RESUMEN
BACKGROUND: The World Health Organization's (WHO) Mental Health Gap Action Programme (mhGAP) aims to provide evidence-based guidelines for the management of mental, neurological, and substance use disorders in non-specialized healthcare settings. However, implementing these guidelines remains a challenge due to various factors, including limited training opportunities for primary care providers. This study con the effectiveness of a social media-delivered distance education program on the mhGAP intervention guide, to overcome barriers of technology access and digital literacy, providing a familiar and accessible platform for primary care providers in Jalisco. METHODS: A quasi-experimental study with a pre-test/post-test design was conducted. Primary care providers from Jalisco were invited to participate in a distance education program on the mhGAP intervention guide. The program consisted of online modules, webinars, and discussion forums facilitated by mental health experts. Knowledge assessments were conducted before and after the intervention using a standardized questionnaire. Participant satisfaction and perceived utility were also evaluated through surveys and focus group discussions. RESULTS: A total of 1,096 primary care providers completed the program. The mean knowledge score significantly improved from 58.2% (SD = 12.8%) in the pre-test to 81.4% (SD = 9.6%) in the post-test (p < 0.001), with a large effect size (Cohen's d = 2.04). Subgroup analyses revealed consistent knowledge gains across different demographic and professional characteristics. Participant satisfaction was high, with 92% rating the program's overall quality as "good" or "excellent." Qualitative findings highlighted the benefits of accessibility, flexibility, interactivity, and practical applicability of the distance education approach. CONCLUSIONS: The social media-delivered distance education program on the mhGAP intervention guide effectively improved the knowledge of primary care providers in Jalisco, Mexico. Participants reported high levels of satisfaction and perceived utility. This study demonstrates the potential of distance education strategies to disseminate evidence-based guidelines and enhance mental health service delivery in primary care settings, particularly in resource-limited areas.
Asunto(s)
Educación a Distancia , Atención Primaria de Salud , Medios de Comunicación Sociales , Humanos , México , Masculino , Femenino , Adulto , Persona de Mediana Edad , Personal de Salud/educación , Evaluación de Programas y Proyectos de SaludRESUMEN
La osteomielitis del pie diabético es una entidad frecuen-te en pacientes diabéticos, siendo el Staphilococcus au-reus el microorganismo mayormente aislado. Si bien es cada vez más frecuente encontrar a los Lactobacillus spp.como patógenos responsables de endocarditis y otras infecciones, no ha sido reportado en la bibliografía como responsable de osteomielitis. El único caso que encontramos en la literatura fue una espondilodiscitis en un paciente con adicción a drogas endovenosas. Presentamos el caso de una mujer diabética con mal control metabólico, internada por pie diabético com-plicado con cetoacidosis, con posterior aislamiento en todas las muestras óseas de Lactobacillus gasseri, identificado por espectrometría de masas MADITOF-MS. Buena respuesta al tratamiento antibiótico con recupe-ración completa del pie. Sin antecedente de consumo de prebióticos. Teniendo en cuenta el aumento de la utilización de pro-bioticos en la industria alimentaria y del poder patóge-no de los Lactobacillus spp. debería plantearse como potencial patógeno en osteomielitis, particularmente en pacientes inmunodeprimidos.
Diabetic foot osteomyelitis is a frequent entity in diabetic patients, being the Staphylococcus aureus the most commonly detected. Even though, Lactobacillus spp is frequently named as responsible of endocarditis and other infections it has never been reported in the bibliography to cause osteomyelitis. Spondylodiscitis in a patient addicted to intravenous drugs was, in fact, the only case reported.We present a case of a diabetic female with poorly controlled metabolic conditions who has been hospitalized due to diabetic foot complicated by cetoacidosis and with later isolation of Lactobacillus gasseri in all bone samples identified by mass spectrometry MADITO-MS. An optimal response to antibiotic treatment ocurred with a complete foot recovery, and with no presence of prebiotics consumption.If we evaluate the increasing consumption of probiotics in food industry and the pathogenic charge of Lactobacillusspp, we will have to take into consideration this microorganism as potential pathogen in osteomyelitis; particularly in immunosuppressed patients
