Título del artículo:

Similar cardiovascular outcomes in patients with diabetes and established or high risk for coronary vascular disease treated with dulaglutide with and without baseline metformin

Objective : Recent European Guidelines for Diabetes, Prediabetes and Cardiovascular Diseases introduced a shift in managing patients with type 2 diabetes at high risk for or established cardiovascular (CV) disease by recommending GLP-1 receptor agonists and SGLT-2 inhibitors as initial glucose-lowering therapy. This is questioned since outcome trials of these drug classes had metformin as background therapy. In this post hoc analysis, the effect of dulaglutide on CV events was investigated according to the baseline metformin therapy by means of a subgroup analysis of the Researching Cardiovascular Events with a Weekly Incretin in Diabetes (REWIND) trial. Research design and methods : Patients in REWIND (n = 9901; women: 46.3%; mean age: 66.2 years) had type 2 diabetes and either a previous CV event (31%) or high CV risk (69%). They were randomized (1:1) to sc. dulaglutide (1.5 mg/weekly) or placebo in addition to standard of care. The primary outcome was the first of a composite of nonfatal myocardial infarction, nonfatal stroke, and death from cardiovascular or unknown causes. Key secondary outcomes included a microvascular composite endpoint, all-cause death, and heart failure. The effect of dulaglutide in patients with and without baseline metformin was evaluated by a Cox regression hazard model with baseline metformin, dulaglutide assignment, and their interaction as independent variables. Adjusted hazard ratios (HRs) and 95% confidence intervals (CIs) were estimated by a Cox regression model with adjustments for factors differing at baseline between people with vs. without metformin, identified using the backward selection. Results : Compared to patients with metformin at baseline (n = 8037; 81%), those without metformin (n = 1864; 19%) were older and slightly less obese and had higher proportions of women, prior CV events, heart failure, and renal disease. The primary outcome occurred in 976 (12%) participants with baseline metformin and in 281 (15%) without. There was no significant difference in the effect of dulaglutide on the primary outcome in patients with vs. without metformin at baseline [HR 0.92 (CI 0.81-1.05) vs. 0.78 (CI 0.61-0.99); interaction P = 0.18]. Findings for key secondary outcomes were similar in patients with and without baseline metformin. Conclusion : This analysis suggests that the cardioprotective effect of dulaglutide is unaffected by the baseline use of metformin therapy.

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European Heart Journal

Título del artículo:

Professors’ perception about evaluation of clinical nursing practice

Introduction: Meta-evaluation, as an instrument in quality processes, has permitted to support decision-making inhigher education institutions, with respect to improvement of the teaching-learning process, by allowing to followup academic discourses and their implementation by professors; in this scenario, new interpretations of the evaluation phenomenon have been found. Objective: To describe professors\' perceptions about the evaluation of the Nursing program at University of Santander in the academic period B-2018 concerning clinical practice formation. Methods: Descriptive, exploratory and qualitative research. The population was made up of professors of theoretical-practical subjects of the Nursing program ofUniversity of Santander. The sampling was intentional (selection by criteria). The data collected was processed using the IRAMUTEQ software. Results: The lexical analysis support resulted in two thematic axes, made up of four semantic classes:thematic axis # 1 (quantitative process to be passed), which contains the classes 1 and 2 (evaluation as qualification and feedback process); and thematic axis # 2 (evaluation guidelines), which contain the classes 3 and 4 (student-centered progress and final evaluation of performance). Conclusions: Professors’ perception about the evaluation of clinical nursing practice is considered in terms of measurement and qualification.

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Revista Cubana de Educacion Medica Superior

Título del artículo:

Fixed-dose combination therapies for cardiovascular prevention: the route traveled

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Revista Colombiana de Cardiologia

Título del artículo:

Histology and structure of the testicles in three species of atelopus frogs (Anura: Bufonidae) endemic to the sierra nevada de Santa Marta, Colombia

Introduction: Testicular histology constitutes one of the least explored aspects in frogs of the genus Atelopus. This taxonomic group shows an alarming population decline; therefore, its reproductive biology is one of the greatest topics of interest for its conservation. Objective: To describe the testicular morphology and the spermatogenetic lineage cells in adult males of Atelopus laetissimus, Atelopus nahumae, and Atelopus carrikeri in the Sierra Nevada de Santa Marta, Colombia. Methods: During June – July 2017 and 2018, sampling was conducted in the localities of San Lorenzo and Páramo Cebolletas, Sierra Nevada de Santa Marta (SNSM), to collect 15 adult males, 5 per species. Testes samples were fixed in Bouin to be processed by the standard paraffin-embedding technique. Histological sections (3 μm) were stained with Hematoxylin-eosin and Mallory-Heidenhain-Azan-Gomori’s. For the description and photographic register of the germ cells, the photonic microscopy technique was used with the differential interference contrast system. Results: The testes are oval organs, compact, light yellow color, and with little vascularization. Externally, they are surrounded by a thin albuginea tunic constituted by regular dense connective tissue. Inside this layer, they are composed of numerous seminiferous tubules of hexagonal contour, in which germ cell cysts are distinguished at different stages of spermatogenesis (spermatogonia I and II, spermatocyte I and II, and early and late spermatids) and spermiogenesis (spermatozoa in fascicles and free spermatozoa). Separating the seminiferous structures is the interstitial tissue in which Leydig cells and blood vessels stand out. Additionally, in the cranial part of the testis, the Bidder’s organ was found, formed by two distinguishable regions, the cortex and the medulla. In the cortex, there are previtellogénic oocytes of different sizes surrounded by a monolayer of flat follicular cells. For its part, the medullary region is the connective tissue that nourishes the oocytes and is constituted by blood capillaries. Conclusions: The gonads of the three species analyzed present a cystic cellular organization similar to other anurans, where all stages of spermatogenesis and spermiogenesis were identified, possibly indicating a con-tinuous reproductive activity. Likewise, the Bidder’s organ is reported for the first time in the three Atelopus species, which allows suggesting a possible sexual reversion in case of a population decrease of females as a reproductive strategy.

