Herramientas de Accesibilidad
Trypanosomatid infections are an important public health threat affecting many low-income countries across the tropics, particularly in the Americas. Trypanosomatids can infect many vertebrate, invertebrate, and plant species and play an important role as human pathogens. Among these clinically relevant pathogens are species from the genera Leishmania and Trypanosoma. Mixed trypanosomatid infections remain a largely unexplored phenomenon. Herein, we describe the application of an amplicon-based next-generation sequencing (NGS) assay to detect and identify trypanosomatid species in mammalian reservoirs, human patients, and sand fly vectors throughout regions of Leishmania endemicity. Sixty-five samples from different departments of Colombia, including two samples from Venezuela, were analyzed: 49 samples from cutaneous leishmaniasis (CL) patients, 8 from sand flies, 2 from domestic reservoirs (Canis familiaris), and 6 from wild reservoirs (Phyllostomus hastatus). DNA from each sample served to identify the presence of trypanosomatids through conventional PCR using heat shock protein 70 (HSP70) gene as the target. PCR products underwent sequencing by Sanger sequencing and NGS, and trypanosomatid species were identified by using BLASTn against a reference database built from trypanosomatid-derived HSP70 sequences. The alpha and beta diversity indexes of amplicon sequence variants were calculated for each group. The results revealed the presence of mixed infections with more than two Leishmania species in 34% of CL samples analyzed. Trypanosoma cruzi was identified in samples from wild reservoirs, as well as in sand fly vectors. Coinfection events with three different Leishmania species were identified in domestic reservoirs. These findings depose the traditional paradigm of leishmaniasis as being a single-species- driven infection and redraw the choreography of host-pathogen interaction in the context of multiparasitism. Further research is needed to decipher how coinfections may influence disease progression. This knowledge is key to developing an integrated approach for diagnosis and treatment.
Microbiology Spectrum
Mycobacterium tuberculosis (M. tuberculosis) was the pathogen responsible for the highest number of deaths from infectious diseases in the world, before the arrival of the COVID-19 pandemic. Whole genome sequencing (WGS) has contributed to the understanding of genetic diversity, the mechanisms involved in drug resistance and the transmission dynamics of this pathogen. The object of this study is to use WGS for the epidemiological and molecular characterization of M. tuberculosis clinical strains from Chinchiná, Caldas, a small town in Colombia with a high incidence of TB. Sputum samples were obtained during the first semester of 2020 from six patients and cultured in solid Löwenstein-Jensen medium. DNA extraction was obtained from positive culture samples and WGS was performed with the Illumina HiSeq 2500 platform for subsequent bioinformatic analysis. M. tuberculosis isolates were typified as Euro-American lineage 4 with a predominance of the Harlem and LAM sublineages. All samples were proven sensitive to antituberculosis drugs by genomic analysis, although no phenotype antimicrobial tests were performed on the samples, unreported mutations were identified that could require further analysis. The present study provides preliminary data for the construction of a genomic database line and the follow-up of lineages in this region.
PLoS ONE
Background: In randomised controlled trials, fixed-dose combination treatments (or polypills) have been shown to reduce a composite of cardiovascular disease outcomes in primary prevention. However, whether or not aspirin should be included, effects on specific outcomes, and effects in key subgroups are unknown. Methods: We did an individual participant data meta-analysis of large randomised controlled trials (each with ≥1000 participants and ≥2 years of follow-up) of a fixed-dose combination treatment strategy versus control in a primary cardiovascular disease prevention population. We included trials that evaluated a fixed-dose combination strategy of at least two blood pressure lowering agents plus a statin (with or without aspirin), compared with a control strategy (either placebo or usual care). The primary outcome was time to first occurrence of a composite of cardiovascular death, myocardial infarction, stroke, or arterial revascularisation. Additional outcomes included individual cardiovascular outcomes and death from any cause. Outcomes were also evaluated in groups stratified by the inclusion of aspirin in the fixed-dose treatment strategy, and effect sizes were estimated in prespecified subgroups based on risk factors. Kaplan-Meier survival curves and Cox proportional hazard regression models were used to compare strategies. Findings: Three large randomised trials were