RESUMEN

OBJECTIVE: Determine the clinical safety and feasibility of implementing a telemedicine and medication delivery service (TMDS) to address gaps in nighttime access to health care for children in low-resource settings. STUDY DESIGN: We implemented a TMDS called 'MotoMeds' in Haiti as a prospective cohort study. A parent/guardian of a sick child ≤ 10 years contacted the call center (6 PM-5 AM). A nurse provider used decision support tools to triage cases (mild, moderate, or severe). Severe cases were referred to emergency care. For nonsevere cases, providers gathered clinical findings to generate an assessment and plan. For cases within the delivery zone, a provider and driver were dispatched and the provider performed a paired in-person exam as a reference standard for the virtual call center exam. Families received a follow-up call at 10 days. Data were analyzed for clinical safety and feasibility. RESULTS: A total of 391 cases were enrolled from September 9, 2019, to January 19, 2021. Most cases were nonsevere (92%; 361); household visits were completed for 89% (347) of these cases. Among the 30 severe cases, 67% (20) sought referred care. Among all cases, respiratory problems were the most common complaint (63%; 246). At 10 days, 95% (329) of parents reported their child had "improved" or "recovered". Overall, 99% (344) rated the TMDS as "good" or "great". The median phone consultation time was 20 minutes, time to household arrival was 73 minutes, and total case time was 114 minutes. CONCLUSION: The TMDS was a feasible health care delivery model. Although many cases were likely self-limiting, the TMDS was associated with high rates of reported improvement in clinical status at 10 days. TRIAL REGISTRATION: clinicaltrials.gov: NCT03943654.

Asunto(s)

RESUMEN

Major depressive disorder (MDD) is the most recurrent mental illness globally, affecting approximately 5% of adults. Furthermore, according to the National Institute of Mental Health (NIMH) of the U.S., calculating an actual schizophrenia prevalence rate is challenging because of this illness's underdiagnosis. Still, most current global metrics hover between 0.33% and 0.75%. Machine-learning scientists use data from diverse sources to analyze, classify, or predict to improve the psychiatric attention, diagnosis, and treatment of MDD, schizophrenia, and other psychiatric conditions. Motor activity data are gaining popularity in mental illness diagnosis assistance because they are a cost-effective and noninvasive method. In the knowledge discovery in databases (KDD) framework, a model to classify depressive and schizophrenic patients from healthy controls is constructed using accelerometer data. Taking advantage of the multiple sleep disorders caused by mental disorders, the main objective is to increase the model's accuracy by employing only data from night-time activity. To compare the classification between the stages of the day and improve the accuracy of the classification, the total activity signal was cut into hourly time lapses and then grouped into subdatasets depending on the phases of the day: morning (06:00-11:59), afternoon (12:00-17:59), evening (18:00-23:59), and night (00:00-05:59). Random forest classifier (RFC) is the algorithm proposed for multiclass classification, and it uses accuracy, recall, precision, the Matthews correlation coefficient, and F1 score to measure its efficiency. The best model was night-featured data and RFC, with 98% accuracy for the classification of three classes. The effectiveness of this experiment leads to less monitoring time for patients, reducing stress and anxiety, producing more efficient models, using wearables, and increasing the amount of data.

RESUMEN

The effect of different foliar sprays numbers of cytokinins - (CK) and brassinosteroids - (BR) on the physiological, biochemical, and panicle parameters of rice plants subjected to combined heat stress (high day/night temperatures) were studied in three different experiments. The treatments established for the first (E1) and second (E2) experiments were the following: i) absolute control, ii) stress control, iii) heat stress + one foliar spray of CK, iv) heat stress + two foliar sprays of CK, v) heat stress + three foliar sprays of CK, vi) heat stress + one foliar spray of BR, vii) heat stress + two foliar sprays of BR, or viii) heat stress + three foliar sprays of BR. For the third experiment (E3), the treatments were the following: i) absolute control, ii) stress control, iii) heat stress + three foliar applications of CK, iv) heat stress + three foliar applications of BR. Rice-stressed plants and sprayed with three foliar sprays of CK or BR had a better stomatal conductance in E1 and E2 compared to their heat-stressed control. The relative tolerance index suggests that three CK or BR applications helped to mitigate the combined heat stress in both experiments. The foliar CK or BR applications at the flowering and grain-filling stages in rice-stressed plants increased Fv/Fm ratio and panicle characteristics (number of filled spikelets and the percentage of panicle blanking in E3). In conclusion, foliar applications of BR or CK can be considered an agronomic strategy to help improve the negative effect of combined heat stress conditions on the physiological behavior of rice plants during different phenological stages.

