Título del artículo:

A community-based comprehensive intervention to reduce cardiovascular risk in hypertension (HOPE 4): a cluster-randomised controlled trial

Background: Hypertension is the leading cause of cardiovascular disease globally. Despite proven benefits, hypertension control is poor. We hypothesised that a comprehensive approach to lowering blood pressure and other risk factors, informed by detailed analysis of local barriers, would be superior to usual care in individuals with poorly controlled or newly diagnosed hypertension. We tested whether a model of care involving non-physician health workers (NPHWs), primary care physicians, family, and the provision of effective medications, could substantially reduce cardiovascular disease risk. Methods: HOPE 4 was an open, community-based, cluster-randomised controlled trial involving 1371 individuals with new or poorly controlled hypertension from 30 communities (defined as townships) in Colombia and Malaysia. 16 communities were randomly assigned to control (usual care, n=727), and 14 (n=644) to the intervention. After community screening, the intervention included treatment of cardiovascular disease risk factors by NPHWs using tablet computer-based simplified management algorithms and counselling programmes; free antihypertensive and statin medications recommended by NPHWs but supervised by physicians; and support from a family member or friend (treatment supporter) to improve adherence to medications and healthy behaviours. The primary outcome was the change in Framingham Risk Score 10-year cardiovascular disease risk estimate at 12 months between intervention and control participants. The HOPE 4 trial is registered at ClinicalTrials.gov, NCT01826019. Findings: All communities completed 12-month follow-up (data on 97% of living participants, n=1299). The reduction in Framingham Risk Score for 10-year cardiovascular disease risk was −6·40% (95% CI 8·00 to −4·80) in the control group and −11·17% (−12·88 to −9·47) in the intervention group, with a difference of change of −4·78% (95% CI −7·11 to −2·44, p<0·0001). There was an absolute 11·45 mm Hg (95% CI −14·94 to −7·97) greater reduction in systolic blood pressure, and a 0·41 mmol/L (95% CI −0·60 to −0·23) reduction in LDL with the intervention group (both p<0·0001). Change in blood pressure control status (<140 mm Hg) was 69% in the intervention group versus 30% in the control group (p<0·0001). There were no safety concerns with the intervention. Interpretation: A comprehensive model of care led by NPHWs, involving primary care physicians and family that was informed by local context, substantially improved blood pressure control and cardiovascular disease risk. This strategy is effective, pragmatic, and has the potential to substantially reduce cardiovascular disease compared with current strategies that are typically physician based. Funding: Canadian Institutes of Health Research; Grand Challenges Canada; Ontario SPOR Support Unit and the Ontario Ministry of Health and Long-Term Care; Boehringer Ingelheim; Department of Management of Non-Communicable Diseases, WHO; and Population Health Research Institute. Video Abstract:

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The Lancet

Título del artículo:

Isometric posterior chain peak force recovery response following match-play in elite youth soccer players: Associations with relative posterior chain strength

The purpose of this study was to determine changes in two tests of lower limb isometric posterior chain force (IPC-F) following 90 min of match-play in elite youth soccer players and the interaction between relative strength and recovery profile. 14 players (age: 16 ± 2 years) performed 3 × 3 second IPC-F tests unilaterally at 30◦ and 90◦ of knee and hip flexion pre-and post-match, +24 h, +48 h, and +72 h post-match. Peak force was recorded for both limbs, combined and expressed relative to bodyweight (N/kg). A two-way repeated measures analysis of variance was performed to determine differences in force output between joint angles, time intervals and subjects. As there was no interaction between angle and time (p = 0.260), we report the change between timepoints as mean ∆ in 90◦ + 30◦ IPC-F. Relative to pre-match IPC-F, there were significant decreases post (∆ = −18%; p > 0.001) and at +24 h (∆ = −8%; p = 0.040), no significant difference at +48 h (∆ = 0%; p = 0.992) and a significant increase at +72 h (∆ = +12%; p = 0.005). There was a large inter-individual variability in recovery profile at both angles and substantial differences between post-match deficits at 90◦ (−10.8%) compared to 30◦ (−20.7%). Higher pre-match IPC-F was correlated with the magnitude of IPC-F deficits at both angles and all time points (r = 0.56 to 0.70, p = < 0.01) except for post-match 90◦ . Regular IPC-F monitoring to determine the magnitude of match-induced fatigue and track recovery may help inform decision-making regarding modifications to individual players training load, particularly as there is a large inter-individual variability in response to competition. Further research is warranted to better understand and address the finding that stronger players showed larger force deficits and slower recovery following match-play.