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Revista de Biologia Tropical

Título del artículo:

Microsporogenesis and micromorphology of pollen grains of the plant alcea rosea (Malvaceae)

Introduction: Studies on microsporogenesis, micromorphology and structure of pollen grains in Malvaceae are scarce. Objectives: To describe the process of microsporogenesis and micromorphological aspects of pollen grains in A. rosea. Methods: Androphores were processed according to standard protocols for sectioning in paraffin. The obtained sections were stained with Safranin-Alcian blue, Aniline blue was used for immature and unfixed anthers and for resin sections of the androphores, Toluidine blue. Ultrathin sections were observed with transmission electron microscopy. For observation with scanning electron microscopy the material was fixed and dehydrated in 2.2 dimethoxypropane, dried to a critical point and coated with gold. Results: Anthers differentiate from a cell mass at the distal ends of the stamen filaments. The wall of the mature anther presents an outer layer of epidermal cells and an inner layer, the endothecium. Microspore mother cells divide by mitosis and then undergo meiosis to form tetrads. The tapetum is initially cellular and forms a single layer of cells and then loses cellular integrity by invading the microsporangium locule, forming a periplasmodia, by the time the pollen grains are released it degenerated. During sporodermis formation, exine is first deposited and then intine. Pollen grains are pantoporate, apolar, with radial symmetry, spheroidal, with spines, bacula, granules and microgranules. Tectum is perforated with foveolae arranged homogeneously over the whole surface and pollenkit is present. Exine is broad and consists of a thick 3.5 to 4 µm endexine and a thin ektexine (0.6-0.7 µm). The ultrastructure shows columellae forming the infratectum. Capitate glandular unicellular nectariferous trichomes covers the whole surface of the stamen filaments. Conclusions: The structure and development of the anthers follows the known patterns for angiosperms. Simultaneous microsporogenesis and centripetal deposit of the sporodermis have been previously described for Malvaceae.

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Revista de Biologia Tropical

Título del artículo:

A commentary on “author level metrics and academic productivity” (int J surg 2021; 90:105,965)

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International Journal of Surgery

Título del artículo:

Prevalence of metabolic syndrome and diabetes mellitus type-2 and their association with intake of dairy and legume in Andean communities of Ecuador

Metabolic syndrome (MetS) and type 2 diabetes (T2D) are metabolic alterations associated with high morbidity and mortality, particularly in low and middle-income countries. Diet has a significant impact on the risk to develop MetS and T2D; in this regard, consumption of fruits, vegetables, and protein rich foods (from plant and animals) are important to prevent and manage these pathologies. There are limited studies regarding the potential association between Andean foods rich in proteins and the presence of cardio-metabolic conditions in Ecuador. It is necessary to develop new low-cost, local-culturally acceptable strategies to reduce the burden of cardio-metabolic diseases. We describe the prevalence (baseline data) of MetS and T2D in the Ecuadorian cohort of the Prospective Urban and Rural Epidemiology (PURE) study and their potential association with the consumption of protein rich foods, including beef, white meat, dairy and legumes. In this cross-sectional study, we assessed 1,997 individuals aged 35–70 years (mean age 51 years, 72% women), included in the Ecuadorian cohort of the PURE study, from February to December 2018. The prevalence of MetS was 42% for male and 44% for female participants; the prevalence of T2D was 9% for male and 10% for female. Metabolic syndrome and T2D were more common in women older than 50 years of age with primary education or less, low economic income, and with obesity; MetS was more frequent in the rural area while T2D was more frequent in the urban area. Using logistic regression analysis, we observed a significant protective effect of higher consumption of dairy and legumes in the prevalence of MetS and T2D compared with low consumption. It will be important to develop policies for ample production and consumption of protein rich foods such as legumes and dairy, part of traditional diets, to reduce the burden of cardio-metabolic diseases.