Asunto(s)

RESUMEN

Rice yield has decreased due to climate variability and change in Colombia. Plant growth regulators have been used as a strategy to mitigate heat stress in different crops. Therefore, this study aimed to evaluate the effect of foliar applications of four growth regulators [auxins (AUX), brassinosteroids (BR), cytokinins (CK), or gibberellins (GA)] on physiological (stomatal conductance, total chlorophyll content, Fv/Fm ratio, plant canopy temperature, and relative water content) and biochemical (Malondialdehyde (MDA) and proline contents) variables in two commercial rice genotypes exposed to combined heat stress (high day and nighttime temperatures). Two separate experiments were carried out using plants of two rice genotypes, Fedearroz 67 ("F67") and Fedearroz 2000 ("F2000") for the first and second experiments, respectively. Both trials were analyzed together as a series of experiments. The established treatments were as follows: absolute control (AC) (rice plants grown under optimal temperatures (30/25°C day/nighttime temperatures), heat stress control (SC) [rice plants only exposed to combined heat stress (40/30°C)], and stressed rice plants and sprayed twice (5 days before and after heat stress) with a plant growth regulator (stress+AUX, stress+BR, stress+CK, or stress+GA). The results showed that foliar CK sprays enhanced the total chlorophyll content in both cultivars (3.25 and 3.65 mg g-1 fresh weight for "F67" and "F2000" rice plants, respectively) compared to SC plants (2.36 and 2.56 mg g-1 fresh weight for "F67," and "F2000" rice plants, respectively). Foliar CK application also improved stomatal conductance mainly in "F2000" rice plants compared to their heat stress control (499.25 vs.150.60 mmol m-2s-1). Foliar BR or CK sprays reduced plant canopy temperature between 2 and 3°C and MDA content in plants under heat stress. The relative tolerance index suggested that foliar CK (97.69%), and BR (60.73%) applications helped to mitigate combined heat stress mainly in "F2000" rice plants. In conclusion, foliar BR or CK applications can be considered an agronomic strategy to help to ameliorate the negative effect of combined heat stress conditions on the physiological behavior of rice plants.

RESUMEN

INTRODUCTION: In 2004, Patricia Skilling developed a new squatting-based pelvic floor rehabilitation method based on strengthening the three reflex pelvic muscles and ligaments hypothesized to control the closure and micturition reflexes. We adapted these methods to test our hypothesis that day/night enuresis was due to the inability of these muscles/ligaments to control an inappropriately activated micturition reflex. MATERIAL AND METHODS: The trial commenced as a randomized control trial to be conducted over 4 months, but was converted to a prospective trial at 4 weeks by order of the Ethics Committee. A total of 48 children, 7.6 ±2.5 years, 34 females, 14 males, had strictly supervised exercises twice daily, 10 squats, 10 bridge, fitball exercises involving proprioception exercises with surface perineal electromyogram (EMG) once a week.Eligibility criteria were daytime urine leakage plus night-time bedwetting. Exclusion criterion was refusal to sign consent forms. Assessment was done by intention to treat. The criterion for cure was complete dryness. RESULTS: At 1st review (4 weeks) 12/24 in the treatment group reported total cure of wetting; 41/48 children (86%) were cured of both daytime/nighttime enuresis (p <0.001) at 4 months. There were no adverse events. Secondary outcomes were concomitant cure of constipation, fecal incontinence, urinary retention as predicted by the underlying integral theory of incontinence. CONCLUSIONS: We believe our methods accelerated normal childhood strengthening of muscles/ligaments which control inappropriate activation of the micturition reflex which we hypothesize is the basis for daytime/nighttime enuresis. This is a simple treatment, needs diligent application and validation by others.