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Sports

Título del artículo:

Developing a teacher training curriculum including computational thinking skills: Early advances on a study focused on Colombia

During training at the Complementary Formation Program (CFP), Colombian primary school teachers do not acquire Computational Thinking (CT) skills, which are considered fundamental for the knowledge economies of the 21st century. In this paper, we describe the early stages of a project aiming to reform the CFP curriculum, such that CT skills becomes an integral part. As a first step, we carried-out four introductory workshops with 64 first-and third-semester CFP students and then surveyed them to gather their perceptions on CT. The results show that the students have a limited understanding of CT and its associated skills, but they recognize their importance. Moreover, they agree that primary school should be the starting point to develop them. The project will continue gathering information from current CFP teachers, current primary school teachers, and university professors who are experts in curriculum development, to develop the curricular proposal.

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Proceedings - 14th Latin American Conference on Learning Technologies, LACLO 2019

Título del artículo:

Physical preparation and return to sport of the football player with a tibia-fibula fracture: Applying the control-chaos continuum\'

Contact in elite football can result in severe injury such as traumatic fracture. Limited information exists regarding the rehabilitation and return to sport (RTS) of these injuries especially in elite football. We outline the RTS of an elite English Premier League footballer following a tibia-fibula fracture including gym-based physical preparation and the use of control-chaos continuum\' as a framework for on-pitch sport-specific conditioning, development of technical skills while returning the player to pre-injury chronic running loads considering the qualitative nature of movement in competition. Strength and power diagnostics were used to back up clinical reasoning and decision-making throughout rehabilitation and the RTS process. The player returned to full team training after 7.5 months, completed 90 min match-play after 9 months and remains injury-free 11 months post-RTS.

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BMJ Open Sport and Exercise Medicine

Título del artículo:

Effect of a very-low-calorie ketogenic diet on circulating myokine levels compared with the effect of bariatric surgery or a low-calorie diet in patients with obesity

The preservation of muscle mass and muscle function after weight loss therapy is currently a considerable challenge in the fight against obesity. Muscle mass secretes proteins called myokines that have relevant functions in the regulation of metabolism and health. This study was aimed to evaluate whether a very low-calorie ketogenic (VLCK) diet may modulate myokine levels, in addition to changes in body composition, compared to a standard, balanced low-calorie (LC) diet or bariatric surgery in patients with obesity. Body composition, ketosis, insulin sensitivity and myokines were evaluated in 79 patients with overweight/obesity after a therapy to lose weight with a VLCK diet, a LC diet or bariatric surgery. The follow-up was 6 months. The weight loss therapies induced changes in myokine levels in association with changes in body composition and biochemical parameters. The effects on circulating myokine levels compared to those at baseline were stronger after the VLCK diet than LC diet or bariatric surgery. Differences reached statistical significance for IL-8, MMP2 and irisin. In conclusion, nutritional interventions or bariatric surgery to lose weight induces changes in circulating myokine levels, being this effect potentially most notable after following a VLCK diet.

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Nutrients

Título del artículo:

Styles of reasoning according to the taxonomy structure of observed learning outcome of John Biggs in the students of geometry of the specialty of mathematics

The objective of this investigation was to determine the styles of reasoning according to the taxonomy structured of observed learning objectives of John Biggs in the students of geometry of the specialty of mathematics of the \"Universidad Pedagógica Experimental Libertador\", Venezuela. The stated problem is that teachers of mathematics must know the problems of teaching mathematics; besides, they should know how their students learn, since according to the reasoning styles of John Biggs, one can determine how and with what depth a person learns. The methodology is quantitative, not experimental, and descriptive at the field level, where specialized literature was reviewed, and the results obtained from the application of the test with the super-item, as a data collection instrument, were analyzed by objectives based on the construction of the database in statistical package for the social sciences, the statistical analysis and the detailed interpretation of the procedure performed for each item, which allowed the analysis and interpretation of the results. These results reach the uni-structural level catalogued by Biggs as inferior or superficial. Therefore, recommendations are offered to improve the learning level of the students in question.

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Journal of Physics: Conference Series

Título del artículo:

Spatial epidemiology of cutaneous leishmaniasis in Colombia: Socioeconomic and demographic factors associated with a growing epidemic

Background: Despite the identification of some environmental factors linked to the cutaneous leishmaniasis (CL) epidemic, little is known about the impact of environmental disturbances caused by human activities. We assessed the association between socioeconomic and demographic factors with the spatial structure of the CL epidemic in Colombia. Methods: Using data from more than 65 000 CL cases collected across the entire country from publicly available sources, we conducted a spatial clustering analysis to identify high burden areas (clusters) of CL. Associations between CL clusters and socioeconomic variables were investigated. Results: We identified seven statistically significant clusters of CL located across all Colombian biomes. Deforestation and livestock were statistically significantly associated with the spatial clustering of CL. Urbanization, time spent traveling to main cities and water bodies were other factors linked with the clustering of CL. Conclusions: This study found that human activities such as deforestation linked to agriculture, livestock production and mining activities are key drivers of the spatial distribution of the CL epidemic. The intensity of these human activities, which are projected to increase because of social and economic transformations in progress in Colombia, will potentially exacerbate the already growing CL epidemic in the country.

