An insight into the main chemical constituents, extraction methods, and functional properties of essential oils from Moringa plants: a mini-review

Moringa plants are recognized as multipurpose plant material due to their high content of bioactive constituents such as phenolic compounds, proteins, and essential oils, among others. This mini-review provided interesting and innovative information collected from the Scopus, Science Direct, and Google Scholar databases on the main chemical constituents of essential oils extracted from different moringa plants. In addition, it highlighted the different conventional and non-conventional techniques applied in the extraction of essential oils from different parts of moringa plants, and the functional properties of these essential oils are reviewed. Thus, this overview offers, for the first time, a compilation of published information on these topics, which may be useful in food and pharmaceutical products.

Elevated serum uric acid is a facilitating mechanism for insulin resistance mediated accumulation of visceral adipose tissue

OBJECTIVE

Serum uric acid (SUA) has been associated with cardiometabolic conditions such as insulin resistance (IR) and visceral adipose tissue (VAT) accumulation. Here, we aimed to clarify a unifying mechanism linking elevated SUA to IR and VAT.

METHODS

We conducted analyses in 226 subjects from the UIEM cohort with both euglycemic hyperinsulinemic clamp (EHC) and dual X-ray absorptiometry (DXA) measurements for IR and VAT accumulation and explored the role of SUA and adiponectin by developing a network of causal mediation analyses to assess their impact on IR and VAT. These models were then translated to two population-based cohorts comprising 6337 subjects from NHANES 2003-2004 and 2011-2012 cycles in the US and ENSANUT Medio Camino 2016 in Mexico, using HOMA2IR and adipoIR as indicators of peripheral and adipose tissue IR, and METS-VF as a surrogate for VAT accumulation.

RESULTS

SUA has a mediating role inside a bidirectional relationship between IR and visceral obesity, which was similar using either gold standard measurements or surrogate measures for IR and VAT. Furthermore, adiponectin acts as a linking mediator between elevated SUA and both peripheral IR and VAT accumulation. The proportion of the mechanism for IR-mediated (in either peripheral or adipose tissue) VAT accumulation was greater, compared to VAT-mediated IR accumulation (10.53% [9.23%-12.00%] to 5.44% [3.78%-7.00%]). Normal-range SUA levels can be used to rule-out underlying cardio-metabolic abnormalities in both men and women.

CONCLUSIONS

Elevated SUA acts as a mediator inside the bidirectional relationship between IR and VAT accumulation and these observations could be applicable at a phenotype scale.

Probing the explanation of the muon (g-2) anomaly and thermal light dark matter with the semi-visible dark photon channel

We report the results of a search for a new vector boson ( A ' ) decaying into two dark matter particles χ 1 χ 2 of different mass. The heavier χ 2 particle subsequently decays to χ 1 and an off-shell Dark Photon A ' ∗ → e + e - . For a sufficiently large mass splitting, this model can explain in terms of new physics the recently confirmed discrepancy observed in the muon anomalous magnetic moment at Fermilab. Remarkably, it also predicts the observed yield of thermal dark matter relic abundance. A detailed Monte-Carlo simulation was used to determine the signal yield and detection efficiency for this channel in the NA64 setup. The results were obtained re-analyzing the previous NA64 searches for an invisible decay A ' → χ χ ¯ and axion-like or pseudo-scalar particles a → γ γ . With this method, we exclude a significant portion of the parameter space justifying the muon g-2 anomaly and being compatible with the observed dark matter relic density for A ' masses from 2 m e up to 390 MeV and mixing parameter ε between 3 × 10 - 5 and 2 × 10 - 2 .

Rathke's cleft cyst infections and pituitary abscesses: case series and review of the literature

PURPOSE

Pituitary abscesses (PAs) are a rare clinical entity which may arise from normal pituitary tissue or underlying lesions within the gland. Rathke's cleft cysts (RCCs) are not commonly associated with the development of PA.

METHODS

Retrospective chart review of three patients with PAs within RCCs at a single university center and review of the literature.

RESULTS

Three cases are reported. The first case presented with fever and headache and a history of prior surgery due to RCC and a recent respiratory tract infection. The second case had a history of recent skin infections and presented with sudden onset headache and hypopituitarism. In the third case, chronic visual field impairment prompted an ophthalmologic evaluation resulting in a diagnosis of an adenoma and an infected RCC. In all three cases, an endoscopic endonasal approach was performed to drain infected tissue and allowed microbiological identification of gram-positive cocci, followed by treatment with antibiotics for at least three weeks. Cases in the literature are scarce and the diagnosis is usually made intraoperatively due to non-specific manifestations and imaging. PAs arising from underlying pituitary lesions are less common than primary PAs. Differential diagnosis should include pituitary apoplexy, hypophysitis and other cystic lesions.

CONCLUSION

PAs occurring in RCCs are infrequent. Clinical manifestations are commonly subacute, without septic symptoms. Imaging is usually non-specific. Preoperative diagnosis is infrequent and a broad differential diagnosis should be considered. Empirical antimicrobial therapy should be initiated and adjusted after obtaining cultures to reduce the rate of recurrence and improve clinical outcomes.

