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[ABSTRACT]. Objectives. To summarize available data on unit costs for human immunodeficiency virus (HIV) testing, prevention, and care interventions in Latin America and the Caribbean. Methods. We conducted a systematic literature review of costing studies published between 2012 and 2024, and selected those reporting empirically measured costing data. The available data were categorized according to predefined intervention categories and compared by time and place. We also explored variations in unit costs by intervention type. Results. Of 1 746 studies identified, 22 met the inclusion criteria, which provided 103 unique unit cost estimates from nine countries. About 50% of the included studies were published between 2019 and 2021. Antiretroviral therapy services had the most cost data available (39% of unit costs), followed by inpatient care (27%) and HIV testing (24%). Considerable cost variations were observed both within and between interventions. Conclusions. Our analysis underscores the need for accurate and reliable cost data to support HIV budgeting and decision-making efforts. We identified several gaps in the availability of cost data and emphasize the importance of presenting results more effectively by incorporating key contextual variables. Given the challenges of shrinking budgets and sustainability risks, robust evidence is indispensable to inform priority setting and budget allocation for HIV services.

[RESUMEN]. Objetivos. Resumir los datos disponibles sobre los costos unitarios de las intervenciones en materia de pruebas de detección, prevención y atención de salud relacionadas con el virus de la inmunodeficiencia humana (VIH) en América Latina y el Caribe. Métodos. Se realizó una revisión bibliográfica sistemática de los estudios sobre costos publicados entre el 2012 y el 2024, y se seleccionaron los estudios que presentaban datos de costos determinados de manera empírica. Los datos disponibles se clasificaron en categorías de intervención predefinidas y se compararon en función del tiempo y el lugar. También se examinaron las variaciones en los costos unitarios según el tipo de intervención. Resultados. De los 1746 estudios encontrados, 22 cumplían los criterios de inclusión; y en ellos se obtuvieron 103 estimaciones distintas de costos unitarios procedentes de nueve países. Alrededor del 50% de los estudios incluidos se publicaron entre el 2019 y el 2021. Los servicios de tratamiento antirretroviral eran los que disponían de más datos sobre costos (39% de los costos unitarios), seguidos de los de atención hospitalaria (27%) y los de pruebas de detección del VIH (24%). Se observaron variaciones considerables en los costos en una misma intervención y entre distintas intervenciones. Conclusiones. En este análisis se subraya la necesidad de disponer de datos de costos exactos y fiables para brindar apoyo a los esfuerzos de elaboración de presupuestos y la toma de decisiones en materia de infección por el VIH. Detectamos varias brechas en cuanto a la disponibilidad de datos sobre costos y hacemos hincapié en la importancia de presentar los resultados de manera más eficaz mediante la incorporación de variables contextuales clave. Ante los desafíos que plantean la reducción presupuestaria y los riesgos para su sostenibilidad, es indispensable contar con evidencia sólida para fundamentar la determinación de prioridades y la asignación de presupuestos a los servicios relacionados con la infección por el VIH.

[RESUMO]. Objetivos. Sintetizar os dados disponíveis sobre os custos unitários de testagem, prevenção e intervenções de saúde relacionados ao vírus da imunodeficiência humana (HIV) na América Latina e Caribe. Métodos. Foi realizada uma revisão sistemática da literatura de estudos de custeio publicados entre 2012 e 2024, com a seleção de estudos que apresentavam dados de custeio medidos empiricamente. Os dados foram classificados em categorias predefinidas de intervenção e comparados por tempo e lugar. Variações nos custos unitários por tipo de intervenção também foram examinadas. Resultados. Dos 1746 estudos identificados, 22 preencheram os critérios de inclusão, fornecendo 103 estimativas de custos unitários em nove países. Cerca de 50% dos estudos incluídos na análise foram publicados entre 2019 e 2021. A maior parte dos dados de custo se referiam a serviços de terapia antirretroviral (39% dos custos unitários), serviços de atenção hospitalar (27%) e serviços de testagem de HIV (24%). Foram observadas variações de custo consideráveis para uma mesma intervenção e entre diferentes intervenções. Conclusões. Esta análise aponta a necessidade de se dispor de dados de custo exatos e confiáveis para apoiar o processo decisório e a alocação de recursos orçamentários relacionados ao HIV. Foram identificadas várias lacunas na disponibilidade de dados de custo. Enfatiza-se a importância de apresentar os resultados com mais eficiência, incorporando as principais variáveis contextuais. Diante dos desafios impostos pela retração orçamentária e pelos riscos à sustentabilidade, é imprescindível dispor de evidências robustas para subsidiar o processo de estabelecimento de prioridades e alocação de recursos orçamentários para serviços de HIV.