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Transactions of the Royal Society of Tropical Medicine and Hygiene

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Dose-Optimization of Respiratory-Gated Auricular Vagal Afferent Nerve Stimulation (RAVANS) for Blood Pressure Modulation in Hypertensive Patients

The objective of this study was to determine the optimal frequency of respiratory-gated auricular vagal afferent nerve stimulation (RAVANS) for the modulation of blood pressure in hypertensive patients.Twelve hypertensive subjects (52.5±6.0 years, 8 females) underwent five randomized stimulation sessions, during which they received exhalatory-gated stimulation at frequencies of 2, 10, 25, and 100 Hz or sham stimulation. A continuous blood pressure signal was collected during a 30-minute stimulation period and a 10-minute recovery period using a Finometer device (Finapress Medical System, the Netherlands). LabChart (ADInstruments, Colorado Springs, CO, USA) was used to process and compute blood pressure responses.A significantly greater reduction of systolic blood pressure values during stimulation was observed in the 100 Hz session compared to sham (p=0.02). In addition, significant reductions in diastolic blood pressure (p=0.04) and mean arterial pressure (p=0.04) values were observed during RAVANS stimulation compared to baseline during the 100 Hz session. Evaluation of other stimulation frequencies did not reveal significant results.RAVANS exhibits a frequency-dependent effect on the modulation of arterial blood pressure levels of hypertensive subjects.

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Computing in Cardiology

Título del artículo:

Comparative Study of the Antennal Phenotype in Species of the Belminus (Hemiptera: Triatominae) Genus Using Optical and Scanning Electron Microscopy

The genus Belminus Stål, 1859 is distinguished by markedly entomophagous species. This genus is a poorly studied group of the Triatominae (Jeannel, 1919), which includes hematophagous species that are vectors of Trypanosoma cruzi (Chagas, 1909), the etiological agent of Chagas disease. This study reports for the first time the description of the antennal sensilla of Belminus corredori (Galvão & Angulo, 2003), Belminus herreri (Lent & Wygodzinsky, 1979), and Belminus ferroae (Sandoval, Pabón, Jurberg & Galvão, 2007) nymphs and adults throughout scanning electron microscopy and optical microscopy. Nine morphological types of sensilla were identified in the three species, including bristles I and II, trichobothria, tapered hairs, thin-walled trichoid, thick-walled trichoid, basiconic, campaniform, and coeloconica sensilla. The analysis of the most abundant types of sensilla and their distribution in nymphs and adults shows similarities with the antennal phenotypes described in other Triatominae. Quantitative differences showed the important phenotypic plasticity of this morphological trait in the genus and allowed for the separation of the species in both sexes. These differences were associated with sexual dimorphism and wing condition (macropterous and brachypterous). The role of the antennal phenotype in sexual behavior, its usefulness as a taxonomic tool, and its relationship with the dispersal capacity of these species are discussed.

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Journal of Medical Entomology

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The Three Nociceptive Responses of the Orbicularis Oculi Reflex in Alzheimer’s Disease: State of the Evidence and Meta-analysis

There is an emerging belief that electrically elicited blink reflexes (BR) may distinguish Alzheimer’s disease (AD) from other disorders characterized by memory dysfunction. To qualitatively and quantitatively distinguish the effects that electrical stimulation has over the blink reflex (eBR) recorded from patients with AD and healthy controls (HCs), we did a systematic review of the literature, and conducted a meta-analysis. Following our selected criteria, 94 AD patients and 97 HCs were identified from articles published in English between 1950 and 2017. Although the 3 responses (R1, R2 and R3) of the eBR were studied in a number of patients, only the R2 response was quantified in all studies. Thresholds and stimulation intensities parameters were found to be used in a miscellaneous form, and the majority of times, such parameters deviated from validated guidelines. The stimulation frequencies used to elicit the BR responses ranged between 0.14 and 0.2 Hz. These frequencies favored HCs compared with AD patients (odds ratio = 1.08; 95% CI = 0.30-1.85), I2 = 0% [P =.99]; Q = 271.89 [df = 7, P <.000]). Egger’s regression test suggested publication bias (intercept = 32.38; 95% CI = −8.98 to −3.2; P =.001). Our results unveiled key shortcomings in the data reported; such shortcomings need to be corrected in future AD research looking for obtaining more reliable and reproducible eBR studies; otherwise, interventions may be misleading.