included in the analysis (TIPS-3, HOPE-3, and PolyIran), with a total of 18 162 participants. Mean age was 63·0 years (SD 7·1), and 9038 (49·8%) participants were female. Estimated 10-year cardiovascular disease risk for the population was 17·7% (8·7). During a median follow-up of 5 years, the primary outcome occurred in 276 (3·0%) participants in the fixed-dose combination strategy group compared with 445 (4·9%) in the control group (hazard ratio 0·62, 95% CI 0·53–0·73, p<0·0001). Reductions were also observed for the separate components of the primary outcome: myocardial infarction (0·52, 0·38–0·70), revascularisation (0·54, 0·36–0·80), stroke (0·59, 0·45–0·78), and cardiovascular death (0·65, 0·52–0·81). Significant reductions in the primary outcome and its components were observed in the analyses of fixed-dose combination strategies with and without aspirin, with greater reductions for strategies including aspirin. Treatment effects were similar at different lipid and blood pressure levels, and in the presence or absence of diabetes, smoking, or obesity. Gastrointestinal bleeding was uncommon but slightly more frequent in the fixed-dose combination strategy with aspirin group versus control (19 [0·4%] vs 11 [0·2%], p=0·15). The frequencies of haemorrhagic stroke (10 [0·2%] vs 15 [0·3%]), fatal bleeding (two [<0·1%] vs four [0·1%]), and peptic ulcer disease (32 [0·7%] vs 34 [0·8%]) were low and did not differ significantly between groups. Dizziness was more common with fixed-dose combination treatment (1060 [11·7%] vs 834 [9·2%], p<0·0001). Interpretation: Fixed-dose combination treatment strategies substantially reduce cardiovascular disease, myocardial infarction, stroke, revascularisation, and cardiovascular death in primary cardiovascular disease prevention. These benefits are consistent irrespective of cardiometabolic risk factors. Funding: Population Health Research Institute.
The Lancet
Feline scabies is a disease that is caused by Notoedres cati, a sarcoptic mite that injures the skin tissue. The present clinical case relates a notoedric scabies in a domestic cat, clinical observations, diagnostic test, and treatment. A 4-year-old male neutered domestic short haired cat was brought at a veterinary clinic. Alopecia, erythema, scales, crusts and hyperkeratosis were observed on the head, and pinnae and malodorous from lesions were observed in dermatological examination. Deep skin scrapings were collected. Microscopic examination revealed adult live mites presence. Based on the morphology, the mites isolated were identified as Notoedres cati. Ivermectin oral capsules (300μg/kg), repeat dose at 14 days. Bath with chlorhexidine and Benzoyl peroxide every 5 days for two months were applied. Moreover, multivitamin complexes were supplied daily, orally. An immunostimulant 1mL/10kg. IM, again applied two days. A clinical improvement in the cat was observed after administered this treatment. The present study reports notoedric mange in a domestic short haired cat in Colombia. The application of ivermectin with supportive therapy was useful in the treatment of notoedric scabies in this cat. The application of products other than ivermectin showed positive clinical observations in the recovery of this patient with feline scabies.
International Journal of Veterinary Science
Soil compaction causes negative effects on crop yield and its mechanical response analysis has recently gained relevance for research through numerical methods. In this work, Finite Element Method (FEM) using the Mohr-Coulomb (MC) and Hardening Soil (HS) constitutive models were employed to simulate the mechanical response of a Vertisol agricultural soil. First, an experimental study of the unconsolidated-undrained (UU) triaxial compression test with different moisture contents (w = 10%, 20% and 34%) and confining pressures (σ3 = σc = 0.05 MPa, 0.10 MPa and 0.15 MPa) was carried out, to obtain the shear strength parameters cohesion (c) and friction angle (φ), as well as the Young’s modulus (E) of the soil. The experimental study was conducted through a 32 factorial design with three replicates that it was used to evaluate the influence of the w and σc on E of the studied soil. Also, an analysis of the behavior of the φ and c parameters at each w was performed. Numerical simulations were done with similar conditions as the experimental tests with respect to loading and boundary conditions. A comparison of the mechanical response between numerical results and physical experiments was carried out. As a result, the MC model allowed to estimate satisfactorily the stress-strain relationship of the soil for w of 10% and 20%, while HS model exhibited a better approximation for w of 34% in comparison with the MC model. Finally, the methodology and the adjusted parameters of the agricultural soil obtained in this work, can be used in the study of soil compaction produced by the agricultural machinery.
