RESUMEN

The oceanic South Atlantic Convergence Zone (SACZ) has played a major role during South America's 2021/2022 summer extreme rainy season, being responsible for more than 90% of the precipitation in some regions of Southeast Brazil and in some regions of the Southwestern Atlantic Ocean (SWA). The summer of 2021/2022 was unique and rare and considered an abnormally humid season as verified by official Brazilian Institutes. First, the unusual number of cases of SACZ episodes (seven), was the highest recorded in the last decade. Second, all the cases that occurred were oceanic SACZ that assumed characteristics of an Atmospheric River and produced an excessively anomalous amount of precipitation during this period. Excess precipitation along with the regions located in mountainous and very uneven relief, which by orographic effects favors high precipitation volumes, were responsible for amplifying the observed impacts, such as landslides and floods that caused several losses to society. We also showed the main effects of coupling and interaction between the waters of the surface layer of the SWA and the atmosphere. Our learning from this study ends with the unprecedented results of how the marine atmospheric boundary layer (MABL) is locally modulated by the sea surface temperature (SST) that lies just below it. Until the present moment, we emphasize that this important mechanism has not been widely highlighted in the literature, showing that even though the ocean is colder than before oceanic SACZ is established, it is still warmer than the overlying air, thus, the ocean continues to be an active source of heat and moisture for the atmosphere and enhances the MABL instability process.

RESUMEN

This study assessed the association between standing intravenous acetaminophen and opioid exposure after cardiac surgery. Before vs after implementation of a standardized pain pathway, we report decreased opioid exposure, 0.38 milligram per kilogram of morphine equivalents [IQR 0.10-0.81] vs 0.26 milligram per kilogram of morphine equivalents [0.09-0.56] (P = .01) and increased acetaminophen exposure, 3 [2-4] vs 4 [4-5] doses (P < .001).

Asunto(s)

Acetaminofén , Analgésicos no Narcóticos , Humanos , Niño , Acetaminofén/efectos adversos , Analgésicos Opioides/efectos adversos , Dolor Postoperatorio/tratamiento farmacológico , Morfina/uso terapéutico , Unidades de Cuidado Intensivo Pediátrico , Analgésicos no Narcóticos/efectos adversos

RESUMEN

The COVID-19 pandemic illuminates possibilities for creating states of exception while simultaneously destabilizing the Mexico-U.S. border through the politics of fear. Specifically, the Migrant Protection Protocols (MPP), Zero Tolerance Policy (ZTP), COVID-19 CAPIO, Asylum Cooperative Agreements (ACA), and Title 42-using the pandemic under an arcane section of U.S. law to immediately expel asylum seekers and refugees, in particular-highlight the formation of a state of exception consistent with the work of Agamben. They also document how the politics of fear is used to reinforce hegemonic narratives targeting asylum seekers while attempting to reinforce political agendas that lean toward a specific brand of nationalism using the lens of public health as a context. The U.S. government under the Trump administration, and the Biden administration to a lesser extent, constructed these policies aimed primarily at refugees and asylum seekers from El Salvador, Guatemala, Honduras, and Mexico, thereby violating laws and international treaty obligations. Related Articles: Correa-Cabrera, Guadalupe. 2013. "Security, Migration, and the Economy in the Texas-Tamaulipas Border Region: The 'Real' Effects of Mexico's Drug War." Politics & Policy 41(1): 65-82. https://doi.org/10.1111/polp.12005.Duman, Yoav H. 2014. "Reducing the Fog? Immigrant Regularization and the State." Politics & Policy 42(2): 187-220. https://doi.org/10.1111/polp.12065.Garrett, Terence M. 2020. "The Security Apparatus, Federal Magistrate Courts, and Detention Centers as Simulacra: The Effects of Trump's Zero Tolerance Policy on Migrants and Refugees in the Rio Grande Valley." Politics & Policy 48(2): 372-35. https://doi.org/10.1111/polp.12348.

