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BACKGROUND: Sedation in intensive care is fundamental for optimizing clinical outcomes. For many years the world has been facing high rates of opioid use, and to combat the increasing opioid addiction plans at both national and international level have been implemented.1 The COVID-19 pandemic posed a major challenge for health systems and also increased the use of sedatives and opioid analgesia for prolonged periods of time, and at high doses, in a significant proportion of patients. In our institutions, the shortage of many drugs for intravenous (IV) analgosedation forces us to alternatives to replace out-of-stock drugs or to seek sedation goals, which are difficult to obtain with traditional drugs at high doses.2 METHODS: This was an analytical retrospective cohort study evaluating the follow-up of subjects with inclusion criteria from ICU admission to discharge (alive or dead). Five end points were measured: need for high-dose opioids (≥ 200 µg/h), comparison of inhaled versus IV sedation of opioid analgesic doses, midazolam dose, need for muscle relaxant, and risk of delirium. RESULTS: A total of 283 subjects were included in the study, of whom 230 were administered IV sedation and 53 inhaled sedation. In the inhaled sedation group, the relative risks (RRs) were 0.5 (95% CI 0.4-0.8, P = .045) for need of high-dose fentanyl, 0.3 (95% CI 0.20-0.45, P < .001) for need of muscle relaxant, and 0.8 (95% CI 0.61-1.15, P = .25) for risk of delirium. The median difference of fentanyl dose between the inhaled sedation and IV sedation groups was 61 µg/h or 1,200 µg/d (2.2 ampules/d, P < .001), and that of midazolam dose was 5.7 mg/h. CONCLUSIONS: Inhaled sedation was associated with lower doses of opioids, benzodiazepines, and muscle relaxants compared to IV sedation. This therapy should be considered as an alternative in critically ill patients requiring prolonged ventilatory support and where IV sedation is not possible, always under adequate supervision of ICU staff.

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The genus Isodacrys Sharp, 1911 is revised. Twenty species of the genus are recognized ranging from south United States of America, Mexico, Guatemala and Honduras of which eight are herein described as new. These species are Isodacrys antrum Cortés-Hernández, new species (Mexico: Tamaulipas, Chiapas; Guatemala: Baja Verapaz); Isodacrys carlae Cortés-Hernández, new species (Mexico: Coahuila, Hidalgo, Nuevo León, San Luis Potosí, Tamaulipas); Isodacrys confusum Cortés-Hernández, new species (Mexico: Tamaulipas); Isodacrys fasciatum Cortés-Hernández, new species (Mexico: Coahuila, Durango, Nuevo León); Isodacrys frontalis Cortés-Hernández, new species (Mexico: Oaxaca; Guatemala: Sacatepéquez, Guatemala); Isodacrys kuchii Cortés-Hernández, new species (Mexico: Puebla); Isodacrys obrienorum Cortés-Hernández, new species (Guatemala: Totonicapán, Jalapa, San Marcos); and Isodacrys okuiltontli Cortés Hernández, new species (Mexico: Oaxaca). Insights into the monophyly of Isodacrys and its phylogenetic relationships with other Tanymecini based on adult morphology are given by implementing a phylogenetic analysis of 43 terminals (21 ingroup, 22 outgroup) coded for 72 adult morphological characters. Characters were discussed and highlighted for the inclusion in the phylogenetic analysis. Final analysis yielded two most-parsimonious cladograms of 242 steps, which support the monophyly of Isodacrys. Isodillex Cortés-Hernández, new genus is here described to accommodate Isodillex minutum (Sharp, 1911), new combination and Isodillex plumosum Cortés-Hernández, new species (Mexico: Zacatecas). Isodillex was recovered as sister group of Isodacrys. Key to separate Isodacrys species, occurrence map and habitus photographs are also provided.

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We provide a key to the eight genera of the tribe Tanymecini distributed in Mexico. Habitus photographs of all genera are included as are photographs of various other key characters. A brief synopsis of each genus is included as well as a list of the species recorded for Mexico. The species Minyomerus languidus Horn and Pandeleteius championi Howden are newly recorded for Mexico.