RESUMEN

BACKGROUND: Dementia of the Alzheimer's type (DAT) impacts Hispanics disproportionately, with almost a twofold elevated risk of developing DAT, as well as earlier onset of the disease, than in non-Hispanic Whites. However, the role of main risk factors for DAT, such as APOE-ɛ4 and blood pressure (BP) levels, remains uncertain among Hispanics. OBJECTIVE: To investigate the association of APOE-ɛ4 and BP levels, measures with 24-h ambulatory BP monitoring, with incidence of DAT in an elderly cohort of Hispanics. METHODS: 1,320 participants from the Maracaibo Aging Study, free of dementia at the baseline, and with ambulatory BP measurements and APOE genotype available were included. Adjusted Cox proportional models were performed to examine 1) the incidence of DAT and 2) the relationship between BP levels and DAT according to APOE genotypes. Models were adjusted by competing risk of death before the onset of DAT. Model performance was assessed by likelihood test. RESULTS: The average follow-up time was 5.3 years. DAT incidence was 5.8 per 1000 person-year. APOE-ɛ4 carriers had a higher risk of DAT. In unadjusted analyses, conventional, 24-h, and nighttime systolic BP levels were significantly higher in participants who developed DAT and of APOE-ɛ4 carriers (p < 0.05). After adjustment for competing risks, only higher nighttime systolic BP was associated with DAT incidence, but only among subjects carrying APOE-ɛ4. CONCLUSION: In this Hispanic population, both APOE-ɛ4 genotype and assessment of nocturnal systolic BP (rather than diurnal or office BP) were necessary to estimate DAT risk.

Asunto(s)

RESUMEN

RESUMEN Introducción: la prótesis dental removible es un tratamiento rehabilitador que devuelve las funciones al sistema estomatognático; para su éxito se necesita responsabilidad y compromiso entre el profesional y el paciente sobre la higiene y modo de uso. Objetivo: determinar el estado higiénico de la prótesis removible acrílica en los pacientes atendidos en las clínicas odontológicas de la Universidad San Gregorio de Portoviejo en el periodo marzo-agosto de 2019. Método: se realizó un estudio descriptivo transversal utilizando un cuestionario y una ficha de observación validados. Todos los sujetos de la investigación firmaron el consentimiento informado antes de responder el cuestionario y ser examinados. Se aplicó la estadística descriptiva, frecuencia y porcentaje. Resultados: fueron evaluados 100 paciente, con predominio del sexo femenino (74 %), y la edad de 50 años o más (54 %). Los resultados muestran que el 53 % de los pacientes usan prótesis confeccionadas por cinco o más años, y que el 94 % no ha asistido a controles subsiguientes. El método mecánico (86 %) es el más utilizado para higienizar las prótesis, y en el 65 % de las prótesis se observó acumulación de placa bacteriana y restos de alimento. La mayoría de los pacientes (78 %) usa la prótesis dental durante todo el día (24 horas) y, cerca de la mitad, tiene signos clínicos de estomatitis subprotésica (46 %). Conclusiones: la mayoría de los pacientes no cumplen con las normas de higiene y uso de las prótesis removibles por lo cual se necesita un cambio en su educación y seguimiento.

ABSTRACT Introduction: the removable dental prostheses is a rehabilitation treatment that returns the functions to the stomatognathic system; for its successful action it is necessary responsibility and commitment between the professional and the patient on hygiene and mode of use. Objective: to determine the hygienic condition of the removable acrylic prostheses in patients attended in the dental clinics at San Gregorio de Portoviejo University in the period March - August 2019. Method: A cross-sectional descriptive study was conducted using a validated questionnaire and observation worksheet. All participants in the research provided handwritten signature informed consent form before answering the questionnaire and being examined. Descriptive statistics, frequency and percentage were applied. Results: a total of 100 patients were evaluated, with higher prevalence in females (74%), and 50 years of age or more (54%). The results show that 53% of the patients use prostheses made for five or more years, and 94% have not attended subsequent checks. The mechanical method (86%) is the most used to sanitize the prostheses, and in 65% of the prostheses was observed accumulation of bacterial plaque and food debris. Most patients (78%) wear their prostheses throughout the day (24 hours) and about half have clinical signs of subprosthetic stomatitis (46%). Conclusions: Most patients do not comply with the rules of hygiene and use of removable prostheses so a change is needed in their education and monitoring.