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Lynch syndrome (LS) is the most frequent cancer predisposition syndrome affecting the colon and rectum. A pathogenic variant (PV) disrupting one of the mismatch repair (MMR) genes is responsible for the disease. The spectrum of tumors in LS is heterogeneous and includes cancer of the colon and rectum (CRC), endometrium, ovaries, stomach, small bowel, urinary tract, bladder, pancreas, and skin. Knowledge of the phenotypic variation of patients with LS, the type and frequency of PVs, and cascade testing studies in the Latin American population is limited. The present study aims to recognize the PVs in MMR genes, describe the phenotype in Mexican-Mestizo patients and their relatives, and identify the acceptance rate of cascade testing of relatives at risk. We included 40 carriers of a MMR gene PV and 142 relatives that developed a LS-related neoplasm. Patients' clinical data, number, and type of malignancies were obtained from their medical records. Amsterdam I-II, Bethesda criteria, and PREMM5® predictive model score were estimated. Available immunohistochemistry (IHC) reports were analyzed. Relatives at risk were determined from index cases pedigrees. The distribution of MMR gene mutations among 40 probands was: MLH1 (67.5 %), MSH2 (22.5 %), MSH6 (7.5 %), and PMS2 (2.5 %). Out of the 182 LS cases, 58 % exhibited the LS phenotype before age 50. The most common tumor was CRC, followed by endometrial cancer in women and gastric cancer in males. We found a 90.0 % concordance between the IHC and germline PV. The most frequent PV in our sample was MLH1 c.676C > T, occurring in 1/6 index cases. All probands disclosed their molecular test result to their family. Out of the 451 asymptomatic relatives at risk, 28.2 % underwent germline testing. Our results highlight the importance of conducting germline genetic studies in LS since it allows the establishment of appropriate cancer screening, risk-reducing measures, and genetic cascade testing among relatives at risk. Interestingly, we observed a significantly higher prevalence of the c.676C > T variant in MLH1, probably a singular characteristic of the Mexican-Mestizo population. New strategies to facilitate accurate communication between index cases and relatives should be implemented to improve the cascade testing acceptance rate.

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The procurement process for organ donation begins with the identification of potential organ donors in emergency or critical care units (CCU), followed by their clinical evaluation, diagnostic procedures, and therapeutic interventions, mostly conducted in CCUs. It concludes with the request for organ donation and, if accepted, the retrieval of organs. Despite most interventions occurring in detection units, there has been a neglect of the strategic role played by critical care specialists (CCS) in managing and caring for brain-dead or near-brain-death patients. Questions arise: Are they willing to undertake this responsibility? Do they fully comprehend the nature of organ procurement? Are they aware of the specific interventions required to maintain possible organ donors in optimal physiological condition? Our objective is to examine the role of CCS in organ procurement and propose ways to enhance it, ultimately aiming to increase and enhance organ donation rates.

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Colorectal cancer (CRC) remains one of the most commonly diagnosed and deadliest types of cancer worldwide. CRC displays a desmoplastic reaction (DR) that has been inversely associated with poor prognosis; less DR is associated with a better prognosis. This reaction generates excessive connective tissue, in which cancer-associated fibroblasts (CAFs) are critical cells that form a part of the tumor microenvironment. CAFs are directly involved in tumorigenesis through different mechanisms. However, their role in immunosuppression in CRC is not well understood, and the precise role of signal transducers and activators of transcription (STATs) in mediating CAF activity in CRC remains unclear. Among the myriad chemical and biological factors that affect CAFs, different cytokines mediate their function by activating STAT signaling pathways. Thus, the harmful effects of CAFs in favoring tumor growth and invasion may be modulated using STAT inhibitors. Here, we analyze the impact of different STATs on CAF activity and their immunoregulatory role.