Chilean Journal of Agricultural Research
Using highly specific antisera, the neuroanatomical distribution of folic acid (FA) and retinoic acid (RA) has been studied for the first time in the children brainstem. Neither immunoreactive structures containing RA nor immunoreactive fibers containing FA were found. FA-immunoreactive perikarya (fusiform, small/medium in size, one short dendrite) were only found in the pons in three regions: central gray, reticular formation, and locus coeruleus. The number of cell bodies decreased with age. In the first case studied (2 years), a moderate density of cell bodies was observed in the central gray and reticular formation, whereas a low density was found in the locus coeruleus. In the second case (6 years), a low density of these perikarya was observed in the central gray, reticular formation, and locus coeruleus. In the third case (7 years), a low density of FA-immunoreactive cell bodies was found in the central gray and reticular formation, whereas in the locus coeruleus no immunoreactive cell bodies were observed. The distribution of FA in the central nervous system of humans and monkeys is different and, in addition, in these species the vitamin was located in different parts of the nerve cells. The restricted distribution of FA suggests that the vitamin is involved in specific physiological mechanisms.
Anatomy and Cell Biology
Decades ago, we and many other groups showed a nucleo-cytoplasmic translocation of La protein in cultured cells. This shuttling of La protein was seen after UV irradiation, virus infections, hydrogen peroxide exposure and the Fenton reaction based on iron or copper ions. All of these conditions are somehow related to oxidative stress. Unfortunately, these harsh conditions could also cause an artificial release of La protein. Even until today, the shuttling and the cytoplasmic function of La/SS-B is controversially discussed. Moreover, the driving mechanism for the shuttling of La protein remains unclear. Recently, we showed that La protein undergoes redox-dependent conformational changes. Moreover, we developed anti-La monoclonal antibodies (anti-La mAbs), which are specific for either the reduced form of La protein or the oxidized form. Using these tools, here we show that redox-dependent conformational changes are the driving force for the shuttling of La protein. Moreover, we show that translocation of La protein to the cytoplasm can be triggered in a ligand/receptor-dependent manner under physiological conditions. We show that ligands of toll-like receptors lead to a redox-dependent shuttling of La protein. The shuttling of La protein depends on the redox status of the respective cell type. Endothelial cells are usually resistant to the shuttling of La protein, while dendritic cells are highly sensitive. However, the deprivation of intracellular reducing agents in endothelial cells makes endothelial cells sensitive to a redox-dependent shuttling of La protein.
International Journal of Molecular Sciences
Mycorrhizal associations are acknowledged as key components of global ecosystem functioning. This is especially relevant in the context of global change, since they contribute to the amelioration of adverse soil conditions and play crucial roles in agriculture. Generally speaking, the lay public is uninformed on the importance of mycorrhizal fungi and symbiosis to our planet. Therefore, mycorrhizal scientific outreach activities are of paramount importance in order to bridge the aforementioned gap. We think that informing people about the benefits of mycorrhizal fungi and symbiosis in the face of global change, will raise general awareness of relevant research and aid conservation efforts. Summary: Science outreach has become a particularly important duty in shortening the knowledge gap between scientists and the public, in order to strengthen societal decision-making power in the global change crisis. Mycorrhizal fungi and mycorrhizal symbioses are key components of terrestrial ecosystems that contribute significantly to endure and reduce certain negative global change effects. Their importance has been gaining recognition in academic circles, but not among the general public. The aim of this article is to encourage as many mycorrhizal fungi researchers around the world as possible to build, through science outreach, a bridge between their scientific work and public interest. To this end, we conducted a review and discussed the relationship between global change and the mycorrhizal symbiosis. We highlight potential audiences, tools, resources, activities, outreach models, pros and cons, as well as the quantification potential for the outreach activities success. We extend an invitation to all mycorrhizologists around the world to contribute with mycorrhizal outreach material. Contributions will become available on the South American Mycorrhizal Research Network website for individuals or organizations interested in starting or innovating in mycorrhizal science outreach activities. Finally, the hashtag #mycorrhizalscienceoutreach is proposed to be used whenever a mycorrhizal fungi-related science outreach activity is shared in social media.