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Clinical EEG and Neuroscience

Título del artículo:

Fixed-dose combination antihypertensive medications

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The Lancet

Título del artículo:

Stable prevalence of chronic back disorders across gender, age, residence, and physical activity in Canadian adults from 2007 to 2014

Background: Chronic back disorders (CBD) are a global health problem and the leading cause of years lived with disability. The present study aims to examine overall and specific trends in CBD in the Canadian population aged 18 to 65 years. Methods: Data from the Canadian Community Health Survey (CCHS), a cross-sectional study, from 2007 to 2014 (8 cycles) were used to calculate CBD prevalence across gender, age, geographical area (urban/rural and ten provinces and northern territories), and physical activity levels. CBD was defined in the CCHS as having back problems, excluding fibromyalgia and arthritis, which have lasted or are expected to last six months or more and that have been diagnosed by a health professional. Prevalence of CBD using survey weights and associated 95% confidence intervals (95% CI) were calculated yearly using balanced repeated replications technique. Trend tests were calculated using joinpoint regressions; ArcGIS software was used for mapping. Results: Age-standardized CBD prevalence in 2007 and 2014 were 18.9% (95% CI = 18.4;19.5) and 17.8% (95% CI = 17.2,18.4), respectively. CBD prevalence was consistently higher in women, older age groups, rural dwellers, and people classified as inactive. Crude and age-standardized CBD prevalence decreased faster in people classified as physically active compared to those who were inactive (p < 0.006). Although CBD slightly decreased over time, no statistically significant trends were found overall or by gender, area of residence, province or level of physical activity. The prevalence of CBD remained consistently high in the province of Nova Scotia, and consistently low in the province of Quebec over the eight CCHS cycles. Conclusion: Despite prevention efforts, such as the Canadian back pain mass media campaign, CBD prevalence has remained stable between 2007 and 2014. Tailored prevention and management of CBD should consider gender, age, and geographical differences. Further longitudinal studies could elucidate the temporal relationship between potentially modifiable risk factors such as physical activity and CBD.

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BMC Public Health

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Seroprevalence and molecular detection of Toxoplasma gondii among donors in a blood bank in Cúcuta, Colombia Introduction: Toxoplasma gondii infection

Introduction: Toxoplasma gondii infection manifests differently in humans according to their immunity ranging from asymptomatic profiles to severe disease. There are multiple transmission mechanisms including blood transfusions, but little is known about the frequency of T. gondii infection in Colombia’s blood banks. Objective: To determine the prevalence of T. gondii infection in blood donors of a blood bank in the city of Cúcuta by serological and molecular diagnostic techniques. Materials and methods: We identified IgG and IgM antibodies against T. gondii by immunoassay in serum from 348 donors. The frequency of T. gondii DNA was determined by polymerase chain reaction (PCR) in whole blood from seropositive donors and relevant variables were analyzed based on the information obtained from surveys during blood donor selection. Results: Out of the 348 enrolled donors, 134 (38.5%) showed IgG antibodies against T. gondii; two of them (0.6%) had both IgG and IgM, and in two of them (1.5%), parasite DNA was detected in blood samples. A bivariate analysis indicated an association between seropositivity to T. gondii and being over 26 years of age (p=0.020). Conclusions: The prevalence of T. gondii infection found in the blood donors of this study suggests a significant exposure to the infectious agent that becomes relevant when parasitemia is detected.

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Biomedica : revista del Instituto Nacional de Salud

Título del artículo:

Antifungal activity and killing kinetics of anidulafungin, caspofungin and amphotericin B against Candida auris

Background: Candida auris is an emerging MDR pathogen. It shows reduced susceptibility to azole drugs and, in some strains, high amphotericin B MICs have been described. For these reasons, echinocandins were proposed as first-line treatment for C. auris infections. However, information on how echinocandins and amphotericin B act against this species is lacking. Objectives: Our aim was to establish the killing kinetics of anidulafungin, caspofungin and amphotericin B against C. auris by time–kill methodology and to determine if these antifungals behave as fungicidal or fungistatic agents against this species. Methods: The susceptibility of 50 C. auris strains was studied. Nine strains were selected (based on echinocandin MICs) to be further studied. Minimal fungicidal concentrations, in vitro dose–response and time–kill patterns were determined. Results: Echinocandins showed lower MIC values than amphotericin B (geometric mean of 0.12 and 0.94 mg/L, respectively). Anidulafungin and caspofungin showed no fungicidal activity at any concentration (maximum log decreases in cfu/mL between 1.34 and 2.22). On the other hand, amphotericin B showed fungicidal activity, but at high concentrations (≥2.00 mg/L). In addition, the tested polyene was faster than echinocandins at killing 50% of the initial inoculum (0.92 versus .8.00 h, respectively). Conclusions: Amphotericin B was the only agent regarded as fungicidal against C. auris. Moreover, C. auris should be considered tolerant to caspofungin and anidulafungin considering that their MFC:MIC ratios were mostly ≥32 and that after 6 h of incubation the starting inoculum was not reduced in .90%.