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PURPOSE: Cost containment and efficiency in the provision of health care are primary concerns for health systems that aim to provide affordable, high-quality care. Between 2005 and 2015, Seguro Poplar's Fund against Catastrophic Expenditures (FPGC) funded ALL treatment in Mexico. Before January 1, 2011, FPGC reimbursed a fixed amount per patient according to risk. In 2011, the per capita reimbursement method changed to fee for service. We used this natural experiment to estimate the impact of the reimbursement policy change on average expenditure and quality of care for ALL treatment in Mexico. METHODS: We used nationwide reimbursement data from the Seguro Poplar's FPGC from 2005 to 2015. We created a patient cohort to assess 3-year survival and estimate the average reimbursement before and after the fee-for-service policy. We examined survival and expenditure impacts, controlling for patients' and providers' characteristics, including sex, risk (standard and high), the volume of patients served, type of institution (federally funded v other), and level of care. To quantify the impact, we used a regression discontinuity approach. RESULTS: The average reimbursement for standard-risk patients in the 3-year survival cohort was $16,512 US dollars (USD; 95% CI, 16,042 to 17,032) before 2011 and $10,205 USD (95% CI, 4,659 to 12,541) under the fee-for-service reimbursement scheme after 2011. The average annual reimbursement per patient decreased by 136% among high-risk patients. The reduction was also significant for the standard-risk cohort, although the magnitude was substantially smaller (34%). CONCLUSION: As Mexico's government is currently restructuring the health system, our study provides evidence of the efficiency and effectiveness of the funding mechanism in the Mexican context. It also serves as a proof of concept for using administrative data to evaluate economic performance and quality of care of publicly funded health programs.

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OBJECTIVE: To establish recommendations through the consensus of a Latin American experts panel on the use of the flash glucose monitoring system (fCGM) in people living with type 2 diabetes mellitus (T2DM) regarding the benefits and challenges of using the fCGM. METHODS: An executive committee of experts was created, comprised by a panel of fifteen physicians, including endocrinologists and internal medicine physicians, with expertise in management of adult patients with T2DM. The experts were from various countries: Colombia, Chile, Peru, Mexico, Argentina, and Brazil. The modified Delphi method was used, considering a consensus level of at least 80% of the participants. A seventeen-item instrument was developed to establish recommendations on the use of fCGM in patients with T2DM in Latin American. RESULTS: The number of glucose scans recommended per day with the fCGM for patients managed with oral antidiabetic drugs or basal insulin was a median of 6 scans per day, and for those managed with multiple insulin doses, a median of 10 scans per day was recommended. Additionally, a holistic and individualized management approach was recommended, taking into account new treatment directions and identifying patients who would benefit from the use of the fCGM. CONCLUSION: Continuous use of the fCGM is recommended for people living with T2DM, regardless of their type of treatment. These metrics must be evaluated individually for each patient profile.

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Kidney transplantation is the best option for kidney replacement therapy, even considering that most of the times the grafts do not survive as long as their recipients. In the Khalil et al's experience, published in this issue of the Journal, they analyze their second kidney graft survival and describe those significant predictors of early loss. This editorial comments on the results and put in perspec tive that most of the times, long-term graft survival could be inadvertently jeopardized if the immunosuppressive therapy is reduced or withdrawn for any reason, and that it could happen frequently if the transplant physician intends to innovate with the clinical care without proper evidence-based data.

