The main complication of placenta accreta spectrum (PAS) is massive bleeding. Endoarterial occlusion techniques have been incorporated into the management of this pathology. Our aim was to examine ...the endovascular practice patterns among PAS patients treated during a 9-year period in a low-middle income country in which an interdisciplinary group's technical skills were improved with the creation of a PAS team.
A retrospective cohort study including all PAS patients treated from December 2011 to November 2020 was performed. We compared the clinical results obtained according to the type of endovascular device used (group 1, internal iliac artery occlusion balloons; group 2, resuscitative endovascular balloons of the aorta; group 3, no arterial balloons due to low risk of bleeding) and according to the year in which they were attended (reflects the PAS team level of experience). A fourth group of comparisons included the woman diagnosed during a cesarean delivery and treated in a nonprotocolized way.
A total of 113 patients were included. The amount of blood loss decreased annually, with a median of 2,500 mL in 2014 (when endovascular occlusion balloons were used in all patients) and 1,394 mL in 2020 (when only 38.5% of the patients required arterial balloons). Group 3 patients (n = 16) had the lowest bleeding volume (1,245 mL) and operative time (173 minutes) of the entire population studied. Group 2 patients (n = 46) had a bleeding volume (mean, 1,700 mL) and transfusions frequency (34.8%) slightly lower than group 1 patients (n = 30) (mean of 2,000 mL and 50%, respectively). They also had lower hysterectomy frequency (63% vs. 76.7% in group 1) and surgical time (205 minutes vs. 275 in group 1) despite a similar frequency of confirmed PAS and S2 compromise.
Endovascular techniques used for bleeding control in PAS patients are less necessary as interdisciplinary groups improve their surgical and teamwork skills.
Therapeutic care management, level III.
We report the case of a 47-year-old male patient with S100 negative granular cell tumor of the oral cavity, focusing on dermoscopic features as well as surgical approach, not previously reported in ...the literature. The study contributes to the literature on dermoscopy and surgical treatment for this tumor and provides a practical approach to differentiating non-neural granular cell tumors and granular cell tumors.
This study aimed to determine ANGPTL3 serum levels in healthy young lean and obese non-diabetic men during an oral glucose tolerance test (OGTT) and correlate them with anthropometric, biochemical ...and hormonal parameters. A case-control study was carried out and 30 young obese non-diabetic (23.90 ± 3.84 years and BMI 37.92 ± 4.85 kg/m
) and 28 age-matched healthy lean (24.56 ± 3.50 years and BMI of 22.10 ± 1.72 kg/m
) men were included in this study. The primary outcome measures were serum basal ANGPTL3 and ANGPTL3-area under the curve (AUC) levels. The percentage of body fat was measured by dual-energy X-ray absorptiometry and biochemical, hormonal and insulin resistance indices were determined. Basal ANGPTL3 and ANGPTL3-AUC levels were significantly elevated (p < 0.05) in young obese subjects compared with lean subjects and were positively and significantly associated with different anthropometric measurements. Fasting ANGPTL3 serum levels were positively correlated with fasting insulin, leptin, Leptin/Adiponectin index and triglyceride-glucose index. Moreover, ANGPTL3-AUC was negatively correlated with Matsuda index. In this regard, chronically high ANGPTL3 levels in young obese subjects might favor triglyceride-rich lipoprotein clearance to replenish triglyceride stores by white adipose tissue rather than oxidative tissues.
A risk haplotype in SLC16A11 characterized by alterations in fatty acid metabolism emerged as a genetic risk factor associated with increased susceptibility to type 2 diabetes (T2D) in Mexican ...population. Its role on treatment responses is not well understood.
We aimed to determine the impact of the risk haplotype on the metabolomic profile during a lifestyle intervention (LSI).
We recruited Mexican-mestizo individuals with ≥1 prediabetes criteria according to the American Diabetes Association with a body mass index between 25 and 45 kg/m2. We conducted a 24-wk quasiexperimental LSI study for diabetes prevention. Here, we compared longitudinal plasma liquid chromatography/mass spectrometry metabolomic changes between carriers and noncarriers. We analyzed the association of risk haplotype with metabolites leveraging repeated assessments using multivariable-adjusted linear mixed models.