Plants People Planet
The present study reports the trypanocidal and cardioprotective properties of fractions derived from Lippia alba (Verbenaceae family) essential oils (EOs), in a murine model of chronic Chagas disease (ChD). This infection represents one of the most serious public health problems in Latin American countries, without an effective therapy for chronic infection and its eventual cardiac complications. In the model established herein, the therapeutic scheme which involved 30 oral and daily doses of OxiLim (a mix composed by fractions enriched in citral, caryophyllene oxide, and limonene) was not toxic and exhibited trypanocidal activity comparable to benznidazole (assessed by parasitic DNA quantification - qPCR); but with an additional protective effects against cardiomyopathy progression. This last finding was confirmed by both echocardiography (reduction in the maximum diameter of the cardiac silhouette), and heart histopathology (tissue recovery, abundant fibroblasts, and mild separation of cardiac fibers). Conversely, rats treated only with benznidazole showed a significant increase in cardiac diameter with severe fiber dilation, angiogenesis, and high diversity of immune infiltrate. This research reports a highly trypanocidal (similar to benznidazole) therapeutic scheme based on L. alba essential oil fractions (OxiLim), which also exhibits a positive cardioprotective effect in the course of chronic chagasic cardiomyopathy, in rats.
Industrial Crops and Products
Background: As the COVID-19 pandemic progresses, the fear of infection increases and, with it, the stigma-discrimination, which makes it an additional problem of the epidemic. However, studies about stigma associated with coronavirus are scarce worldwide. Aims: To determine the association between stigmatisation and fear of COVID-19 in the general population of Colombia. Method: A cross-sectional study was carried out. A total of 1,687 adults between 18 and 76 years old (M = 36.3; SD = 12.5), 41.1% health workers, filled out an online questionnaire on Stigma-Discrimination and the COVID-5 Fear Scale, adapted by the research team. Results: The proportion of high fear of COVID-19 was 34.1%; When comparing the affirmative answers to the questionnaire on stigma-discrimination towards COVID-19, it was found that the difference was significantly higher in the general population compared to health workers in most of the questions evaluated, which indicates a high level of stigmatisation in that group. An association between high fear of COVID-19 and stigma was evidenced in 63.6% of the questions in the questionnaire. Conclusion: Stigma-discrimination towards COVID-19 is frequent in the Colombian population and is associated with high levels of fear towards said disease, mainly people who are not health workers.
International Journal of Social Psychiatry
The aim of this study was to determine the prevalence of Toxoplasma gondii and Mycoplasma agalactiae in sheep and goats from the south of La Guajira and north of Cesar as part of the establishment of a serological profile of these species in the Colombian region. Serum samples (n=1039) were analysed with commercial ELISA kits specific for these pathogens. The global prevalence found in the region was 25.1 and 18.3% for T. gondii and 0.12 and 0.8% for M. agalactiae in sheep and goats, respectively. Positive samples for T. gondii were more frequent in females than in males. Likewise, all samples positive for M. agalactiae were determined in females.
Revista de Investigaciones Veterinarias del Peru
Blastocystis is frequently reported in fecal samples from animals and humans worldwide, and a variety of subtypes (STs) have been observed in wild and domestic animals. In Colombia, few studies have focused on the transmission dynamics and epidemiological importance of Blastocystis in animals. In this study, we characterized the frequency and subtypes of Blastocystis in fecal samples of domestic animals including pigs, minipigs, cows, dogs, horses, goats, sheep, and llama from three departments of Colombia. Of the 118 fecal samples included in this study 81.4% (n = 96) were positive for Blastocystis using a PCR that amplifies a fragment of the small subunit ribosomal RNA (SSU rRNA) gene. PCR positive samples were sequenced by next generation amplicon sequencing (NGS) to determine subtypes. Eleven subtypes were detected, ten previously reported, ST5 (50.7%), ST10 (47.8%), ST25 (34.3%), ST26 (29.8%), ST21 (22.4%), ST23 (22.4%), ST1 (17.9%), ST14 (16.4%), ST24 (14.9%), ST3 (7.5%), and a novel subtype, named ST32 (3.0%). Mixed infection and/or intra -subtype variations were identified in most of the samples. Novel ST32 was observed in two samples from a goat and a cow. To support novel subtype designation, a MinION based sequencing strategy was used to generate the full-length of the SSU rRNA gene. Comparison of full-length nucleotide sequences with those from current valid subtypes supported the designation of ST32. This is the first study in Colombia using NGS to molecularly characterize subtypes of Blastocystis in farm animals. A great diversity of subtypes was observed in domestic animals including subtypes previously identified in humans. Additionally, subtype overlap between the different hosts examined in this study were observed. These findings highlight the presence of Blastocystis subtypes with zoonotic potential in farm animals indicating that farm animals could play a role in transmission to humans.