Asunto(s)
Humanos , Femenino , Osteomielitis/patología , Pie Diabético/patología , Probióticos , Lacticaseibacillus rhamnosus/patogenicidadRESUMEN
Introducción: Tocilizumab (TCZ) es un bloqueador del re-ceptor de la interleuquina 6, propuesto como tratamiento de pacientes con COVID-19 grave o crítico. El objetivo es evaluar el impacto clínico de la administración de TCZ en pacientes hospitalizados con COVID-19 grave y describir los eventos adversos e infecciosos más frecuentes.Materiales y métodos: Estudio analítico, observacional de casos y controles emparejado por edad, sexo y co-morbilidades de pacientes adultos con COVID-19 grave, hospitalizados entre diciembre de 2020 y marzo de 2021. Criterios de inclusión: requerimiento de aporte de O2 ma-yor o igual 5 l/min para lograr saturación >93% y uno de los siguientes: ACV, IAM, IMC >30, ERC, edad >60 años, dímero D >1000 ng/ml o proteína C reactiva cuantitativa >75 mg/l. Desenlaces evaluados: muerte por todas las causas, traslado a unidad de cuidados críticos (UCC) y requerimiento de asistencia ventilatoria mecánica (AVM).Resultados: Se incluyeron 320 pacientes, 210 expuestos a corticoterapia (controles) y 110 recibieron además TCZ (casos). La tasa de letalidad fue 44% en el grupo contro-les vs.29% en el grupo casos (p= 0.0081); el traslado a UCC fue del 81% vs.48% (p= 0.0081) respectivamente y el requerimiento de AVM en el grupo casos fue del 56% vs.24% (p= 0.0001) respectivamente. Conclusiones: Los pacientes tratados con TCZ presenta-ron una proporción de uso de UCC, de AVM y de mortali-dad menor en comparación con pacientes con similares características que no lo recibieron. Estos resultados coinciden con la evidencia disponible a la fecha
Introduction: Tocilizumab (TCZ) is an interleukin-6 recep-tor blocker proposed to treat severe or critical COVID-19 patients. This study aims to evaluate the clinical effects of TCZ administration in hospitalized patients with severe COVID-19. Additionally, the study investigates the most common adverse and infectious events associated with the use of TCZ.Materials and Methods: Analytical, observational case-control study matched by age, sex, and comorbidi-ties of adult patients with severe COVID-19, hospitalized between December 2020 and March 2021. Inclusion criteria: requirement for oxygen provision greater than or equal to 5 l/min to achieve saturation >93% and one of the following: stroke, myocardial infarction, BMI >30, chronic kidney disease, age >60 years, D-dimer >1000 ng/ml, or quantitative C-reactive protein >75 mg/l. Outcomes evaluated: all-cause mortality, transfer to critical care unit (CCU), and mechanical ventilatory assistance (MVA) re-quirement.Results: The study included 320 patients, out of which 110 patients received TCZ in addition to corticosteroids (cas-es), while 210 patients were only exposed to corticoste-roids (controls). The mortality rate was 29% in the cases group, compared to 44% in the control group (p=0.0081). Similarly, 48% of the cases were transferred to CCU, while 81% of the control group were transferred (p=0.0081). The requirement for mechanical ventilation (MVA) was 24% in the cases group and 56% in the control group (p=0.0001).Conclusion: Patients treated with TCZ had a lower propor-tion of CCU use, MVA, and mortality compared to similar patients who did not receive it. These results are consis-tent with the current evidence
Asunto(s)
Humanos , Masculino , Femenino , Receptores de Interleucina-6/uso terapéutico , COVID-19/terapiaRESUMEN
El «conducto en C¼ es un tipo de anatomía dentaria compleja que debe ser evaluado previo a la realiza- ción de un tratamiento endodóntico. Esta variación anatómica es vista principalmente en segundos mola- res inferiores aunque también puede encontrarse en premolares y molares, tanto superior como inferior. Para su diagnóstico se solicitan distintos tipos de estudios imagenológicos. Debemos tener en cuenta que este tipo de anatomía no es observado fácilmen- te en imágenes bidimensionales por lo cual es muy importante considerar para estos casos complejos, la solicitud de un estudio de alta complejidad como lo es la tomografía computada de haz cónico, la cual nos permitirá explorar este tipo de anatomía para tenerlo en cuenta al momento de realizar un correcto aborda- je del conducto en C (AU)
The "C-canal" is a type of complex dental anatomy that must be evaluated prior to performing endodontic treatment. This anatomical variation is seen mainly in lower second molars although it can also be found in premolars and molars, both upper and lower. For its diagnosis we can use different types of imaging studies. We must keep in mind that this type of anatomy is not easily observed in two-dimensional images, which is why it is very important to consider, for these complex cases, the request for a highly complex study such as cone beam computed tomography, which will allow us to explore this type of anatomy to take it into account when performing a correct approach to the C-duct (AU)