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PLoS ONE

Título del artículo:

Cattle seroprevalence and risk factors associated with bovine viral diarrhea in the northeastern of Colombia

Bovine viral diarrhea (BVD) is one of the most common and economically significant viral infections in cattle. Different risk factors have been associated with viral exposure and transmission, generating endemic regions with different biotype circulations. To find the BVD status in the northeastern region of Colombia, this study aimed to determine the seroprevalence and risk factors associated with the disease in non-vaccinated farms. For this purpose, a two-time point sampling strategy was developed, obtaining serum from 1157 animals housed in 25 farms distributed in 46 townships, thus for antibody detection against non-structural protein 3 (NS3, p80) of bovine viral diarrhea virus (BVDV) using an indirect ELISA test. For the first time in Colombia, the presence of serological persistent cattle was evaluated in 1047 animals 3 weeks later of first sampling. The information on a standardized questionnaire with closed and dichotomic answers was used to calculate the putative risk factors. The association analysis by univariate and multivariate logistic regression reported odds ratios (OR) with a 95% of confidence interval (C.I). The overall seroprevalence was 65% (95% CI 62.5–72.9%), with variations according to age ranges. The prevalence of persistent serological positive corresponded to 37.7% (95% CI 34.2–41.5). The risk factors found by multivariate analyses were the lease of pastures (OR = 2.071 CI 1.485–3.690), the use of the same needle (OR = 2.249 CI 1.354–3.736), the molasses supplementation (OR = 2.742 CI 1.156–5.807), and the native Creole breed (OR = 1.895 CI 1.416–2.804). The results of this study confirmed the endemism and higher common exposure to BVDV, as well as the presence of serological persistent cattle in Valledupar, Colombia.

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Tropical Animal Health and Production

Título del artículo:

Drill design using the ’control-chaos continuum’: Blending science and art during return to sport following knee injury in elite football

Establishing the level of risk, planning and adapting the return to sport (RTS) process following a complex knee injury involves drawing on a combination of relevant high-quality evidence and practitioner experience. On-pitch rehabilitation is a critical element of this process, providing an effective transition from rehabilitation to team training. The ‘control-chaos continuum’ (CCC) is an adaptable framework for on-pitch rehabilitation moving from high control to high chaos, progressively increasing running load demands and incorporating greater perceptual and neurocognitive challenges within sport-specific drills. Drills are a key element of the CCC, and are designed to ensure specificity, ecological validity and maintaining player interest. We showcase drill progression through the phases of the CCC, highlighting the use of constraints to create drills that incorporate the physical, technical, tactical and injury-specific needs of the player. We also provide recommendations to help practitioners create training session content using the CCC to help replicate the demands of team training within their own environment.

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Physical Therapy in Sport

Título del artículo:

The effects of maintenance cardiac rehabilitation: A systematic review and Meta-analysis, with a focus on sex

Phase III/IV cardiac rehabilitation (CR) is recommended to promote maintenance of benefits achieved during Phase II; there has been no meta-analysis to test this to date. This study determined the effects of maintenance CR on any outcome, with consideration of sex. Seven databases were searched from inception-January 2020. Randomized controlled trials on the effects of maintenance CR in cardiovascular disease patients who had graduated from CR were included. Level of evidence was evaluated with GRADEPro. 819 citations were identified, with 10 trials (21 papers) included (5238 participants; 859 [16.4%] female). Maintenance CR resulted in lower low-density lipoprotein (mean difference [MD]=-0.58; 95% confidence interval [CI]=-1.06–-0.10, n = 392) and greater quality of life (MD = 0.28, 95% CI = 0.05–0.52, n = 118) when compared to usual care only. Outcomes for women and sex differences were mixed. In conclusion, maintenance programs appear to sustain patient\'s quality of life, but more focus on women\'s outcomes is needed.

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Heart and Lung

Título del artículo:

Considerations in interpreting neuromuscular state in elite level Australian Rules football players

Objectives: Examine the influence of test modality, season stage, match load and physical qualities on the interpretation of neuromuscular function (NF) post Australian Rules Football (ARF) matches. Design: Repeated measures design. Methods: Thirty-two elite ARF players’ NF was assessed 72 h following competitive matches (7 ± 2) via the counter movement jump (CMJ) and isometric mid-thigh pull (IMTP). Influence of season stage, external load parameters (GPS; 10 Hz) and moderating influences of lower body strength (LBS), lower body power (LBP) and intermittent exercise capacity upon NF recovery were assessed using linear mixed effects models. Results: Moderate negative seasonal trends were evident for both rate of force development (RFD) 0−100 ms (d = −0.86, 95%, CI: ±0.57) and 0−200 ms (d = −0.76, CI: ±0.64). Significant but trivial effects of match load were observed between one standardised unit increase in high speed running (HSR) versus CMJ: Force at zero velocity (d = 0.12, CI: ±0.12), and sum of high intensity accelerations and CMJ: Eccentric deceleration RFD (d = −0.18, CI: ±0.14). Accounting for baseline LBS better explained (weight of evidence: W = 87%) seasonal trends observed in IMTP: peak force, with lower LBS showing greater capacity for improvement. Positive moderating influences were observed with baseline LBS and LBP (W = 91 & 75%) on CMJ: eccentric mean power responses to HSR, and CMJ: jump height responses to very-HSR, respectively. Conclusions: Interpretation of athlete NF responses is complicated by the inconsistent and interacting influence of contextual factors (assessment modality, stage of season, load), in-particular higher baseline LBS and LBP may improve acute load related responses of NF.