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This study aimed to estimate the carcinogenic and non-carcinogenic risk as well as the attributable cases due to exposure to organochlorine pesticides (OCPs): hexachlorobenzene (HCB), dichlorophenyltrichloroethane (DDT), hexachlorocyclohexane (HCH), heptachlor, and chlordane. From serum concentrations of pesticides of interest in a sample of 908 women from Northern Mexico, the risk for both cancer and non-cancer health effects was evaluated. The population attributable fraction (PAF) was also calculated based on summary association estimates between exposure to OCPs and different health events. Findings revealed that due to their OCP exposure slightly less than half of the women in the sample were at increased risk of developing non-cancerous diseases. Moreover, approximately 25% and 75% of participants were at risk of develop some type of cancer associated with their HCB and DDE concentrations, respectively. In addition, it was estimated that 40.5% of type 2 diabetes, 18.7% of endometriosis, and 23.1% of non-Hodgkin's lymphoma cases could have been prevented if women had not been exposed to these OCPs. Results suggest that the use of OCPs may have contributed to the disease burden in the study area and, based on the time required for these substances to be eliminated from the body, there are probably some women who are still at elevated risk of developing diseases associated to OCPs.

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The medical literature has shown that populations under high stress have a lower sex ratio at birth (i.e. number of males for every 100 females). In this paper, I examine the relationship between income, as a source of economic stress, and the sex ratio at a subnational level for the 1895-2010 period. For this, I use census microdata from Argentina -a developing country that experienced rapid growth at the end of the 19th century and stagnated in recent decades- and I estimate from a two-way fixed effects model that exploits the wide temporal and geographic variability in income. The results show that as per capita income increases, the sex ratio at birth also increases. In particular, for every US$ 1,000 increase in per capita income, the sex ratio increases between 0.3 and 0.6 points. These findings make it possible to quantify the lost boys (i.e. those boys who were not born due to high economic stress on their parents) and constitute a call for attention in favor of the implementation of prenatal care policies -especially in periods of stagnation or income decline- to maintain a more balanced sex ratio.

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OBJECTIVE: To compare the short- and long-term outcomes of infants with hypoxic-ischemic encephalopathy (HIE) treated with whole-body therapeutic hypothermia (TH), monitored by esophageal vs rectal temperature. STUDY DESIGN: We conducted a secondary analysis of the multicenter High-Dose Erythropoietin for Asphyxia and Encephalopathy (HEAL) trial. All infants had moderate or severe HIE and were treated with whole-body TH. The primary outcome was death or neurodevelopmental impairment (NDI) at 22-36 months of age. Secondary outcomes included seizures, evidence of brain injury on magnetic resonance imaging, and complications of hypothermia. Logistic regression was used with adjustment for disease severity and site as clustering variable because cooling modality differed by site. RESULTS: Of the 500 infants who underwent TH, 294 (59%) and 206 (41%) had esophageal and rectal temperature monitoring, respectively. There were no differences in death or NDI, seizures, or evidence of injury on magnetic resonance imaging between the 2 groups. Infants treated with TH and rectal temperature monitoring had lower odds of overcooling (OR 0.52, 95% CI 0.34-0.80) and lower odds of hypotension (OR 0.57, 95% CI 0.39-0.84) compared with those with esophageal temperature monitoring. CONCLUSIONS: Although infants undergoing TH with esophageal monitoring were more likely to experience overcooling and hypotension, the rate of death or NDI was similar whether esophageal monitoring or rectal temperature monitoring was used. Further studies are needed to investigate whether esophageal temperature monitoring during TH is associated with an increased risk of overcooling and hypotension.

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OBJECTIVE: To assess among a cohort of neonates with hypoxic-ischemic encephalopathy (HIE) the association of pretreatment maximal hourly seizure burden and total seizure duration with successful response to initial antiseizure medication (ASM). STUDY DESIGN: This was a retrospective review of data collected from infants enrolled in the HEAL Trial (NCT02811263) between January 25, 2017, and October 9, 2019. We evaluated a cohort of neonates born at ≥36 weeks of gestation with moderate-to-severe HIE who underwent continuous electroencephalogram monitoring and had acute symptomatic seizures. Poisson regression analyzed associations between (1) pretreatment maximal hourly seizure burden, (2) pretreatment total seizure duration, (3) time from first seizure to initial ASM, and (4) successful response to initial ASM. RESULTS: Among 39 neonates meeting inclusion criteria, greater pretreatment maximal hourly seizure burden was associated with lower chance of successful response to initial ASM (adjusted relative risk for each 5-minute increase in seizure burden 0.83, 95% CI 0.69-0.99). There was no association between pretreatment total seizure duration and chance of successful response. Shorter time-to-treatment was paradoxically associated with lower chance of successful response to treatment, although this difference was small in magnitude (relative risk 1.007, 95% CI 1.003-1.010). CONCLUSIONS: Maximal seizure burden may be more important than other, more commonly used measures in predicting response to acute seizure treatments.