Frontiers in Veterinary Science
Aims: Rosuvastatin (10 mg per day) compared with placebo reduced major adverse cardiovascular (CV) events by 24% in 12 705 participants at intermediate CV risk after 5.6 years. There was no benefit of blood pressure (BP) lowering treatment in the overall group, but a reduction in events in the third of participants with elevated systolic BP. After cessation of all the trial medications, we examined whether the benefits observed during the active treatment phase were sustained, enhanced, or attenuated. Methods and results: After the randomized treatment period (5.6 years), participants were invited to participate in 3.1 further years of observation (total 8.7 years). The first co-primary outcome for the entire length of follow-up was the composite of myocardial infarction, stroke, or CV death [major adverse cardiovascular event (MACE)-1], and the second was MACE-1 plus resuscitated cardiac arrest, heart failure, or coronary revascularization (MACE-2). In total, 9326 (78%) of 11 994 surviving Heart Outcomes Prevention Evaluation (HOPE)-3 subjects consented to participate in extended follow-up. During 3.1 years of post-trial observation (total follow-up of 8.7 years), participants originally randomized to rosuvastatin compared with placebo had a 20% additional reduction in MACE-1 [95% confidence interval (CI), 0.64-0.99] and a 17% additional reduction in MACE-2 (95% CI 0.68-1.01). Therefore, over the 8.7 years of follow-up, there was a 21% reduction in MACE-1 (95% CI 0.69-0.90, P = 0.005) and 21% reduction in MACE-2 (95% CI 0.69-0.89, P = 0.002). There was no benefit of BP lowering in the overall study either during the active or post-trial observation period, however, a 24% reduction in MACE-1 was observed over 8.7 years. Conclusion: The CV benefits of rosuvastatin, and BP lowering in those with elevated systolic BP, compared with placebo continue to accrue for at least 3 years after cessation of randomized treatment in individuals without cardiovascular disease indicating a legacy effect. Trial Registration Number: NCT00468923.
European Heart Journal
Background: Guidelines recommend nonstatin lipid-lowering agents in patients at very high risk for major adverse cardiovascular events (MACE) if low-density lipoprotein cholesterol (LDL-C) remains ≥70 mg/dL on maximum tolerated statin treatment. It is uncertain if this approach benefits patients with LDL-C near 70 mg/dL. Lipoprotein(a) levels may influence residual risk. Objectives: In a post hoc analysis of the ODYSSEY Outcomes (Evaluation of Cardiovascular Outcomes After an Acute Coronary Syndrome During Treatment With Alirocumab) trial, the authors evaluated the benefit of adding the proprotein subtilisin/kexin type 9 inhibitor alirocumab to optimized statin treatment in patients with LDL-C levels near 70 mg/dL. Effects were evaluated according to concurrent lipoprotein(a) levels. Methods: ODYSSEY Outcomes compared alirocumab with placebo in 18,924 patients with recent acute coronary syndromes receiving optimized statin treatment. In 4,351 patients (23.0%), screening or randomization LDL-C was <70 mg/dL (median 69.4 mg/dL; interquartile range: 64.3-74.0 mg/dL); in 14,573 patients (77.0%), both determinations were ≥70 mg/dL (median 94.0 mg/dL; interquartile range: 83.2-111.0 mg/dL). Results: In the lower LDL-C subgroup, MACE rates were 4.2 and 3.1 per 100 patient-years among placebo-treated patients with baseline lipoprotein(a) greater than or less than or equal to the median (13.7 mg/dL). Corresponding adjusted treatment hazard ratios were 0.68 (95% confidence interval [CI]: 0.52-0.90) and 1.11 (95% CI: 0.83-1.49), with treatment-lipoprotein(a) interaction on MACE (Pinteraction = 0.017). In the higher LDL-C subgroup, MACE rates were 4.7 and 3.8 per 100 patient-years among placebo-treated patients with lipoprotein(a) >13.7 mg/dL or ≤13.7 mg/dL; corresponding adjusted treatment hazard ratios were 0.82 (95% CI: 0.72-0.92) and 0.89 (95% CI: 0.75-1.06), with Pinteraction = 0.43. Conclusions: In patients with recent acute coronary syndromes and LDL-C near 70 mg/dL on optimized statin therapy, proprotein subtilisin/kexin type 9 inhibition provides incremental clinical benefit only when lipoprotein(a) concentration is at least mildly elevated. (ODYSSEY Outcomes: Evaluation of Cardiovascular Outcomes After an Acute Coronary Syndrome During Treatment With Alirocumab; NCT01663402)