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Journal of Science and Medicine in Sport

Título del artículo:

Fire-resistant cellulose boards from waste newspaper, boric acid salts, and protein binders

Housing construction consumes more materials than any other economic activity, with a total of 40.6 Gt/year. Boards are placed between construction materials to serve as non-load-bearing partitions. Studies have been performed to find alternatives to conventional materials using recycled fibers, agro-industrial waste, and protein binders as raw materials. Here, fire-resistant cellulose boards with low density and adequate flexural strength were produced for use as non-load-bearing partitions using waste newspapers, soy protein, boric acid, and borax. A central composite design was employed to study the influence of the board component percentage on flame retardancy (UL 94 horizontal burning test), density (ASTM D1037–12), and flexural strength (ISO 178–2010). The cellulose boards were characterized by thermal analysis (ASTM E1131–14) and scanning electron microscopy. Fire-resistant cellulose boards were successfully made with low densities (120–170 kg/m3) and flexural strength (0.06–0.64 MPa). The mechanical performance and fire resistance of cellulose boards suggest their suitability for use as building materials. A useful and sustainable construction material with great potential is produced with the valorization of waste materials. Graphic abstract: [Figure not available: see fulltext.].

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Clean Technologies and Environmental Policy

Título del artículo:

Evaluation of cardiometabolic profile in Health Professionals of Latin America

Objective: To evaluate presence of risk factors for cardiovascular diseases (CVD) and type 2 diabetes mellitus (DM2) in a group of health care workers. Methods: During the X Latin American Congress of Internal Medicine held in August 2017, in Cartagena, Colombia, attendees were invited to participate in the study that included a survey on medical, pharmacological and family history, lifestyle habits, blood pressure measurement, anthropometry, muscle strength and laboratory studies. The INTERHEART and FINDRISC scales were used to calculate the risk of CVD and diabetes, respectively. Results: Among 186 participants with an average age of 37.9 years, 94% physicians (52.7% specialists), the prevalence of hypertension was 20.4%, overweight 40.3%, obesity 19.9%, and dyslipidemia 67.3%. 20.9% were current smokers or had smoked, and 60.8% were sedentary. Hypertensive patients were found to be older, had higher Body Mass Index (BMI), higher waist circumference, higher waist-to-hip ratio, higher of body fat and visceral fat, smoked more and had lower muscle strength (high jump: 0.38 vs. 0.42̊cm; p̊=̊0.01). In 44.3% of participants was observed a high-risk score for CVD. The prevalence of diabetes was 6.59% and 27.7% were at risk. Conclusion: The prevalence of risk factors for CVD among the Latin American physicians studied was similar to that reported in the general population. The prevalence of high-risk scores for CVD and DM2 was high and healthy lifestyle habits were low. It is necessary to improve adherence to healthy lifestyles among these physicians in charge of controlling these factors in the general population.

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Clinica e Investigacion en Arteriosclerosis

Título del artículo:

Timing and Length of Nocturnal Sleep and Daytime Napping and Associations with Obesity Types in High-, Middle-, and Low-Income Countries

Importance: Obesity is a growing public health threat leading to serious health consequences. Late bedtime and sleep loss are common in modern society, but their associations with specific obesity types are not well characterized. Objective: To assess whether sleep timing and napping behavior are associated with increased obesity, independent of nocturnal sleep length. Design, Setting, and Participants: This large, multinational, population-based cross-sectional study used data of participants from 60 study centers in 26 countries with varying income levels as part of the Prospective Urban Rural Epidemiology study. Participants were aged 35 to 70 years and were mainly recruited during 2005 and 2009. Data analysis occurred from October 2020 through March 2021. Exposures: Sleep timing (ie, bedtime and wake-up time), nocturnal sleep duration, daytime napping. Main Outcomes and Measures: The primary outcomes were prevalence of obesity, specified as general obesity, defined as body mass index (BMI; calculated as weight in kilograms divided by height in meters squared) of 30 or greater, and abdominal obesity, defined as waist circumference greater than 102 cm for men or greater than 88 cm for women. Multilevel logistic regression models with random effects for study centers were performed to calculate adjusted odds ratios (AORs) and 95% CIs. Results: Overall, 136652 participants (81652 [59.8%] women; mean [SD] age, 51.0 [9.8] years) were included in analysis. A total of 27195 participants (19.9%) had general obesity, and 37024 participants (27.1%) had abdominal obesity. The mean (SD) nocturnal sleep duration was 7.8 (1.4) hours, and the median (interquartile range) midsleep time was 2:15 am (1:30 am-3:00 am). A total of 19660 participants (14.4%) had late bedtime behavior (ie, midnight or later). Compared with bedtime between 8 pm and 10 pm, late bedtime was associated with general obesity (AOR, 1.20; 95% CI, 1.12-1.29) and abdominal obesity (AOR, 1.20; 95% CI, 1.12-1.28), particularly among participants who went to bed between 2 am and 6 am (general obesity: AOR, 1.35; 95% CI, 1.18-1.54; abdominal obesity: AOR, 1.38; 95% CI, 1.21-1.58). Short nocturnal sleep of less than 6 hours was associated with general obesity (eg, <5 hours: AOR, 1.27; 95% CI, 1.13-1.43), but longer napping was associated with higher abdominal obesity prevalence (eg, ≥1 hours: AOR, 1.39; 95% CI, 1.31-1.47). Neither going to bed during the day (ie, before 8pm) nor wake-up time was associated with obesity. Conclusions and Relevance: This cross-sectional study found that late nocturnal bedtime and short nocturnal sleep were associated with increased risk of obesity prevalence, while longer daytime napping did not reduce the risk but was associated with higher risk of abdominal obesity. Strategic weight control programs should also encourage earlier bedtime and avoid short nocturnal sleep to mitigate obesity epidemic..

