Título del artículo:

Proposal of a scale for COVID-19 stigma-discrimination toward health workers

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Journal of Investigative Medicine

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The corn cob gasification-based renewable energy recovery in the life cycle environmental performance of seed-corn supply chain: An Ecuadorian case study

The influence of energy recovery from corn cob residues on the environmental performance of the seed-corn supply chain was the main research purpose of this work. An experimental and theoretical analysis as research methods were considered. In this way, an experimental study of corn cob gasification by using air as gasifying agent was conducted, while syngas-based power generation was assessed in a typical gas-ICE. Additionally, life cycle assessment (LCA) of two scenarios (combustion and gasification cases of corn cob residues) for the seed-corn supply chain was accomplished. According to results, a syngas yield in the range of 1.23 and 2.35 Nm3/kg of corn cob was obtained, with LHV close to 5.32 MJ/Nm3. Specific energy recovery from corn cob residues showed, an electricity surplus index of 744 kWh/t corn cob. Moreover, the carbon footprint for both combustion and gasification cases was 913 kg CO2-eq/t seed-corn and 797 kg CO2-eq/t seed-corn, respectively. Integrated thermochemical conversion of corn cob and power generation system represents a technological alternative for its sustainable management. This study provides a holistic inventory, energy balance, and life cycle analysis of corn cob energy utilization. No similar approaches were found in the reviewed literature.

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Renewable Energy

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Sprint pattern analysis of professional female soccer players on artificial and natural turf

Introduction: There is few evidence that details the behavior of each spatiotemporal variable of the running pattern of female soccer players using different surfaces. Objective: To describe the spatiotemporal variables of the sprint pattern developed on natural and artificial turf by professional female soccer players. Methods: A cross-sectional study was conducted on nineteen (n=19) professional athletes with an average age of 22.3 years, who´s sprint spatiotemporal variables were evaluated in a natural (Bermuda 419) and artificial (Star 2) playing field through an optical measurement system (Opto Gait, Italy). The analysis of the differences of the space and time variables by turf was done with the Wilcoxon test for paired data and the differences in speed and acceleration by playing position was done using the Kruskal–Wallis test. The Spearman test was used to compare the correlation between speed, acceleration and anthropometric variables. Finally, an alpha level of 5% was considered for the whole analysis. Results: On the natural turf, the speed and cadence of the players were higher; on the artificial turf, the energy, flight time, contact phase and step angle were higher (p<0.05). On the other hand, an indirect relationship was observed between speed, contact time, percentage and fat weight (p=0.01). Conclusion: Our results suggest that the natural turf, Bermuda 419, allows for a faster sprinting patterns, characterized by lower energy use, flight time, contact phase and step angle.

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Retos

Título del artículo:

Validity of the patient health questionnaire-2 (PHQ-2) for the detection of depression in primary care in Colombia

Background: The PHQ-2 is a screening test for major depressive disorder (MDD) derived from PHQ-9, which has shown to be useful in the detection of cases of clinical significance in previous studies. The psychometric properties of PHQ-2 in the Colombian population are unknown. Methods: PHQ-2 were assessed in 243 patients in general medical consultations using the Mini-International Neuropsychiatric Interview (MINI) as the gold standard. Internal consistency, convergent validity and criterion validity were calculated by analyzing the Receptor Operating Characteristics (ROC) and the area under the curve (AUC). Results: Cronbach\'s alpha and McDonald\'s omega coefficients were 0.71. Spearman\'s rho coefficients for correlations with PHQ-9 and HADS-D scores were 0.63 and 0.59 (p<0.01). AUC was 0.89. The optimal cut point was ≥2 with the following indicators: sensitivity 0.87 specificity 0.74; Youden index 0.60; PPV 0.47; NPV 0.95; (LR+) 3.24; (LR-) 0.18 (95% CI 0.09-0.37). Kappa coefficient between PHQ-2 and MINI for depression was .458 and 0.46 for HADS-D. Limitations: Since this study was done with people attending hospital, which could has implications for the prevalence of depression, affecting the validity indicators of the instrument. Conclusions: PHQ-2 show an acceptable test performance in the context of the study. However, the test could yield a considerable amount of false positives that would require specialized evaluation to establish a reliable diagnosis.