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La pandemia de COVID­19 ilumina las posibilidades de crear estados de excepción y, al mismo tiempo, desestabilizar la relación México­Estados Unidos. frontera a través de la política del miedo. Específicamente, los Protocolos de Protección de Migrantes (MPP), la Política de Tolerancia Cero (ZTP), Covid­19 CAPIO, los Acuerdos Cooperativos de Asilo (ACA) y el Título 42: usar la pandemia bajo una sección arcana de la ley de EE. UU. para expulsar de inmediato a los solicitantes de asilo y refugiados, en particular, destaca la formación de un estado de excepción consistente con el trabajo de Agamben mientras documenta cómo la política del miedo se usa para reforzar las narrativas hegemónicas dirigidas a los solicitantes de asilo mientras intenta reforzar las agendas políticas que se inclinan hacia una marca específica de nacionalismo usando la lente de la salud pública como contexto. El gobierno de los EE. UU. bajo la administración de Trump, y la administración de Biden en menor medida, construyeron estas políticas dirigidas principalmente a refugiados y solicitantes de asilo de El Salvador, Guatemala, Honduras y México, violando así las leyes y las obligaciones de los tratados internacionales.

RESUMEN

OBJECTIVE: Lymphedema affects >1 in 1000 Americans, most often resulting from breast cancer surgery. Conservative treatment, such as compression garments, combined decongestive therapy (CDT), and pneumatic compression pumps, is the current standard of care. Despite the wide availability of these therapies, lymphedema has remained undertreated worldwide. We investigated whether third-party insurance coverage might be a barrier to obtaining conservative treatment in the United States. METHODS: We conducted a cross-sectional analysis of publicly accessible insurance policies. A total of 58 insurers were included in accordance with their state enrollment data and market share. The analysis was conducted using a web-based search and individual telephone interviews. For those policies that extended coverage, the medical necessity criteria were abstracted. RESULTS: A total of 50 insurance companies (86%) had a policy in place addressing conservative management. Included in 37 policies (64%), compression garments were covered the least often (n = 33; 89%). Although CDT was included in only 22 policies (38%), it was universally covered. Noncalibrated pneumatic compression pumps were the most frequently addressed intervention (n = 46; 79%), significantly more often than CDT (P < .01) and were universally covered, significantly more often than were compression garments (P < .04). Criteria for reimbursement were present for more than one half of the policies that provided coverage. CONCLUSIONS: A large proportion of U.S. insurers provided coverage for conservative treatment of lymphedema. However, only 38% of the policies included a statement of coverage for CDT. Most of the policies that did provide coverage for these four therapies also had multiple criteria that were required to be met before considering reimbursement. These requirements could create barriers to the receipt of treatment.

Asunto(s)

Tratamiento Conservador , Linfedema , Tratamiento Conservador/efectos adversos , Estudios Transversales , Humanos , Cobertura del Seguro , Linfedema/diagnóstico , Linfedema/terapia , Mastectomía , Estados Unidos

RESUMEN

Sea surface temperature (SST) anomalies caused by a warm core eddy (WCE) in the Southwestern Atlantic Ocean (SWA) rendered a crucial influence on modifying the marine atmospheric boundary layer (MABL). During the first cruise to support the Antarctic Modeling and Observation System (ATMOS) project, a WCE that was shed from the Brazil Current was sampled. Apart from traditional meteorological measurements, we used the Eddy Covariance method to directly measure the ocean-atmosphere sensible heat, latent heat, momentum, and carbon dioxide (CO2) fluxes. The mechanisms of pressure adjustment and vertical mixing that can make the MABL unstable were both identified. The WCE also acted to increase the surface winds and heat fluxes from the ocean to the atmosphere. Oceanic regions at middle and high latitudes are expected to absorb atmospheric CO2, and are thereby considered as sinks, due to their cold waters. Instead, the presence of this WCE in midlatitudes, surrounded by predominantly cold waters, caused the ocean to locally act as a CO2 source. The contribution to the atmosphere was estimated as 0.3 ± 0.04 mmol m-2 day-1, averaged over the sampling period. The CO2 transfer velocity coefficient (K) was determined using a quadratic fit and showed an adequate representation of ocean-atmosphere fluxes. The ocean-atmosphere CO2, momentum, and heat fluxes were each closely correlated with the SST. The increase of SST inside the WCE clearly resulted in larger magnitudes of all of the ocean-atmosphere fluxes studied here. This study adds to our understanding of how oceanic mesoscale structures, such as this WCE, affect the overlying atmosphere.