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JAMA Network Open

Título del artículo:

Compassion fatigueand related factors in intensive care nurses:A multicentre study

Objective: To determine the levels of compassion fatigue and its Related factors in nursing professionals from three Units Intensive Care. Material and methods: Cross-sectional correlational study carried out between February 2018 and February 2020. A sampling at convenience. The Quality of life questionnaire for professionals ProQOL (Professional Quality of Life Scale) was applied. Results: In general, it was found according to the scale guidelines lower than average levels of compassion satisfaction 45.71% (n = 32), mean levels of Burnout: 56.34% (n = 40) and mean levels of compassion trauma: 49.30% (n = 35). Significant differences were not found in relation to sociodemographic factors. Conclusions: Low levels of satisfaction were found for compassion, which increases the risk of compassion fatigue. No significant differences were found in relation to the years of work experience, age, gender, years of experience, or civil status.

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Revista de la Asociacion Espanola de Especialistas en Medicina del Trabajo

Título del artículo:

Jumping in ballet a systematic review of kinetic and kinematic parameters

AIMS: Understanding the biomechanics of jumping in ballet dancers provides an opportunity to optimize performance and mitigate injury risk. This systematic review aimed to summarize research investigating kinetics and kinematics of jumping in ballet dancers. METHODS: PubMed (MEDLINE), SPORTDiscus, and Web of Science were systematically searched for studies published before December 2020. Studies were required to investigate dancers specializing in ballet, assess kinetics or kinematics during take-off or landing, and be published in English. RESULTS: A total of 3,781 articles were identified, of which 29 met the inclusion criteria. Seven studies investigated take-off (kinetics: n = 6; kinematics: n = 4) and 23 studies investigated landing (kinetics: n = 19; kinematics: n = 12). Included articles were categorized into six themes: Activity Type (n = 10), Environment and Equipment (n = 10), Demographics (n = 8), Physical Characteristics (n = 3), Injury Status (n = 2), and Skill Acquisition and Motor Control (n = 1). Peak landing vertical ground reaction force (1.4-9.6 times body weight) was most commonly reported. Limited evidence suggests greater ankle involvement during the take-off of ballet jumps compared to countermovement jumps. There is also limited evidence indicating greater sagittal plane joint excursions upon landing in ballet dancers compared to nondancers, primarily through a more extended lower extremity at initial contact. Only 4 articles investigated male ballet dancers, which is a notable gap in the literature. CONCLUSIONS: The findings of this review can be used by dance science and medicine practitioners to improve their understanding of jumping in ballet dancers.

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Medical Problems of Performing Artists

Título del artículo:

Student Permanence in E-learning Postgraduate Programs: a case Study

The primary objective of this research study is to examine the factors that affect student permanence in a virtual methodology postgraduate academic program at a Colombian university. A literature review on student permanence in higher education programs is performed and a perception exercise is developed and applied to students. The situations that affect academic continuity are determined and strategies are generated to promote student permanence and graduation. The results show that the factors that have the greatest impact on student permanence are personal, socioeconomic, and academic, while technological and institutional factors are less relevant. It is concluded that the motivations that lead students to drop out of their studies are diverse and complex and that different strategies are needed to increase student permanence. This includes strengthening the capabilities of educational institutions to analyze internal and external scenarios to improve education quality and successful completion of academic programs.