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Journal of Affective Disorders

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Validity of the Patient Health Questionnaire-9 (PHQ-9) for depression screening in adult primary care users in Bucaramanga, Colombia

The patient health questionnaire-9 (PHQ-9) is one of the most widely used self-report instruments in primary care. There is no criterion validity of the PHQ-9 in Colombia. The objective was to validate the PHQ-9 as a screening tool in primary care. A cross-sectional, scale criterion validity study was performed using as reference criterion the mini neuropsychiatric interview (MINI) in male and female adult users of primary care centres. We calculated the internal consistency and convergent and criterion validity of the PHQ-9 by analysing the receiver operating characteristics (ROC) and the area under the curve (AUC). We analysed 243 participants; 184 (75.7%) were female. The average age was 34.05 (median of 31 and SD = 12.47). Cronbach\'s α was 0.80 and McDonald\'s ω was 0.81. Spearman\'s Rho was 0.64 for HADS-D (P <0.010) and 0.70 for PHQ-2 (P <0.010). The AUC was 0.92 (95% CI 0.880-0.963). The optimal cut-off point of PHQ-9 was ≥7: sensitivity of 90.38 (95% CI: 81.41-99.36); specificity of 81.68 (95% CI: 75.93-87.42); PPV 57.32 (95% CI: 46.00-68.63); NPV 96.89 (95% CI: 93.90-99.88); Youden index 0.72 (95% CI: 0.62-0.82); LR+ 4.93 (95% CI: 3.61-6.74); LR– 0.12 (95% CI: 0.005-0.270). In sum, the Colombian version of PHQ-9 is a valid and reliable instrument for depression screening in primary care in Bucaramanga, with a cut-off point ≥7.

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Revista Colombiana de Psiquiatria

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Gelation kinetics of colloidal dispersion gels by viscoelasticrheological methods

Colloidal dispersion gels are one of the methodologies implemented, such as chemical recovery processes, in mature wells, their components are mainly polyacrylamide and aluminum citrate, both aqueous unlike other types of gelling, in this there is an intramolecular process, between the polymer chains and the crosslinker, generating a ball of polyacrylamide of nanometric dimensions. The usual gelling processes increase the viscosity of a fluid because of an increase in the molecular weight of the polymer, but in this case, the viscosity of the fluid decreases to the point of being close to that of the solvent, for this reason a monitoring of its gelation kinetics, in a conventional way is not possible, in view of this problem, this research implements techniques of viscoelastic characterization of fluids, to determine the loss and storage modules G\' and G?, as well as the phase angle in the time, in order to learn more about the gelling mechanism, as well as to be able to estimate a reaction speed, from the point of view of viscoelastic variables, the results obtained revealed that despite being gelling, there is a decrease in the storage modulus, to a greater extent than the loss modulus, which implies that the material loses elastic properties, that is, from solid to become a material more viscous or liquid. With this information, an equation was proposed that can be used both in the laboratory and in oil field work. In addition to being extended to fluids with similar behaviors, where the interactions between the polymeric chains and their crosslinker generate a decrease in their elastic properties.

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Journal of Physics: Conference Series

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Comparative analysis between asphaltites and extra heavy oil asphaltenes

The asphaltite material receives many names depending on the country, or area of knowledge, for this reason it is also known as bitumen, asphalt and gilsonite, its composition is a mixture of high molecular weight organic substances, mainly polyaromatic compounds characterized by a black color, and they appear in a semi-solid or solid state. Asphaltenes correspond to the oil fraction with the highest molecular weight, this characteristic provides a high viscosity to hydrocarbons, which contain, in their composition, a concentration equal to or greater than 10%, although the exact structure of this is not known. molecular family, it has been possible to elucidate the functional groups present, such as carbonyl acids, thiols and pyridines, implying the presence of heteroatoms, such as nitrogen, sulfur and oxygen, but the most characteristic part of this type of molecules is their nucleus polyaromatic, which can contain up to 20 or more benzene rings. A sample of Colombian asphaltite was taken and compared with a sample of asphaltenes from a Colombian extra-heavy crude, solubility tests, a spectroscopic characterization by Ultraviolet-Visible, infrared, a thermal evaluation by Thermogravimetry and Differential Scanning Calorimetry were carried out., in addition to an analysis by X-ray diffraction, in order to determine if the behavior and composition of both The objective of this investigation is to be analyzed by comparing a traditional asphaltite and an asphaltite, if the latter has the same properties and composition, with a view to being used as an energy source. The results obtained reveal that despite the fact that both substances present a similar composition, their glass transitions are different, as well as the crystalline phases present in each of the materials.