Asunto(s)
Cavidad Pulpar/anatomía & histología , Tomografía Computarizada de Haz Cónico , Interpretación de Imagen Asistida por Computador , Diente Molar/anatomía & histologíaRESUMEN
INTRODUCTION AND OBJECTIVES: Liver fibrosis remains a complication derived from a chronic Hepatitis C Virus (HCV) infection even when it is resolved, and no liver antifibrotic drug has been approved. Molecular mechanisms on hepatocytes and activation of hepatic stellate cells (HSCs) play a central role in liver fibrogenesis. To elucidate molecular mechanisms, it is important to analyze pathway regulation during HSC activation and HCV infection. MATERIALS AND METHODS: We evaluate the fibrosis-associated molecular mechanisms during a co-culture of human HSCs (LX2), with human hepatocytes (Huh7) that express HCV NS5A or Core protein. We evaluated LX2 activation induced by HCV NS5A or Core expression in Huh7 cells during co-culture. We determined a fibrosis-associated gene expression profile in Huh7 that expresses NS5A or Core proteins during the co-culture with LX2. RESULTS: We observed that NS5A induced 8.3-, 6.7- and 4-fold changes and that Core induced 6.5-, 1.8-, and 6.2-fold changes in the collagen1, TGFß1, and timp1 gene expression, respectively, in LX2 co-cultured with transfected Huh7. In addition, NS5A induced the expression of 30 genes while Core induced 41 genes and reduced the expression of 30 genes related to fibrosis in Huh7 cells during the co-culture with LX2, compared to control. The molecular pathways enriched from the gene expression profile were involved in TGFB signaling and the organization of extracellular matrix. CONCLUSIONS: We demonstrated that HCV NS5A and Core protein expression regulate LX2 activation. NS5A and Core-induced LX2 activation, in turn, regulates diverse fibrosis-related gene expression at different levels in Huh7, which can be further analyzed as potential antifibrotic targets during HCV infection.
Asunto(s)
Técnicas de Cocultivo , Colágeno Tipo I , Hepacivirus , Células Estrelladas Hepáticas , Hepatocitos , Cirrosis Hepática , Inhibidor Tisular de Metaloproteinasa-1 , Factor de Crecimiento Transformador beta1 , Proteínas del Núcleo Viral , Proteínas no Estructurales Virales , Humanos , Proteínas no Estructurales Virales/genética , Proteínas no Estructurales Virales/metabolismo , Células Estrelladas Hepáticas/metabolismo , Cirrosis Hepática/metabolismo , Cirrosis Hepática/genética , Cirrosis Hepática/patología , Cirrosis Hepática/virología , Hepacivirus/genética , Hepatocitos/metabolismo , Hepatocitos/virología , Inhibidor Tisular de Metaloproteinasa-1/metabolismo , Inhibidor Tisular de Metaloproteinasa-1/genética , Colágeno Tipo I/metabolismo , Colágeno Tipo I/genética , Proteínas del Núcleo Viral/genética , Proteínas del Núcleo Viral/metabolismo , Factor de Crecimiento Transformador beta1/metabolismo , Factor de Crecimiento Transformador beta1/genética , Regulación de la Expresión Génica , Transducción de Señal , Cadena alfa 1 del Colágeno Tipo I/genética , Cadena alfa 1 del Colágeno Tipo I/metabolismo , Perfilación de la Expresión Génica/métodos , Línea Celular Tumoral , ARN Polimerasa Dependiente del ARNRESUMEN
Triacylglycerols (TAGs) are a primary energy source for marine mammals during lipid digestion. Walruses (Odobenus rosmarus divergens) consume prey with a high content of long-chain polyunsaturated fatty acids; however, their digestive physiology and lipid digestion remain poorly studied. The present study aims to model and characterize the gastric (PWGL) and pancreatic (PWPL) lipases of Pacific walruses using an in-silico approach. The confident 3D models of PWGL and PWPL were obtained via homology modeling and protein threading and displayed the structural features of lipases. Molecular docking analysis demonstrated substrate selectivity for long-chain TAG (Trieicosapentaenoin; TC20:5n-3) in PWGL and short-chain TAG (Trioctanoin; TC8:0) in PWPL. Molecular dynamics simulations demonstrate that PWGL bound to tridocosahexaenoin (TC22:6n-3), the protein is considerably stable at all three salinity conditions, but fluctuations are observed in the regions associated with catalytic sites and the lid, indicating the potential hydrolysis of the substrate. This is the first study to report on the digestion of TAGs in walruses, including modeling and lipases characterization and proposing a digestive tract for pinnipeds.