RESUMEN

OBJECTIVES: To describe the development and initial results of an examination and certification process assessing competence in critical care echocardiography. DESIGN: A test writing committee of content experts from eight professional societies invested in critical care echocardiography was convened, with the Executive Director representing the National Board of Echocardiography. Using an examination content outline, the writing committee was assigned topics relevant to their areas of expertise. The examination items underwent extensive review, editing, and discussion in several face-to-face meetings supervised by National Board of Medical Examiners editors and psychometricians. A separate certification committee was tasked with establishing criteria required to achieve National Board of Echocardiography certification in critical care echocardiography through detailed review of required supporting material submitted by candidates seeking to fulfill these criteria. SETTING: The writing committee met twice a year in person at the National Board of Medical Examiner office in Philadelphia, PA. SUBJECTS: Physicians enrolled in the examination of Special Competence in Critical Care Electrocardiography (CCEeXAM). MEASUREMENTS AND MAIN RESULTS: A total of 524 physicians sat for the examination, and 426 (81.3%) achieved a passing score. Of the examinees, 41% were anesthesiology trained, 33.2% had pulmonary/critical care background, and the majority had graduated training within the 10 years (91.6%). Most candidates work full-time at an academic hospital (46.9%). CONCLUSIONS: The CCEeXAM is designed to assess a knowledge base that is shared with echocardiologists in addition to that which is unique to critical care. The National Board of Echocardiography certification establishes that the physician has achieved the ability to independently perform and interpret critical care echocardiography at a standard recognized by critical care professional societies encompassing a wide spectrum of backgrounds. The interest shown and the success achieved on the CCEeXAM by practitioners of critical care echocardiography support the standards set by the National Board of Echocardiography for testamur status and certification in this imaging specialty area.

Asunto(s)

Certificación/normas , Competencia Clínica/normas , Cuidados Críticos/normas , Ecocardiografía/normas , Medicina Interna/normas , Evaluación Educacional , Humanos , Consejos de Especialidades

RESUMEN

Background: Oculocutaneous albinism (OCA) is a Mendelian disorder characterized by hypopigmentation of the skin, hair, and eyes, hypoplastic fovea, and low vision, known to be caused by mutations in the Tyrosinase (TYR) gene. Among the known TYR variants, some reduce but do not completely eliminate tyrosinase activity, allowing residual production of melanin and resulting in a contradictory assignment as either pathogenic or benign, preventing a precise clinical diagnostic.Materials and Methods: In the present work, we performed Whole Exome Sequencing and subsequent Sanger sequencing in a young male clinically diagnosed with OCA.Results: Whole-exome sequencing analysis revealed the identification of two variants in trans in TYR. The first, corresponds to a known pathogenic variant G47D, while the second S192Y, was considered a polymorphism due to its relatively high frequency in the European population.Conclusion: The lack of other pathogenic variants in TYR, the reported reduced enzymatic activity (ca. 40% respect to wt) for S192Y, together with the structural in-silico analysis strongly suggest that both reported variants are jointly disease-causing and that S192Y should be considered as likely pathogenic, especially when it is found in trans with a null variant.

Asunto(s)

Albinismo Oculocutáneo/genética , Monofenol Monooxigenasa/genética , Mutación Missense/genética , Polimorfismo de Nucleótido Simple/genética , Adolescente , Albinismo Oculocutáneo/diagnóstico , Secuencia de Aminoácidos , Estudios de Asociación Genética , Predisposición Genética a la Enfermedad , Genotipo , Humanos , Masculino , Datos de Secuencia Molecular , Linaje , Secuenciación del Exoma