Constraints on New Physics in Electron g-2 from a Search for Invisible Decays of a Scalar, Pseudoscalar, Vector, and Axial Vector

We performed a search for a new generic X boson, which could be a scalar (S), pseudoscalar (P), vector (V), or an axial vector (A) particle produced in the 100 GeV electron scattering off nuclei, e^{-}Z→e^{-}ZX, followed by its invisible decay in the NA64 experiment at CERN. No evidence for such a process was found in the full NA64 dataset of 2.84×10^{11} electrons on target. We place new bounds on the S, P, V, A coupling strengths to electrons, and set constraints on their contributions to the electron anomalous magnetic moment a_{e}, |Δa_{X}|≲10^{-15}-10^{-13} for the X mass region 1  MeV≲m_{X}≲1  GeV. These results are an order of magnitude more sensitive compared to the current accuracy on a_{e} from the electron g-2 experiments and recent high-precision determination of the fine structure constant.

Hunting down the X17 boson at the CERN SPS

Recently, the ATOMKI experiment has reported new evidence for the excess of e + e - events with a mass ∼ 17 MeV in the nuclear transitions of 4 He, that they previously observed in measurements with 8 Be. These observations could be explained by the existence of a new vector X 17 boson. So far, the search for the decay X 17 → e + e - with the NA64 experiment at the CERN SPS gave negative results. Here, we present a new technique that could be implemented in NA64 aiming to improve the sensitivity and to cover the remaining X 17 parameter space. If a signal-like event is detected, an unambiguous observation is achieved by reconstructing the invariant mass of the X 17 decay with the proposed method. To reach this goal an optimization of the X 17 production target, as well as an efficient and accurate reconstruction of two close decay tracks, is required. A dedicated analysis of the available experimental data making use of the trackers information is presented. This method provides independent confirmation of the NA64 published results [1], validating the tracking procedure. The detailed Monte Carlo study of the proposed setup and the background estimate show that the goal of the proposed search is feasible.

Search for Axionlike and Scalar Particles with the NA64 Experiment

We carried out a model-independent search for light scalar (s) and pseudoscalar axionlike (a) particles that couple to two photons by using the high-energy CERN SPS H4 electron beam. The new particles, if they exist, could be produced through the Primakoff effect in interactions of hard bremsstrahlung photons generated by 100 GeV electrons in the NA64 active dump with virtual photons provided by the nuclei of the dump. The a(s) would penetrate the downstream HCAL module, serving as a shield, and would be observed either through their a(s)→γγ decay in the rest of the HCAL detector, or as events with a large missing energy if the a(s) decays downstream of the HCAL. This method allows for the probing of the a(s) parameter space, including those from generic axion models, inaccessible to previous experiments. No evidence of such processes has been found from the analysis of the data corresponding to 2.84×10^{11} electrons on target, allowing us to set new limits on the a(s)γγ-coupling strength for a(s) masses below 55 MeV.

Clinical characterization of data-driven diabetes subgroups in Mexicans using a reproducible machine learning approach

INTRODUCTION

Previous reports in European populations demonstrated the existence of five data-driven adult-onset diabetes subgroups. Here, we use self-normalizing neural networks (SNNN) to improve reproducibility of these data-driven diabetes subgroups in Mexican cohorts to extend its application to more diverse settings.

RESEARCH DESIGN AND METHODS

We trained SNNN and compared it with k-means clustering to classify diabetes subgroups in a multiethnic and representative population-based National Health and Nutrition Examination Survey (NHANES) datasets with all available measures (training sample: NHANES-III, n=1132; validation sample: NHANES 1999-2006, n=626). SNNN models were then applied to four Mexican cohorts (SIGMA-UIEM, n=1521; Metabolic Syndrome cohort, n=6144; ENSANUT 2016, n=614 and CAIPaDi, n=1608) to characterize diabetes subgroups in Mexicans according to treatment response, risk for chronic complications and risk factors for the incidence of each subgroup.

RESULTS

SNNN yielded four reproducible clinical profiles (obesity related, insulin deficient, insulin resistant, age related) in NHANES and Mexican cohorts even without C-peptide measurements. We observed in a population-based survey a high prevalence of the insulin-deficient form (41.25%, 95% CI 41.02% to 41.48%), followed by obesity-related (33.60%, 95% CI 33.40% to 33.79%), age-related (14.72%, 95% CI 14.63% to 14.82%) and severe insulin-resistant groups. A significant association was found between the SLC16A11 diabetes risk variant and the obesity-related subgroup (OR 1.42, 95% CI 1.10 to 1.83, p=0.008). Among incident cases, we observed a greater incidence of mild obesity-related diabetes (n=149, 45.0%). In a diabetes outpatient clinic cohort, we observed increased 1-year risk (HR 1.59, 95% CI 1.01 to 2.51) and 2-year risk (HR 1.94, 95% CI 1.13 to 3.31) for incident retinopathy in the insulin-deficient group and decreased 2-year diabetic retinopathy risk for the obesity-related subgroup (HR 0.49, 95% CI 0.27 to 0.89).

CONCLUSIONS

Diabetes subgroup phenotypes are reproducible using SNNN; our algorithm is available as web-based tool. Application of these models allowed for better characterization of diabetes subgroups and risk factors in Mexicans that could have clinical applications.