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Lake Caviahue (37° 50 'S and 71° 06' W; Patagonia, Argentina) is an extreme case of a glacial, naturally acidic, aquatic environment (pH ~ 3). Knowledge of the bacterial communities in the water column of this lake, is incipient, with a basal quantification of the bacterioplankton abundance distribution in the North and South Basins of Lake Caviahue, and the described the presence of sulfur and iron oxidizing bacteria in the lake sediments. The role that bacterioplankton plays in nutrient utilization and recycling in this environment, especially in the phosphorus cycle, has not been studied. In this work, we explore this aspect in further depth by assessing the diversity of pelagic, littoral and sediment bacteria, using state of the art molecular methods and identifying the differences and commonalties in the composition of the cognate communities. Also, we investigate the interactions between the sediments of Lake Caviahue and the microbial communities present in both sediments, pore water and the water column, to comprehend the ecological relationships driving nutrient structure and fluxes, with a special focus on carbon, nitrogen, and phosphorus. Two major environmental patterns were observed: (a) one distinguishing the surface water samples due to temperature, Fe2+, and electrical conductivity, and (b) another distinguishing winter and summer samples due to the high pH and increasing concentrations of N-NH4+, DOC and SO42-, from autumn and spring samples with high soluble reactive phosphorus (SRP) and iron concentrations. The largest bacterial abundance was found in autumn, alongside higher levels of dissolved phosphorus, iron forms, and increased conductivity. The highest values of bacterial biomass were found in the bottom strata of the lake, which is also where the greatest diversity in microbial communities was found. The experiments using continuous flow column microcosms showed that microbial growth over time, in both the test and control columns, was accompanied by a decrease in the concentration of dissolved nutrients (SRP and N-NH4+), providing proof that sediment microorganisms are active and contribute significantly to nutrient utilization/mobilization.

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OBJECTIVES: This study aims to evaluate the disruption in HIV screening and diagnoses due to the coronavirus disease 2019 (COVID-19) pandemic and to investigate the pandemic's subsequent influence on the HIV epidemic. DESIGN: A retrospective examination of testing and confirmed diagnoses time series was undertaken from 2011 to 2022. The analysis encompassed testing, positive tests, positivity rates, and diagnosis outcomes, including new HIV diagnoses, asymptomatic HIV diagnoses, and symptomatic HIV diagnoses. METHODS: We used Autoregressive Integrated Moving Average (ARIMA) models to estimate the COVID-19 epidemic's impact on screening and diagnosis outcomes. We gauged the pandemic's effect between January 2020 and December 2022 by comparing modeled predicted results with actual outcomes. RESULTS: The advent of COVID-19 prompted a reduction of 50.7% in HIV testing, followed by a monthly escalation in testing afterward, estimated at 30.2 and 65.1% for 2021 and 2022, respectively. Although new diagnoses reported between 2020 and 2022 gradually increased to prepandemic levels, we estimate a gap of 13 207 new diagnoses, with symptomatic detections increasing more than proportionally in 2021 and 2022. CONCLUSION: Our results suggest that the COVID-19 pandemic resulted in missed HIV diagnoses and a rise in late HIV diagnoses. Implementing tailored post-COVID-19 strategies to accelerate timely HIV testing and prevention is needed to avert additional burdens and remain on track toward achieving the 2030 HIV management goals.

