatments, UV 180 s reduced 98.42% and UV 60 s + ZnONP reduced 99.46%, respectively. The results show the combinatorial effect of UV light and zinc nanoparticles in decreasing the viral viability of avian coronavirus, as a model of other important coronaviruses in public health such as SARS-CoV-2.

Cu2O nanoparticles synthesized by green and chemical routes, and evaluation of their antibacterial and antifungal effect on functionalized textiles.

The potential for the application of metal-containing nanomaterials at the nanoscale promotes the opportunity to search for new methods for their elaboration, with special attention to those sustainable methods. In response to these challenges, we have investigated a new method for green synthesis of cuprous oxide nanoparticles (Cu2O NPs) using Myrciaria dubia juice as an organic reductant and, comparing it with chemical synthesis, evaluating in both cases the influence of the volume of the organic (juice) and chemical (ascorbic acid) reductants, for which a large number of techniques such as spectrophotometry, EDX spectrometry, TEM, SEM, DLS, FTIR spectroscopy have been used. Likewise, the nanomaterial with better morphological characteristics, stability, and size homogeneity has been applied in the functionalization of textiles by means of in situ and post-synthesis impregnation methods. The success of the synthesis process has been demonstrated by the antimicrobial activity (bacteria and fungi) of textiles impregnated with Cu2O NPs.

ZnO Nanoparticles Obtained by Green Synthesis as an Alternative to Improve the Germination Characteristics of L. esculentum.

Tomato is an important crop due to its nutritional contributions and organoleptic properties, which make it an appetizing vegetable around the world. In its sowing, the use of seed is the most accessible propagation mechanism for farmers. However, the induction to germination and emergence is often limited in the absence of stimulants that promote the development and growth of the seedling, added to the interference of infectious agents that notoriously reduce the vitality and viability of the seed. Given this, it was proposed as a research objective to determine the effect of zinc oxide nanoparticles (ZnO NPs) mediated by a green route on the germinative characteristics of Lycopersicon esculentum Mill. 1768 "tomato". The experimental phase consisted of the synthesis of ZnO NPs and its subsequent characterization. After its synthesis, its inoculation was conducted during the germination of seeds of L. esculentum, considering six sample groups for the treatment with zinc nanoparticles (T1: Control; T2: 21.31 ppm; T3: 33.58 ppm; T4: 49.15 ppm; T5: 63.59 and T6: 99.076 ppm). The results indicate that concentrations close to 100 ppm of ZnO NPs are ideal in the treatment of L. esculentum seeds, due to the promotion of enzymatic and metabolic activity to achieve cell elongation; likewise, the biosynthesized nanoparticles showed no phytotoxicity, due to the fact that, in all the treatments, there were processes of germination and emergence. This was linked to the generation of a Zn0-phenolate complex through a chelating effect, which generates compatibility with the seed and, compared to classic inorganic synthesis, usually shows phytotoxicity. In this sense, green synthesis is presented as a great alternative in this type of application.

Topical Chitosan-Based Thermo-Responsive Scaffold Provides Dexketoprofen Trometamol Controlled Release for 24 h Use.

Chronic and non-healing wounds demand personalized and more effective therapies for treating complications and improving patient compliance. Concerning that, this work aims to develop a suitable chitosan-based thermo-responsive scaffold to provide 24 h controlled release of Dexketoprofen trometamol (DKT). Three formulation prototypes were developed using chitosan (F1), 2:1 chitosan: PVA (F2), and 1:1 chitosan:gelatin (F3). Compatibility tests were done by DSC, TG, and FT-IR. SEM was employed to examine the morphology of the surface and inner layers from the scaffolds. In vitro release studies were performed at 32 °C and 38 °C, and the profiles were later adjusted to different kinetic models for the best formulation. F3 showed the most controlled release of DKT at 32 °C for 24 h (77.75 ± 2.72%) and reduced the burst release in the initial 6 h (40.18 ± 1.00%). The formulation exhibited a lower critical solution temperature (LCST) at 34.96 °C, and due to this phase transition, an increased release was observed at 38 °C (88.52 ± 2.07% at 12 h). The release profile for this formulation fits with Hixson-Crowell and Korsmeyer-Peppas kinetic models at both temperatures. Therefore, the developed scaffold for DKT delivery performs adequate controlled release, thereby; it can potentially overcome adherence issues and complications in wound healing applications.