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Journal of Physics: Conference Series

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Association between HPV infection, presence of intraepithelial lesions in the cervix and risk factors

Objective: To establish associations between risk factors and the presence of intraepithelial lesions and human papillomavirus infection. Methods: Cross-sectional study with 1639 from the Santos Marquina municipality, Mérida, Venezuela. Cervical cytology and colposcopy, human papillomavirus detection and genotyping were analyzed using PCR and surveys to measure risk factors. Results: 477 women (31.8%) had human papillomavirus infection and 82 women (5.6%) had abnormalities in cervical cytology. Among the cases where human papillomavirus genotyping was performed, 135 (42%) correspond to low-risk types, while 177 (55%) correspond to high-risk types. A higher proportion of abnormal cytologies was found in cases with high-risk human papillomavirus with 21 cases (13.4%) compared to low-risk human papillomavirus with 9 cases (6.4%). The number of lifetime sexual partners greater than 1 (OR=2,303; p=0.001) and the history of pregnancy (OR=3,283; p=0.036) were significant independently associated with the presence of abnormal cytology. While the number of lifetime sexual partners greater than 1 (OR=1.304; p=0.026), the residence in rural area (OR=1.957; p <0.001) and the age under 35 years (OR=1,397; p=0.003) were significant independently associated with the presence of human papillomavirus infection. Conclusion: The type of human papillomavirus and other risk factors play an important role in the appearance of cervical intraepithelial lesions.

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Revista de Obstetricia y Ginecologia de Venezuela

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Chemical study, antioxidant capacity, and hypoglycemic activity of malva pseudolavatera webb & berthel and malva sylvestris l. (malvaceae), grown in ecuador

Malva pseudolavatera and M. sylvestris (Malvaceae) are two species in great demand in Ecuador for their medicinal virtues. However, the chemical and biological information on M. psudolavatera is scarce. The present study aims to carry out a comparative chemical study of the antioxidant and hypoglycemic activities of the leaves of the species M. pseudolavatera and M. sylvestris to justify their traditional use. Extracts were made with 80% hydroalcoholic mixture from the leaves of M. sylvestris and M. pseudolavatera. The chemical composition was analyzed by Liquid chromatography coupled to mass spectrometry. The antioxidant capacity was performed by the Ferric Reducing Antioxidant Power, 2,2-diphenyl-1-picrylhydrazyl and 2,2\'azino-bis(3-ethylbenzothiazoline-6-sulfonic acid techniques and the hypoglycemic activity in Wistar rats at the doses of 250, 500 and 1000 mg/kg, of the extracts, were evaluated. Liquid chromatography coupled to mass spectrometry analysis allowed the detection of similarities and differences in the chemical composition of both leaf extracts, the flavonoid gosipetin 3-O-β-D-glucopyranosyl-8-O-β-D-glucuronopyranoside, was found in both species and for M. pseudolavatera is reported for the first time. The extract of M. sylvestris showed antioxidant capacity and hypoglycemic activity, superior to the extract of M. pseudolavatera. The results of this research report for the first time the phenolic and flavonoid composition, as well as the antioxidant and hypoglycemic activity of the extracts of the leaves of M. pseudolavatera and its comparison with that of M. sylvestris for which there were previous reports.

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Tropical Journal of Natural Product Research

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Analysis of the atmospheric macro-physical using spatial methods

The central western area of Venezuela has an unequal distribution of precipitation. Due to its agricultural importance, is necessary to plan water accounting and this requires a evaluation of spatial and temporal variability of precipitation and an estimate of local geophysical effect from the relief. In this research we use an iterative computationally lattice approach to perform a confirmatory analysis of the variability and the spatial correlation structure in monthly precipitation stations. Spatial correlograms and pooled empirical semivariogram were applied to evaluate the most appropriate spatial weighting matrix to estimate the Moran\'s I. The altitude effect over monthly rainfall was estimated through spatial regression algorithm which determine the predominant spatial process in each slice. A homogeneous spatial stochastic process with positive spatial autocorrelation is evidenced. There is a trend towards a higher frequency of spatial error and spatial auto-regressive processes between the months of June and August whilst there are not dominant process between October and December. This response is caused by the dynamics of the intertropical convergence zone, which generates a seasonal effect on precipitation. These estimations allows decision-making in modeling and will lead to an improvement for analysis and forecasting in areas strongly affected by climate change and water stress.