RESUMEN

Natural products have been recognized as important bioactive compounds on the basis of their wide biological properties. Here we investigated the antitumor effect and molecular mechanisms of the diterpene Fruticuline A (fruti) from Salvia lachnostachys, in human cancer cell lineages and Solid Ehrlich Carcinoma in mice. Fruti reduced MCF-7 and HepG2 proliferation by the reduction of Cyclin D1 levels and decreased NF-κB gene levels in both cell types. Furthermore, fruti also induced apoptosis in HepG2 cells, reduced Bcl-2 gene expression and induced necroptosis by increasing Ripk in MCF-7 cells. In mice, fruti prevented tumor development and reduced Cyclin D1, Bcl-2 and Rela gene levels, and reduced the p-NF-κB/NF-κB ratio in tumor tissue. Furthermore, fruti induced necrosis and apoptosis, increased N-acetyl-ß-D-glucosaminidase and TNF-α levels and reduced IL-10 and Vegf levels in tumor tissue. Collectively, fruti exerts antitumor effects through the inhibition of the NF-κB pathway, reducing Cyclin D1 and Bcl-2 levels. In vitro the apoptosis and necroptosis pathways are involved in the cellular death, whereas in vivo, cells undergo necrosis by increased tumor inflammation and reduction of angiogenesis. Thus, fruticuline A acts in tumor cells by multiple mechanisms and represents a promising molecule for drug development in cancer treatment.

Asunto(s)

Antineoplásicos/farmacología , Diterpenos/farmacología , Animales , Apoptosis/efectos de los fármacos , Línea Celular , Línea Celular Tumoral , Ciclina D1/metabolismo , Femenino , Fibroblastos/efectos de los fármacos , Fibroblastos/metabolismo , Células Hep G2 , Humanos , Células MCF-7 , Ratones , FN-kappa B/metabolismo , Neovascularización Patológica/tratamiento farmacológico , Neovascularización Patológica/metabolismo , Proteínas Proto-Oncogénicas c-bcl-2/metabolismo , Factor de Necrosis Tumoral alfa/metabolismo , Factor A de Crecimiento Endotelial Vascular/metabolismo

RESUMEN

AIMS: Left atrium (LA) dilation is associated with adverse cardiovascular (CV) outcomes. Blood stasis, thrombus formation and atrial fibrillation may occur, especially in heart failure (HF) patients. It is not known whether preventive antithrombotic treatment may decrease the incidence of CV events in HF patients with LA enlargement. We investigated the relationship between LA enlargement and CV outcomes in HF patients and the effect of different antithrombotic treatments. METHODS AND RESULTS: Two-dimensional echocardiography with LA volume index (LAVi) measurement was performed in 1148 patients with systolic HF from the Warfarin versus Aspirin in Reduced Ejection Fraction (WARCEF) trial. Patients were randomized to warfarin or aspirin and followed for 3.4 ± 1.7 years. While the primary aim of the trial was a composite of ischaemic stroke, death, and intracerebral haemorrhage, the present report focuses on the individual CV events, whose incidence was compared across different LAVi and treatment subgroups. After adjustment for demographics and clinical covariates, moderate or severe LA enlargement was significantly associated with total death (hazard ratio 1.6 and 2.7, respectively), CV death (HR 1.7 and 3.3), and HF hospitalization (HR 2.3 and 2.6) but not myocardial infarction (HR 1.0 and 1.4) or ischaemic stroke (1.1 and 1.5). The increased risk was observed in both patients treated with warfarin or aspirin. In warfarin-treated patients, a time in therapeutic range >60% was associated with lower event rates, and an interaction between LAVi and time in therapeutic range was observed for death (P = 0.034). CONCLUSIONS: In patients with systolic HF, moderate or severe LA enlargement is associated with death and HF hospitalization despite treatment with antithrombotic medications. The possibility that achieving a more consistent therapeutic level of anticoagulation may decrease the risk of death requires further investigation.

Asunto(s)

Aspirina/administración & dosificación , Volumen Cardíaco/fisiología , Atrios Cardíacos/diagnóstico por imagen , Insuficiencia Cardíaca Sistólica/fisiopatología , Volumen Sistólico/efectos de los fármacos , Tromboembolia/prevención & control , Warfarina/administración & dosificación , Anticoagulantes/administración & dosificación , Argentina/epidemiología , Canadá/epidemiología , Relación Dosis-Respuesta a Droga , Ecocardiografía , Femenino , Atrios Cardíacos/fisiopatología , Insuficiencia Cardíaca Sistólica/complicaciones , Insuficiencia Cardíaca Sistólica/tratamiento farmacológico , Humanos , Incidencia , Masculino , Persona de Mediana Edad , Inhibidores de Agregación Plaquetaria/administración & dosificación , Tasa de Supervivencia/tendencias , Tromboembolia/epidemiología , Tromboembolia/etiología , Resultado del Tratamiento , Estados Unidos/epidemiología

