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INTRODUCTION: Heart failure (HF) is associated with significant alterations in body composition, including malnutrition due to insufficient intake, chronic inflammation and increased energy expenditure. Identifying the prevalence of malnutrition and the risk of sarcopenia in patients with HF is crucial to improve clinical outcomes. MATERIAL AND METHODS: This cross-sectional, single-center, observational study involved 121 outpatients diagnosed with HF. Nutritional status was assessed using the Mini Nutritional Assessment (MNA), the Malnutrition Universal Screening Tool (MUST), and the Subjective Global Rating (SGA). Sarcopenia was screened using the SARC-F (Strength, Assistance in walking, Rise from a chair, Climb stairs, Falls) questionnaire and diagnosed based on the European Working Group in Older People (EWGSOP2) criteria and functionality with the Short Performance Battery (SPPB) test. Malnutrition was diagnosed according to the Global Leadership Initiative on Malnutrition (GLIM) criteria. RESULTS: The study found that 10.7% had cardiac cachexia and 45.4% of deceased patients had been in this condition (p = 0.002). Moderate-to-high risk of malnutrition was identified in 37.1%, 23.9%, and 31.4% of patients according to the MNA, MUST, and SGA tests, respectively. According to the GLIM criteria, 56.2% of patients were malnourished. Additionally, 24.8% of patients had a high probability of sarcopenia, and 57.8% were not autonomous according to SPPB. Patients with less than 30% quadriceps muscle contraction were at a high risk of sarcopenia. CONCLUSIONS: There is a high prevalence of malnutrition among outpatients with HF, which is associated with worse prognosis, increased risk of sarcopenia, and greater frailty. These findings underscore the importance of early nutritional and functional assessments in this population to improve clinical outcomes.

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Experiential learning (ExL) is the process of learning through experience or more specifically "learning through reflection on doing". In this paper, we propose a simulation of these experiences, in Augmented Reality (AR), addressing the problem of language learning. Such systems provide an excellent setting to support "adaptive guidance", in a digital form, within a real environment. Adaptive guidance allows the instructions and learning content to be customised for the individual learner, thus creating a unique learning experience. We developed an adaptive guidance AR system for language learning, we call Arigato (Augmented Reality Instructional ¯ Guidance & Tailored Omniverse), which offers immediate assistance, resources specific to the learner's needs, manipulation of these resources, and relevant feedback. Considering guidance, we employ this prototype to investigate the effect of the amount of guidance (fixed vs. adaptive-amount) and the type of guidance (fixed vs. adaptive-associations) on the engagement and consequently the learning outcomes of language learning in an AR environment. The results for the amount of guidance show that compared to the adaptive-amount, the fixed-amount of guidance group scored better in the immediate and delayed (after 7 days) recall tests. However, this group also invested a significantly higher mental effort to complete the task. The results for the type of guidance show that the adaptive-associations group outperforms the fixed-associations group in the immediate, delayed (after 7 days) recall tests, and learning efficiency. The adaptive-associations group also showed significantly lower mental effort and spent less time to complete the task.

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The aspartic proteases, also called aspartyl and aspartate proteases or acid proteases (E.C.3.4.23), belong to the endopeptidase family and are characterized by the conserved sequence Asp-Gly-Thr at the active site. These enzymes are found in a wide variety of microorganisms in which they perform important functions related to nutrition and pathogenesis. In addition, their high activity and stability at acid pH make them attractive for industrial application in the food industry; specifically, they are used as milk-coagulating agents in cheese production or serve to improve the taste of some foods. This review presents an analysis of the characteristics and properties of secreted microbial aspartic proteases and their potential for commercial application (AU)

Las aspartil-proteasas, también denominadas aspartato-proteasas o proteasas ácidas (E.C.3.4.23), pertenecen a la familia de las endopeptidasas, que se caracterizan por una secuencia conservada de Asp-Gly-Thr en su sitio activo. Estas enzimas se encuentran distribuidas en una amplia variedad de microorganismos, donde desempeñan funciones importantes en la nutrición y la patogenia, además de poseer otras características, como alta actividad catalítica y estabilidad en pH ácido, lo que las vuelve atractivas para su uso en industrias como la alimentaria, específicamente en la industria láctea, como agentes coagulantes para la elaboración de quesos o para mejorar el sabor de ciertos alimentos. En la presente revisión se lleva a cabo un análisis de las características y propiedades de las aspartil-proteasas secretadas por hongos y su potencial para aplicaciones comerciales (AU)