Changes in the GN/GCof the M segment show positive selection and recombination of one aggressive isolate and two mild isolates of tomato spotted wilt virus

We isolated and compared three tomato spotted wilt virus (TSWV) isolates from lettuce (TSWV-Let), pepper (TSWV-Pep), and tomato (TSWV-Tom) from central Mexico to determine their ability to infect a set of eighteen differential plant species from seven families. TWSV-Let was an aggressive isolate with the ability to infect up to 52% of the differential plants, including maize, under greenhouse conditions. The nucleotide (nt) sequences of the three isolates are more than 90% similar in the M and S RNA segments. In the M segment of the TSWV-Let isolate, we detected nt changes in their intergenic region (IGR) and, in the Gc gene, a region containing a recombination site, as well as a synapomorphy associated with one of three sites under positive selection with a change in one aa residue (a cysteine-to-valine mutation). We speculate on the association of these features in the Gc gene with host selection, adaptation, aggressiveness, and ability to infect maize plants.

Unilateral Nonvisualization of a Transverse Dural Sinus on Phase-Contrast MRV: Frequency and Differentiation from Sinus Thrombosis on Noncontrast MRI

BACKGROUND AND PURPOSE

Unilateral decreased/nonvisualization of a transverse dural sinus on MRV poses a diagnostic dilemma when gadolinium administration is contraindicated. We determined the frequency of unilateral decreased/nonvisualization of the transverse dural sinus and the performance of pregadolinium MR imaging sequences in diagnosing transverse sinus thrombosis in the presence of unilateral decreased/nonvisualization on phase-contrast MRV.

MATERIALS AND METHODS

We conducted a retrospective review of consecutive 3D phase-contrast MRV (VENC, 30 cm/s) and routine brain imaging (noncontrast sagittal T1, axial T2, FLAIR, DWI, GRE, and postgadolinium 3D-MPRAGE images) performed during a 3-year period for a total of 208 patients. Nonvisualization of a transverse dural sinus was defined as ≥50% nonvisualization of the transverse sinus caliber versus the contralateral side on MRV. Noncontrast imaging findings were considered abnormal when hyperintense signal was present on T2, FLAIR, T1, and DWI, and there were T2* blooming artifacts on GRE and DWI. Postgadolinium 3D-MPRAGE was used to confirm the diagnosis of transverse sinus thrombosis.

RESULTS

Nonvisualization of a transverse dural sinus was observed in 72/208 (34.6%) patients on MRV; 56/72 (77.8%) were without transverse sinus thrombosis, and 16/72 (22.2%) patients had transverse dural sinus thrombosis. Nonvisualization of a transverse dural sinus was seen in 56/192 (29.2%) patients without transverse sinus thrombosis and 16/16 (100%) with transverse sinus thrombosis. Abnormal findings on DWI (transverse sinus hyperintense signal or T2* blooming artifact) are 93.8% sensitive and 100.0% specific for transverse sinus thrombosis. Other noncontrast MR imaging sequences ranged from 56.3%-68.8% sensitive and 91.1%-100.0% specific.

CONCLUSIONS

Nonvisualization of a transverse dural sinus is a frequent phenomenon on phase-contrast MRV. DWI can be effectively used to exclude sinus thrombosis when nonvisualization of a transverse dural sinus is a diagnostic conundrum on phase-contrast MRV and contrast-enhanced studies are contraindicated.

P4558Hemodynamic management of resistant hypertension

Background

Hypertension is the most prevalent chronic disease worldwide and is is related with high probability of cardiac disease, kidney disease and cerebrovascular events. Blood pressure measurement was used in the last decades to diagnose and guide antihypertensive therapy; however blood pressure is the result of interaction of more complex hemodynamic parameters previously reserved to experimental studies or critical care patients management using invasive methods. Since 1996 few studies has proposed the use of hemodynamic parameters to classify and guide hypertension therapy with good results.

Purpose

The present study purpose was to measure hemodynamic parameters in patients with non-controlled resistant hypertension and use it to guide pharmacologic treatment in order to archive control blood pressure values according to the European Society of Cardiology guidelines.

Methods

A total of 84 patients between 32 and 95 years old diagnosed with non-controlled primary resistant hypertension were recruited and after previous therapy washout hemodynamic parameters were measured using noninvasive methods: preload by central venous pressure (CVP) using inferior vena cava diameter, cardiac index and systemic vascular resistance using Lyljestrand & Zander modified formula. Patients were classified in 3 basic groups depending on which parameter was above normal value: hyperdynamic (HD) for high cardiac index >3.5 L/min/m2, fluid overload (FO) for CVP >8cmH2O and high systemic vascular resistance index (HSVRi) >2500 dynes/sec/m2/cm–5, also 3 combined groups were a patient had 2 simultaneous hemodynamic alterations (HD+FO, HD+HSVRi and FO+HSRVi), according to this classification pharmacotherapy was guided indicating Bisoprolol in HD group, Amlodipine to HSVR patients and Hydrochlorothiazide to FO patients, in combined groups, combined therapy was given. Patients were observed for 6 months period taking as primary endpoint blood pressure control, acute cardiovascular events and hypotension.

Results

A significant reduction of hemodynamic parameters and blood pressure was observed since the first month of treatment obtaining a 100% hemodynamic and blood pressure goals in all patients at the third month of therapy without hypotension or acute cardiovascular event during this period, the HD+FO group reach goals at the 6th month of treatment without reported complications.

Conclusions

In this preliminary studied we observed that hemodynamic guided high blood pressure control may be a useful tool to a better understanding, classifications and treatment in patients with resistant hypertension; however a larger outcome studies to confirm this hypothesis.