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Journal of Physics: Conference Series

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Genetic polymorphisms in multispecific transporters mitigate mercury nephrotoxicity in an artisanal and small-scale gold mining community in Colombia

In artisanal and small-scale gold mining, occupational exposure to mercury (Hg) vapor is related to harmful effects on several organs, including the kidneys. We previously reported significantly increased levels of Hg in blood and urine despite normal kidney function in individuals from Colombia occupationally exposed to Hg compared with those nonexposed. We evaluated the contribution of 4 genetic variants in key genes encoding the transporters solute carrier (SLC; rs4149170 and rs4149182) and ATP-binding cassette(ABC; rs1202169 and rs1885301) in the pathogenesis of nephrotoxicity due to Hg exposure in these groups. Regression analysis was performed to determine the association between the blood- and urine-Hg concentration with SLC and ABC polymorphisms in 281 Colombian individuals (160 exposed and 121 nonexposed to Hg). We found an enrichment of ABCB1 rs1202169-T allele in the exposed group (p ¼ .011; OR¼ 2.05; 95% CI ¼ 1.18–3.58) compared with the nonexposure group. We also found that carriers of SLC22A8 rs4149182-G and ABCB1 rs1202169-T alleles had a higher urinary clearance rate of Hg than noncarriers (b ¼ 0.13, p ¼ .04), whereas carriers of SLC22A6 rs4149170-A and ABCB1 rs1202169-C alleles showed abnormal levels of estimated glomerular filtration rate (b ¼ -84.96, p ¼ .040) and beta-2microglobulin (b ¼ 743.38, p < .001). Our results suggest that ABCB1 rs1202169 and its interaction with SLC22A8 rs4149182 and SLC22A6 rs4149170 could mitigate Hg nephrotoxicity by controlling the renal proximal tubule cell accumulation of inorganic Hg. This will be useful to estimate the risk of kidney toxicity associated to Hg and the genetic selection to aid adaptation to Hg-rich environments.

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Toxicological Sciences

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Total cardiovascular or fatal events in people with type 2 diabetes and cardiovascular risk factors treated with dulaglutide in the REWIND trail: a post hoc analysis

Background: The Researching cardiovascular Events with a Weekly INcretin in Diabetes (REWIND) double blind randomized trial demonstrated that weekly subcutaneous dulaglutide 1.5 mg, a glucagon like peptide-1 receptor agonist, versus matched placebo reduced the first outcome of major adverse cardiovascular event (MACE), cardiovascular death, nonfatal myocardial infarction or nonfatal stroke (594 versus 663 events) in 9901 persons with type 2 diabetes and either chronic cardiovascular disease or risk factors, and followed during 5.4 years. These findings were based on a time-to-first-event analysis and preclude relevant information on the burden of total major events occurring during the trial. This analysis reports on the total cardiovascular or fatal events in the REWIND participants Methods: We compared the total incidence of MACE or non-cardiovascular deaths, and the total incidence of expanded MACE (MACE, unstable angina, heart failure or revascularization) or non-cardiovascular deaths between participants randomized to dulaglutide and those randomized to placebo. Incidences were expressed as number per 1000 person-years. Hazard ratios (HR) were calculated using the conditional time gap and proportional means models. Results: Participants had a mean age of 66.2 years, 46.3% were women and 31% had previous cardiovascular disease. During the trial there were 1972 MACE or non-cardiovascular deaths and 3673 expanded MACE or non-cardiovascular deaths. The incidence of total MACE or non-cardiovascular deaths in the dulaglutide and placebo groups was 35.8 and 40.3 per 1000 person-years, respectively [absolute reduction = 4.5 per 1000 person-years; conditional time gap HR 0.90 (95% CI, 0.82–0.98) p = 0.020, and proportional means HR 0.89 (95% CI, 0.80–0.98) p = 0.022]. The incidence of total expanded MACE or non-cardiovascular deaths in the dulaglutide and placebo groups was 67.1 and 74.7 per 1000 person-years, respectively [absolute reduction = 7.6 per 1000 person-years; conditional time gap HR 0.93 (95% CI, 0.87–0.99) p = 0.023, and proportional means HR 0.90 (95% CI, 0.82–0.99) p = 0.028]. Conclusions: These findings suggest that weekly subcutaneous dulaglutide reduced total cardiovascular or fatal event burden in people with type 2 diabetes at moderate cardiovascular risk. Clinical Trial Registration:https://www.clinicaltrials.gouv. Unique Identifier NCT01394952).

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Cardiovascular Diabetology

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Physical preparation and return to performance of an elite female football player following ACL reconstruction: A journey to the FIFA Women\'s World Cup

ACL injuries are among the most severe knee injuries in elite sport, with a high injury burden and re-injury risk. Despite extensive literature on the injury and the higher incidence of injury and re-injury in female athletes, there is limited evidence on the return to sport (RTS) of elite female football players following ACL reconstruction (ACLR). RTS is best viewed on a continuum aligning the recovery and rehabilitation process with the ultimate aim-A return to performance (RTP erf). We outline the RTS and RTP erf of an elite female football player following ACLR and her journey to the FIFA Women\'s World Cup, including the gym-based physical preparation and the on-pitch/sports-specific reconditioning. We used the control-chaos continuum\' as a framework for RTS, guiding a return above pre-injury training load demands while considering the qualitative nature of movement in competition. We then implemented the RTP erf pathway\' to facilitate a return to team training, competitive match play and a RTP erf. Objective information, clinical reasoning and shared decision-making contributed to this process and helped the player to reach her goal of representing her country at the FIFA Women\'s World Cup.