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OBJECTIVE: To determine if time to reaching target temperature (TT) is associated with death or neurodevelopmental impairment (NDI) at 2 years of age in infants with hypoxic-ischemic encephalopathy (HIE). STUDY DESIGN: Newborn infants ≥36 weeks of gestation diagnosed with moderate or severe HIE and treated with therapeutic hypothermia were stratified based on time at which TT was reached, defined as early (ie, ≤4 hours of age) or late (>4 hours of age). Primary outcomes were death or NDI. Secondary outcomes included neurodevelopmental assessment with Bayley Scales of Infant and Toddler Development, third edition (BSID-III) at age 2. RESULTS: Among 500 infants, the median time to reaching TT was 4.3 hours (IWR, 3.2-5.7 hours). Infants in early TT group (n = 211 [42%]) compared with the late TT group (n = 289 [58%]) were more likely to be inborn (23% vs 13%; P < .001) and have severe HIE (28% vs 19%; P = .03). The early and late TT groups did not differ in the primary outcome of death or any NDI (adjusted RR, 1.05; 95% CI, 0.85-0.30; P = .62). Among survivors, neurodevelopmental outcomes did not differ significantly in the 2 groups (adjusted mean difference in Bayley Scales of Infant Development-III scores: cognitive, -2.8 [95% CI, -6.1 to 0.5], language -3.3 [95% CI, -7.4 to 0.8], and motor -3.5 [95% CI, -7.3 to 0.3]). CONCLUSIONS: In infants with HIE, time to reach TT is not independently associated with risk of death or NDI at age 2 years. Among survivors, developmental outcomes are similar between those who reached TT at <4 and ≥4 hours of age. TRIAL REGISTRATION: High-dose Erythropoietin for Asphyxia and Encephalopathy (HEAL); NCT02811263; https://beta. CLINICALTRIALS: gov/study/NCT02811263.

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In this paper I examine the evolution of parental gender preferences in Argentina (i.e., parents who prefer a certain gender composition in their children). To do this, I use census microdata that spans the 19th, 20th, and 21st centuries. The estimation strategy exploits the plausibly random assignment in the gender of children. The results show a persistent preference for a mixed gender composition (i.e., having at least one boy and one girl) instead of children of the same gender. This translates into an increase in the probability of having a third child, conditional on already having two children of between 9%-23% for those couples who have children of the same gender -in relation to couples with children of opposite genders-. These preferences are heterogeneous over time and have important implications in terms of fertility (i.e., the reduction of these mixed gender preferences -in favor of greater gender-neutrality- could contribute to reducing the number of children per couple). In addition, the findings of this work support the empirical literature that uses the gender composition of the first two children as an instrumental variable to study the impact of fertility on labor participation.

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OBJECTIVE: To assess the impact of a vaccination campaign that administered five different technologies in a middle-income country with one of the largest Covid-19 epidemics. MATERIALS AND METHODS: Using data from Mexico's Epidemiological Surveillance System for Viral Respiratory Disease (Sisver) and the design of the vaccine policy in Mexico as a natural experiment, we applied difference-in-differences econometric methods to assess the strategy's effectiveness on transmission, hospitalizations, and mortality rates among adults 60 to 64 years old in Mexico between April and June 2021. RESULTS: We estimated average effectiveness levels of 60.9% against confirmed cases of Covid-19. Vaccination also decreased hospitalizations and deaths by 62.7 and 62.6%, respectively. After adjusting for vaccination coverage, we found an impact of 79.1, 80.9, and 81.3% reduction in new cases, hospitalizations, and deaths among the vaccinated. CONCLUSION: Despite the significant progress in our knowledge of Covid-19 vaccination effectiveness, the available evidence relies mostly on experiences from high-income countries. This study contributes to the scientific literature of Covid-19 vaccination effectiveness in a middle-income country with a multi-vaccine scheme.