Dark Matter Search in Missing Energy Events with NA64

A search for sub-GeV dark matter production mediated by a new vector boson A^{'}, called a dark photon, is performed by the NA64 experiment in missing energy events from 100 GeV electron interactions in an active beam dump at the CERN SPS. From the analysis of the data collected in the years 2016, 2017, and 2018 with 2.84×10^{11} electrons on target no evidence of such a process has been found. The most stringent constraints on the A^{'} mixing strength with photons and the parameter space for the scalar and fermionic dark matter in the mass range ≲0.2  GeV are derived, thus demonstrating the power of the active beam dump approach for the dark matter search.

Prediction of incident hypertension and arterial stiffness using the non-insulin-based metabolic score for insulin resistance (METS-IR) index

Hypertension is associated with insulin resistance (IR), metabolic syndrome (MS), and arterial stiffness. Non-insulin-based IR indexes were developed as tools for metabolic screening. Here, we aimed to evaluate the novel non-insulin-based Metabolic Score for IR (METS-IR) index for the prediction of incident hypertension and arterial stiffness evaluated using pulse wave velocity (PWV) analysis, compared with other non-insulin-based IR indexes. We evaluated two populations, a cross-sectional evaluation of high-risk individuals (n = 305) with a wide range of metabolic comorbidities and dyslipidemia in whom PWV measurement was performed and a 3-year prospective cohort of normotensive individuals (N = 6850). We observed a positive correlation between METS-IR and PWV in the cross-sectional cohort, which was higher compared with other non-insulin-based fasting IR indexes; furthermore, PWV values >75th percentile were associated with the upper tercile of METS-IR values. In the prospective cohort, we observed an increased risk for incident hypertension for the upper METS-IR tercile (METS-IR ≥ 46.42; HR: 1.81, 95% CI: 1.41-2.34), adjusted for known cardiovascular risk factors, and observed that METS-IR had greater increases in the predictive capacity for hypertension along with SBP and the Framingham Hypertension Risk Prediction Model compared with other non-insulin-based IR indexes. Therefore, METS-IR is a novel non-insulin-based IR index which correlates with arterial stiffness and is a predictor of incident hypertension, complementary to previously validated risk prediction models.

Development and validation of a predictive model for incident type 2 diabetes in middle-aged Mexican adults: the metabolic syndrome cohort

BACKGROUND

Type 2 diabetes mellitus (T2D) is a leading cause of morbidity and mortality in Mexico. Here, we aimed to report incidence rates (IR) of type 2 diabetes in middle-aged apparently-healthy Mexican adults, identify risk factors associated to ID and develop a predictive model for ID in a high-risk population.

METHODS

Prospective 3-year observational cohort, comprised of apparently-healthy adults from urban settings of central Mexico in whom demographic, anthropometric and biochemical data was collected. We evaluated risk factors for ID using Cox proportional hazard regression and developed predictive models for ID.

RESULTS

We included 7636 participants of whom 6144 completed follow-up. We observed 331 ID cases (IR: 21.9 per 1000 person-years, 95%CI 21.37-22.47). Risk factors for ID included family history of diabetes, age, abdominal obesity, waist-height ratio, impaired fasting glucose (IFG), HOMA2-IR and metabolic syndrome. Early-onset ID was also high (IR 14.77 per 1000 person-years, 95%CI 14.21-15.35), and risk factors included HOMA-IR and IFG. Our ID predictive model included age, hypertriglyceridemia, IFG, hypertension and abdominal obesity as predictors (Dxy = 0.487, c-statistic = 0.741) and had higher predictive accuracy compared to FINDRISC and Cambridge risk scores.

CONCLUSIONS

ID in apparently healthy middle-aged Mexican adults is currently at an alarming rate. The constructed models can be implemented to predict diabetes risk and represent the largest prospective effort for the study metabolic diseases in Latin-American population.

Economic evaluation of sunitinib versus pazopanib and best supportive care for the treatment of metastatic renal cell carcinoma in Chile: cost-effectiveness analysis and a mixed treatment comparison

Background: Sunitinib and Pazopanib are two metastatic renal cell carcinoma (MRCC) treatment alternatives, however the health system in Chile does not consider coverage for any. The cost-effectiveness versus relevant comparator was assessed to support evidence-based decision making. Methods: A four health states Markov model was built: first, second line treatments, BSC and death. Benefits were measured in QALYs, and efficacy estimates were obtained from an indirect treatment comparison. A 10-year time horizon and a 3% undifferentiated discount rate were considered. Deterministic and probabilistic sensitivity analyses were performed. Results: The costs of treating MRCC with Sunitinib were higher than Pazopanib and BSC. When comparing Sunitinib versus Pazopanib, the incremental benefit is small favoring Sunitinib (0.03 QALYs). The base case scenario shows an average ICER of PA versus BSC of US$62,327.11/QALY and of US$85,885/QALY for Sunitinib versus Pazopanib. The ICER was most sensitive to the OS relative to BSC, where evidence was associated to important bias. Conclusions: Sunitinib or Pazopanib can be considered cost-effective if a 3 GDP per-capita threshold is assumed. The decision between SU or PA is highly sensitive to the price of the drugs, rather than the outcomes. Therefore, the decision might be made based on cost-minimization exercise.

Child labor and severe functioning difficulties and disability in Mexican children and adolescents 5-17 years of age

OBJECTIVE

To describe the characteristics of Mexican children and adolescents 5-17 years with severe functioning difficulties and disability and explore their participation in child labor.

MATERIALS AND METHODS

Using data from the National Survey of Boys, Girls and Women in Mexico 2015 we estimated prevalence of functioning difficulties and disability and used logistic regression to explore the association between this condition and child labor.