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Journal of Antimicrobial Chemotherapy

Título del artículo:

Aqueductal Cerebrospinal Fluid Stroke Volume Flow in a Rodent Model of Chronic Communicating Hydrocephalus: Establishing a Homogeneous Study Population for Cerebrospinal Fluid Dynamics Exploration

Background: Idiopathic normal pressure hydrocephalus (iNPH) is a cause of dementia that can be reversed when treated timely with cerebrospinal fluid (CSF) diversion. Understanding CSF dynamics throughout the development of hydrocephalus is crucial to identify prognostic markers to estimate benefit/risk to shunts. Objective: To explore the cerebral aqueduct CSF flow dynamics with phase-contrast magnetic resonance imaging (MRI) in a novel rodent model of adult chronic communicating hydrocephalus. Methods: Kaolin was injected into the subarachnoid space at the convexities in Sprague-Dawley adult rats. 11.7-T Bruker MRI was used to acquire T2-weighted images for anatomic identification and phase-contrast MRI at the cerebral aqueduct. Aqueductal stroke volume (ASV) results were compared with the ventricular volume (VV) at 15, 60, 90, and 120 days. Results: Significant ventricular enlargement was found in kaolin-injected animals at all times (P < 0.001). ASV differed between cases and controls/shams at every time point (P = 0.004, 0.001, 0.001, and <0.001 at 15, 60, 90, and 120 days, respectively). After correlation between the ASV and the VV, there was a significant correlation at 15 (P = 0.015), 60 (P = 0.001), 90 (P < 0.001), and 120 days. Moreover, there was a significant positive correlation between the VV expansion and the aqueductal CSF stroke between 15 and 60 days. Conclusions: An initial active phase of rapid ventricular enlargement shows a strong correlation between the expansion of the VV and the increment in the ASV during the first 60 days, followed by a second phase with less ventricular enlargement and heterogeneous behavior in the ASV. Further correlation with complementary data from intracranial pressure and histologic/microstructural brain parenchyma assessments are needed to better understand the ASV variations after 60 days.

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World Neurosurgery

Título del artículo:

Household, community, sub-national and country-level predictors of primary cooking fuel switching in nine countries from the PURE study

Introduction. Switching from polluting (e.g. wood, crop waste, coal) to clean (e.g. gas, electricity) cooking fuels can reduce household air pollution exposures and climate-forcing emissions. While studies have evaluated specific interventions and assessed fuel-switching in repeated cross-sectional surveys, the role of different multilevel factors in household fuel switching, outside of interventions and across diverse community settings, is not well understood. Methods. We examined longitudinal survey data from 24 172 households in 177 rural communities across nine countries within the Prospective Urban and Rural Epidemiology study. We assessed household-level primary cooking fuel switching during a median of 10 years of follow up (∼2005-2015). We used hierarchical logistic regression models to examine the relative importance of household, community, sub-national and national-level factors contributing to primary fuel switching. Results. One-half of study households (12 369) reported changing their primary cooking fuels between baseline and follow up surveys. Of these, 61% (7582) switched from polluting (wood, dung, agricultural waste, charcoal, coal, kerosene) to clean (gas, electricity) fuels, 26% (3109) switched between different polluting fuels, 10% (1164) switched from clean to polluting fuels and 3% (522) switched between different clean fuels. Among the 17 830 households using polluting cooking fuels at baseline, household-level factors (e.g. larger household size, higher wealth, higher education level) were most strongly associated with switching from polluting to clean fuels in India; in all other countries, community-level factors (e.g. larger population density in 2010, larger increase in population density between 2005 and 2015) were the strongest predictors of polluting-to-clean fuel switching. Conclusions. The importance of community and sub-national factors relative to household characteristics in determining polluting-to-clean fuel switching varied dramatically across the nine countries examined. This highlights the potential importance of national and other contextual factors in shaping large-scale clean cooking transitions among rural communities in low- and middle-income countries.

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Environmental Research Letters

Título del artículo:

Dulaglutide and renal outcomes in type 2 diabetes: an exploratory analysis of the REWIND randomised, placebo-controlled trial