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BACKGROUND: The "fitness" of an infectious pathogen is defined as the ability of the pathogen to survive, reproduce, be transmitted, and cause disease. The fitness of multidrug-resistant tuberculosis (MDRTB) relative to drug-susceptible tuberculosis is cited as one of the most important determinants of MDRTB spread and epidemic size. To estimate the relative fitness of drug-resistant tuberculosis cases, we compared the incidence of tuberculosis disease among the household contacts of MDRTB index patients to that among the contacts of drug-susceptible index patients. METHODS AND FINDINGS: This 3-y (2010-2013) prospective cohort household follow-up study in South Lima and Callao, Peru, measured the incidence of tuberculosis disease among 1,055 household contacts of 213 MDRTB index cases and 2,362 household contacts of 487 drug-susceptible index cases. A total of 35/1,055 (3.3%) household contacts of 213 MDRTB index cases developed tuberculosis disease, while 114/2,362 (4.8%) household contacts of 487 drug-susceptible index patients developed tuberculosis disease. The total follow-up time for drug-susceptible tuberculosis contacts was 2,620 person-years, while the total follow-up time for MDRTB contacts was 1,425 person-years. Using multivariate Cox regression to adjust for confounding variables including contact HIV status, contact age, socio-economic status, and index case sputum smear grade, the hazard ratio for tuberculosis disease among MDRTB household contacts was found to be half that for drug-susceptible contacts (hazard ratio 0.56, 95% CI 0.34-0.90, p = 0.017). The inference of transmission in this study was limited by the lack of genotyping data for household contacts. Capturing incident disease only among household contacts may also limit the extrapolation of these findings to the community setting. CONCLUSIONS: The low relative fitness of MDRTB estimated by this study improves the chances of controlling drug-resistant tuberculosis. However, fitter multidrug-resistant strains that emerge over time may make this increasingly difficult.

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Um estudo de coorte histórico foi desenvolvido incluindo 116 pacientes com câncer de mamaatendidas no Hospital Femina, Grupo Hospitalar Conceição (GHC), Ministério da Saúde (MS),entre setembro de 1997 e dezembro de 2000. Foi aplicado o índice prognóstico de Nottingham(IPN) na população em estudo e avaliada a sua associação com a recidiva da doença. O IPNconseguiu identificar um grupo com bom prognóstico, em que de 26 pacientes somente 2 (7,7%)evoluíram para recidiva, e um grupo de 32 pacientes com pobre prognóstico, em que 24 delas(75%) evoluíram para recidiva em cinco anos. Nesta amostra composta de pacientes provenientesda rede pública, a média e o desvio-padrão do tamanho tumoral foi de 3,1 ± 1,8 cm e somente25% das mulheres apresentaram tumores menores do que 2 cm na primeira consulta no hospitalterciário. Isso sugere que o diagnóstico de câncer de mama ainda está sendo realizado tardiamente,em nosso meio.

A history cohort study that included 116 breast cancer patients treated at the Femina Hospital, GrupoHospitalar Conceição (GHC), Health Ministry (HM), between September 1997 to December 2000 wasconducted. The Nottingham Prognostic Index (NPI) and its association with the disease recidivationwas assessed in the study population. The NPI identified two groups; good prognosis group (n = 26) with7.7% recidivation and a poor prognosis group (n = 32) with 75% recidivation at 5 years. The tumorsize in our study population was 3.1 ± 1.8 cm and it was less than 2 cm in only 25% of the patients atthe first consultation at a tertiary hospital. These observations suggested that the breast cancer diagnosis isperformed late in our environment.