RESULTS

While 11.2% of Mexicans 5-17 years-old has severe functioning difficulties or disability, 13.4% work. The functioning difficulty and disability domains with the highest prevalence are experiencing anxiety (5.4%) and depression (1.5%) daily. Children and adolescents with severe functioning difficulties and disability are 70% more likely to do child labor [OR=1.7, 95%CI:1.2,2.4]. Educational lag doubles the likelihood of doing child labor [OR=2.2, 95%CI:1.5,3.3].

CONCLUSIONS

Guaranteeing educational opportunities and respect for the rights of children with severe functioning difficulties and disability is essential to achieve development of their full potential.

Search for a Hypothetical 16.7 MeV Gauge Boson and Dark Photons in the NA64 Experiment at CERN

We report the first results on a direct search for a new 16.7 MeV boson (X) which could explain the anomalous excess of e^{+}e^{-} pairs observed in the excited ^{8}Be^{*} nucleus decays. Because of its coupling to electrons, the X could be produced in the bremsstrahlung reaction e^{-}Z→e^{-}ZX by a 100 GeV e^{-} beam incident on an active target in the NA64 experiment at the CERN Super Proton Synchrotron and observed through the subsequent decay into a e^{+}e^{-} pair. With 5.4×10^{10} electrons on target, no evidence for such decays was found, allowing us to set first limits on the X-e^{-} coupling in the range 1.3×10^{-4}≲ε_{e}≲4.2×10^{-4} excluding part of the allowed parameter space. We also set new bounds on the mixing strength of photons with dark photons (A^{'}) from nonobservation of the decay A^{'}→e^{+}e^{-} of the bremsstrahlung A^{'} with a mass ≲23  MeV.

[Comprehensive sexual education in Mexico: an analysis of coverage, comprehensiveness and continuity of contents in Mexican public and private schools]

Objective:

To analyze coverage of comprehensive sex education (CSE) in high schools in Mexico and describe whether it is comprehensive, homogeneous and has continuity based on student reports of exposure to topics in three dimensions: reproductive and sexual health, self-efficacy and rights and relations.

Materials and methods:

Within a probabilistic, cross-sectional survey with stratified, cluster sampling, a nationally representative sample of 3 824 adolescents attending 45 public and private high-schools in urban and rural areas completed questionnaires on CSE.

Results:

The proportion of adolescents reporting having received sex education from school personnel varies depending on topics and grade level. Topics most frequently covered are those related to sexual and reproductive health while rights and relations are least frequently dealt with. Most sex education topics are covered during junior high school and much less frequently in elementary or high school.

Conclusions:

CSE needs to be comprehensive and homogenous in terms of content, ensure inclusion of priority topics, meet national and international recommendations, ensure continuity and adapt contents to student age through all education levels.

[Contraception in Mexican adolescents in upper secondary schools: use and unmet needs]

OBJECTIVE

To describe sexual behavior and contraceptive use in adolescent students.

MATERIALS AND METHODS

National representative survey in upper secondary schools in Mexico 2014. Logistic regressions identify the factors associated with contraceptive use and unmet needs for contraception (UNC).

RESULTS

For male adolescents, non-contraceptive use in the last sexual relation is associated with non-contraceptive use in the sexual debut (OR=11.5; IC95%:5.6,23.4) and not recognizing effective contraceptive methods (OR=2.4;IC95%:1.04,5.5). For female adolescents, non-contraceptive use is associated with non-contraceptive use in sexual debut (OR=4.5;IC95%:2.3,8.4) and low self-efficacy towards condom use and negotiation (OR=3.1; IC95%:1.1,8.2). UNC were associated with insecure attitudes towards condom use and negotiation (OR=3.5;IC95%:1.3,9.4), non-contraceptive use in sexual debut (OR=9.0;IC95%:2.5,32.4) and use of alcohol or drugs during sexual relations (OR=3.0;IC95%:1.1,8.1).

CONCLUSIONS

Strategies to ensure contraceptive use from sexual debut onwards are required, promoting self-efficacy and safe sex practices among adolescents.

Diagnostic Utility of Increased STIR Signal in the Posterior Atlanto-Occipital and Atlantoaxial Membrane Complex on MRI in Acute C1-C2 Fracture

BACKGROUND AND PURPOSE

Acute C1-C2 fractures are difficult to detect on MR imaging due to a paucity of associated bone marrow edema. The purpose of this study was to determine the diagnostic utility of increased STIR signal in the posterior atlanto-occipital and atlantoaxial membrane complex (PAOAAM) in the detection of acute C1-C2 fractures on MR imaging.

MATERIALS AND METHODS

Eighty-seven patients with C1-C2 fractures, 87 with no fractures, and 87 with other cervical fractures with acute injury who had both CT and MR imaging within 24 hours were included. All MR images were reviewed by 2 neuroradiologists for the presence of increased STIR signal in the PAOAAM and interspinous ligaments at other cervical levels. Sensitivity and specificity of increased signal within the PAOAAM for the presence of a C1-C2 fracture were assessed.

RESULTS

Increased PAOAAM STIR signal was seen in 81/87 patients with C1-C2 fractures, 6/87 patients with no fractures, and 51/87 patients with other cervical fractures with 93.1% sensitivity versus those with no fractures, other cervical fractures, and all controls. Specificity was 93.1% versus those with no fractures, 41.4% versus those with other cervical fractures, and 67.2% versus all controls for the detection of acute C1-C2 fractures. Isolated increased PAOAAM STIR signal without increased signal in other cervical interspinous ligaments showed 89.7% sensitivity versus all controls. Specificity was 95.3% versus those with no fractures, 83.7% versus those with other cervical fractures, and 91.4% versus all controls.