Before the intervention, carriers (N = 21) showed higher concentrations of hippurate, C16 carnitine, glycine, and cinnamoylglycine. After 24 wk of LSI, carriers exhibited a deleterious metabolomic profile. This profile was characterized by increased concentrations of hippurate, cinnamoglycine, xanthosine, N-acetylputrescine, L-acetylcarnitine, ceramide (d18:1/24:1), and decreased concentrations of citrulline and phosphatidylethanolamine. These metabolites were associated with higher concentrations of total cholesterol, triglycerides, and low density lipoprotein cholesterol. The effect of LSI on the risk haplotype was notably more pronounced in its impact on 2 metabolites: methylmalonylcarnitine (β: −0.56; P-interaction = 0.014) and betaine (β: −0.64; P-interaction = 0.017). Interestingly, lower consumption across visits of polyunsaturated (β: −0.038; P = 0.017) fatty acids were associated with higher concentrations of methylmalonylcarnitine. Covariates for adjustment across models included age, sex, genetic ancestry principal components, and body mass index.
Our study highlights the persistence of deleterious metabolomic patterns associated with the risk haplotype before and during a 24-wk LSI. We also emphasize the potential regulatory role of polyunsaturated fatty acids on methylmalonylcarnitine concentrations suggesting a route for improving interventions for individuals with high-genetic risk.
Despite having an appealing nutritional profile and lower environmental impacts compared to traditional meat products, edible insects face challenges in gaining consumer acceptance, especially in ...western societies. No consumer study on edible insects has been conducted in France. Hence, this study aims to evaluate French consumers’ willingness to adopt insect-based food (IBF) and identify factors influencing entomophagy (the consumption of insects as food). A 46-question online questionnaire was administered to 617 subjects to assess how various explanatory variables impact IBF acceptance through difference tests, correlation analysis, and multiple correspondence analysis. The results revealed that 69% of respondents were introduced to entomophagy, and 53% had consumed IBF before the survey. Environmental sustainability and nutritional value were identified as major motivators for entomophagy, which could inform promotional strategies for IBF in France. Unfamiliarity and disgust emerged as primary barriers to entomophagy. However, the study suggested that these challenges could be overcome by repeated exposure to entomophagy, which reduced food neophobia and food disgust sensitivity, increased familiarity with entomophagy, and improved insect-eating experiences and willingness to consume IBF. Overall, the study highlights the potential for entomophagy in France and emphasizes the need to address consumer perceptions to foster broader acceptance of IBF.
•Consumers aged 18–30 are more receptive to insect-based food than older consumers.•Sustainability, nutrition, and flavor influence entomophagy among French consumers.•Unfamiliarity, limited availability, and disgust are key barriers to entomophagy.•High consumption frequency improved consumer experience and willingness scores.
This study summarizes the evidence from quantitative systematic reviews that assessed the association between urban environment attributes and physical activity. It also documents sociopolitical ...barriers and facilitators involved in urban interventions linked with active living in the ten most populated urban settings of Latin America. The synthesis of evidence indicates that several attributes of urban environments are associated with physical activity, including land-use mix and cycling infrastructure. The documentary analysis indicated that despite the benefits and opportunities provided by the programs and existing infrastructure in the examined cities, an overall concern is the rising inequality in the coverage and distribution of the initiatives in the region. If these programs and initiatives are to achieve a real population level effect that helps to reduce health disparities, they need to examine their social and spatial distribution within the cities so they can reach underserved populations and develop to their full potential.
•Most research on physical activity and the environment was in high income countries.•There is an unequal distribution of supportive urban environments in Latin American.•The Ciclovia program may offset urban inequalities existing in public green areas.•Strong civil society leadership is needed for sustainable policy and programs.
Trauma is a significant public health problem in Latin America (LA), contributing to substantial death and disability in the region. Several LA countries have implemented trauma registries and injury ...surveillance systems. However, the region lacks an integrated trauma system. The consensus conference's goal was to integrate existing LA trauma data collection efforts into a regional trauma program and encourage the use of the data to inform health policy.
We created a consensus group of 25 experts in trauma and emergency care with previous data collection and injury surveillance experience in the LA. region. Experts participated in a consensus conference to discuss the state of trauma data collection in LA. We utilized the Delphi method to build consensus around strategic steps for trauma data management in the region. Consensus was defined as the agreement of ≥ 70% among the expert panel.