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BACKGROUND: The expression of empathy improves the quality of health care, which is why its instruction is suggested during the years of academic training of medical students. However, expressing empathy can also cause anxiety and impair psychological well-being. OBJECTIVE: To identify profiles that describe the relationship between empathy, anxiety and psychological well-being in Mexican medical students. METHOD: Cross-sectional study in Mexican medical students completed the Multidimensional Empathy Scale, the Beck Anxiety Inventory, and the Psychological Well-Being Scale for Adults. RESULTS: Women presented greater empathy and anxiety and lower psychological well-being (p < 0.01). Anxiety in students of the last year of training was lower compared to students of the first and second year (p < 0.01). Four profiles were detected: 1) men, minimal anxiety, low empathy; 2) first-year students, moderate to severe anxiety, low psychological well-being, high empathy; 3) last year of training, mild anxiety, adequate psychological well-being, medium empathy; 4) women, second and third year of training, very high empathy. CONCLUSIONS: Medical students in their first year of training constitute a population at risk. Attention strategies are necessary for this student group.

ANTECEDENTES: La expresión de empatía mejora la calidad de la atención a la salud, y por ello se sugiere su instrucción durante los años de formación académica de estudiantes de medicina. No obstante, la expresión de empatía también puede ocasionar ansiedad y perjudicar el bienestar psicológico. OBJETIVO: Identificar perfiles que describan la relación entre empatía, ansiedad y bienestar psicológico en estudiantes mexicanos de medicina. MÉTODO: Estudio transversal en estudiantes mexicanos de medicina que completaron la Escala Multidimensional de Empatía, el Inventario de Ansiedad de Beck y la Escala de Bienestar Psicológico para Adultos. RESULTADOS: Las mujeres presentaron mayor empatía y ansiedad, y menor bienestar psicológico (p < 0.01). La ansiedad en estudiantes del último año de formación fue menor que en los estudiantes de primer y segundo año (p < 0.01). Se detectaron cuatro perfiles: 1) hombres, ansiedad mínima, empatía baja; 2) estudiantes de primer año de formación, ansiedad moderada a grave, bienestar psicológico bajo, empatía alta; 3) último año de formación, ansiedad leve, bienestar psicológico adecuado, empatía media; 4) mujeres, segundo y tercer años de formación, muy alta empatía. CONCLUSIONES: Los estudiantes de medicina del primer año de formación constituyen una población de riesgo. Son necesarias estrategias de atención para este grupo estudiantil.

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Objetivo: Presentar una causa rara de obstrucción duodenal como es el sindrome de arteria mesentérica superior (SAMS). Material y Método: se presentan tres casos clínicos de sindrome de SAMS. Resultados: el tratamiento médico y nutricional fue exitoso en los primeros dos casos, mientras que en el último fue necesario realizar una derivación quirúrgica. Discusión: en este sindrome, el ángulo aortomesentérico normal se encuentra disminuído, causando la compresión de la tercera porción del duodeno entre la aorta y la arteria mesentérica superior. Esto determina una obstrucción duodenal que se ve más frecuentemente en pacientes con pérdida importante y rápida de peso. Esto determina alteraciones hidroelectrolíticas y desnutrición severas. El tratamiento médico consiste en soporte nutricional y corrección de anormalidades hidroelectrolíticas. Los procedimientos quirúrgicos se reservan frente a los casos de falla del tratamiento médico. Conclusión: el SAMS es una entidad poco frecuente y un reto diagnóstico. El cuadro clínico puede ser grave con desnutrición severa y trastornos hidroelectrolíticos que ponen en riesgo la vida del paciente. El soporte hidroelectrolítico y nutricional, junto a la duodenoyeyunostomía, son los tratamientos de elección.

Aim: To present a rare cause of duodenal obstruction known as the superior mesenteric artery syndrome (SMAS). Material and Method: we present three cases of SMAS. Results: medical and nutritional treatment were effective in the first two cases while in the last case, a derivative procedure was necessary. Discussion: in this syndrome, the normal aortomesenteric angle is narrowed, causing compression of the third portion of the duodenum between the aorta and the superior mesenteric artery. This leads to duodenal obstruction more frequently observed in patients with severe and fast weight loss. Medical treatment consists in nutritional support and correction of hydro electrolyte imbalance. Surgical procedures are reserved for cases with failure of medical treatment. Conclusion: SMAS is a rare entity and a diagnosis challenge. Clinical setting may be severe with extreme malnutrition and life-threatening dehydration and electrolyte disorder. Nutritional support, hydro electrolyte correction, combined with duodenojejunostomy, if necessary, are the treatments of choice.