CONCLUSIONS

Increased PAOAAM signal on STIR is a highly sensitive indicator of an acute C1-C2 fracture on MR imaging. Furthermore, increased PAOAAM STIR signal as an isolated finding is highly specific for the presence of a C1-C2 fracture, making it a useful sign on MR imaging when CT is either unavailable or the findings are equivocal.

Poor early childhood outcomes attributable to maternal depression in Mexican women

We aimed to estimate the population fraction of poor early child health and developmental outcomes attributable to maternal depressive symptoms (DS) contrasting it between low- and middle/high-income households. We used a nationally representative probabilistic sample of 4240 children younger than 5 years old and their mothers, derived from the Mexican National Health and Nutrition Survey Data (ENSANUT 2012). Complex survey design, sampling, and analytic weights were taken into account in analyses. DS was measured by CESD-7. Child outcomes were as follows: breastfeeding, attending well-child check-ups, respiratory disease, diarrhea and general health problems, immunization, accidents, growth, obesity, and food insecurity. Prevalence of DS among mothers was 21.36%. In low-SES households, DS was associated with higher risk of never being breastfed (RR = 1.77; p < .05), health problems (RR = 1.37; p < .05), acute respiratory disease (RR = 1.51; p < .05), accidents requiring child hospitalization (RR = 2.16; p < .01), and moderate or severe food insecurity (RR = 1.58; p < .001). In medium- or high-SES households, DS was associated with higher risk of never attending a developmental check-up (RR = 2.14; p < .05) and moderate or severe food insecurity (RR = 1.75; p < .01). Population risks attributable to DS ranged from 2.30 to 17.45%. Prevention of DS could lead to reduction of problematic early childhood outcomes in both low and medium/high SES.

Prevalence of functioning difficulties and disability in Mexican adolescent women and their populational characteristics

Objective. Report prevalence of functioning difficulties and disabilities among Mexican adolescent women 15-17 years old and identify differences in characteristics of those with and without a functioning difficulty or disability Materials and methods. Using data from the National Survey of Boys, Girls and Women in Mexico 2015 we estimated prevalence of functioning difficulties and disability and used chi square tests for independence and logistic regression to explore associations between this condition and various character­istics. Results. Of Mexican adolescent women 15-17 years old, 11.1% had a functioning difficulty or disability. The group of domains of functioning difficulty and disability with by far the highest prevalence was socio-emotional and behavioral functioning difficulties or disability with 8.6%. Being employed, rural residence and self-reported depression symptoms were associated with having functioning difficulties or disability. Conclusions. This survey constitutes an important initial step in collecting data on functioning difficulty and disability in Mexico although larger samples should be studied.

Autologous stem cell transplantation (ASCT) in patients with mantle cell lymphoma: a retrospective study of the Spanish lymphoma group (GELTAMO)

Guidelines recommend autologous stem cell transplantation (ASCT) consolidation in first complete or partial response after regimens including rituximab (R) and high-dose AraC (HDAC), but its use beyond that response is questioned. We present a retrospective analysis of 268 patients with MCL who received ASCT. With a median follow-up for survival patients of 54 months, progression-free survival and overall survival for the whole series were 38 and 74 months, respectively, and for patients transplanted in first CR 49 and 97 months, respectively. Patients without CR before transplant were analyzed separately, those who achieved CR after transplantation had better PFS (48 vs 0.03 months, p < 0.001) and OS (92 vs 16 months, p < 0.001) than the remaining. In univariate analysis, first CR at transplant (p = 0.01) and prior rituximab (p = 0.02) were the variables associated with PFS. For OS, the same variables resulted significant (p = 0.03 and p < 0.001, respectively). In multivariate analysis, only the status at transplant (first CR) remained significant. This retrospective study concludes that ASCT consolidation in first CR induces high survival rates. In other stages of disease, the need of ASCT as consolidation may be questioned.

Modeling the hepatitis A epidemiological transition in Brazil and Mexico

Background: Many low- to middle-income countries have completed or are in the process of transitioning from high or intermediate to low endemicity for hepatitis A virus (HAV). Because the risk of severe hepatitis A disease increases with age at infection, decreased incidence that leaves older children and adults susceptible to HAV infection may actually increase the population-level burden of disease from HAV. Mathematical models can be helpful for projecting future epidemiological profiles for HAV.

Methods: An age-specific deterministic, dynamic compartmental transmission model with stratification by setting (rural versus urban) was calibrated with country-specific data on demography, urbanization, and seroprevalence of anti-HAV antibodies. HAV transmission was modeled as a function of setting-specific access to safe water. The model was then used to project various HAV-related epidemiological outcomes in Brazil and in Mexico from 1950 to 2050.

Results: The projected epidemiological outcomes were qualitatively similar in the 2 countries. The age at the midpoint of population immunity (AMPI) increased considerably and the mean age of symptomatic HAV cases shifted from childhood to early adulthood. The projected overall incidence rate of HAV infections decreased by about two thirds as safe water access improved. However, the incidence rate of symptomatic HAV infections remained roughly the same over the projection period. The incidence rates of HAV infections (all and symptomatic alone) were projected to become similar in rural and urban settings in the next decades.