Background: Two glucagon-like peptide-1 (GLP-1) receptor agonists reduced renal outcomes in people with type 2 diabetes at risk for cardiovascular disease. We assessed the long-term effect of the GLP-1 receptor agonist dulaglutide on renal outcomes in an exploratory analysis of the REWIND trial of the effect of dulaglutide on cardiovascular disease. Methods: REWIND was a multicentre, randomised, double-blind, placebo-controlled trial at 371 sites in 24 countries. Men and women aged at least 50 years with type 2 diabetes who had either a previous cardiovascular event or cardiovascular risk factors were randomly assigned (1:1) to either weekly subcutaneous injection of dulaglutide (1·5 mg) or placebo and followed up at least every 6 months for outcomes. Urinary albumin-to-creatinine ratios (UACRs) and estimated glomerular filtration rates (eGFRs) were estimated from urine and serum values measured in local laboratories every 12 months. The primary outcome (first occurrence of the composite endpoint of non-fatal myocardial infarction, non-fatal stroke, or death from cardiovascular causes), secondary outcomes (including a composite microvascular outcome), and safety outcomes of this trial have been reported elsewhere. In this exploratory analysis, we investigate the renal component of the composite microvascular outcome, defined as the first occurrence of new macroalbuminuria (UACR >33·9 mg/mmol), a sustained decline in eGFR of 30% or more from baseline, or chronic renal replacement therapy. Analyses were by intention to treat. This trial is registered with ClinicalTrials.gov, number NCT01394952. Findings: Between Aug 18, 2011, and Aug 14, 2013, 9901 participants were enrolled and randomly assigned to receive dulaglutide (n=4949) or placebo (n=4952). At baseline, 791 (7·9%) had macroalbuminuria and mean eGFR was 76·9 mL/min per 1·73 m2 (SD 22·7). During a median follow-up of 5·4 years (IQR 5·1–5·9) comprising 51 820 person-years, the renal outcome developed in 848 (17·1%) participants at an incidence rate of 3·5 per 100 person-years in the dulaglutide group and in 970 (19·6%) participants at an incidence rate of 4·1 per 100 person-years in the placebo group (hazard ratio [HR] 0·85, 95% CI 0·77–0·93; p=0·0004). The clearest effect was for new macroalbuminuria (HR 0·77, 95% CI 0·68–0·87; p<0·0001), with HRs of 0·89 (0·78–1·01; p=0·066) for sustained decline in eGFR of 30% or more and 0·75 (0·39–1·44; p=0·39) for chronic renal replacement therapy. Interpretation: Long-term use of dulaglutide was associated with reduced composite renal outcomes in people with type 2 diabetes. Funding: Eli Lilly and Company.

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The Lancet

Título del artículo:

Dulaglutide and cardiovascular outcomes in type 2 diabetes (REWIND): a double-blind, randomised placebo-controlled trial

Background: Three different glucagon-like peptide-1 (GLP-1) receptor agonists reduce cardiovascular outcomes in people with type 2 diabetes at high cardiovascular risk with high glycated haemoglobin A1c (HbA1c) concentrations. We assessed the effect of the GLP-1 receptor agonist dulaglutide on major adverse cardiovascular events when added to the existing antihyperglycaemic regimens of individuals with type 2 diabetes with and without previous cardiovascular disease and a wide range of glycaemic control. Methods: This multicentre, randomised, double-blind, placebo-controlled trial was done at 371 sites in 24 countries. Men and women aged at least 50 years with type 2 diabetes who had either a previous cardiovascular event or cardiovascular risk factors were randomly assigned (1:1) to either weekly subcutaneous injection of dulaglutide (1·5 mg) or placebo. Randomisation was done by a computer-generated random code with stratification by site. All investigators and participants were masked to treatment assignment. Participants were followed up at least every 6 months for incident cardiovascular and other serious clinical outcomes. The primary outcome was the first occurrence of the composite endpoint of non-fatal myocardial infarction, non-fatal stroke, or death from cardiovascular causes (including unknown causes), which was assessed in the intention-to-treat population. This study is registered with ClinicalTrials.gov, number NCT01394952. Findings: Between Aug 18, 2011, and Aug 14, 2013, 9901 participants (mean age 66·2 years [SD 6·5], median HbA1c 7·2% [IQR 6·6–8·1], 4589 [46·3%] women) were enrolled and randomly assigned to receive dulaglutide (n=4949) or placebo (n=4952). During a median follow-up of 5·4 years (IQR 5·1–5·9), the primary composite outcome occurred in 594 (12·0%) participants at an incidence rate of 2·4 per 100 person-years in the dulaglutide group and in 663 (13·4%) participants at an incidence rate of 2·7 per 100 person-years in the placebo group (hazard ratio [HR] 0·88, 95% CI 0·79–0·99; p=0·026). All-cause mortality did not differ between groups (536 [10·8%] in the dulaglutide group vs 592 [12·0%] in the placebo group; HR 0·90, 95% CI 0·80–1·01; p=0·067). 2347 (47·4%) participants assigned to dulaglutide reported a gastrointestinal adverse event during follow-up compared with 1687 (34·1%) participants assigned to placebo (p<0·0001). Interpretation: Dulaglutide could be considered for the management of glycaemic control in middle-aged and older people with type 2 diabetes with either previous cardiovascular disease or cardiovascular risk factors. Funding: Eli Lilly and Company.