Asunto(s)
Lipasa , Simulación del Acoplamiento Molecular , Simulación de Dinámica Molecular , Páncreas , Animales , Lipasa/metabolismo , Lipasa/química , Páncreas/enzimología , Morsas/metabolismo , Metabolismo de los Lípidos , Especificidad por Sustrato , Triglicéridos/metabolismo , Digestión , Estómago/enzimología , Secuencia de AminoácidosRESUMEN
INTRODUCTION: Attempts have been made to identify the genetic factors related to susceptibility to inflammatory bowel disease (IBD), and the current conclusions are in favor of a complex pathology model, without a clear hereditary pattern. OBJECTIVE: To perform phenotypic and genotypic characterization of patients with IBD in Colombian population and to describe its possible association with predisposition. MATERIALS AND METHODS: case series, 16 patients with IBD according to clinical and pathological criteria, onset of gastrointestinal symptoms after 18 years of age. All had pre-test genetic counseling and family trees of at least three generations were made. Also, genotyping, using a multi-gene panel that included genes related to IBD and some autoimmune disorders. Finally, a genomic analysis of variants was performed. RESULTS: 9 women and 7 men, with mean age of diagnosis of IBD of 35 years, and gastrointestinal symptoms appearance of 32 years. 11/16 (68.75%) required biological therapy. 10/16 (62.5%) were refractory to standard therapy. 3/16 (18.75%) had positive family history of IBD. 100% cases presented at least one single nucleotide polymorphism related to IBD risk in more than one gene. The genes most related to ulcerative colitis (UC) were CD48, CD6, and TYK2 for UC, and CD6 and ITGAM for Crohn's disease. The most frequent gene was CD6. It was found presence of up to 5 genes in 3/16 (18.75%), 4 in 3/16 (18.75%), and three in 5/16 (31.25%). CONCLUSION: In IBD there is the presence of genetic variants with associated predisposition, but without confirmed pathogenicity, and whose sum seems to contribute to its pathophysiology.
Asunto(s)
Predisposición Genética a la Enfermedad , Genotipo , Fenotipo , Humanos , Colombia/epidemiología , Femenino , Masculino , Adulto , Persona de Mediana Edad , Adulto Joven , Enfermedades Inflamatorias del Intestino/genética , Adolescente , Enfermedad de Crohn/genética , Enfermedad de Crohn/epidemiología , Colitis Ulcerosa/genéticaRESUMEN
La varicela es una infección poco frecuente durante la gestación, el riesgo para el feto y las manifestaciones clínicas, variarán en función del momento del embarazo en que se produce la infección materna, cuando la erupción maculopapular materna se produce entre los 5 días previos al parto y las 48 horas posteriores, se habla de varicela neonatal tardía. La clínica es grave, con afectación visceral (pulmonar, cerebral, hepática, hemorragias cutáneas, etc.) y un 30 % de los casos desarrollarán una varicela fulminante. Se presenta el caso de neonato masculino que consultó por lesiones en piel, tipo pápulas eritematosas y vesiculares pleomorfas, de distribución dispersa. Con evolución clínica tórpida, permaneció 24 horas en la institución, con franco deterioro respiratorio y neurológico, compatible con cuadro de varicela neonatal tardía fulminante(AU)
Chickenpox is considered a rare infection during pregnancy, the risk to the fetus and the clinical manifestations will vary depending on the time of pregnancy when the maternal infection occurs, when the maternal maculo-papular injuries occurs within the previous 5 days after delivery and 48 hours after, there is talk of late neonatal chickenpox. The symptoms are severe with visceral involvement (lung, brain, liver, skin bleeding, etc.) and 30% of cases will develop fulminant chickenpox. We present the case of a male neonate who consults due to skin lesions, such as erythematous papules and pleomorphic vesicles, with scattered distribution. With a torpid clinical course, who remains in the institution for 24 hours, with frank respiratory and neurological deterioration compatible with late-neonatal fulminant varicella symptoms(AU)
Asunto(s)
Humanos , Masculino , Recién Nacido , Varicela , Herpesvirus Humano 3RESUMEN
RESUMEN Introducción: Se ha tratado de identificar los factores genéticos relacionados con susceptibilidad para enfermedad inflamatoria intestinal (EII), y los hallazgos actuales se inclinan por un modelo de patología complejo, sin un patrón hereditario claro. Objetivo: Realizar caracterización fenotípica y genotípica de pacientes con EII en población colombiana y describir su posible asociación con predisposición. Materiales y métodos: Serie de casos, 16 pacientes con EII por criterios clínicos y anatomopatológicos, inicio de síntomas gastrointestinales después de los 18 años. Todos tuvieron asesoramiento genético pre-test y se realizaron árboles genealógicos de mínimo tres generaciones. También, genotipificación, por medio de un panel de genes múltiples que incluía genes relacionados con EII y algunos trastornos autoinmunitarios. Finalmente, se realizó análisis genómico de variantes. Resultados: 9 mujeres y 7 hombres, con edad media de diagnóstico de EII 35 años, y 32 años para aparición de síntomas gastrointestinales. 11/16(68,75%) requirieron terapia biológica. 10/16 (62,5%) presentaron refractariedad a terapia estándar. 3/16 (18,75%) tenían antecedentes familiares positivos de EII. 100% casos presentaron al menos un single nucleotide polymorphism relacionado con riesgo de EII en más de un gen. Los genes más relacionados con colitis ulcerosa (CU), fueron CD48, CD6, y TYK2 para CU, y CD6 e ITGAM para la enfermedad de Crohn. El gen más frecuente fue CD6. Se observó en 3/16 (18,75%) presencia de hasta 5 genes, 4 en 3/16 (18,75%), y tres en 5/16 (31,25%). Conclusión: En EII hay presencia de variantes genéticas con predisposición asociada, pero sin patogenicidad confirmada, y cuya sumatoria parece contribuir en su fisiopatología.