Asunto(s)

RESUMEN

Rationale: Compliance with sepsis bundles is associated with better outcomes, but information to support structural actions that might improve compliance is scarce. Few studies have evaluated bundle compliance in different time periods, with conflicting results.Objectives: To evaluate the association of sepsis identification during the daytime versus during the nighttime and on weekdays versus weekends with 3-hour sepsis treatment bundle compliance.Methods: This was an observational, multicenter study including patients with sepsis admitted between 2010 and 2017 to 10 hospitals in Brazil. Our exposures of interest were daytime (7:00 a.m.-6:59 p.m.) versus nighttime (7:00 p.m.-6:59 a.m.) and weekdays (Monday 7:00 a.m.-Friday 6:59 p.m.) versus weekends (Friday 7:00 p.m.-Monday 6:59 a.m.). Our primary outcome was full compliance with the 3-hour sepsis treatment bundles. We adjusted by potential confounding factors with multivariable logistic regression models.Results: Of 11,737 patients (8,733 sepsis and 3,004 septic shock), 3-hour bundle compliance was 79.1% and hospital mortality was 24.7%. The adjusted odds ratio (adjOR) for 3-hour full bundle compliance for patients diagnosed during the daytime versus during the nighttime was 1.35 (95% confidence interval [CI], 1.23-1.49; P < 0.001) and was more pronounced in the emergency department (adjOR, 1.55; 95% CI, 1.35-1.77; P < 0.001) than in nonemergency areas (adjOR, 1.19; 95% CI, 1.04-1.37; P = 0.014). Overall, there was no association between diagnosis on the weekends versus on weekdays and 3-hour full bundle compliance (adjOR, 1.08; 95% CI, 0.98-1.19; P = 0.115), although there was an association among those diagnosed in nonemergency areas (adjOR, 1.15; 95% CI, 1.00-1.32; P = 0.047). The lower compliance observed for sepsis diagnosed during the nighttime was more evident 2 years after implementation of the quality improvement initiative.Conclusions: Compliance with sepsis bundles was associated with the moment of sepsis diagnosis. The place of diagnosis and the time from campaign implementation were factors modifying this association. Our results support areas for better design of quality improvement initiatives to mitigate the influence of the period of sepsis diagnosis on treatment compliance.

Asunto(s)

RESUMEN

Methylmercury (MeHg) is a well-known toxic pollutant. However, little is known about the effects of this toxic agent in an adult as a consequence of a parental or preimaginal exposure. This study used Drosophila melanogaster to investigate whether a parental or a preimaginal (eggs-larvae-pupae stages) exposure could impact parameters as viability, locomotor activity, and sleep patterns of fruit flies. Thus, we performed two exposure protocols. One where just parents were exposed to MeHg (0-12 µM) during 24 h, then flies were transferred to lay eggs in a healthy medium (without MeHg). In the other, flies were set to lay eggs in a MeHg medium, same concentrations, and discarded after this (preimaginal exposure). Viability was evaluated from egg to adult flies. F1 progeny was collected within 24 h and transferred to a fresh healthy medium. Sleep behavior analysis was performed using Drosophila Active Monitoring System (DAMS), and the locomotor activity was evaluated by climbing assay. Results have shown that the parental exposure had a significant impact on F1 progeny reducing viability and locomotor activity performance, but no significant circadian rhythm alterations. Whereas the preimaginal exposure had a stronger effect decreasing viability and locomotor activity, it also disrupted sleep patterns. MeHg preimaginal exposure showed a longer sleep duration and lower daily activity. Results corroborate the hypothesis that low MeHg exposure could trigger subclinical symptoms related to a 'neurotoxicological development effect'. Complementary investigations could clarify the underlying mechanisms of MeHg effects in neural functions due to parental and early development exposure to this toxicant.