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Exposures to fine particulate matter PM2.5 and ozone O3 are associated with Alzheimer's disease (AD) risk. Mexico City residents have lifetime exposures to PM2.5 and O3 above annual USEPA standards and their brains contain high redox, combustion, and friction-derived magnetite nanoparticles. AD pathological changes with subcortical pre-tangle stages in infancy and cortical tau pre-tangles, NFT Stages I-II, and amyloid phases 1-2 are identified by the 2nd decade. Given their AD continuum, a reliable identification of cognitive impairment is of utmost importance. The Montreal Cognitive Assessment (MoCA) was administered to 517 urbanites, age 21.60±5.88 years, with 13.69±1.28 formal education years, in Mexican PM2.5 polluted cities. MoCA score was 23.92±2.82, and 24.7% and 30.3% scored ≤24 and ≤22, respectively (MCI≤24, AD≤22). Cognitive deficits progressively targeted Visuospatial, Executive, Language, and Memory domains, body mass index (BMI) impacting total scores negatively (p = 0.0008), aging driving down Executive, Visuospatial, and Language index scores (p < 0.0001, 0.0037, and 0.0045), and males performing better in Executive tasks. Average age for AD MoCA scores was 22.38±7.7 years. Residency in polluted cities is associated with progression of multi-domain cognitive impairment affecting 55% of Mexican seemingly healthy youth. Normal BMI ought to be a neuroprotection goal. MoCA provides guidance for further mandatory neuropsychological testing in young populations. Identifying and lowering key neurotoxicants impacting neural risk trajectories in the developing brain and monitoring cognitive performance would greatly facilitate multidisciplinary early diagnosis and prevention of AD in high risk young populations. Cognitive deficits hinder development of those representing the force moving the country in future years.

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El vólvulo, o torsión de la vesícula biliar, es una enfermedad de la sexta a la octava décadas de la vida, condición excepcional por su poca frecuencia y síntomas atípicos. Dado que tiende a confundirse con la colecistitis de origen no litiásico, su diagnóstico suele ser intraoperatorio y puede llegar a causar complicaciones graves, como la gangrena y la sepsis biliar e incluso la muerte. Pese a que hace 120 años se hizo el primer reporte de caso, en la actualidad se notifican cada vez más casos en la población añosa. En este artículo se presentan dos casos clínicos de vólvulo de la vesícula biliar y se hace una revisión de la literatura

Volvulus, or torsion of the gallbladder, is a disease of the sixth to eighth decades of life, an exceptional condition due to its infrequent and atypical symptoms.Since it tends to be confused with non-lithiasic cholecystitis, its diagnosis is usually intraoperative and can lead to serious complications such as gangrene and biliary sepsis, even death.Although the first case was reported 120 years ago, more cases are reported in the elderly population.In this article, two clinical cases of gallbladder volvulus are presented and a review of the literature is made

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RegulonDB (http://regulondb.ccg.unam.mx) is one of the most useful and important resources on bacterial gene regulation,as it integrates the scattered scientific knowledge of the best-characterized organism, Escherichia coli K-12, in a database that organizes large amounts of data. Its electronic format enables researchers to compare their results with the legacy of previous knowledge and supports bioinformatics tools and model building. Here, we summarize our progress with RegulonDB since our last Nucleic Acids Research publication describing RegulonDB, in 2013. In addition to maintaining curation up-to-date, we report a collection of 232 interactions with small RNAs affecting 192 genes, and the complete repertoire of 189 Elementary Genetic Sensory-Response units (GENSOR units), integrating the signal, regulatory interactions, and metabolic pathways they govern. These additions represent major progress to a higher level of understanding of regulated processes. We have updated the computationally predicted transcription factors, which total 304 (184 with experimental evidence and 120 from computational predictions); we updated our position-weight matrices and have included tools for clustering them in evolutionary families. We describe our semiautomatic strategy to accelerate curation, including datasets from high-throughput experiments, a novel coexpression distance to search for 'neighborhood' genes to known operons and regulons, and computational developments.

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