ABSTRACT Introduction: Attempts have been made to identify the genetic factors related to susceptibility to inflammatory bowel disease (IBD), and the current conclusions are in favor of a complex pathology model, without a clear hereditary pattern. Objective: To perform phenotypic and genotypic characterization of patients with IBD in Colombian population and to describe its possible association with predisposition. Materials and methods: case series, 16 patients with IBD according to clinical and pathological criteria, onset of gastrointestinal symptoms after 18 years of age. All had pre-test genetic counseling and family trees of at least three generations were made. Also, genotyping, using a multigene panel that included genes related to IBD and some autoimmune disorders. Finally, a genomic analysis of variants was performed. Results: 9 women and 7 men, with mean age of diagnosis of IBD of 35 years, and gastrointestinal symptoms appearance of 32 years. 11/16 (68.75%) required biological therapy. 10/16 (62.5%) were refractory to standard therapy. 3/16 (18.75%) had positive family history of IBD. 100% cases presented at least one single nucleotide polymorphism related to IBD risk in more than one gene. The genes most related to ulcerative colitis (UC) were CD48, CD6, and TYK2 for UC, and CD6 and ITGAM for Crohn's disease. The most frequent gene was CD6. It was found presence of up to 5 genes in 3/16 (18.75%), 4 in 3/16 (18.75%), and three in 5/16 (31.25%). Conclusion: In IBD there is the presence of genetic variants with associated predisposition, but without confirmed pathogenicity, and whose sum seems to contribute to its pathophysiology.
RESUMEN
BACKGROUND: Epidermoid cysts are rare benign lesions that originate from remnants of ectodermal epithelial tissue, particularly infrequent in the pediatric population. They exhibit characteristic imaging features, with occasional variations leading to the development of a "white" epidermoid cyst. This transformation results from the presence of protein and lipid material within the cyst, causing intrinsic hyperintensity in T1-weighted images, signal hypointensity in T2-weighted images, and a bright signal in diffusion-weighted imaging. CASE PRESENTATION: We describe the case of a 5-year-old Latina pediatric patient initially diagnosed with a typical epidermoid cyst. After 13 years of follow-up, this typical epidermoid cyst underwent a transformation, becoming a "white" epidermoid cyst. CONCLUSIONS: Epidermoid cysts are rare intracranial lesions. The term "white epidermoid cyst" does not denote a variant; it represents a distinct transformation within an epidermoid cyst due to liquid and protein accumulation. This transformation should be considered in cases with specific imaging characteristics.
Asunto(s)
Quiste Epidérmico , Humanos , Niño , Preescolar , Quiste Epidérmico/diagnóstico por imagen , Quiste Epidérmico/cirugía , Imagen por Resonancia Magnética/métodos , Imagen de Difusión por Resonancia MagnéticaRESUMEN
Background: Residents usually cover night and weekend shifts issuing the preliminary reading of radiological studies in university hospitals. This is essential to strengthening decision-making skills when facing complex cases independently. However, there should be a balance between patient safety and academic experience since some concern has been expressed about the accuracy of the interpretations generated by trainees. This work aims to evaluate and characterize the discrepancies in preliminary reports issued by radiology residents. Material and methods: Radiologists filled out a questionnaire to evaluate preliminary reports of trainees considering diagnosis, findings description, clinical approach changes, and critical findings. Analysis was performed considering modality, imaging type, body part, and resident academic year. A Chi-square test with a significance level α of 0.05 was used to make group comparisons. Results: A total of 9072 studies were reviewed. Major and minor overall discrepancy rates were 1.7% and 8.3%, respectively. Minor discrepancy rate, findings description, and critical findings identification improved with increasing academic year, both overall and by modality. Discrepancy rates were lower for CT than MR and neuroimaging than for body-imaging studies. The highest major and minor discrepancy rates as abdomen/pelvis CT and lumbar-spine MR, respectively. Two percent of reports presented discrepancies that could generate a medical approach change. Conclusion: Discrepancy rates are low and comparable with those reported in the literature. These rates tend to improve as the resident's academic year increases. Our results suggest that radiology residents' coverage of night shifts and weekends is a practice that benefits the educational process without negatively impacting patient safety.