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La protección que supone la práctica de actividad física respecto al riesgo de cardiopatía isquémica, hipertensión arterial y accidentes cerebrovasculares está firmemente apoyada en una abundante, rigurosa y uniforme investigación epidemiológica. También es consistente el hallazgo de que niveles bajos de actividad física son importantes determinantes del desarrollo y mantenimiento de la obesidad, cuya prevalencia alcanza niveles alarmantes en la actualidad. La asociación directa entre el sedentarismo y la incidencia de diabetes mellitus es también consistente y reviste una gran importancia para la salud pública. Otros efectos beneficiosos se refieren a la reducción de la incidencia y prevalencia de osteoporosis, disminuyendo el riesgo de caídas y fracturas, y un menor riesgo de trastornos depresivos y de ansiedad. Por último, aunque la evidencia disponible es menos uniforme, niveles bajos de actividad física se han relacionado con un mayor riesgo de desarrollar cáncer de colon, mama y pulmón. Evidencias preliminares también relacionan la actividad física con un menor riesgo de demencia. En las tres últimas décadas el abundante análisis epidemiológico de la actividad física ha alcanzado conclusiones muy uniformes acerca de los beneficios de su práctica regular. A pesar de ello, la prevalencia de estilos de vida sedentarios sigue aumentando, por lo que son necesarias intervenciones de promoción de la actividad física que permitan alcanzar el objetivo de "acumular al menos 30 min de actividad física de intensidad moderada en casi todos, o mejor todos, los días de la semana" (AU)

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Objetivos: Identificar y describir factores asociados a la presentación de malaria en la población atendida por el Centro de salud de Cardozo. Material y Métodos: Realizamos un estudio epidemiológico transversal con enfoque analítico basado en los resultados de un tamizaje masivo de gota gruesa para el diagnóstico de malaria realizado en la jurisdicción del Centro de Salud de Cardozo en Iquitos, en junio de 1996. Una muestra de 72 personas contestó un cuestionario acerca de factores de riesgo reconocidos en la transmisión de malaria. El grupo casos estuvo constituido por 36 personas quienes tuvieron un resultado de examen gota gruesa positivo a cualquier tipo de malaria; y el grupo control por 36 personas seleccionadas al azar entre los participantes del tamizaje con un resultado negativo. Se realizó un análisis bivariado. La asociación se midió a través de la prueba de Chi2 y la fuerza de asociación se midió por OR. Resultados: La prevalencia de malaria fue de 2.3%. El 72.5% correspondieron a P. vivax y el 27.5% a P. falciparum. Los principales factores asociados a la presentación de malaria fueron los viajes a zona rural (OR=12.14 p<0.001), los viajes a poblados del río Nanay (OR=11.67 p=0.02) y el antecedente de haber presentado antes la enfermedad (OR=12.40 p<0.001). Otros factores asociados fueron la residencia en el AA.HH. Jessica Inchaustegui (OR=6.22 p<0.001) y la residencia cercana a zonas inundables (p=0.040). Por otra parte, se identificó como protector el baño en una habitación cerrada (OR=0.09; p=0.02). Las características personales (edad, sexo, escolaridad y ocupación), de la vivienda (tipo de material), así como la utilización de mosquiteros y de mallas no se asociaron a la presentación de malaria. Conclusiones: El desplazamiento frecuente de la población hacia el río Nanay y las condiciones geográficas de Cardozo, explicarían la prevalencia de malaria en esta área.

Objectives: To identify and to describe the association between malaria and risk factors in the attended population in the Health's Center of Cardozo. Methods: We made a cross-sectional study based on the results of thick drop's screening test for the diagnosis of malaria completed in the jurisdiction of the Center of Health of Cardozo in Iquitos in June of 1996. A sample of 72 people answered a questionnaire about recognized factors of risk in the malaria transmission. The caseswent 36 people who had a positive result of thick drop test to any type of malaria; the control group was formed by 36 people selected at random between all the participants of the thick drop's screening who had a negative result. A bivaried analysis was made. The association was measured through the test of Chi2 and the association force was measured by OR. Results: the prevalence of malaria was of 2.3%; 72.5% corresponded to P. vivax and the 27.5% to P. falciparum. The mainfactors malaria associate went the trips to rural zones (OR=12.14 p<0.001), the trips to towns of the Nanay river (OR=11.67 p=0.02) and the antecedent of malaria (OR=12.40 p<0.001). Other factors associate were the residence in the A.H. "Jessica Inchaustegui" (OR=6.22 p = 0.001) and the residence near inundable zones (p=0.04). On the other hand, it was identified as protection factor the bath in a closed room (OR=0.09 p=0.02). The characteristics of the houses (type of material), personal (age, sex, schooling and occupation) as well as the use of mosquito nettings and meshes; they were not associated upon presentment of malaria. Conclutions: The frequent displacement of the population studied towards the Nanay river and the geographic conditions of Cardozo, would explain the prevalence of malaria in this area.

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