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Formacion Universitaria

Título del artículo:

Global variations in the prevalence, treatment, and impact of atrial fibrillation in a multi-national cohort of 153 152 middle-aged individuals

Aims: To compare the prevalence of electrocardiogram (ECG)-documented atrial fibrillation (or flutter) (AF) across eight regions of the world, and to examine antithrombotic use and clinical outcomes. Methods and results: Baseline ECGs were collected in 153 152 middle-aged participants (ages 35-70 years) to document AF in two community-based studies, spanning 20 countries. Medication use and clinical outcome data (mean follow-up of 7.4 years) were available in one cohort. Cross-sectional analyses were performed to document the prevalence of AF and medication use, and associations between AF and clinical events were examined prospectively. Mean age of participants was 52.1 years, and 57.7% were female. Age and sex-standardized prevalence of AF varied 12-fold between regions; with the highest in North America, Europe, China, and Southeast Asia (270-360 cases per 100 000 persons); and lowest in the Middle East, Africa, and South Asia (30-60 cases per 100 000 persons) (P < 0.001). Compared with low-income countries (LICs), AF prevalence was 7-fold higher in middle-income countries (MICs) and 11-fold higher in high-income countries (HICs) (P < 0.001). Differences in AF prevalence remained significant after adjusting for traditional AF risk factors. In LICs/MICs, 24% of participants with AF and a CHADS2 score ≥1 received antithrombotic therapy, compared with 85% in HICs. AF was associated with an increased risk of stroke [hazard ratio (HR) 2.29; 95% confidence interval (CI) 1.49-3.52] and death (HR 2.97; 95% CI 2.25-3.93); with similar rates in different countries grouped by income level. Conclusions: Large variations in AF prevalence occur in different regions and countries grouped by income level, but this is only partially explained by traditional AF risk factors. Antithrombotic therapy is infrequently used in poorer countries despite the high risk of stroke associated with AF.

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Cardiovascular Research

Título del artículo:

Health-Related Quality of Life and Mortality in Heart Failure The Global Congestive Heart Failure Study of 23000 Patients From 40 Countries

BACKGROUND: Poor health-related quality of life (HRQL) is common in heart failure (HF), but there are few data on HRQL in HF and the association between HRQL and mortality outside Western countries. METHODS: We used the Kansas City Cardiomyopathy Questionnaire–12 (KCCQ-12) to record HRQL in 23 291 patients with HF from 40 countries in 8 different world regions in the G-CHF study (Global Congestive Heart Failure). We compared standardized KCCQ-12 summary scores (adjusted for age, sex, and markers of HF severity) among regions (scores range from 0 to 100, with higher score indicating better HRQL). We used multivariable Cox regression with adjustment for 15 variables to assess the association between KCCQ-12 summary scores and the composite of all-cause death, HF hospitalization, and each component over a median follow-up of 1.6 years. RESULTS: The mean age of participants was 65 years; 61% were men; 40% had New York Heart Association class III or IV symptoms; and 46% had left ventricular ejection fraction ≥40%. Average HRQL differed between regions (lowest in Africa [mean± SE, 39.5±0.3], highest in Western Europe [62.5±0.4]). There were 4460 (19%) deaths, 3885 (17%) HF hospitalizations, and 6949 (30%) instances of either event. Lower KCCQ-12 summary score was associated with higher risk of all outcomes; the adjusted hazard ratio (HR) for each 10-unit KCCQ-12 summary score decrement was 1.18 (95% CI, 1.17–1.20) for death. Although this association was observed in all regions, it was less marked in South Asia, South America, and Africa (weakest association in South Asia: HR, 1.08 [95% CI, 1.03–1.14]; strongest association in Eastern Europe: HR, 1.31 [95% CI, 1.21–1.42]; interaction P<0.0001). Lower HRQL predicted death in patients with New York Heart Association class I or II and III or IV symptoms (HR, 1.17 [95% CI, 1.14–1.19] and HR, 1.14 [95% CI, 1.12–1.17]; interaction P=0.13) and was a stronger predictor for the composite outcome in New York Heart Association class I or II versus class III or IV (HR 1.15 [95% CI, 1.13–1.17] versus 1.09 [95% CI, [1.07–1.11]; interaction P<0.0001). HR for death was greater in ejection fraction ≥40 versus <40% (HR, 1.23 [95% CI, 1.20–1.26] and HR, 1.15 [95% CI, 1.13–1.17]; interaction P<0.0001). CONCLUSION: HRQL is a strong and independent predictor of all-cause death and HF hospitalization across all geographic regions, in mildly and severe symptomatic HF, and among patients with preserved and reduced ejection fraction.