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BMJ Open Sport and Exercise Medicine

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Prevalence of Dirofilaria immitis in shelter dogs in Bucaramanga metropolitan area, Colombia

The heartworm Dirofilaria immitis is the causative agent of cardiopulmonary dirofilariosis in dogs and cats and also infects humans. The current knowledge about this parasite in South America is scarce compared to North America and Europe. Nevertheless, this parasite has been reported in some regions of Colombia. The objective of this study was to determine the prevalence and risk factors associated with D. immitis infection in shelter dogs from Bucaramanga metropolitan area. We performed a cross-sectional study using blood samples from shelter dogs. Microfilariae testing of whole blood included a blood smear and modified Knott\'s test. Antigen testing of serum was performed using the Anigen Rapid HW Ag Test Kit 2.0 ®. A descriptive analysis and univariable logistic regression analysis were applied. A total of 207 whole blood samples, from 7 shelters dogs in the Bucaramanga metropolitan area, were utilized. The overall prevalence of D. immitis observed in shelter dogs in the Bucaramanga metropolitan area by blood smears and modified Knott\'s test was 6.3% (13/ 207) and 0.5% (1/207) by immunochromatography test kit. Regarding the prevalence by municipalities, there was a statistical association (P < .05), indicating that the prevalence was higher in dogs in Girón municipality. Likewise, there was a statistical association (P < .05) between the prevalence with respect to heartworm knowledge and mosquito control. For prevalence by gender, age group, dog breed, and hair length, there was no statistical association (P > .05). For Girón municipality there was a 7.1 times (OR = 7.1; CI95% 0.8–59.2; P < .05) increased infection risk. This study provides current data and the first known report of the prevalence of D. immitis microfilaremia and antigenemia in shelter dogs in the Bucaramanga metropolitan area, and these results could be useful for designing new control measures for this infection. We observed that the prevalence of both microfilaremia and antigenemia was significantly lower in these sampled dogs compared to previous reports.

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Veterinary Parasitology: Regional Studies and Reports

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Risk of dengue virus infection according to serostatus in individuals from dengue endemic areas of Mexico

The variability in the host immune response directed against dengue virus (DENV) has demonstrated the need to understand the immune response associated with protection in incident infection. The objective was to estimate the association between serostatus and the risk of incident DENV infection. We used a prospective study from 2014 to 2016 in the localities of Axochiapan and Tepalcingo, Morelos, Mexico. We recruited 966 participants, of which, according to their infection history registered were categorized in four groups. To accomplish the objectives of this study, we selected to 400 participants older than 5 years of age were followed for 2.5 years. Blood samples were taken every 6 months to measure serological status and infection by ELISA. In individuals with at least two previous infections the risk of new infection was lower compared to a seronegative group (hazard ratio adjusted 0.49, 95% CI 0.24–0.98), adjusted for age and locality. Therefore, individuals who have been exposed two times or more to a DENV infection have a lower risk of re-infection, thus showing the role of cross-immunity and its association with protection.

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Scientific Reports

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Standardized treatment to improve hypertension control in primary health care: The HEARTS in the Americas Initiative

Hypertension is the leading risk factor for cardiovascular disease (CVD) worldwide. Despite the availability of effective antihypertensive medications, the control of hypertension at a global level is dismal, and consequently, the CVD burden continues to increase. In response, countries in Latin America and the Caribbean are implementing the HEARTS in the Americas, a community-based program that focuses on increasing hypertension control and CVD secondary prevention through risk factor mitigation. One key pillar is the implementation of a standardized hypertension treatment protocol supported by a small, high-quality formulary. This manuscript describes the methodology used by the HEARTS in the Americas program to implement a population-based standardized hypertension treatment protocol. It is rooted in a seamless transition from existing treatment practices to best practice using pharmacologic protocols built around a core set of ideal antihypertensive medications. In alignment with recent major hypertension guidelines, the HEARTS in the Americas protocols call for the rapid control of blood pressure, through the use of two antihypertensive medications, preferably in the form of a single pill, fixed-dose combination, in the initial treatment of hypertension. To date, the HEARTS in the Americas program has seen the improvement in antihypertensive medication formularies and the establishment of pharmacologic treatment protocols tailored to individual participating countries. This has translated to significant increases in hypertension control rates post-program implementation in these jurisdictions. Thus, the HEARTS in the Americas program could serve as a model, for not only the Americas Region but globally, and ultimately decrease the burden of CVD.