Coronavirus awareness, confinement stress, and mental health: Evidence from Honduras, Chile, Costa Rica, Mexico and Spain.

RATIONALE: The purpose of the current study was to analyze the influence of coronavirus awareness, psychological stress responses, and sociodemographic variables on mental health indicators (somatization, depression, and anxiety) in residents of Honduras, Chile, Costa Rica, Mexico, and Spain. METHODS: The study used a quantitative, cross-sectional approach. Data was collected online using the Brief Symptom Inventory-18 (BSI-18); the Coronavirus Awareness Scale-6 (CAS-6) and a questionnaire that included psychological and sociodemographic questions. The total sample size consisted of 1559 respondents from Honduras (34%), Chile (29%), Costa Rica (17%), Mexico (11%), and Spain (9%). RESULTS: The most common stress domains correspond to family (22.97%), financial (22.53%), academic (16.47%), leisure time constraints (14.23%), health (12.48%), peer group (7.63%), and religious concerns (3.69%). These domains are significantly associated with the respondent's country, sex, employment status, and being or not a health worker. Respondents who reported confinement stress also reported higher scores in anxiety, depression, and somatization. The Global Severity Index was significantly predicted by confinement stress, health, academic, and leisure time-related stress, sex, age, being a health worker, COVID-19 Personal Concern, and Perceived Seriousness. Non-significant predictors were employment status, the number of people at home, presence of older adults and children at home, financial, peer group, family, and religious concerns; the regression model had an R2 of 0.26. Similar analyses were conducted for somatization, depression, and anxiety subscales. CONCLUSIONS: The COVID-19 pandemic has adverse effects on the mental health of the general population, particularly regarding anxiety, depression, and somatization. Specific populations, such as women and healthcare workers, are at particular risk of suffering a deterioration in mental wellbeing. The implications of the study for public policy are discussed.

Enzymatic bypass of an N6-deoxyadenosine DNA-ethylene dibromide-peptide cross-link by translesion DNA polymerases.

Unrepaired DNA-protein cross-links, due to their bulky nature, can stall replication forks and result in genome instability. Large DNA-protein cross-links can be cleaved into DNA-peptide cross-links, but the extent to which these smaller fragments disrupt normal replication is not clear. Ethylene dibromide (1,2-dibromoethane) is a known carcinogen that can cross-link the repair protein O6-alkylguanine-DNA alkyltransferase (AGT) to the N6 position of deoxyadenosine (dA) in DNA, as well as four other positions in DNA. We investigated the effect of a 15-mer peptide from the active site of AGT, cross-linked to the N6 position of dA, on DNA replication by human translesion synthesis DNA polymerases (Pols) η, ⍳, and κ. The peptide-DNA cross-link was bypassed by the three polymerases at different rates. In steady-state kinetics, the specificity constant (kcat/Km) for incorporation of the correct nucleotide opposite to the adduct decreased by 220-fold with Pol κ, tenfold with pol η, and not at all with Pol ⍳. Pol η incorporated all four nucleotides across from the lesion, with the preference dT > dC > dA > dG, while Pol ⍳ and κ only incorporated the correct nucleotide. However, LC-MS/MS analysis of the primer-template extension product revealed error-free bypass of the cross-linked 15-mer peptide by Pol η. We conclude that a bulky 15-mer peptide cross-linked to the N6 position of dA can retard polymerization and cause miscoding but that overall fidelity is not compromised because only correct pairs are extended.

Green Synthesis of Gold and Silver Nanoparticles from Plant Extracts and Their Possible Applications as Antimicrobial Agents in the Agricultural Area.

Currently, metal nanoparticles have varied uses for different medical, pharmaceutical, and agricultural applications. Nanobiotechnology, combined with green chemistry, has great potential for the development of novel and necessary products that benefit human health, environment, and industries. Green chemistry has an important role due to its contribution to unconventional synthesis methods of gold and silver nanoparticles from plant extracts, which have exhibited antimicrobial potential, among other outstanding properties. Biodiversity-rich countries need to collect and convert knowledge from biological resources into processes, compounds, methods, and tools, which need to be achieved along with sustainable use and exploitation of biological diversity. Therefore, this paper describes the relevant reported green synthesis of gold and silver nanoparticles from plant extracts and their capacity as antimicrobial agents within the agricultural field for fighting against bacterial and fungal pathogens that can cause plant, waterborne, and foodborne diseases. Moreover, this work makes a brief review of nanoparticles' contribution to water treatment and the development of "environmentally-friendly" nanofertilizers, nanopesticides, and nanoherbicides, as well as presenting the harmful effects of nanoparticles accumulation in plants and soils.