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The Lancet

Título del artículo:

Physical activity in institutions of integral care to the early childhood

Objective To describe the knowledge about physical activity of the directors and educational agents that work in two institutions of integral care to the early childhood of the municipality of Los Patios, Colombia. Magisterial and Methods Qualitative research with field design, in which was applied an instrument type interview to 2 directors and 22 educational agents of the institutions of integral care to the early childhood that caters 500 girls and boys. The analysis of the information was done through the ATLAS software. You. Results It was identified that they do possess knowledge of physical activity, their benefits and the importance of fostering healthy habits in early childhood; on the other hand, the concept of physical activity covers many important aspects not only from the point of view of the prevention of illnesses but the importance in the growth and development of the children to have healthy adults in the future and with lower index of chronic diseases. Conclusion In addition to the knowledge of basic aspects of physical activity by the educational agents and directors, training and accompaniment of professionals and state agencies is required in a joint work that extends to the family and allows the promotion of the Physical activity as a healthy habit from childhood.

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Revista de Salud Publica

Título del artículo:

Physical exercise in the patient with renal failure

Kidney disease is a pathology where the kidneys are seriously damaged, generating alterations in the ability to filter toxins and other waste substances in the blood. The aim of this study was to evidence the effects and role of physiotherapeutic intervention in patients with kidney disease. A systematic review was conducted, with retrospective and descriptive analysis, of scientific articles published in indexed databases between January 2007 and November 2018. The search was performed for studies in the EBSCO, SciELO, MEDLINE, Medscape, PubMed databases, as well as in Central, EMBASE, REDALYC, DOAJ, OVID and several journals on the subject. The criteria for inclusion of studies were used for systematic reviews of the PRISMA Statement, and a riskof-bias assessment was performed through the evaluation of the Cochrane Collaboration and the PEDro scale. 68,620 scientific articles were recovered before applying the corresponding filters. After that, 20 articles were obtained which support the existence of an improvement in the quality of life, strength, physical capacity, oxygen consumption, physical, mental and social well-being in patients with renal failure. The performance of physical exercise in patients with renal failure improves the physical, social and mental response, as well as the activities of daily living. These effects are the result of an evaluation, prescription and adequate monitoring of the exercise. Therefore, we conclude it is essential that a professional in physiotherapy should participate in the interdisciplinary team necessary for the treatment of kidney disease.

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Revista de Nefrologia, Dialisis y Trasplante

Título del artículo:

Design of a gastric cancer model in SCID mice by means of genetic engineering of normal human gastric mucosa cells: Advances

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Iatreia

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Semisynthetic eugenol derivatives as antifungal agents against dermatophytes of the genus Trichophyton

Purpose. Eugenol, the main component of clove bud essential oil (Eugenia caryophyllus), has been linked to antimicrobial, anti-inflammatory, insecticidal and immunomodulatory properties. The purpose of this study was to evaluate the antifungal and cytotoxic activity of eugenol, the essential oil of Eugenia caryophyllus, and some semisynthetic derivatives of eugenol against dermatophytes of the genus Trichophyton. Methodology. We evaluated the antifungal effect of the compounds, determining the minimum inhibitory concentrations (MICs) by the microdilution method and the minimum fungicidal concentrations by cultures from the inhibitions. Additionally, the inhibition of the radial growth of the mycelium of the dermatophyte fungi was tested by poisoned substrate. Cytotoxicity was measured by the colorimetric method on Vero cells. Results: All of the eugenol compounds tested exhibited antifungal properties, showing MICs of 62.5–500 µg ml−1, determined within three dermatophyte species: Trichophyton rubrum, Trichophyton mentagrophytes and Trichophyton tonsurans. Among these derivatives, methyl isoeugenol, at concentrations of 300 and 100 µg ml−1, was found to completely inhibit (100 %) radial growth of the mycelium of all three species after 20 days of treatment. Additionally, phenotypic variations related to the decrease in pigment production of T. rubrum were observed after treatment with O-ethyl and O-butyl isoeugenol derivatives. Meanwhile, all of the tested (iso)eugenol molecules exhibited moderate toxicity in Vero cells [50 % cytotoxic concentration (the concentration required for a 50 % reduction in cell viability; CC50): 54.06–265.18 µg ml−1). Conclusion: The results suggest that the semisynthetic eugenol derivatives (SEDs) show promising antifungal activity and selectivity against dermatophyte fungi.