RESUMEN

AIMS: To determine the diagnostic accuracy of semi-automatic quantitative metrics compared to expert reading for interpretation of computed tomography perfusion (CTP) imaging. METHODS: The CORE320 multicenter diagnostic accuracy clinical study enrolled patients between 45 and 85 years of age who were clinically referred for invasive coronary angiography (ICA). Computed tomography angiography (CTA), CTP, single photon emission computed tomography (SPECT), and ICA images were interpreted manually in blinded core laboratories by two experienced readers. Additionally, eight quantitative CTP metrics as continuous values were computed semi-automatically from myocardial and blood attenuation and were combined using logistic regression to derive a final quantitative CTP metric score. For the reference standard, hemodynamically significant coronary artery disease (CAD) was defined as a quantitative ICA stenosis of 50% or greater and a corresponding perfusion defect by SPECT. Diagnostic accuracy was determined by area under the receiver operating characteristic curve (AUC). RESULTS: Of the total 377 included patients, 66% were male, median age was 62 (IQR: 56, 68) years, and 27% had prior myocardial infarction. In patient based analysis, the AUC (95% CI) for combined CTA-CTP expert reading and combined CTA-CTP semi-automatic quantitative metrics was 0.87(0.84-0.91) and 0.86 (0.83-0.9), respectively. In vessel based analyses the AUC's were 0.85 (0.82-0.88) and 0.84 (0.81-0.87), respectively. No significant difference in AUC was found between combined CTA-CTP expert reading and CTA-CTP semi-automatic quantitative metrics in patient based or vessel based analyses(p > 0.05 for all). CONCLUSION: Combined CTA-CTP semi-automatic quantitative metrics is as accurate as CTA-CTP expert reading to detect hemodynamically significant CAD.

Asunto(s)

Angiografía por Tomografía Computarizada/métodos , Angiografía Coronaria/métodos , Enfermedad de la Arteria Coronaria/diagnóstico por imagen , Circulación Coronaria , Vasos Coronarios/diagnóstico por imagen , Tomografía Computarizada Multidetector/métodos , Imagen de Perfusión Miocárdica/métodos , Interpretación de Imagen Radiográfica Asistida por Computador/métodos , Anciano , Anciano de 80 o más Años , Área Bajo la Curva , Asia , Automatización , Angiografía por Tomografía Computarizada/normas , Angiografía Coronaria/normas , Enfermedad de la Arteria Coronaria/fisiopatología , Vasos Coronarios/fisiopatología , Europa (Continente) , Femenino , Humanos , Modelos Logísticos , Masculino , Persona de Mediana Edad , Tomografía Computarizada Multidetector/normas , Imagen de Perfusión Miocárdica/normas , América del Norte , Variaciones Dependientes del Observador , Valor Predictivo de las Pruebas , Estudios Prospectivos , Curva ROC , Interpretación de Imagen Radiográfica Asistida por Computador/normas , Estándares de Referencia , Reproducibilidad de los Resultados , Índice de Severidad de la Enfermedad , América del Sur , Tomografía Computarizada de Emisión de Fotón Único

RESUMEN

BACKGROUND: Population-based studies conducted in Latin America have shown a high proportion of asymptomatic and submicroscopic malarial infections. Considering efforts aiming at regional elimination, it is important to investigate the role of this asymptomatic reservoir in malaria transmission in peri-urban areas. This study aimed to estimate the prevalence of Plasmodium spp. and gametocyte burden on symptomatic and asymptomatic infections in the Brazilian Amazon. RESULTS: Two cross-sectional household surveys (CS) were conducted including all inhabitants in a peri-urban area of Manaus, western Amazonas State, Brazil. Malaria parasites were detected by light microscopy (LM) and qPCR. Sexual stages of Plasmodium spp. were detected by LM and RT-qPCR. A total of 4083 participants were enrolled during the two surveys. In CS1, the prevalence of Plasmodium vivax infections was 4.3% (86/2010) by qPCR and 1.6% (32/2010) by LM. Fifty percent (43/86) of P. vivax infected individuals (qPCR) carried P. vivax gametocytes. In CS2, 3.4% (70/2073) of participants had qPCR-detectable P. vivax infections, of which 42.9% (30/70) of infections were gametocyte positive. The P. vivax parasite density was associated with gametocyte carriage (P < 0.001). Sixty-seven percent of P. vivax infected individuals and 53.4% of P. vivax gametocyte carriers were asymptomatic. CONCLUSIONS: This study confirms a substantial proportion of asymptomatic and submicroscopic P. vivax infections in the study area. Most asymptomatic individuals carried gametocytes and presented low asexual parasitemia. This reservoir actively contributes to malaria transmission in the Brazilian Amazon, underscoring a need to implement more efficient control and elimination strategies.