Organic amendments exacerbate the effects of silver nanoparticles on microbial biomass and community composition of a semiarid soil.

Increased utilization of silver nanoparticles (AgNPs) can result in an accumulation of these particles in the environment. The potential detrimental effects of AgNPs in soil may be associated with the low fertility of soils in semiarid regions that are usually subjected to restoration through the application of organic amendments. Microbial communities are responsible for fundamental processes related to soil fertility, yet the potential impacts of low and realistic AgNPs concentrations on soil microorganisms are still unknown. We studied the effects of realistic citrate-stabilized AgNPs concentrations (0.015 and 1.5 µg kg-1) at two exposure times (7 and 30 days) on a sandy clay loam Mediterranean soil unamended (SU) and amended with compost (SA). We assessed soil microbial biomass (microbial fatty acids), soil enzyme activities (urease, ß-glucosidase, and alkaline phosphatase), and composition of the microbial community (bacterial 16S rRNA gene and fungal ITS2 sequencing) in a microcosm experiment. In the SA, the two concentrations of AgNPs significantly decreased the bacterial biomass after 7 days of incubation. At 30 days of incubation, only a significant decrease in the Gram+ was observed at the highest AgNPs concentration. In contrast, in the SU, there was a significant increase in bacterial biomass after 30 days of incubation at the lowest AgNPs concentration. Overall, we found that fungal biomass was more resistant to AgNPs than bacterial biomass, in both SA and SU. Further, the AgNPs changed the composition of the soil bacterial community in SA, the relative abundance of some bacterial taxa in SA and SU, and fungal richness in SU at 30 days of incubation. However, AgNPs did not affect the activity of extracellular enzymes. This study demonstrates that the exposure time and organic amendments modulate the effects of realistic concentrations of AgNPs in the biomass and composition of the microbial community of a Mediterranean soil.

Environmentally relevant concentrations of silver nanoparticles diminish soil microbial biomass but do not alter enzyme activities or microbial diversity.

The increasing use of silver nanoparticles (AgNPs) due to their well-known antimicrobial activity, has led to their accumulation in soil ecosystems. However, the impact of environmental realistic concentrations of AgNPs on the soil microbial community has been scarcely studied. In this work, we have assessed the impact of AgNPs, that mimic real concentrations in nature, on tropical soils cultivated with Coffea arabica under conventional and organic management systems. We evaluated the biomass, extracellular enzyme activities, and diversity of the soil microbial community, in a microcosm experiment as a function of time. After seven days of incubation, we found an increase in microbial biomass in an AgNPs-concentration-independent manner. In contrast, after 60-day-incubation, there was a decrease in Gram+ and actinobacterial biomass, in both soils and all AgNPs concentrations. Soil physico-chemical properties and enzyme activities were not affected overall by AgNPs. Regarding the microbial community composition, only some differences in the relative abundance at phylum and genus level in the fungal community were observed. Our results suggest that environmental concentrations of AgNPs affected microbial biomass but had little impact on microbial diversity and may have little effects on the soil biogeochemical cycles mediated by extracellular enzyme activities.

Candida auris: what have we learned so far?

PURPOSE OF REVIEW: The increasing prevalence of fungal infections due to Candida species has been well described in critically ill patient populations, but in recent years a new species, Candida auris has received attention from the medical community worldwide. We aim to summarize the current knowledge related to C. auris, as new identification techniques, novel antifungal agents and more experience with outbreak management have been published in the past few years. RECENT FINDINGS: C. auris has been described in several countries, arising independently in separate clades. Its resistance to multiple antifungals and persistent colonization of patients and medical surfaces have become a therapeutic and infection control challenge. Recent elucidation of some of the molecular mechanisms related to pathogenicity and studies of in-vitro efficacy of novel antifungal agents can better guide therapy. SUMMARY: As C. auris continues to cause outbreaks worldwide, newer, and more efficient identification techniques, novel antifungals, and more knowledge in effective infection control techniques will allow better clinical outcomes in the management and control of invasive fungal disease.