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Journal of Clinical Hypertension

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Amidated Cellulose Nanofibrils as Demulsifying Agents for a Natural Water-in-Heavy-Crude-Oil Emulsion

The presence of emulsified water in heavy crude oils invariably causes processing problems and financial costs associated with an increased energy input required to handle highly viscous fluids. Thus, physical or chemical separation methods are usually applied to dehydrate crude oils before processing. Dehydration chemicals or demulsifiers are among the most widely used chemical strategies to rid heavy crude oil from water. In this work, we explore the use of amidated cellulose nanofibrils as dehydrating agents for a water-in-heavy-crude-oil emulsion. Using microcrystalline cellulose (MCC) as raw material, we extracted oxidized cellulose nanofibrils (1.25 mmol COOH/g cellulose) via ultrasound-assisted TEMPO oxidation. TEMPO-oxidized cellulose nanofibrils (TOCNs) were rendered hydrophobic through the coupling with dodecyl- and octadecylamine through one-pot amidation reactions. The introduction of C12 and C18 alkyl moieties on the cellulose surface was enough to promote the dispersion of the materials in toluene and increase the water contact angle (CA) from 17° for TOCN to 61° and 67° for TOCN-AMDC12 and TOCN-AMDC18, respectively. HLB values of 9.6 and 9.2 for TOCN-AMDC12 and TOCN-AMDC18 are characteristic of dehydrating agents for w/o emulsions. Thus, the materials were tested as demulsifying agents for the disruption of a natural water-in-heavy-crude-oil emulsion with a water content of 55%. Conventional tests (BSW, bottle test) showed the ability of TOCN-AMDC12 and TOCN-AMDC18 to effectively dehydrate the emulsions, with a water recovery up to 74%, when used at 1500 ppm in toluene as the carrier fluid. Optical microscopy and rheological analysis were performed before and after the nanofluids\' application to determine the viscosity profile of the emulsion and to observe the types and sizes of water droplets in the oil phase after dehydration.

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Energy and Fuels

Título del artículo:

Availability and affordability of medicines and cardiovascular outcomes in 21 high-income, middle-income and low-income countries

Objectives We aimed to examine the relationship between access to medicine for cardiovascular disease (CVD) and major adverse cardiovascular events (MACEs) among people at high risk of CVD in high-income countries (HICs), upper and lower middle-income countries (UMICs, LMICs) and low-income countries (LICs) participating in the Prospective Urban Rural Epidemiology (PURE) study. Methods We defined high CVD risk as the presence of any of the following: hypertension, coronary artery disease, stroke, smoker, diabetes or age >55 years. Availability and affordability of blood pressure lowering drugs, antiplatelets and statins were obtained from pharmacies. Participants were categorised: group 1-all three drug types were available and affordable, group 2-all three drugs were available but not affordable and group 3-all three drugs were not available. We used multivariable Cox proportional hazard models with nested clustering at country and community levels, adjusting for comorbidities, sociodemographic and economic factors. Results Of 163 466 participants, there were 93 200 with high CVD risk from 21 countries (mean age 54.7, 49% female). Of these, 44.9% were from group 1, 29.4% from group 2 and 25.7% from group 3. Compared with participants from group 1, the risk of MACEs was higher among participants in group 2 (HR 1.19, 95% CI 1.07 to 1.31), and among participants from group 3 (HR 1.25, 95% CI 1.08 to 1.50). Conclusion Lower availability and affordability of essential CVD medicines were associated with higher risk of MACEs and mortality. Improving access to CVD medicines should be a key part of the strategy to lower CVD globally.

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BMJ Global Health

Título del artículo:

Noncardiogenic pulmonary edema after intoxication with amlodipine

BACKGROUND: Dihydropyridines are a group of calcium channel antagonist drugs used in the management of high blood pressure, angina pectoris and cardiac arrhythmias. Their adverse reactions are infrequent, acute noncardiogenic lung edema is one of them. It is caused by various disorders that trigger an increase in the permeability of the alveolar capillary membrane. CLINICAL CASE: A 16-year-old male, who, 8 hours after taking six tablets of amlodipine, presented persistent chest pain associated with dyspnea. In his hospital stay, hypoxemia marked with signs of edema and pulmonary congestion was evidenced, thus, diuretic therapy was initiated, and vasopressor support required. It was considered a picture of noncardiogenic pulmonary edema related to amlodipine intoxication with good response to treatment. CONCLUSIONS: In many occasions, distinguishing what type of acute lung edema the patient has can be complex; however, the possibility of ingesting medications should not be ruled out, as in the reported case.