Conclusion: This model featuring population age structure, urbanization and access to safe water as key contributors to the epidemiological transition for HAV was previously validated with data from Thailand and fits equally well with data from Latin American countries. Assuming no introduction of a vaccination program over the projection period, both Brazil and Mexico were projected to experience a continued decrease in HAV incidence rates without any substantial decrease in the incidence rates of symptomatic HAV infections.

Bases metodológicas y resultados de la implementación de la Encuesta Nacional de Niños, Niñas y Mujeres en México 2015

 Objetivo. Describir la metodología y los resultados del levantamiento de la Encuesta Nacional de Niños, Niñas y Mujeres en México (ENIM 2015). Material y métodos. La ENIM 2015 es una encuesta probabilística con muestreo polietápico, estratificado y por conglomerados, con representatividad regional, por estratos rural y urbano, y para la población indígena. Se aplicaron cuestionarios para obtener información sobre el hogar, mujeres de 15 a 49 años, niños y niñas menores de cinco años y niños y niñas y adolescentes de 5 a 17 años. Resultados. La tasa de respuesta en hogares y en mujeres fue de 94%; se obtuvo información de 10 760 hogares y 12 110 mujeres; para los niños y niñas y adolescentes y niños y niñas menores de cinco años, estos valores fueron de 98%, 11 607 y 8 066, respectivamente. Conclusión. El diseño probabilístico de la ENIM 2015 permite generar indicadores que se pueden desagregar en cinco regiones, para los estratos rural y urbano y para la población indígena, así como una línea base para 15 indicadores de los ODS. 

[Opinion of professionals in an intensive care unit on the limitations of therapeutic effort]

OBJECTIVE

To determine the opinion held by professionals in an intensive care unit on the limitation of therapeutic effort process at the end-of-life (LTE). To collect this information, and then use it to improve the basic aspects that the LTE have on the quality of care by intensive care unit staff.

MATERIAL AND METHODS

A prospective descriptive study was carried out in the Intensive Care Unit of a third level public university hospital. A questionnaire was prepared that included questions on their demographic profile and others to provide an ethical valuation profile, as well as to find out the knowledge and information that the professional had on the LTE. Descriptive study of the sample and comparative statistics were performed using the chi-squared statistical test.

RESULTS

A total of 65 valid questionnaires were obtained from a convenience sample of 70 professionals. Almost all of them (98%) were in favour of the limitation of therapeutic effort. The LTE was considered as some kind of euthanasia (active or passive) in up to 28% of the replies, valuations by professional categories is shown in. More than three-quarters (77%) had the belief that not to start treatment was not the same as withdrawing an already established treatment. Just over half (52%) of the respondents believe the value that should have more weight when considering LET would be the prognosis of the current illness of the patient, and 46% the future quality of life of the patient. The economic cost of treatment to be applied was not considered in any case.

CONCLUSIONS

The LTE is approved by the majority of professionals in our Intensive Care Unit. Although a non-negligible percentage understood it as a form of euthanasia.

CPT-11/bevacizumab for the treatment of refractory brain metastases in patients with HER2-neu-positive breast cancer

Nervous system relapse of patients with advanced HER2-neu-positive breast cancer is an increasing problem, with one-third of women developing brain metastases. Standard therapies using steroids, surgery and radiotherapy do not provide a lasting response. We evaluated CPT-11 and bevacizumab, which can both cross the blood-brain barrier, as combination therapy to treat HER2-neu-positive breast cancer with brain metastases.

Size-tunable LDH–protein hybrids toward the optimization of drug nanocarriers

Stabilization of LDH nanoparticles containing chloride and dodecylsulfate with BSA points to optimization of drug nanocarriers based on these solids.

Assessment of in vitro pharmacological effect of Neotropical Piperaceae in GABAergic bioassays in relation to plants traditionally used for folk illness by the Yanesha (Peru)

ETHNOPHARMACOLOGICAL RELEVANCE

A previous pilot ethnobotanical and ethnopharmacological study with the Q'echi׳ Maya identified the family Piperaceae, as an important taxonomic group traditionally used for the treatment of epileptic and culture-bound anxiety disorders and possessing activity in the GABA system. Following that lead, a botanical survey was conducted in Peru, where 47 species of Piperaceae were collected including 21 plants traditionally used for folk illnesses by the Yanesha of Peru, an indigenous Amazonian group.

MATERIALS AND METHODS

Two high throughput bioassays were used to quantify the in vitro activity of botanical extracts on the GABA system.

RESULTS

Plant extracts demonstrated moderate to high affinity to the γ-aminobutyric acid benzodiazepine (GABA-BZD) receptor. In addition, extracts demonstrated low to moderate activity in the inhibition of the GABA-transaminase, with select plants exhibiting significant activity. Plants indicated by the Yanesha showed comparable activity to the other Piperaceae plants collected. Piper cremii was the most active plant in the GABA-BZD receptor assay, and Drymaria cordata (Caryophyllaceae) in the GABA-T assay.

CONCLUSION

The study provides evidence that there is a pharmacological basis behind the use of plants in the treatment of susto and mal aire in both Central and South America, and we propose that the possible mechanism of action includes an interaction with the GABA-T enzyme and/or the GABAA-BZD receptor.