Point-Counterpoint: Should Serum ß-d-Glucan Testing Be Used for the Diagnosis of Pneumocystis jirovecii Pneumonia?

INTRODUCTIONDespite the widespread use of prophylactic antibiotics in high-risk individuals, Pneumocystis jirovecii remains an important cause of pneumonia in immunocompromised patients. During the peak of the AIDS epidemic, many hospitals and outpatient clinics were very proficient at collecting induced sputum specimens for the diagnosis of Pneumocystis jirovecii pneumonia (PJP). With the dramatic reduction in the occurrence PJP in the current era of highly effective antiretroviral therapy, many centers no longer collect induced sputum samples. Thus, the diagnosis of PJP requires bronchoalveolar lavage (BAL) specimens or a decision to treat the patient empirically without a definitive diagnosis. Sputum or BAL specimens are tested for P. jirovecii using special stains or molecular assays, which require highly trained staff that may not be available with a rapid turnaround time. Given the invasive nature of collecting BAL specimens and the expertise needed for interpreting PJP test results, there is interest in using serum 1,3-ß-d-glucan (BDG) testing for the diagnosis of PJP. In this point-counterpoint, Luis Ostrosky-Zeichner and Gabriela Corsi-Vasquez discuss the pro view of using BDG testing for the diagnosis of PJP, while Paul E. Sax and Edward F. Pilkington III present the con view of using BDG testing for the diagnosis of PJP.

Progressive Cl- channel defects reveal disrupted skeletal muscle maturation in R6/2 Huntington's mice.

Huntington's disease (HD) patients suffer from progressive and debilitating motor dysfunction. Previously, we discovered reduced skeletal muscle chloride channel (ClC-1) currents, inwardly rectifying potassium (Kir) channel currents, and membrane capacitance in R6/2 transgenic HD mice. The ClC-1 loss-of-function correlated with increased aberrant mRNA processing and decreased levels of full-length ClC-1 mRNA (Clcn1 gene). Physiologically, the resulting muscle hyperexcitability may help explain involuntary contractions of HD. In this study, the onset and progression of these defects are investigated in R6/2 mice, ranging from 3 wk old (presymptomatic) to 9-13 wk old (late-stage disease), and compared with age-matched wild-type (WT) siblings. The R6/2 ClC-1 current density and level of aberrantly spliced Clcn1 mRNA remain constant with age. In contrast, the ClC-1 current density increases, and the level of aberrantly spliced Clcn1 mRNA decreases with age in WT mice. The R6/2 ClC-1 properties diverge from WT before the onset of motor symptoms, which occurs at 5 wk of age. The relative decrease in R6/2 muscle capacitance also begins in 5-wk-old mice and is independent of fiber atrophy. Kir current density is consistently lower in R6/2 compared with WT muscle. The invariable R6/2 ClC-1 properties suggest a disruption in muscle maturation, which we confirm by measuring elevated levels of neonatal myosin heavy chain (MyHC) in late-stage R6/2 skeletal muscle. Similar changes in ClC-1 and MyHC isoforms in the more slowly developing Q175 HD mice suggest an altered maturational state is relevant to adult-onset HD. Finally, we find nuclear aggregates of muscleblind-like protein 1 without predominant CAG repeat colocalization in R6/2 muscle. This is unlike myotonic dystrophy, another trinucleotide repeat disorder with similar ClC-1 defects, and suggests a novel mechanism of aberrant mRNA splicing in HD. These early and progressive skeletal muscle defects reveal much needed peripheral biomarkers of disease progression and better elucidate the mechanism underlying HD myopathy.

Multiplex PCR to detect four different tomato-infecting pathogens.

This work was aimed to develop a multiplex PCR assay to detect infectious agents such as Clavibacter michiganensis subsp. michiganensis, Fusarium sp, Leveillula taurica, and begomoviruses in tomato (Solanum lycopersicum) plants. Specific primer sets of each pathogen were designed based on intergenic ribosomal RNA sequences for the first three, whereas for begomoviruses, primers were designed based on conserved regions. The design also considered that the length (200-800 bp) of the PCR products was resolvable by electrophoresis; thus 296, 380, 457, and 731 bp fragments for Clavibacter, Fusarium, Leveillula, and begomoviruses, respectively, were considered. PCR conditions were optimized to amplify all the products in a single tube from genomic DNA and circumvent PCR inhibitors from infected plants. Finally, when the multiplex PCR assay was tested with tomato plants infected with any of the four pathogens, specific PCR products confirmed the presence of the pathogens. Optimized PCR multiplex allowed for the accurate and simultaneous detection of Clavibacter, Fusarium, Leveillula, and begomoviruses in infected plants or seeds from tomato.