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Circulation

Título del artículo:

Protein sumoylation is crucial for phagocytosis in entamoeba histolytica trophozoites

Posttranslational modifications provide Entamoeba histolytica proteins the timing and signaling to intervene during different processes, such as phagocytosis. However, SUMOylation has not been studied in E. histolytica yet. Here, we characterized the E. histolytica SUMO gene, its product (EhSUMO), and the relevance of SUMOylation in phagocytosis. Our results indicated that EhSUMO has an extended N-terminus that differentiates SUMO from ubiquitin. It also presents the GG residues at the C-terminus and the ΨKXE/D binding motif, both involved in target protein contact. Addition-ally, the E. histolytica genome possesses the enzymes belonging to the SUMOylation-deSUMOylation machinery. Confocal microscopy assays disclosed a remarkable EhSUMO membrane activity with convoluted and changing structures in trophozoites during erythrophagocytosis. SUMOylated proteins appeared in pseudopodia, phagocytic channels, and around the adhered and ingested erythrocytes. Docking analysis predicted interaction of EhSUMO with EhADH (an ALIX family protein), and immunoprecipitation and immunofluorescence assays revealed that the association increased during phagocytosis; whereas the EhVps32 (a protein of the ESCRT-III complex)-EhSUMO interaction appeared stronger since basal conditions. In EhSUMO knocked-down trophozoites, the bizarre membranous structures disappeared, and EhSUMO interaction with EhADH and EhVps32 diminished. Our results evidenced the presence of a SUMO gene in E. histolytica and the SUMOyla-tion relevance during phagocytosis. This is supported by bioinformatics screening of many other proteins of E. histolytica involved in phagocytosis, which present putative SUMOylation sites and the ΨKXE/D binding motif.

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International Journal of Molecular Sciences

Título del artículo:

Renal Impairment and Risk of Acute Stroke: The INTERSTROKE Study

Background: Previous studies reported an association of renal impairment with stroke, but there are uncertainties underpinning this association. Aims: We explored if the association is explained by shared risk factors or is independent and whether there are regional or stroke subtype variations. Methods: INTERSTROKE is a case-control study and the largest international study of risk factors for first acute stroke, completed in 27 countries. We included individuals with available serum creatinine values and calculated estimated glomerular filtration rate (eGFR). Renal impairment was defined as eGFR <60 mL/min/1.73 m2. Multivariable conditional logistic regression was used to determine the association of renal function with stroke. Results: Of 21,127 participants, 41.0% were female, the mean age was 62.3 ± 13.4 years, and the mean eGFR was 79.9 ± 23.5 mL/min/1.73 m2. The prevalence of renal impairment was higher in cases (22.9% vs. 17.7%, p < 0.001) and differed by region (p < 0.001). After adjustment, lower eGFR was associated with increased odds of stroke. Renal impairment was associated with increased odds of all stroke (OR 1.35; 95% CI: 1.24-1.47), with higher odds for intracerebral hemorrhage (OR 1.60; 95% CI: 1.35-1.89) than ischemic stroke (OR 1.29; 95% CI: 1.17-1.42) (pinteraction 0.12). The largest magnitudes of association were seen in younger participants and those living in Africa, South Asia, or South America (pinteraction < 0.001 for all stroke). Renal impairment was also associated with poorer clinical outcome (RRR 2.97; 95% CI: 2.50-3.54 for death within 1 month). Conclusion: Renal impairment is an important risk factor for stroke, particularly in younger patients, and is associated with more severe stroke and worse outcomes.

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Neuroepidemiology

Título del artículo:

Bench-scale bubbling fluidized bed systems around the world - Bed agglomeration and collapse: A comprehensive review

Thermochemical conversion by gasification process is one of the most relevant technologies for energy recovery from solid fuel, with an energy conversion efficiency better than other alternatives like combustion and pyrolysis. Nevertheless, the most common technology used in the last decades for thermochemical conversion of solid fuel through gasification process, such as coal, agriculture residues or biomass residues are the fluidized bed or bubbling fluidized bed system. For these gasification technologies, an inert bed material is fed into reactor to improve the homogenization of the particles mixture and increase the heat transfer between solid fuel particles and the bed material. The fluidized bed reactors usually operate at isothermal bed temperatures in the range of 700–1000 °C, providing a suitable contact between solid and gas phases. In this way, chemical reactions with high conversion yield, as well as an intense circulation and mixing of the solid particles are encouraged. Moreover, a high gasification temperature favours carbon conversion efficiency, increasing the syngas production and energy performance of the gasifier. However, the risk of eutectic mixtures formation and its subsequent melting process are increased, and hence the probability of bed agglomeration and the system collapse could be increased, mainly when alkali and alkaline earth metals-rich biomasses are considered. Generally, bed agglomeration occurs when biomass-derived ash reacts with bed material, and the lower melting temperature of ash components promotes the formation of highly viscous layers, which encourages the progressive agglomerates creation, and consequently, the bed collapse and system de-fluidization. Taking into account the relevance of this topic to ensure the normal gasification process operating, this paper provides several aspects about bed agglomeration, mostly for biomass gasification systems. In this way, chemistry and mechanism of bed agglomeration, as well as, some methods for in-situ detection and prediction of the bed agglomeration phenomenon are reviewed and discussed.