Asunto(s)

Infecciones Asintomáticas/epidemiología , Malaria Vivax/epidemiología , Malaria Vivax/transmisión , Plasmodium vivax/aislamiento & purificación , Adolescente , Adulto , Brasil/epidemiología , Niño , Preescolar , Estudios Transversales , ADN Protozoario/genética , Reservorios de Enfermedades/parasitología , Composición Familiar , Femenino , Humanos , Malaria Vivax/parasitología , Masculino , Microscopía , Persona de Mediana Edad , Parasitemia/epidemiología , Plasmodium vivax/genética , Plasmodium vivax/ultraestructura , Prevalencia , Reacción en Cadena en Tiempo Real de la Polimerasa , Encuestas y Cuestionarios , Remodelación Urbana , Adulto Joven

RESUMEN

BACKGROUND: In northeastern Brazil, grape pomace has become a potential alternative byproduct because of the recover phenolic compounds from the vinification process. Comparative analyses were performed between lyophilized extract of grape skins from pomace, described as fermented (FGS), and fresh, unfermented (UGS) grape skins to show the relevant brand's composition upon the first maceration in winemaking. METHODS: The use of in vitro testing such as Folin-Ciocalteu's, DPPH free radical scavenger and HPLC methods were performed to evidence antioxidant effect and phenolic compounds. Additionally, vascular reactivity studies were performed in third-order branches of rat superior mesenteric arteries, which were obtained and placed in organ baths containing Krebs-Henseleit solution, maintained at 37 °C, gassed with a mixture of 95% O2 and 5% CO2, and maintained at pH 7.4. The in situ formation of reactive oxygen species (ROS) was evaluated in small mesenteric rings using oxidative fluorescent dihydroethidium dye. RESULTS: We found higher phenolic content and antioxidant activity in FGS when compared to UGS. HPLC analyses identified a significant number of phenolic compounds with antioxidant potential in both samples. The vasorelaxant effect induced by FGS was more potent than that induced by UGS, and the activity was attenuated after removal of vascular endothelium or by blockade of endothelium-derived relaxing factors, such as NO and EDHF. CONCLUSIONS: The FGS extract may be a great source of natural polyphenol products with potent antioxidant effects and endothelium-dependent vasodilatory actions involving NO and EDHF pathways.

Asunto(s)

Antioxidantes/farmacología , Frutas/química , Fenoles/farmacología , Epidermis de la Planta/química , Extractos Vegetales/farmacología , Vasodilatadores/farmacología , Vitis/química , Animales , Antioxidantes/análisis , Arterias/efectos de los fármacos , Arterias/fisiología , Compuestos de Bifenilo/metabolismo , Brasil , Cromatografía Líquida de Alta Presión , Fermentación , Fenoles/análisis , Picratos/metabolismo , Ratas , Especies Reactivas de Oxígeno/metabolismo , Vasodilatadores/análisis

RESUMEN

BACKGROUND: The neurosurgical boot camp has been fully incorporated into U.S. postgraduate education. This is the first implementation of the neurosurgical boot in a developing country. To advance neurosurgical education, we developed a similar boot camp program, in collaboration with Bolivian neurosurgeons, to determine its feasibility and effectiveness in an international setting. METHODS: In a collective effort, the Bolivian Society for Neurosurgery, Foundation for International Education in Neurological Surgery, Solidarity Bridge, and University of Massachusetts organized and executed the first South American neurosurgical boot camp in Bolivia in 2015. Both U.S. and Bolivian faculty led didactic lectures followed by a practicum day using mannequins and simulators. South American residents and faculty were surveyed after the course to determine levels of enthusiasm and their perceived improvement in fund of knowledge and course effectiveness. RESULTS: Twenty-four neurosurgery residents from 5 South American countries participated. Average survey scores ranged between 4.2 and 4.9 out of 5. Five Bolivian neurosurgeons completed the survey with average scores of 4.5-5. This event allowed for Bolivian leaders in the field to unify around education, resulting in the formation of an institute to continue similar initiatives. Total cost was estimated at $40 000 USD; however, significant faculty, industry, and donor support helped offset this amount. CONCLUSION: The first South American neurosurgical boot camp had significant value and was well received in Bolivia. This humanitarian model provides a sustainable solution to education needs and should be expanded to other regions as a means for standardizing the core competencies in neurosurgery.