RESUMEN
El síndrome de Stevens-Johnson (SSJ) y la necrólisis epidérmica tóxica (NET), constituyen el espectro de una enfermedad aguda, originada por una reacción de hipersensibilidad, secundaria a ingesta de medicamentos o infecciones, que afecta la piel y las membranas mucosas, causadas por apoptosis y posterior necrosis de los queratinocitos. Se presenta un escolar masculino de 8 años de edad, con antecedente de epilepsia estructural, a quien en su último control por Neuropediatría, se le indicó tratamiento con Lamotrigina, presentando posteriormente lesiones tipo pápulas faciales, que progresaron rápidamente en sentido céfalo caudal; a las 48 horas, las lesiones evolucionaron a pústulas en mentón, y posteriormente a flictenas. Se utilizaron medidas de soporte vital, limpieza quirúrgica, obteniéndose mejoría clínica progresiva, incluyendo recuperación de las lesiones en piel. El aislamiento temprano por contacto, los cuidados de la piel y la mínima invasión, fueron factores fundamentales en la evolución satisfactoria de este paciente(AU)
Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) constitute the spectrum of an acute disease, caused by a hypersensitivity reaction, secondary to medication intake or infections, which affects the skin and mucous membranes. Caused by apoptosis and subsequent necrosis of keratinocytes. An 8-year-old male schoolboy is presented, with a history of structural epilepsy, who was prescribed treatment with Lamotrigine during his last Neuropediatric check-up, subsequently presenting facial papule-type lesions, which progressed rapidly in the cephalocaudal direction; 48 hours later, the lesions evolved into pustules on the chin, and later to blisters. Life support measures and surgical cleaning wereused, obtaining progressive clinical improvement, including recovery of skin lesions. Early contact isolation, skin care and minimal invasion were fundamental factors in the satisfactory evolution of this patient(AU)
Asunto(s)
Humanos , Masculino , Niño , Hipersensibilidad a las DrogasRESUMEN
Background & Aims: Model for End-Stage Liver Disease (MELD) score better predicts mortality in alcohol-associated hepatitis (AH) but could underestimate severity in women and malnourished patients. Using a global cohort, we assessed the ability of the MELD 3.0 score to predict short-term mortality in AH. Methods: This was a retrospective cohort study of patients admitted to hospital with AH from 2009 to 2019. The main outcome was all-cause 30-day mortality. We compared the AUC using DeLong's method and also performed a time-dependent AUC with competing risks analysis. Results: A total of 2,124 patients were included from 28 centres from 10 countries on three continents (median age 47.2 ± 11.2 years, 29.9% women, 71.3% with underlying cirrhosis). The median MELD 3.0 score at admission was 25 (20-33), with an estimated survival of 73.7% at 30 days. The MELD 3.0 score had a better performance in predicting 30-day mortality (AUC:0.761, 95%CI:0.732-0.791) compared with MELD sodium (MELD-Na; AUC: 0.744, 95% CI: 0.713-0.775; p = 0.042) and Maddrey's discriminant function (mDF) (AUC: 0.724, 95% CI: 0.691-0.757; p = 0.013). However, MELD 3.0 did not perform better than traditional MELD (AUC: 0.753, 95% CI: 0.723-0.783; p = 0.300) and Age-Bilirubin-International Normalised Ratio-Creatinine (ABIC) (AUC:0.757, 95% CI: 0.727-0.788; p = 0.765). These results were consistent in competing-risk analysis, where MELD 3.0 (AUC: 0.757, 95% CI: 0.724-0.790) predicted better 30-day mortality compared with MELD-Na (AUC: 0.739, 95% CI: 0.708-0.770; p = 0.028) and mDF (AUC:0.717, 95% CI: 0.687-0.748; p = 0.042). The MELD 3.0 score was significantly better in predicting renal replacement therapy requirements during admission compared with the other scores (AUC: 0.844, 95% CI: 0.805-0.883). Conclusions: MELD 3.0 demonstrated better performance compared with MELD-Na and mDF in predicting 30-day and 90-day mortality, and was the best predictor of renal replacement therapy requirements during admission for AH. However, further prospective studies are needed to validate its extensive use in AH. Impact and implications: Severe AH has high short-term mortality. The establishment of treatments and liver transplantation depends on mortality prediction. We evaluated the performance of the new MELD 3.0 score to predict short-term mortality in AH in a large global cohort. MELD 3.0 performed better in predicting 30- and 90-day mortality compared with MELD-Na and mDF, but was similar to MELD and ABIC scores. MELD 3.0 was the best predictor of renal replacement therapy requirements. Thus, further prospective studies are needed to support the wide use of MELD 3.0 in AH.