Journal of the American College of Cardiology
Biocontrol and plant growth-promoting bacteria (PGPB) are important agricultural bioinoculants. This study aimed to prospect new potential bioinoculants for a more sustainable agriculture from ferruginous caves of the Brazilian Iron Quadrangle. Culturable bacteria, from seven caves and one canga soil sample, were evaluated for biocontroller activity of the phytopathogens Xanthomonas citri subsp. Citri—Xcc306 (citrus canker), Fusarium oxysporum—Fo (fusariosis), and Colletotrichum lindemuthianum—Cl89 (bean anthracnose). The ability of the superior candidates to solubilize inorganic phosphate, fix nitrogen, and produce hydrolytic enzymes and siderophores was then analyzed. Out of 563 isolates, 47 inhibited the growth of Xcc306 in vitro, of which 9 reduced citrus canker up to 68% when co-inoculated with the pathogen on host plants. Twenty of the 47 inhibited Fo growth directly by 51–73%, and 15 indirectly by 75–81%. These 15 inhibited Cl89 growth in vitro (up to 93% directly and 100% indirectly), fixed nitrogen, produced proteases and siderophores, showed motility ability, produced biofilm, and all but one solubilized inorganic phosphate. Therefore, 15 (2.66%) bacterial isolates, from the genera Serratia, Nissabacter, and Dickeya, act simultaneously as biocontrollers and PGPBs, and could be important candidates for future investigations in planta as an alternative to minimize the use of pesticides and chemical fertilizers through sustainable agricultural management practices.
Sustainability (Switzerland)
Seedling emergence is the main propagation method of forest species. Thus, we aimed to evaluate emergence aspects of the tree legume Clathrotropis brunnea Amshoff (sapán or blackheart sapán), a Fabaceae of high economic value endemic to the Colombian rainforest. We characterized the biometry of legumes and seeds and assessed seedling emergence in three experiments: (1) effect of fruit color and substrate, (2) seed conservation in storage, and (3) presoaking and seed position. Our results showed that seeds of green-yellow fruits have greater length and weight and a water content of up to 53%. Seedling emergence did not differ between green-yellow and dark-brown fruits but did differ with substrate type; nearly 80% of seedlings emerged in the sand substrate (S1), but only 62% emerged in the mixed substrate (S3). Fresh sapán seeds are nondormant, showing a recalcitrant behavior in which seedling emergence decreased after storage in all tested conditions. Both seed-sowing positions allowed an emergence of >80% with a small benefit of the hilum downward, regardless of presoaking treatments. However, these differences did not affect seedling height or biomass after emergence. Our results provide basic knowledge on production of tropical seedlings, seeking species conservation, and use in restoration projects.
Forest Science
The primary objective of this study is to develop a methodology for evaluating digital skills in a population of 524 master\'s degree students in virtual learning and a sample of 222 participants at the Universidad de Santander (Colombia). A reliable and validated data collection instrument was used (Cronbach\'s alpha coefficient = 0.987). The approach is quantitative, non-experimental, correlational in scope, and crosssectional. A descriptive-inferential statistical analysis was applied by using a Pearson χ2 correlation test and a principal component analysis with KMO and Bartlett tests. The results show that the relationship between the use and knowledge of information and communication technology (ICT) that the population has, significantly influences the integration of technological resources in teaching practices. It is concluded that evaluating digital competence allows improving pedagogic training of teachers who are master\'s degree students in a virtual learning mode.