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Journal of Medical Microbiology

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Evolution and interspecies transmission of canine distemper virus—an outlook of the diverse evolutionary landscapes of a multi-host virus

Canine distemper virus (CDV) is a worldwide distributed virus which belongs to the genus Morbillivirus within the Paramyxoviridae family. CDV spreads through the lymphatic, epithelial, and nervous systems of domestic dogs and wildlife, in at least six orders and over 20 families of mammals. Due to the high morbidity and mortality rates and broad host range, understanding the epidemiology of CDV is not only important for its control in domestic animals, but also for the development of reliable wildlife conservation strategies. The present review aims to give an outlook of the multiple evolutionary landscapes and factors involved in the transmission of CDV by including epidemiological data from multiple species in urban, wild and peri-urban settings, not only in domestic animal populations but at the wildlife interface. It is clear that different epidemiological scenarios can lead to the presence of CDV in wildlife even in the absence of infection in domestic populations, highlighting the role of CDV in different domestic or wild species without clinical signs of disease mainly acting as reservoirs (peridomestic and mesocarnivores) that are often found in peridomestic habits triggering CDV epidemics. Another scenario is driven by mutations, which generate genetic variation on which random drift and natural selection can act, shaping the genetic structure of CDV populations leading to some fitness compensations between hosts and driving the evolution of specialist and generalist traits in CDV populations. In this scenario, the highly variable protein hemagglutinin (H) determines the cellular and host tropism by binding to signaling lymphocytic activation molecule (SLAM) and nectin-4 receptors of the host; however, the multiple evolutionary events that may have facilitated CDV adaptation to different hosts must be evaluated by complete genome sequencing. This review is focused on the study of CDV interspecies transmission by examining molecular and epidemiological reports based on sequences of the hemagglutinin gene and the growing body of studies of the complete genome; emphasizing the importance of long-term multidisciplinary research that tracks CDV in the presence or absence of clinical signs in wild species, and helping to implement strategies to mitigate the infection. Integrated research incorporating the experience of wildlife managers, behavioral and conservation biologists, veterinarians, virologists, and immunologists (among other scientific areas) and the inclusion of several wild and domestic species is essential for understanding the intricate epidemiological dynamics of CDV in its multiple host infections.

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Viruses

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Inhibition of C. albicans dimorphic switch by cobalt(II) complexes with ligands derived from pyrazoles and dinitrobenzoate: Synthesis, characterization and biological activity

Seven cobalt(II) complexes of pyrazole derivatives and dinitrobenzoate ligands were synthesized and characterized. The single-crystal X-ray diffraction structure was determined for one of the ligands and one of the complexes. The analysis and spectral data showed that all the cobalt complexes had octahedral geometries, which was supported by DFT calculations. The complexes and their free ligands were evaluated against fungal strains of Candida albicans and emerging non-albicans species and epimastigotes of Trypanosoma cruzi. We obtained antifungal activity with a minimum inhibitory concentration (MIC) ranging from 31.3 to 250 µg mL−1 . The complexes were more active against C. krusei, showing MIC values between 31.25 and 62.5 µg mL−1 . In addition, some ligands (L1–L6) and complexes (5 and Co(OAc)2 · 4H2 O) significantly reduced the yeast to hypha transition of C. albicans at 500 µg mL−1 (inhibition ranging from 30 to 54%). Finally, the complexes and ligands did not present trypanocidal activity and were not toxic to Vero cells. Our results suggest that complexes of cobalt(II) with ligands derived from pyrazoles and dinitrobenzoate may be an attractive alternative for the treatment of diseases caused by fungi, especially because they target one of the most important virulence factors of C. albicans.

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International Journal of Molecular Sciences

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Health Care Expenditures of Medicare Beneficiaries with Normal Pressure Hydrocephalus

Background: Normal pressure hydrocephalus (NPH) is an underdiagnosed and undertreated condition affecting the elderly population and with costs associated with its surgical management reported to be less than those associated with conservative management. Objective: To determine if the rate of diagnosis of NPH has improved over the last decade, the rate of treatment has increased, and if surgical treatment costs and socioeconomic factors related to receipt of treatment have changed over time compared with conservative therapy. Methods: A retrospective study based on data from a nationally representative random sample of 2,378,637 Medicare beneficiaries (2006–2010) was performed. Shunt surgery, shunt revision, replacement, and removal were analyzed as independent variables. Results: A total of 2321 patients with NPH were included, with 580 (24.99%) receiving a first shunt procedure. The adjusted effect of the procedure is that total 5-year expenditures are $11,676 more per patient (P < 0.001) than expenditures associated with nonsurgical management. Shunt revision ($22,715, P < 0.01) and/or replacement ($46,607, P < 0.001) add significantly to 5-year expenditures. Socioeconomic factors including African American race (P = 0.006); age 75–79 years (P = 0.024), 80–84 years (P < 0.001), and ≥85 years (P < 0.001); and Medicaid (P < 0.001) have significant negative associations with shunt surgery. Conclusions: There was a 1.66-fold increase in the rate of diagnosis of NPH, from 0.12% in 1999 to 0.2% in 2008. The total costs per surgical patient rose by approximately 145% to 160% comparing 2001 and 2010. This increase was mainly due to hospital (by 167% to 168%) and home health costs (by 118% to 148%). Providing appropriate care across the socioeconomic spectrum warrants further study and requires identifying the factors that limit access to care.

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World Neurosurgery