RESUMEN
Colorectal cancer (CRC) is a complex disease, determined by genetic, environmental and lifestyle-associated risk factors. Genetic (inherited) factors have great influence on its development; however, most cases of CRC are sporadic and gradually develop over several years. The main environmental risk factors are associated with b-catenin signaling pathway, including obesity, lack of physical activity, consumption of red and processed meats, alcoholism, and smoking. The pathway is related to cell homeostasis regulation and cell self-renewal during embryogenesis and adulthood. The main recommendation for preventing the development of CRC is to reduce the risk factors, increase the consumption of fruits, vegetables and grains, exercise regularly and limit the consumption of both alcohol and tobacco. However, family history and the presence of a hereditary syndrome increase the risk, which is why carrying out periodic examinations to detect CRC is suggested, using development predictors such as biochemical and molecular markers, which are discussed in this work.
El cáncer colorrectal (CCR) es una enfermedad compleja determinada por factores de riesgo genéticos, ambientales y de estilo de vida. Los factores genéticos (hereditarios) tienen gran influencia en su desarrollo, sin embargo, la mayoría de los casos de CCR son esporádicos y se desarrollan gradualmente a lo largo de varios años. Los principales factores ambientales de riesgo están asociados a la vía de señalización de ß-catenina, entre ellos obesidad, falta de actividad física, consumo de carnes rojas y procesadas, alcoholismo y tabaquismo. La vía está relacionada con la regulación de la homeostasis celular, autorrenovación celular durante la embriogénesis y edad adulta. La principal recomendación para evitar el desarrollo del CCR es reducir los factores de riesgo, aumentar el consumo de frutas, verduras y granos, hacer ejercicio de manera rutinaria y limitar el consumo tanto de alcohol como de tabaco. Dado que los antecedentes familiares y la presencia de un síndrome hereditario aumentan el riesgo, se sugiere hacer exámenes periódicos para detectar CCR y emplear predictores del desarrollo como los marcadores bioquímicos y moleculares, los cuales se presentan en este trabajo.
Asunto(s)
Neoplasias Colorrectales , Humanos , Neoplasias Colorrectales/etiología , Neoplasias Colorrectales/genética , beta Catenina/metabolismo , Factores de Riesgo , Obesidad/complicaciones , Transducción de Señal , Regulación Neoplásica de la Expresión GénicaRESUMEN
Gut metagenome in pediatric subjects with metabolic syndrome (MetS) and type-2 diabetes mellitus (T2DM) has been poorly studied, despite an alarming worldwide increase in the prevalence and incidence of obesity and MetS within this population. The objective of this study was to characterize the gut microbiome taxonomic composition of Mexican pediatric subjects with MetS and T2DM using shotgun metagenomics and analyze the potential relationship with metabolic changes and proinflammatory effects. Paired-end reads of fecal DNA samples were obtained through the Illumina HiSeq X Platform. Statistical analyses and correlational studies were conducted using gut microbiome data and metadata from all individuals. Gut microbial dysbiosis was observed in MetS and T2DM children compared to healthy subjects, which was characterized by an increase in facultative anaerobes (i.e., enteric and lactic acid bacteria) and a decrease in strict anaerobes (i.e., Erysipelatoclostridium, Shaalia, and Actinomyces genera). This may cause a loss of gut hypoxic environment, increased gut microbial nitrogen metabolism, and higher production of pathogen-associated molecular patterns. These metabolic changes may trigger the activation of proinflammatory activity and impair the host's intermediate metabolism, leading to a possible progression of the characteristic risk factors of MetS and T2DM, such as insulin resistance, dyslipidemia, and an increased abdominal circumference. Furthermore, specific viruses (Jiaodavirus genus and Inoviridae family) showed positive correlations with proinflammatory cytokines involved in these metabolic diseases. This study provides novel evidence for the characterization of MetS and T2DM pediatric subjects in which the whole gut microbial composition has been characterized. Additionally, it describes specific gut microorganisms with functional changes that may influence the onset of relevant health risk factors.
RESUMEN
Rheumatoid arthritis (RA) is a chronic joint autoimmune disease with a higher prevalence of depressive symptoms due to the burden of the disease. There are several patient-self-depression scales used for the assessment and a wide range of variations in the prevalence of depression could be related to this. No evidence was found that reports the most accurate, sensitive, and specific depression instrument through an extensive review in the literature. To determine the most precise depression instrument to evaluate RA patients. A systematic review search was directed, considering type of study, prevalence of depressive symptoms, usage of validated depression scales, and reported scale performance measurements. The data extraction followed the PRISMA guidelines, and the risk of bias was assessed using RoB 2, ROBINS-I, and QUADAS-2. From a total of 1958, only 28 articles included in the analysis. The total number of patients analyzed was 6405, with a mean age of 56.53 years, 4474 women (75.22%), and a mean prevalence of depressive symptoms of 27.4%. The most frequent and the best scale used was the CES-D (n = 12), considering all characteristics. The CES-D reported the best psychometric properties, and it was the most frequently used tool.