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Medicina Interna de Mexico

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White rice intake and incident diabetes: A study of 132,373 participants in 21 countries

OBJECTIVE Previous prospective studies on the association of white rice intake with incident diabetes have shown contradictory results but were conducted in single countries and predominantly in Asia. We report on the association of white rice with risk of diabetes in the multinational Prospective Urban Rural Epidemiology (PURE) study. RESEARCH DESIGN AND METHODS Data on 132,373 individuals aged 35–70 years from 21 countries were analyzed. White rice consumption (cooked) was categorized as <150, ≥150 to <300, ≥300 to <450, and ≥450 g/day, based on one cup of cooked rice 5 150 g. The primary outcome was incident diabetes. Hazard ratios (HRs) were calculated using a multivariable Cox frailty model. RESULTS During a mean follow-up period of 9.5 years, 6,129 individuals without baseline diabetes developed incident diabetes. In the overall cohort, higher intake of white rice (≥450 g/day compared with <150 g/day) was associated with increased risk of diabetes (HR 1.20; 95% CI 1.02–1.40; P for trend 5 0.003). However, the highest risk was seen in South Asia (HR 1.61; 95% CI 1.13–2.30; P for trend 5 0.02), followed by other regions of the world (which included South East Asia, Middle East, South America, North America, Europe, and Africa) (HR 1.41; 95% CI 1.08–1.86; P for trend 5 0.01), while in China there was no significant association (HR 1.04; 95% CI 0.77–1.40; P for trend 5 0.38). CONCLUSIONS Higher consumption of white rice is associated with an increased risk of incident diabetes with the strongest association being observed in South Asia, while in other regions, a modest, nonsignificant association was seen.

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Diabetes Care

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Compressive evaluation of mansory bricks produced with industrial byproduct aggregates

This study evaluates the effect upon the compressive strength of ceramic masonry bricks when industrial byproducts known as soot are added. The research includes an analysis of the granulometric properties of the constituent components, performed manually with ASTM C136-01 screens to determine particle size using apertures sized from large to small; an analysis by XRD of the mineralogical phases present; a compressive strength analysis performed using standard compression testing machinery; and a water absorption measurement calculated according to Colombian Technical Standard: 4017:2015—Methods for the Sampling and Testing of Masonry Elements and other Clay Products. Five trials were performed using different mixtures of clay and soot, at substitution rates of 20%, 30%, 40%, 50%, and 60%. These mixtures were prepared under identical conditions in order to ensure validity of the resulting comparisons. The results showed that bricks with 20%, 30%, 40%, and 50% added soot demonstrated superior structural strength compared to conventional units. Bricks incorporating 60% soot, however, were found to have lower strength and high porosity.

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International Journal of Applied Ceramic Technology

Título del artículo:

Managing the return to sport of the elite footballer following semimembranosus reconstruction

Hamstring strains are the most common injury in elite football and typically occur during high-speed running. Despite its important contribution to power production in the late swing phase, injury to the semimembranosus (SM) is less common than to the biceps femoris, but may involve the free tendon and depending on the degree of retraction, warrant surgical repair. Few case reports detail clinical reasoning, supported by objective data during rehabilitation in elite footballers, and none have described the return to sport (RTS) process following this type of hamstring injury. In this article, we outline the management and RTS of an English Premier League (EPL) footballer who suffered a high-grade SM proximal tendon tear during training. Due to the degree of retraction of the free tendon, the player underwent surgical reconstruction at the recommendation of an orthopaedic surgeon. Early physiotherapy care, nutritional support, on-and off-pitch injury-specific reconditioning and global athletic development are outlined, alongside strength and power diagnostic and global positioning systems data, assessment of pain, player feedback and MRI informed clinical reasoning and shared decision-making during the RTS process. 18 weeks post-surgery the player returned to team training, transferring to a new club 3 weeks later. 2.5 years post RTS, the player remains free of re-injury playing regularly in the EPL.

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BMJ Open Sport and Exercise Medicine

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A New Homoisoflavonoid from Caesalpinia bahamensis

Homoisoflavonoids constitute a rare subclass of flavonoids restricted to only some plant species, including members of the genus Caesalpinia. This research focused on homoisoflavonoids from Caesalpinia bahamensis Lam., Fabaceae, a medicinal plant used in Cuban traditional medicine and known as “brasilete.” An hydroalcoholic extract was prepared from the stem, followed by liquid-liquid partition and further chromatographic separations, resulting in the isolation and structure elucidation by nuclear magnetic resonance spectroscopy and mass spectrometry of an undescribed 3-(2-hydroxy-4-methoxybenzyl)chromane-4,7-diol, for which the name metasappanin was proposed. Graphical abstract: [Figure not available: see fulltext.].