Formacion Universitaria
Background: Diabetes is a major risk factor for erectile dysfunction, however, the effect of GLP-1 receptor agonists on erectile dysfunction is unknown. We aimed to assess the incidence, prevalence, and progression of erectile dysfunction in men treated with dulaglutide compared with placebo, and to determine whether dulaglutide\'s effect on erectile dysfunction was consistent with its effect on other diabetes-related outcomes. Methods: The Researching Cardiovascular Events with a Weekly Incretin in Diabetes (REWIND) trial was a double-blind, placebo-controlled randomised trial of the effect of dulaglutide on cardiovascular outcomes. REWIND was done at 371 sites in 24 countries. Men and women aged older than 50 years with type 2 diabetes, who had either a previous cardiovascular event or cardiovascular risk factors, were randomly assigned (1:1) to receive either dulaglutide or placebo. Participating men were offered the opportunity to complete the standardised International Index of Erectile Function (IIEF) questionnaire at baseline, 2 years, 5 years, and study end. We did an exploratory analysis, in which we included participants who completed a baseline and at least 1 follow-up IIEF questionnaire. The primary outcome for these analyses was the first occurrence of moderate or severe erectile dysfunction following randomisation, assessed by the erectile function subscores on IIEF. This analysis was part of the REWIND trial, which is registered with ClinicalTrials.gov, NCT01394952. Findings: Between Aug 18, 2011, and Aug 14, 2013, 3725 (70·1%) of 5312 male participants with a mean age of 65·5 years (SD 6·4 years) were analysed, of whom 1487 (39·9%) had a history of cardiovascular disease, and 2104 (56·5%) had moderate or severe erectile dysfunction at baseline. The incidence of erectile dysfunction following randomisation was 21·3 per 100 person-years in the dulaglutide group and 22·0 per 100 person-years in the placebo group (HR 0·92, 95% CI 0·85–0·99, p=0·021). Men in the dulaglutide group also had a lesser fall in erectile function subscore compared with the placebo group, with a least square mean difference of 0·61 (95% CI 0·18–1·05, p=0·006). Interpretation: Long-term use of dulaglutide might reduce the incidence of moderate or severe erectile dysfunction in men with type 2 diabetes. Funding: Eli Lilly and Company.
The Lancet Diabetes and Endocrinology
Blue Rubber Bleb Nevus Syndrome, is a rare condition characterized by skin lesions caused by vascular malformations most frequently associated with lesions of the gastrointestinal tract, although rare, it can present with lesions in the central nervous system, thyroid, liver, spleen and lungs; common symptoms are: digestive tract bleeding and iron deficiency anemia. The main manifestation are skin lesions that are characterized by being button-like, with a bluish tint, covered by skin, called blue nevus with a rubbery consistency due to its rubber-like consistency. We present a case of Blue Rubber Bleb Nevus Syndrome with involvement in the central nervous and gastrointestinal systems.
Radiology Case Reports
This study investigates the effects of the addition of the intermetallic compounds ZrMn2 and Zr7Cu10 to the alloy TiCr1.1V0.9, in terms of the resulting structure and hydrogen absorption/desorption properties. 4 wt % of each intermetallic compound was co-melted into the TiCr1.1V0.9, creating two new alloys. The resulting structure, as studied by X-ray, predominantly exhibited a body-centered cubic (BCC) structural phase coexisting with a C14 Laves phase. A SEM analysis found C14 Laves phase to be distributed at the grain boundaries of the BCC structure. An analysis carried out using Sieverts-type equipment showed that this type of microstructure could be advantageous due to the fact that hydrogen absorption capacity did not decrease with the addition of the intermetallic compounds, in fact, its value increased to 3.85 wt %. Additionally, the structure exhibited fast hydrogen absorption kinetics.
Transactions of the Indian Institute of Metals
This article addresses human resilience and environmental regeneration in training the population to adapt and mitigate climate change\'s negative effects. The objective is to let teachers know about these constructs\' implications in the behavior of societies in future climate scenarios and the urgent need for their assessment in the classroom. Constructing the essay implied conducting a thorough review of updated bibliography available in indexed journals and documents of international organizations and its subsequent pedagogical contextualization. The analysis allowed concluding that the school should strengthen, in its students, the biological, cognitive, and emotional processes related to resilience to endure uncertain, vulnerable, and complex environments as a result of the occurrence of extreme temperature events (heat and cold waves) and precipitation (droughts, floods, hurricanes). Likewise, education must train future societies to undertake environmental regeneration processes that rebuild the broken tissues of nature as a mechanism to mitigate and compensate for anthropic damages. In these pedagogical scenarios, the school is an institution of the first order to train citizens who will inhabit a planet with environmental conditions and natural resources still unknown to human beings today. Implementing the analyzed constructs requires educational policies, school curricula, and teachers trained to develop them in their classrooms.