Asunto(s)

RESUMEN

UNLABELLED: The monitoring of distance is crucial to calculate the metabolic requirement and the ratings of perceived exertion (RPE) for a given exercise bout. Visual cues provide valuable information for distance estimation, navigation and orientation. The present study investigated if light deprivation may affect the conscious monitoring of distance, RPE and associative thoughts to exercise (ATE) during a 20-km cycling time trial (TT20km). Eleven male, endurance cyclists performed two TT20km in illuminated-control and light-deprived laboratory. They were asked to self-report RPE and ATE when they perceived they had completed each 2km. RESULTS: The light deprivation resulted in elongated perceived distance at each actual 2km, rather than in illuminated-control trial (P<0.05). Although there was no difference in RPE when it was plotted as a function of the perceived distance, RPE was lowered in light-deprived environment when it was plotted as a function of the actual distance (P<0.05). Additionally, ATE was lowered during TT20km in light deprivation (P<0.01); however, pacing and performance were unaffected in light-deprived environment. CONCLUSION: Results suggest that pacing and performance were regulated through a system which was unaffected in light-deprived environment, despite the altered conscious distance monitoring and perceptive responses.

Asunto(s)

RESUMEN

Nitric oxide (NO) synthesis capacity is determined by the availability of substrate(s) such as L-arginine and the influence of nitric oxide synthase (NOS) inhibitors, asymmetric dimethylarginine (ADMA) and symmetric dimethylarginine (SDMA). These factors may be important in black South Africans with a very high prevalence of hypertension. We compared ambulatory blood pressure (BP), markers of end organ damage and NO synthesis capacity markers [L-arginine, L-homoarginine, L-citrulline, L-arginine:ADMA, ADMA, SDMA and dimethylarginine (DMA)], between black and white teachers (n = 390). Associations of nighttime BP and markers of end organ damage with NO synthesis capacity markers were also investigated. Although black men and women had higher BP and albumin-to-creatinine ratio (ACR) (all p < 0.001), they also had higher L-arginine, L-homoarginine, L-arginine:ADMA and lower SDMA and DMA levels (all p < 0.05). Only in white men ADMA concentrations associated positively with nighttime systolic blood pressure (R (2) = 0.20, ß = 0.26, p = 0.009), nighttime diastolic blood pressure (R (2) = 0.23, ß = 0.27, p = 0.007), carotid intima media thickness (cIMT) (R (2) = 0.36, ß = 0.22, p = 0.008) and ACR (R (2) = 0.14, ß = 0.32, p = 0.001). Our findings suggest that despite an adverse cardiovascular profile in blacks, their NO synthesis capacity profile seems favourable, and that other factors, such as NO inactivation, may prove to be more important.

Asunto(s)

RESUMEN

PURPOSE: Nighttime salivary cortisol (NSC) has been proposed for the diagnosis of Cushing's syndrome during pregnancy. However, reference values for NCS in pregnant women have not been adequately determined. The aim of this study was to determine the reference values of NSC in the three gestational trimesters in order to help distinguish physiological from pathological hypercortisolism during pregnancy. METHODS: This prospective and retrospective study evaluated 85 pregnant women in whom samples were collected in the first, second and/or third gestational trimester (pregnancy group), 33 non-pregnant women (control group), and 25 non-pregnant women with Cushing's disease (CD group). NSC was measured by enzyme-linked immunosorbent assay. RESULTS: NSC increased progressively during pregnancy, reaching maximum levels on the third trimester (median 2.1-fold increase compared with controls, p < 0.001). Reference values for NSC were determined and the upper limits on each gestational trimester were: first trimester 0.25 µg/dL (6.9 nmol/L), second trimester 0.26 µg/dL (7.2 nmol/L), and third trimester 0.33 µg/dL (9.1 nmol/L). Cutoff values that separated the CD group from the three trimesters in the pregnancy groups were, respectively, 0.255 µg/dL (7.0 nmol/L), 0.260 µg/dL (7.2 nmol/L), and 0.285 µg/dL (7.9 nmol/L). Comparison of NSC cutoff values in pregnant women with CD patients showed high sensitivity and specificity in all three trimesters. CONCLUSIONS: We established cutoff values for determination of NSC which can be useful for pregnant women with a diagnostic suspicion of CD.