Asunto(s)
Artritis Reumatoide , Humanos , Femenino , Persona de Mediana Edad , Autoinforme , Artritis Reumatoide/diagnóstico , Artritis Reumatoide/epidemiología , Prevalencia , Depresión/diagnóstico , Depresión/epidemiologíaRESUMEN
Resumen El cáncer colorrectal (CCR) es una enfermedad compleja determinada por factores de riesgo genéticos, ambientales y de estilo de vida. Los factores genéticos (hereditarios) tienen gran influencia en su desarrollo, sin embargo, la mayoría de los casos de CCR son esporádicos y se desarrollan gradualmente a lo largo de varios años. Los principales factores ambientales de riesgo están asociados a la vía de señalización de β-catenina, entre ellos obesidad, falta de actividad física, consumo de carnes rojas y procesadas, alcoholismo y tabaquismo. La vía está relacionada con la regulación de la homeostasis celular, autorrenovación celular durante la embriogénesis y edad adulta. La principal recomendación para evitar el desarrollo del CCR es reducir los factores de riesgo, aumentar el consumo de frutas, verduras y granos, hacer ejercicio de manera rutinaria y limitar el consumo tanto de alcohol como de tabaco. Dado que los antecedentes familiares y la presencia de un síndrome hereditario aumentan el riesgo, se sugiere hacer exámenes periódicos para detectar CCR y emplear predictores del desarrollo como los marcadores bioquímicos y moleculares, los cuales se presentan en este trabajo.
Abstract Colorectal cancer (CRC) is a complex disease, determined by genetic, environmental and lifestyle-associated risk factors. Genetic (inherited) factors have great influence on its development; however, most cases of CRC are sporadic and gradually develop over several years. The main environmental risk factors are associated with β-catenin signaling pathway, including obesity, lack of physical activity, consumption of red and processed meats, alcoholism, and smoking. The pathway is related to cell homeostasis regulation and cell self-renewal during embryogenesis and adulthood. The main recommendation for preventing the development of CRC is to reduce the risk factors, increase the consumption of fruits, vegetables and grains, exercise regularly and limit the consumption of both alcohol and tobacco. However, family history and the presence of a hereditary syndrome increase the risk, which is why carrying out periodic examinations to detect CRC is suggested, using development predictors such as biochemical and molecular markers, which are discussed in this work.
RESUMEN
Interdisciplinary knowledge is necessary to achieve sustainable management of natural resources. However, research is still often developed in an exclusively disciplinary manner, hampering the capacity to holistically address environmental issues. This study focuses on páramo, a group of high-elevation ecosystems situated around â¼3000 to â¼5000 m a.s.l. in the Andes from western Venezuela and northern Colombia through Ecuador down to northern Peru, and in the highlands of Panama and Costa Rica in Central America. Páramo is a social-ecological system that has been inhabited and shaped by human activity since â¼10,000 years BP. This system is highly valued for the water-related ecosystem services provided to millions of people because it forms the headwaters of major rivers in the Andean-Amazon region, including the Amazon River. We present a multidisciplinary assessment of peer-reviewed research on the abiotic (physical and chemical), biotic (ecological and ecophysiological), and social-political aspects and elements of páramo water resources. A total of 147 publications were evaluated through a systematic literature review process. We found that thematically 58, 19, and 23 % of the analyzed studies are related to the abiotic, biotic, and social-political aspects of páramo water resources, respectively. Geographically, most publications were developed in Ecuador (71 % of the synthesized publications). From 2010 onwards, the understanding of hydrological processes including precipitation and fog dynamics, evapotranspiration, soil water transport, and runoff generation improved, particularly for the humid páramo of southern Ecuador. Investigations on the chemical quality of water generated by páramo are rare, providing little empirical support to the widespread belief that páramo environments generate water of high quality. Most ecological studies examined the coupling between páramo terrestrial and aquatic environments, but few directly assessed in-stream metabolic and nutrient cycling processes. Studies focused on the connection between ecophysiological and ecohydrological processes influencing páramo water balance are still scarce and mainly related to the dominant vegetation in the Andean páramo, i.e., tussock grass (pajonal). Social-political studies addressed páramo governance and the implementation and significance of water funds and payment for hydrological services. Studies directly addressing water use, access, and governance in páramo communities remain limited. Importantly, we found only a few interdisciplinary studies combining methodologies from at least two disciplines of different nature despite their value in supporting decision-making. We expect this multidisciplinary synthesis to become a milestone to foster interdisciplinary and transdisciplinary dialogue among individuals and entities involved in and committed to the sustainable management of páramo natural resources. Finally, we also highlight key frontiers in páramo water resources research, which in our view need to be addressed in the coming years/decades to achieve this goal.