Asunto(s)

Países en Desarrollo , Educación de Postgrado en Medicina/organización & administración , Internacionalidad , Neurocirugia/educación , Bolivia , Curriculum , Docentes Médicos , Estudios de Factibilidad , Humanos , Internado y Residencia , Sociedades Médicas

RESUMEN

BACKGROUND: Calcifying nonneoplastic pseudoneoplasms of the neuraxis (CAPNON) have been reported in 59 cases in literature, however, they rarely involve the spinal cord. Owing to the advances in immunohistochemical markers, their structure and origin are better understood now. CASE REPORT: We present the case of a 72-year-old female who had longstanding history of low back pain that exacerbated 20 days prior to the presentation to the emergency room with a frank cauda equina syndrome. The lumbar computed tomography scan showed a hyperdense lesion, suggestive of calcified tumor, whereas the magnetic resonance imaging revealed a hypointense lesion on theT1 and T2-weighted images, without contrast enhancement or edema on fluid-attenuated inversion recovery. She underwent an emergent L2-L4 laminectomy and L3-L4 discectomy with resection of L2 intradural tumor, following which she regained normal function. CONCLUSION: A 72-year-old female presented with a cauda equina syndrome attributed to an L2 intradural CAPNON. Following gross total resection, the patient was neurologically intact.

RESUMEN

Recent advances in wireless networking technology and the proliferation of industrial wireless sensors have led to an increasing interest in using wireless networks for closed loop control. The main advantages of Wireless Networked Control Systems (WNCSs) are the reconfigurability, easy commissioning and the possibility of installation in places where cabling is impossible. Despite these advantages, there are two main problems which must be considered for practical implementations of WNCSs. One problem is the sampling period constraint of industrial wireless sensors. This problem is related to the energy cost of the wireless transmission, since the power supply is limited, which precludes the use of these sensors in several closed-loop controls. The other technological concern in WNCS is the energy efficiency of the devices. As the sensors are powered by batteries, the lowest possible consumption is required to extend battery lifetime. As a result, there is a compromise between the sensor sampling period, the sensor battery lifetime and the required control performance for the WNCS. This paper develops a model-based soft sensor to overcome these problems and enable practical implementations of WNCSs. The goal of the soft sensor is generating virtual data allowing an actuation on the process faster than the maximum sampling period available for the wireless sensor. Experimental results have shown the soft sensor is a solution to the sampling period constraint problem of wireless sensors in control applications, enabling the application of industrial wireless sensors in WNCSs. Additionally, our results demonstrated the soft sensor potential for implementing energy efficient WNCS through the battery saving of industrial wireless sensors.

Asunto(s)

Humanos , Ecocardiografía/métodos , Ecocardiografía/tendencias , Guías como Asunto/normas , Resucitación/métodos , Técnicas y Procedimientos Diagnósticos , Ultrasonido , Derrame Pericárdico/diagnóstico

RESUMEN

Objetivo: revisar la historia inicial de la promoción de la salud oral para los bebés y niños peque-ños, el impacto de la directiva de la AAPD sobre los cuidados al niño, la salud oral y las formas de maximizar los resultados de salud. Métodos: revisión de literatura. Resultados: conceptos sobre la prevención primaria y la intervención temprana fueron reportados ya en el siglo XIX. Los avances para impactar positivamente en la salud oral de los niños se han realizado. Sin embargo, el consejo de los primeros entendidos y médicos que la atención bucodental y la prevención debe comenzar tempranamente con los cuidadores y la aparición del primer diente del bebé no han sido plenamente aceptado por la profesión. Conclusiones: Se presenta una perspectiva histórica sobre el cuidado de la salud oral para los bebés y niños pequeños. Existe la necesidad de alejarse de la vía de abordaje de las enfermedades bucodentales e incorporar los conceptos de atención primaria a partir del período perinatal, y de manera más amplia sobre los factores determinantes sociales de la salud.

