Collet Sicard syndrome secondary to granulomatosis with polyangiitis

Granulomatosis with polyangiitis (GPA) is a systemic vasculitis that affects small to medium-sized blood vessels. Although uncommon, cranial nerve (CN) involvement can result in CN palsy. We present a clinical case of a female with collet Sicard syndrome (CSS), displaying left-sided CN IX, X, XI, and XII involvement, which we determined to be caused by GPA. Our patient met 7 points on the American College of Rheumatology 2018 (ACR) criteria for GPA with positive ANCA, bilateral mastoiditis, and decreased sensorineural hearing. Early identification of GPA is crucial due to systemic CN involvement, as it can lead to dysphonia, dysphagia, and other complications. Early treatment can improve the functional prognosis of patients, requiring intensive induction immunosuppression due to frequent bilateral progression and worse prognosis. Despite its infrequency, timely diagnosis is critical for better patient outcomes

MÉTODO PARA EL ANÁLISIS DEL COMPORTAMIENTO DE LA ESTACIONALIDAD DE LOS PRECIOS EN LAS SERIES HISTÓRICAS DE IMPORTACIÓN Y EXPORTACIÓN

Seasonality is a characteristic of a time series in which data is subjected to regular and predictable variations that repeat on each period. On the other hand, the price series jointly include the conjunctural evolution in the mid-and-long term, as well as seasonal variations. To measure these seasonal variations, seasonality indexes are constructed. In this analysis, a summary of the estimated monthly seasonality is obtained, based on the historical series of prices of the main import and export products. The objective of this research is to identify the most feasible months to export or import products, based on the international market prices. The main tool used for the estimation was the statistical package EViews 9 for Microsoft Windows.La estacionalidad es una característica de las series de tiempo en la que los datos experimentan variaciones regulares y predecibles que se repiten cada período. Por otro lado, las series de precios incluyen conjuntamente la evolución coyuntural a mediano y largo plazo, así como las variaciones estacionales. Para medir dichas variaciones se construyen los índices de estacionalidad. En la presente investigación se obtiene un resumen de las estacionalidades mensuales estimadas, a partir de las series históricas de precios en el mercado internacional de los principales productos que Cuba comercializa. El objetivo de estudio de la presente investigación es identificar los meses más factibles para realizar la exportación o importación de diferentes productos, dado el comportamiento mensual de sus precios en el mercado internacional. Se empleó como herramienta principal para la estimación, el paquete estadístico Eviews 9 para Microsoft Windows

Structure and tree diversity of secondary dry tropical forests in the Sierra de Huautla Biosphere Reserve, Morelos

"Se estudió la recuperación en riqueza, composición, estructura y diversidad arbórea en 3 condiciones de bosque tropical caducifolio secundario con diferente tiempo de abandono (C35, C45 y C65 años) en el sureste del estado de Morelos. En cada condición se establecieron 3 unidades de muestreo de 50 × 50 m (2,500 m2) y se midieron a todos los individuos ≥ 2.5 cm de diámetro normal (DN). En total se registraron 2,791 individuos, pertenecientes a 79 especies, 53 géneros y 30 familias. Fabaceae fue la familia con el mayor número de especies e individuos. C45 presentó la mayor riqueza de especies (57), seguida de C35 (48) y C65 (43). Las condiciones fueron diferentes (p < 0.0001) en área basal, altura total, DN y cobertura de copa. Las especies con mayores índices relativos de valor de importancia (IVIR) y de valor forestal (IVFR) fueron Pachycereus grandis (IVIR = 22.6, IVFR = 28.7), Amphipterygium adstringens (IVIR = 20.9, IVFR = 17.0), Lysiloma divaricatum (IVIR = 11.2, IVFR = 18.9) y Quercus glaucoides (IVIR = 10.5, IVFR = 13.1). Se encontraron diferencias altamente significativas (p < 0.001) entre condiciones de abandono para la heterogeneidad (Shannon-Wiener: H´), y valores significativamente (p < 0.05) mayores en C65 para el recíproco de Simpson (1/D), así como en C35 y C45 para los índices de Margalef (DMG) y α de Fisher (S). La semejanza florística (Sorensen: Is) fue máxima entre condiciones con menor tiempo de abandono (72%) y mínima con la condición de mayor tiempo (54%). El procedimiento de permutación de respuesta múltiple indicó diferencias significativas (p < 0.05) en la composición de especies entre condiciones tempranas (C35 y C45) y tardías (C65). Estos resultados explican el proceso de la sucesión secundaria en los bosques tropicales caducifolios del área de estudio y dan elementos para efectuar una mejor planificación de las actividades conducentes a su conservación.""The recovery in richness, composition, structure and tree diversity was studied in three conditions of secondary tropical deciduous forest with different time of abandonment (C35, C45 and C65 years) in the southeast of the state of Morelos. In each condition, three plots of 50 × 50 m (2,500 m2) were established and all individuals ≥ 2.5 cm of normal diameter (ND) were measured. In total, 2,791 individuals belonging to 79 species, 53 genera and 30 families were registered. Fabaceae was the family with the largest number of species and individuals. C45 had the highest species richness (57), followed by C35 (48) and C65 (43). The conditions were different (p < 0.0001) in basal area, total height, ND and crown coverage. The species with the highest relative value of importance (IVIR) and forest value (IVFR) were Pachycereus grandis (IVIR = 22.6, IVFR = 28.7), Amphipterygium adstringens (IVIR = 20.9, IVFR = 17.0), Lysiloma divaricatum (IVIR =11.2, IVFR = 18.9) and Quercus glaucoides (IVIR = 10.5, IVFR = 13.1). High significant differences (p < 0.001) between abandonment conditions were found for heterogeneity (Shannon-Wiener: H’), and highest significant values (p < 0.05) for Simpson reciprocal index (1/D) in C65, as well as to Margalef (DMG) and Fisher’s α (S) indexes in C35 and C45. The floristic similarity (Sorensen: Is) was highest among conditions with less time of abandonment (72%) and minimum with the condition of greater time (54%). The multiple response permutation procedure indicated significant differences (p < 0.05) in the species composition between early (C35 and C45) and late (C65) conditions. These results explain the process of secondary succession in the tropical deciduous forests of the study area and provide elements for improve planning of the activities leading to its conservation.