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International Journal of Hydrogen Energy

Título del artículo:

Novel arylidene malonate derivative, KM-34, showed neuroprotective effects on in vitro and in vivo models of ischemia/reperfusion

Cerebral ischemia constitutes the most frequent type of cerebrovascular disease. The reduction of blood supply to the brain initiates the ischemic cascade starting from ionic imbalance to subsequent glutamate excitotoxicity, neuroinflammation and oxidative stress, eventually causing neuronal death. Previously, the authors have demonstrated the in vitro cytoprotective and antioxidant effects of a new arylidene malonate derivative, KM-34, against oxidizing agents like hydrogen peroxide, glutamate or Fe3+/ascorbate. Here, we examined for the first time the neuroprotective effect of KM-34 on ischemia/reperfusion models. In vitro, treatment with 10 and 50 μM KM-34 reduced the cellular death (propidium iodide incorporation) induced by oxygen glucose deprivation (OGD) in rat organotypic hippocampal slices cultures. In vivo, stroke was induced in male Wistar rats through middle cerebral artery occlusion (MCAO), followed by 23 h of reperfusion. KM-34 was orally administered 105 min after MCAO onset. We noticed that 1 mg/kg KM-34 reduced infarct volume and neurological score, and increased the latency to fall in the Hanging Wire test compared to vehicle-treated ischemic animals. While ischemic and sham-operated groups showed similar horizontal locomotor activity, vertical counts decreased after MCAO, suggesting that vertical movements are more sensitive to the ischemic injury. Treatment with KM-34 also alleviated the mitochondrial impairment (ROS generation, swelling and membrane potential dissipation) induced by transient MCAO but not significant alterations were found in oxidative stress parameters. Overall, the study provides preclinical evidences confirming the neuroprotective effects of a novel synthetic molecule and paved the way for future investigations regarding its therapeutic potential against brain ischemia/reperfusion injury.

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European Journal of Pharmacology

Título del artículo:

Nanoemulsions with chloroaluminium phthalocyanine and paromomycin for combined photodynamic and antibiotic therapy for cutaneous leishmaniasis

Background: Photodynamic therapy (PDT) using chloroaluminium phthalocyanine (ClAlPc) and paromomycin sulfate (PM) can be effective against New World Leishmania species involved in cutaneous leishmaniasis (CL). The aim of this study is to assay the skin permeation and the antileishmanial effects of a nanoemulsion (NE) containing both ClAlPc and PM in experimental CL by Leishmania (Viannia) braziliensis. Material and Methods: Cremophor ELP/castor oil-based NEs were prepared by a low-energy method and characterized for their physicochemical parameters. The NEs were used to deliver both ClAlPc and PM to leishmania cells. The in vitro toxicity of NEs were tested in vitro against L. (V.) braziliensis and THP-1 cells. The in vivo toxicity was assessed in non-infected BALB/c mice. Ex-vivo permeation and retention studies using healthy mice skin were also conducted. Finally, the in vivo activity of NE-PM+ClAlPc after PDT was tested in BALB/c mice infected with parasites. Results: NEs are colloidally stable with average droplet diameter of 30 nm, polydispersity index (PDI) below 0.2, and zeta potential near zero. Both promastigotes and intracellular amastigotes treated with NE-PM, NE-ClAlPc and NE-PM+ClAlPc were inhibited at >50%, >95%, >88%, respectively, after PDT with a phototoxic index (PI) >1.2. No skin ClAlPc permeation was observed. In contrast, PM skin permeation was 80-fold higher using PM-loaded NE formulation in comparison to aqueous PM solution. Topical treatment with NE formulations showed no signs of local toxicity or genotoxicity. In addition, concentrations of PM between 27.3 - 292.5 μM/25 mg of tissue were detected in different organs. In vivo, the NE-PM+ClAlPc treatment did not reduce skin lesions. Conclusion: The Cremophor ELP/castor oil NE formulation increases the permeation of PM through the skin and can be used to co-deliver PM plus ClAlPc for combined PDT protocols. However, the lack of efficacy in the in vivo model evidences that the therapeutical scheme has to be improved.

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Infection and Chemotherapy

Título del artículo:

Hamman’s syndrome in an adolescent with asthma crisis

BACKGROUND: Pneumomediastinum is defined as the presence of air in the mediastinum. It may appear after surgical procedures, trauma, or spontaneous. This last one is related with situations where the intra-alveolar pressure is increased, as in the Valsalva maneuvers, coughing, vomiting, among others. Asthma is a very frequent factor associated with spontaneous pneumomediastinum. It is developed due to the distension of the airways to the bronchial obstruction where the alveolar rupture occurs. It is a rare disease with a lot of differential diagnoses. The most common symptoms are chest pain, dyspnea and pain in the neck. The physical examination can show edema in the neck and subcutaneous emphysema. The initial study should be performed with chest radiography but up to the 30% could be normal, in this case it must be confirmed with chest tomography. The evolution is good and the treatment is generally conservative. CLINICAL CASE: A 17-year-old female patient with moderate asthmatic attack, acute bronchitis with pneumomediastinum, pneumopericardium, for which it was indicated bronchodilator, corticosteroid and antibiotic treatment. CONCLUSIONS: Spontaneous pneumomediastinum is a rare condition, with signs and symptoms that may suggest various diagnostic options, so clinical suspicion and diagnostic guidance are vital to prescribe the effective treatment.

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Medicina Interna de Mexico