Repeated-measures analysis of the National Institute of Neurological Disorders and Stroke rt-PA stroke trial.

Previous analyses, including the National Institute of Neurological Disorders and Stroke (NINDS) rt-PA Stoke Trial, have assessed the clinical treatment efficacy only at single study point, but did not assess efficacy using outcomes collected at multiple time points and incorporate within-patient correlation. The data from the NINDS rt-PA Stroke Trial was analyzed with repeated-measures analysis with generalized estimating equations (GEE) approach using dichotomized outcomes (modified Rankin Scale [mRS], National Institutes of Health Stroke Scale [NIHSS], Barthel Index [BI], and Glasgow Outcome Scale [GOS]). The results were compared with data from previous analyses. All of the outcome variables at different time points were significantly correlated. rt-PA was superior to placebo overall and at specific time points individually. The overall odds of having minimal or no disability (mRS score 0 or 1) for patients treated with rt-PA was higher than those treated with placebo (odds ratio [OR], 2.1; 95% confidence interval [CI], 1.5-3.0). The ORs were 2.3 (95% CI, 1.5-3.4) times higher at 3 months, 1.9 (95% CI, 1.3-2.8) times higher at 6 months, and 2.0 (95% CI, 1.3-2.9) times higher at 12 months. A similar treatment effect also was observed with the NIHSS, BI, and GOS. Compared with previous analyses, an augmented treatment effect with larger ORs and smaller P values were observed. Repeated-measures analysis provides an alternative method for assessing treatment effect, as demonstrated in the analysis of data from the NINDS rt-PA Stroke Trial. This method could be used in future stroke trials in which outcomes of interest are collected at multiple time points.

Complicaciones de la apendicitis aguda en niños, hospital León Becerra, período 2001-2002 / Acute appendicitis complications in children, hospital

Tipo de estudio: retrospectivo, longitudinal y descriptivo. Objetivo: determinar las complicaciones más frecuentes de la apendicitis en niños. Establecer los factores de riesgo que inciden en el desarrollo de las complicaciones. Determinar si la práctica del drenaje de cavidad incidió en la presencia o no de las complicaciones posoperatorias. Material: historias clínicas del departamento de estadística correspondientes a pacientes que ingresaron con diagnóstico de “Síndrome doloroso abdominal” y “Apendicitis aguda” desde septiembre de 2001 a septiembre de 2002. Resultados: la peritonitis y el plastrón apendicular fueron las complicaciones más frecuentes, con predominio en el género masculino. Los factores de riesgo que conllevan a que una apendicitis se complique fueron: tiempo de evolución (el promedio fue de 59,7 horas); la medicación previa a su ingreso (la recibieron 63 pacientes). Conclusiones: en el estudio predominó el género masculino con el 70,53 y la edad más frecuente fue entre los 6 a 9 años. El total de las complicaciones ascendió al 34,74; disminuyeron significativamente las complicaciones en aquellos pacientes que se les realizó apendicectomía más drenaje y lavado de cavidad abdominal. La morbilidad fue del 29,47 y la mortalidad fue del 0.

Study type: retrospective, longitudinal and descriptive. Objective: to determine the most frequent of the appendicitis complications in children. Find out about the risk factors which contribute to the development of such complications. To determine if the cavity drainage practice did or did not have a bearing on the presence of the post-operative complications. Material: clinical reports from the statistics department corresponding to patients who were admitted with “abdominal pain syndrome” and “acute appendicitis” diagnosis from September 2001 to September 2002. Results: peritonitis and the appendicular plastron were the most frequents complications, prevailing in males. Risk factors that could worsen an appendicitis are the evolution time; the average was of 59.7 hours; the medication received before admission by 63 patients. Conclusions: males prevailed in the study, being 70.53 and the most frequent age was between 6 and 9 years old. Complications appeared in 34.74. Out of the 22 patients who were practiced appendectomy plus cavity drainage and cleaning as treatment, one got worse which means 4.55. This tells us that those patients, who get cavity drainage and cleaning, diminish the complications significantly. Morbidity in our study was about 29.47 and mortality was about 0.