The consensus conference determined that action was necessary from academic bodies, scientific societies, and ministries of health to encourage a culture of collection and use of health data in trauma. The panel developed a set of recommendations for these groups to encourage the development and use of robust trauma information systems in LA. Consensus was achieved in one Delphi round.
The expert group successfully reached a consensus on recommendations to key stakeholders in trauma information systems in LA. These recommendations may be used to encourage capacity building in trauma research and trauma health policy in the region.
Cutaneous leishmaniasis (CL) and mucocutaneous leishmaniasis (MCL) are endemic diseases in America, especially in some countries such as Colombia. Among the therapeutic options is amphotericin B ...(AB). Nevertheless, its lipid-associated formulations have better safety profiles and effectiveness in other diseases, so far with no comparative studies in CL or MCL. We conducted a retrospective descriptive study describing the effectiveness and adverse effects of AB deoxycholate (ABD), AB colloidal dispersion (ABCD), and liposomal AB (LAB) as third-line treatments for CL and MCL. The effectiveness of LAB (88.5%) was greater than those of ABCD (66.6%) and ABD (80.8%). There were also fewer adverse effects in the LAB group (46.2%) than in the ABD (96.1%) and ABCD (80.9%) groups. LAB is an alternative for the treatment of CL and MCL in patients with therapeutic failure to first- and second-line drugs; findings suggest it might be less toxic and more effective than ABD and ABCD.
The tectonic and volcanic environment in Guatemala is large and complex. Three major tectonic plates constantly interacting with each other, and a volcanic arc that extends from east to west in the ...southern part of the country, demand special attention in terms of monitoring and scientific studies. The Instituto Nacional de Sismología, Vulcanología, Meteorología e Hidrología (INSIVUMEH) is the institute in charge of executing these actions at the national and civil level.In recent years, INSIVUMEH has formed a volcanology team consisting of multi-disciplinary personnel that conducts the main volcanological monitoring and research activities. These activities include: seismic and acoustic signal analysis, evaluation and analysis of the volcanic hazards, installation and maintenance of monitoring equipment, and the socialization and dissemination of volcanic knowledge. Of all the volcanic structures in Guatemala, three volcanoes (Fuego, Pacaya, and Santiaguito) are in constant eruption and require all of the available resources (economic and human). These volcanoes present a wide range of volcanic hazards (regarding type and magnitude) that make daily monitoring a great challenge. One of the greatest goals achieved by the volcanology team has been the recent development of a Relative Threat Ranking of Guatemala Volcanoes, taking into account different parameters that allow improved planning in the future, both in monitoring and research.
El ambiente tectónico y volcánico de Guatemala es extenso y complejo. Tres grandes placas tectónicas, que interactúan constantemente entre sí, y un arco volcánico, que se extiende de este a oeste en la parte sur del país, exigen especial atención en términos de monitoreo y estudios científicos. El Instituto Nacional de Sismología, Vulcanología, Meteorología e Hidrología (INSIVUMEH) es el instituto encargado de ejecutar estas acciones a nivel nacional y civil. En los últimos años, INSIVUMEH ha formado un equipo de vulcanología conformado por personal multidisciplinario que realiza las principales actividades de seguimiento e investigación vulcanológica. Estas actividades incluyen: análisis de señales sísmicas y acústicas, evaluación y análisis de peligros volcánicos, instalación y mantenimiento de equipos de monitoreo, y socialización y difusión del conocimiento volcánico. De todas las estructuras volcánicas de Guatemala, tres volcanes (Fuego, Pacaya y Santiaguito) están en constante erupción y requieren todos los recursos disponibles (económicos y humanos). Estos volcanes presentan una amplia gama de peligros volcánicos (en cuanto a tipo y magnitud), haciendo que el monitoreo diario sea un gran desafío. Uno de los mayores logros del equipo de vulcanología ha sido el desarrollo reciente de un Ranking de Peligrosidad Relativa de los Volcanes de Guatemala, tomando en cuenta diferentes parámetros que permitan una mejor planificación en el futuro, tanto en el monitoreo como en la investigación.
PDF