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Purpose: To review the early history of the promotion of oral health for infants and toddlers, the impact of the AAPD guideline on infant oral health care and ways to maximize health outcomes. Methods: Review of the literature. Results: Concepts on primary prevention and early intervention were reported as early as the 19th century. Progress to positively impact the oral health of children has been made. Nevertheless, the advice of early scholars and clinicians that oral care and prevention must begin early with the caregivers and the emergence of the infantÆs first tooth have not been fully embraced by the profession. Conclusions: A historical perspective on oral health care for infants and toddlers has been presented. There is a need to move away from the surgical approach of managing oral disease and embrace the concepts of primary care beginning perinatally while more broadly addressing social determinants of health.

Asunto(s)

Humanos , Preescolar , Promoción de la Salud/historia , Salud Bucal/historia

RESUMEN

Two decades of scientific ocean drilling have demonstrated widespread microbial life in deep sub-seafloor sediment, and surprisingly high microbial-cell numbers. Despite the ubiquity of life in the deep biosphere, the large community sizes and the low energy fluxes in this vast buried ecosystem are not yet understood. It is not known whether organisms of the deep biosphere are specifically adapted to extremely low energy fluxes or whether most of the observed cells are in a dormant, spore-like state. Here we apply a new approach--the D:L-amino-acid model--to quantify the distributions and turnover times of living microbial biomass, endospores and microbial necromass, as well as to determine their role in the sub-seafloor carbon budget. The approach combines sensitive analyses of unique bacterial markers (muramic acid and D-amino acids) and the bacterial endospore marker, dipicolinic acid, with racemization dynamics of stereo-isomeric amino acids. Endospores are as abundant as vegetative cells and microbial activity is extremely low, leading to microbial biomass turnover times of hundreds to thousands of years. We infer from model calculations that biomass production is sustained by organic carbon deposited from the surface photosynthetic world millions of years ago and that microbial necromass is recycled over timescales of hundreds of thousands of years.

Asunto(s)

Organismos Acuáticos/aislamiento & purificación , Archaea/crecimiento & desarrollo , Bacterias/crecimiento & desarrollo , Biomasa , Sedimentos Geológicos/microbiología , Agua de Mar/microbiología , Altitud , Aminoácidos/análisis , Aminoácidos/química , Aminoácidos/metabolismo , Organismos Acuáticos/química , Organismos Acuáticos/crecimiento & desarrollo , Archaea/química , Archaea/citología , Archaea/aislamiento & purificación , Bacterias/química , Bacterias/citología , Bacterias/aislamiento & purificación , Biomarcadores/análisis , Carbono/metabolismo , Pared Celular/química , Ácidos Murámicos/análisis , Océanos y Mares , Oxidación-Reducción , Perú , Fotosíntesis , Ácidos Picolínicos/análisis , Esporas Bacterianas/química , Esporas Bacterianas/crecimiento & desarrollo , Esporas Bacterianas/aislamiento & purificación , Factores de Tiempo

RESUMEN

The present study characterizes the genetic variability of Mulatto population based on the polymorphism of six miniSTR autosomal loci, known as Non Codis 01 and 02 (NC01 and NC02) and evaluate their applicability in forensic genetics. A sample of 102 unrelated Brazilian mulattoes were genotyped for miniSTR loci D1S1677, D2S441, D4S2364 (miniplex NC02) and 45 individuals for D10S1248, D14S1434, D22S1045 (miniplex NC01). No significant deviations from Hardy-Weinberg equilibrium expectations were detected. The combined power of discrimination (PD) and mean power of exclusion (PE) were 0.999996 and 0.98991, respectively. The results also support the effectiveness of the NC01and NC02 miniplexes for human identification.

Asunto(s)

Etnicidad/genética , Variación Genética , Genética de Población , Repeticiones de Microsatélite , Brasil , Dermatoglifia del ADN , Frecuencia de los Genes , Genotipo , Humanos