Low-power inversion recovery MRI preserves brain tissue contrast for patients with Parkinson disease with deep brain stimulators

BACKGROUND AND PURPOSE

Fast spin-echo short τ inversion recovery sequences have been very useful for MR imaging-guided deep brain stimulation procedures in Parkinson disease. However, high-quality fast spin-echo imaging deposits significant heat, exceeding FDA-approved limits when patients already have undergone deep brain stimulation and need a second one or a routine brain MR imaging for neurologic indications. We have developed a STIR sequence with an ultra-low specific absorption rate that meets hardware limitations and produces adequate tissue contrast in cortical and subcortical brain tissues for deep brain stimulation recipients.

MATERIALS AND METHODS

Thirteen patients with medically refractory Parkinson disease who qualified for deep brain stimulation were imaged at 1.5T with a fast spin-echo short τ inversion recovery sequence modified to meet conditional MR imaging hardware and specific absorption rate restrictions. Tissue contrast-to-noise ratios and implant localization were objectively and subjectively compared by 2 neuroradiologists, and image quality for surgical planning was assessed by a neurosurgeon for high and low specific absorption rate images.

RESULTS

The mean contrast-to-noise ratio for cerebral tissues without including the contrast-to-noise ratio for ventricular fluid was 35 and 31 for high and low specific absorption rate images. Subjective ratings for low specific absorption rate tissue contrast in 77% of patients were identical to (and in a few cases higher than) those of high specific absorption rate contrast, while the neurosurgical coordinates for fusing the stereotactic atlas with low specific absorption rate MR imaging were equivalent to those of the high specific absorption rate for 69% of patients.

CONCLUSIONS

Patients with Parkinson disease who have already had a deep brain stimulation face a risk of neural injury if routine, high specific absorption rate MR imaging is performed. Our modified fast spin-echo short τ inversion recovery sequence conforms to very conservative radiofrequency safety limits, while it maintains high tissue contrast for presurgical planning, postsurgical assessment, and radiologic evaluations with greater confidence for radiofrequency safety.

Fruit wastes fermentation for phenolic antioxidants production and their application in manufacture of edible coatings and films

Agro-industrial by-products are important sources of potent bioactive phenolic compounds. These compounds are of extreme relevance for food and pharmacological industries due to their great variety of biological activities. Fermentation represents an environmentally clean technology for production and extraction of these bioactive compounds, providing high quality and high activity extracts, which can be incorporated in foods using coatings/films wax-based in order to avoid alterations in their quality. In this document is presented an overview about importance and benefits of solid-state fermentation, pointing out this bioprocess as an alternative technology for use agro-industrial by-products as substrates to produce valuable secondary metabolites and their applications as food quality conservatives.

[Prevalence and factors associated with intimate partner abuse in female users of public health services in Mexico: a comparative analyses]

OBJECTIVE

To analyze the evolution of the prevalence in intimate partner violence during the years 2003 and 2006 in Mexico, identifying factors associated with its severity, comparing our results with findings from 2003.

MATERIAL AND METHODS

Data from the Encuesta Nacional de Violencia contra las Mujeres (ENVIM 2006) was used; it has urban-rural national representation of female users of Mexican public health services. A total of 22,318 women above 14 years of age were interviewed. A multinomial logistic regression model was adjusted. The dependent variable was the Index of Intimate Partner Abuse.

RESULTS

Intimate partner abuse increased 17% in comparison to the year 2003. Women's personal history of childhood abuse (ORA= 5.12, 95% CI4.15-6.30) and rape (ORA = 3.5, 95% CI = 2.66-4.62) were the most important women's factors that were found associated with severe violence. Male partner's daily alcohol consumption increased eleven fold the possibility of severe violence; higher disagreement with traditional female gender roles and higher education of both partners were protective factors. Factors associated with violence and their severities were consistent with findings reported in 2003.

CONCLUISIONS

Intimate partner violence is a highly prevalent social problem which requires comprehensive strategies supporting empowerment of women through higher education, early detection and care of those battered, as well as structured interventions to prevent violence in future generations.

Seroprevalences of varicella-zoster virus, herpes simplex virus and cytomegalovirus in a cross-sectional study in Mexico

We estimated the seroprevalences of varicella-zoster virus (VZV), herpes simplex virus (HSV) and cytomegalovirus (CMV) in this cross-sectional database study. Serum samples collected during the National Health and Nutrition survey (ENSANUT 2006) were obtained from subjects aged 1-70 years between January and October 2010. Serological assays for the determination of antibodies against VZV, HSV and CMV were performed. The overall seroprevalences of VZV, HSV-1, HSV-2 and CMV were 85.8%, 80.9%, 9.9% and 89.2%, respectively. Seroprevalences of VZV, HSV-1 and CMV were comparable between males and females. For HSV-2, although the seroprevalence rate was higher in females when compared to males, this difference in seroprevalence was not statistically significant. Seroprevalence rates for VZV, HSV-1, HSV-2 and CMV increased with age (p-value<.0001). Differences in seroprevalence rate for VZV by socioeconomic status (SES) were significant (p-value<0001). Results of the serological analyses reported high VZV seroprevalence, indicating high transmission in the Mexican population with children and adolescents at risk of acquiring VZV. Global HSV-1 seroprevalence was high, especially in adults. HSV-1 and HSV-2 seroprevalences were consistently higher in women than men, particularly for HSV-2. CMV seroprevalence was higher in Mexico when compared to developed countries. Seroepidemiological data on VZV supports the fact that varicella vaccination may serve as an alternative effective solution to reduce transmission in the Mexican population. For CMV and HSV, since no vaccines are available, activities to reduce transmission are important to reduce the risk of complications and therefore need to be considered.