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Revista Brasileira de Farmacognosia

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Household and personal air pollution exposure measurements from 120 communities in eight countries: results from the PURE-AIR study

Background: Approximately 2·8 billion people are exposed to household air pollution from cooking with polluting fuels. Few monitoring studies have systematically measured health-damaging air pollutant (ie, fine particulate matter [PM2·5] and black carbon) concentrations from a wide range of cooking fuels across diverse populations. This multinational study aimed to assess the magnitude of kitchen concentrations and personal exposures to PM2·5 and black carbon in rural communities with a wide range of cooking environments. Methods: As part of the Prospective Urban and Rural Epidemiological (PURE) cohort, the PURE-AIR study was done in 120 rural communities in eight countries (Bangladesh, Chile, China, Colombia, India, Pakistan, Tanzania, and Zimbabwe). Data were collected from 2541 households and from 998 individuals (442 men and 556 women). Gravimetric (or filter-based) 48 h kitchen and personal PM2·5 measurements were collected. Light absorbance (10−5m−1) of the PM2·5 filters, a proxy for black carbon concentrations, was calculated via an image-based reflectance method. Surveys of household characteristics and cooking patterns were collected before and after the 48 h monitoring period. Findings: Monitoring of household air pollution for the PURE-AIR study was done from June, 2017, to September, 2019. A mean PM2·5 kitchen concentration gradient emerged across primary cooking fuels: gas (45 μg/m3 [95% CI 43–48]), electricity (53 μg/m3 [47–60]), coal (68 μg/m3 [61–77]), charcoal (92 μg/m3 [58–146]), agricultural or crop waste (106 μg/m3 [91–125]), wood (109 μg/m3 [102–118]), animal dung (224 μg/m3 [197–254]), and shrubs or grass (276 μg/m3 [223–342]). Among households cooking primarily with wood, average PM2·5 concentrations varied ten-fold (range: 40–380 μg/m3). Fuel stacking was prevalent (981 [39%] of 2541 households); using wood as a primary cooking fuel with clean secondary cooking fuels (eg, gas) was associated with 50% lower PM2·5 and black carbon concentrations than using only wood as a primary cooking fuel. Similar average PM2·5 personal exposures between women (67 μg/m3 [95% CI 62–72]) and men (62 [58–67]) were observed. Nearly equivalent average personal exposure to kitchen exposure ratios were observed for PM2·5 (0·79 [95% 0·71–0·88] for men and 0·82 [0·74–0·91] for women) and black carbon (0·64 [0·45–0·92] for men and 0·68 [0·46–1·02] for women). Interpretation: Using clean primary fuels substantially lowers kitchen PM2·5 concentrations. Importantly, average kitchen and personal PM2·5 measurements for all primary fuel types exceeded WHO\'s Interim Target-1 (35 μg/m3 annual average), highlighting the need for comprehensive pollution mitigation strategies. Funding: Canadian Institutes for Health Research, National Institutes of Health.

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The Lancet Planetary Health

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Pharmacognostic, chemical and mucolytic activity study of malva pseudolavatera webb & berthel. And malva sylvestris l. (malvaceae) leaf extracts, grown in ecuador

Among the cultivated and/or native plant species of Ecuador, are those belonging to Malvaceae. Of these, the most traditionally used are Malva pseudolavatera Webb & Berthel. and Malva sylvestris L., which are grown and sold in indigenous markets. Various articles have been published for M. sylvestris about its chemical composition and pharmacological properties; however, M. pseudolavatera lacks references and is the most commercialized in Ecuador. Therefore, this work sets the following objective: To carry out a comparative study of the pharmacognostic, chemical and mucolytic activity of the species M. pseudolavatera and M. sylvestris. The species studied were collected in the province of Chimborazo. Extracts were obtained with different solvents: water, hexane and 80% ethanol. The aqueous extract was used to determine the mucolytic activity; the hexane and alcoholic extracts were analyzed by the coupled gas chromatography-mass spectrometry system. It was found that M. pseudolavatera has a very similar chemical composition to M. sylvestris; The presence of fatty acids, di and triterpenoids, phytosterols and abundant amino acids was detected. Both species showed an important mucolytic effect, the activity of M. pseudolavatera being higher than the highest doses tested. These studies provide scientific data that allow demonstrating the high potentiality of extracts from the leaves of two Malva species as sources of plant material for possible research and development of phytotherapeutic products with mucolytic and gastroprotective activity in correspondence with their uses in traditional Ecuadorian herbal medicine.

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Biodiversitas