Asunto(s)

RESUMEN

Trees from tropical montane cloud forest (TMCF) display very dynamic patterns of water use. They are capable of downwards water transport towards the soil during leaf-wetting events, likely a consequence of foliar water uptake (FWU), as well as high rates of night-time transpiration (Enight) during drier nights. These two processes might represent important sources of water losses and gains to the plant, but little is known about the environmental factors controlling these water fluxes. We evaluated how contrasting atmospheric and soil water conditions control diurnal, nocturnal and seasonal dynamics of sap flow in Drimys brasiliensis (Miers), a common Neotropical cloud forest species. We monitored the seasonal variation of soil water content, micrometeorological conditions and sap flow of D. brasiliensis trees in the field during wet and dry seasons. We also conducted a greenhouse experiment exposing D. brasiliensis saplings under contrasting soil water conditions to deuterium-labelled fog water. We found that during the night D. brasiliensis possesses heightened stomatal sensitivity to soil drought and vapour pressure deficit, which reduces night-time water loss. Leaf-wetting events had a strong suppressive effect on tree transpiration (E). Foliar water uptake increased in magnitude with drier soil and during longer leaf-wetting events. The difference between diurnal and nocturnal stomatal behaviour in D. brasiliensis could be attributed to an optimization of carbon gain when leaves are dry, as well as minimization of nocturnal water loss. The leaf-wetting events on the other hand seem important to D. brasiliensis water balance, especially during soil droughts, both by suppressing tree transpiration (E) and as a small additional water supply through FWU. Our results suggest that decreases in leaf-wetting events in TMCF might increase D. brasiliensis water loss and decrease its water gains, which could compromise its ecophysiological performance and survival during dry periods.

Asunto(s)

RESUMEN

BACKGROUND/AIMS: To evaluate the effectiveness of pantoprazole magnesium (pantoprazole-Mg) 40 mg in the relief of esophageal and extra-esophageal symptoms of gastroesophageal reflux disease (GERD), particularly night-time symptoms. METHODS: Patients (aged 18-50 years) with 3-month history of heartburn and/or acid regurgitation plus at least one other symptom in the last week were enrolled in a nationwide, prospective and observational study in Mexico. Patients received pantoprazole-Mg 40 mg once daily during 4 weeks. Symptoms were assessed through a physician-administered structured interview and the patient-completed ReQuest in Practice™ questionnaire. Night-time GERD was defined as arousal from sleep during the night due to GERD-associated symptoms. RESULTS: Out of 4,343 patients included at basal visit, 3,665 were considered for the effectiveness per protocol analysis. At baseline, patients had a median of 8 GERD related symptoms. Patients with night-time GERD symptoms (42.7%) were more likely to have extra-esophageal symptoms (P < 0.001) than other GERD patients. Pantoprazole-Mg 40 mg once daily for 4 weeks improved a broad range of GERD-associated symptoms from baseline (80% reduction on physicians assessments; 68-77% reduction on ReQuest in Practice™ dimensions), including both day- and night-time GERD symptoms; improvements were the greatest for extra-esophageal symptoms in patients with night-time symptoms. Pantoprazole-Mg was well tolerated. CONCLUSIONS: Pantoprazole-Mg 40 mg significantly improved a broad range of esophageal and extra-esophageal GERD related symptoms including sleep disturbances, as well as well-being, in patients with daytime or night-time GERD, making it a good option for patients with GERD, especially when extra-esophageal and night-time symptoms are present.

RESUMEN

OBJECTIVE: Our primary purpose was to assess the impact of objectively measured nighttime sleep duration on gestational glucose tolerance. We additionally examined associations of objectively measured daytime sleep duration and nap frequency on maternal glycemic control. METHODS: Sixty-three urban, low-income, pregnant women wore wrist actigraphs for an average of 6 full days in mid-pregnancy prior to screening for hyperglycemia using the 1-h oral glucose tolerance test (OGTT). Correlations of nighttime and daytime sleep durations with 1-h OGTT values were analyzed. Multivariable logistic regression was used to evaluate independent associations between sleep parameters and hyperglycemia, defined as 1-h OGTT values ≥130 mg/dL. RESULTS: Mean nighttime sleep duration was 6.9±0.9 h which was inversely correlated with 1-h OGTT values (r=-0.28, P=.03). Shorter nighttime sleep was associated with hyperglycemia, even after controlling for age and body mass index (adjusted odds ratio [OR], 0.2 [95% confidence interval {CI}, 0.1-0.8]). There were no associations of daytime sleep duration and nap frequency with 1-h OGTT values or hyperglycemia. CONCLUSIONS: Using objective measures of maternal sleep time, we found that women with shorter nighttime sleep durations had an increased risk for gestational hyperglycemia. Larger prospective studies are needed to confirm our negative daytime sleep findings.

Asunto(s)