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Probiotic supplementation in dairy cattle has achieved several beneficial effects (improved growth rate, immune response, and adequate ruminal microbiota). This study assessed the effects on the growth parameters and gut microbiota of newborn dairy calves supplemented with two Lactobacillus-based probiotics, individually (6BZ or 6BY) or their combination (6BZ + 6BY), administrated with the same concentration (1 × 109 CFU/kg weight) at three times, between days 5 and 19 after birth. The control group consisted of probiotic-unsupplemented calves. Growth parameters were recorded weekly until eight weeks and at the calves' ages of three, four, and five months. Fecal microbiota was described by high-throughput sequencing and bioinformatics. Although no significant effects were observed regarding daily weight and height gain among probiotic-supplemented and non-supplemented calves, correlation analysis showed that growth rate was maintained until month 5 through probiotic supplementation, mainly when the two-strain probiotics were supplied. Modulation effects on microbiota were observed in probiotic-supplemented calves, improving the Bacteroidota: Firmicutes and the Proteobacteria ratios. Functional prediction by PICRUSt also showed an increment in several pathways when the two-strain probiotic was supplemented. Therefore, using the three-administration scheme, the two-strain probiotic improved the growth rate and gut microbiota profile in newborn dairy calves. However, positive effects could be reached by applying more administrations of the probiotic during the first 20 days of a calf's life.

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INTRODUCTION: Breast cancer is the leading cause of cancer mortality in Mexican women. OBJECTIVE: The objective of the study was to identify concordances among core needle biopsy (CNB) and excisional biopsies (EB) regarding diagnosis, hormonal receptors (HR), and human epidermal growth factor receptor 2 (Her2). MATERIALS AND METHODS: Core number, demographic data, histological type, and treatment were documented for each sample. Reported HR and Her2 score from both samples were compiled. RESULTS: 70 women with both CNB/EB were included. Median age was 58 (36-87) years; initial diagnosis in CNB were invasive ductal 56 (80%), lobular 10 (14%), and mixed 4 (6%) carcinomas. Diagnostic agreement among CNB and EB was of 97%, k = 0.65. A concordance of 92% (k = 0.75), 75% (k = 0.26), and 67% (k = 0.46) was observed for estrogen receptors, progesterone receptors, and Her2 determinations, and positive predictive values in CNB were 0.96, 0.89, and 0.44, respectively. CONCLUSION: HR and Her2 concordances using manual-immunohistochemistry (IHC) were found within the range of values obtained using automatized-IHC. When compared to tumor heterogeneity, technical/reading errors contribute more to discordances.

INTRODUCTION: El cáncer de mama es la principal causa de mortalidad por cáncer en mujeres mexicanas. OBJETIVO: Identificar la concordancia entre la biopsia con aguja de corte (BAC) y la biopsia escisional (BE) con respecto al diagnóstico, receptores hormonales (RH) y Her2. MATERIAL Y MÉTODOS: Se registró el número de fragmentos cilíndricos, datos demográficos, tipo histológico y tratamiento. Se recopilaron resultados de RH y Her2. RESULTADOS: Se incluyeron 70 mujeres con mediana de edad de 58 años. El diagnóstico inicial en BAC fue carcinoma ductal invasivo 56 (80%), lobular 10 (14%) y mixtos 4 (6%). El acuerdo de diagnóstico entre BAC y BE fue del 97%, k = 0.65. Se observó una concordancia de 92% (k = 0.75), 75% (k = 0.26) y 67% (k = 0.46) para las determinaciones de receptor de estrógenos (RE), receptor de progesterona (RP) y Her2, y los valores predictivos positivos en BAC fueron 0.96, 0.89 y 0.44, respectivamente. CONCLUSIÓN: Los RH y la concordancia de Her2 mediante inmunohistoquímica (IHC) manual se encuentran dentro del rango de valores obtenidos mediante el uso de IHC automatizada. Los errores técnicos/de lectura contribuyeron más a discordancia que la heterogeneidad tumoral.

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