Revista Electronica Educare
The objective of this essay is to analyze the concepts of environmental uncertainty, vulnerability, and complexity in the scenarios of present and future climate change, and the essential role of the school in forming citizens with capacities for mitigation and adaptation. As this article takes into consideration the bet on education and the risks for the human species, it is addressed to teachers and their students to incorporate new constructs in cognitive, axiological, and procedural competencies as useful tools to survive in vulnerable, complex, and uncertain environments. The methodology to write the essay was based on the review of the concepts analyzed in studies conducted by international organizations related to climate science, and by researchers who report evidence in indexed journals and their subsequent assessment of applications in educational processes. As a synthesis of the discussion carried out, we conclude that the contemporary human society is worryingly exposed to drastic climate changes that increase the vulnerability of the poor population by affecting food production, availability of drinking water, the incidence of pests and diseases, and loss of human lives in extreme climate events. In this scenario, education emerges as one of the institutions called to train new generations to survive on a warmer planet and with an unknown demographic map due to gradual climate migrations in search for water, food, soil, and livable climates.
Revista Electronica Educare
Objectives To describe the incidence rate, severity, burden and aetiology of medical attention and time-loss injuries across five consecutive seasons at a professional ballet company. Methods Medical attention injuries, time-loss injuries and dance exposure hours of 123 professional ballet dancers (women: n=66, age: 28.0±8.3 years; men: n=57, age: 27.9±8.5 years) were prospectively recorded between the 2015/2016 and 2019/2020 seasons. Results The incidence rate (per 1000 hours) of medical attention injury was 3.9 (95% CI 3.3 to 4.4) for women and 3.1 (95% CI 2.6 to 3.5) for men. The incidence rate (per 1000 hours) of time-loss injury was 1.2 (95% CI 1.0 to 1.5) for women and 1.1 (95% CI 0.9 to 1.3) for men. First Soloists and Principals experienced between 2.0-2.2 additional medical attention injuries per 1000 hours and 0.9-1.1 additional time-loss injuries per 1000 hours compared with Apprentices (p≤0.025). Further, intraseason differences were observed in medical attention, but not time-loss, injury incidence rates with the highest incidence rates in early (August and September) and late (June) season months. Thirty-five per cent of time-loss injuries resulted in over 28 days of modified dance training. A greater percentage of time-loss injuries were classified as overuse (women: 50%; men: 51%) compared with traumatic (women: 40%; men: 41%). Conclusion This is the first study to report the incidence rate of medical attention and time-loss injuries in professional ballet dancers. Incidence rates differed across company ranks and months, which may inform targeted injury prevention strategies.
British Journal of Sports Medicine
Objective To evaluate the relation between intake of ultra-processed food and risk of inflammatory bowel disease (IBD). Design Prospective cohort study. Setting 21 low, middle, and high income countries across seven geographical regions (Europe and North America, South America, Africa, Middle East, south Asia, South East Asia, and China). Participants 116 087 adults aged 35-70 years with at least one cycle of follow-up and complete baseline food frequency questionnaire (FFQ) data (country specific validated FFQs were used to document baseline dietary intake). Participants were followed prospectively at least every three years. Main outcome measures The main outcome was development of IBD, including Crohn\'s disease or ulcerative colitis. Associations between ultra-processed food intake and risk of IBD were assessed using Cox proportional hazard multivariable models. Results are presented as hazard ratios with 95% confidence intervals. Results Participants were enrolled in the study between 2003 and 2016. During the median follow-up of 9.7 years (interquartile range 8.9-11.2 years), 467 participants developed incident IBD (90 with Crohn\'s disease and 377 with ulcerative colitis). After adjustment for potential confounding factors, higher intake of ultra-processed food was associated with a higher risk of incident IBD (hazard ratio 1.82, 95% confidence interval 1.22 to 2.72 for ≥5 servings/day and 1.67, 1.18 to 2.37 for 1-4 servings/day compared with <1 serving/day, P=0.006 for trend). Different subgroups of ultra-processed food, including soft drinks, refined sweetened foods, salty snacks, and processed meat, each were associated with higher hazard ratios for IBD. Results were consistent for Crohn\'s disease and ulcerative colitis with low heterogeneity. Intakes of white meat, red meat, dairy, starch, and fruit, vegetables, and legumes were not associated with incident IBD. Conclusions Higher intake of ultra-processed food was positively associated with risk of IBD. Further studies are needed to identify the contributory factors within ultra-processed foods.
The BMJ
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.
European Heart Journal
Universidad de Santander UDES. Vigilada Mineducación.
Resolución otorgada por el Ministerio de Educación Nacional: No. 6216 del 22 de diciembre de 2005 / Personería Jurídica 810 de 12/03/96.
Institución sujeta a inspección y vigilancia por el Ministerio de Educación Nacional. Resolución 12220 de 2016.
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