Dinámica empresarial: análisis de coyuntura en Ecuador

Economía en pandemia surge como un aporte al análisis y conocimiento de la realidad económica, social y empresarial ecuatoriana desde la Maestría de Administración de Empresas de la Universidad Politécnica Salesiana. La publicación aborda distintos temas: desde cuestiones relacionadas con las reformas tributarias ocurridas entre 2014 y 2018 hasta el análisis del impacto de la pandemia del COVID-19, en el sector de la construcción de la ciudad de Cuenca. Además, temas comerciales como el crecimiento de la demanda de automóviles de marcas chinas frente a marcas tradicionales, el análisis de las herramientas del comercio en línea utilizadas por la mipymes del sector textil y la relación comercial entre la concesionaria Yilport Terminal Operations del Terminal Marítimo Portuario de Puerto Bolívar ubicado en la provincia de El Oro

Marco activo de recursos de innovación docente: Madrid

Una guía de espacios e instituciones para actividades educativas complementarias en enseñanza secundaria y Formación Profesional

Impact of COVID-19 on cardiovascular testing in the United States versus the rest of the world

Objectives: This study sought to quantify and compare the decline in volumes of cardiovascular procedures between the United States and non-US institutions during the early phase of the coronavirus disease-2019 (COVID-19) pandemic. Background: The COVID-19 pandemic has disrupted the care of many non-COVID-19 illnesses. Reductions in diagnostic cardiovascular testing around the world have led to concerns over the implications of reduced testing for cardiovascular disease (CVD) morbidity and mortality. Methods: Data were submitted to the INCAPS-COVID (International Atomic Energy Agency Non-Invasive Cardiology Protocols Study of COVID-19), a multinational registry comprising 909 institutions in 108 countries (including 155 facilities in 40 U.S. states), assessing the impact of the COVID-19 pandemic on volumes of diagnostic cardiovascular procedures. Data were obtained for April 2020 and compared with volumes of baseline procedures from March 2019. We compared laboratory characteristics, practices, and procedure volumes between U.S. and non-U.S. facilities and between U.S. geographic regions and identified factors associated with volume reduction in the United States. Results: Reductions in the volumes of procedures in the United States were similar to those in non-U.S. facilities (68% vs. 63%, respectively; p = 0.237), although U.S. facilities reported greater reductions in invasive coronary angiography (69% vs. 53%, respectively; p < 0.001). Significantly more U.S. facilities reported increased use of telehealth and patient screening measures than non-U.S. facilities, such as temperature checks, symptom screenings, and COVID-19 testing. Reductions in volumes of procedures differed between U.S. regions, with larger declines observed in the Northeast (76%) and Midwest (74%) than in the South (62%) and West (44%). Prevalence of COVID-19, staff redeployments, outpatient centers, and urban centers were associated with greater reductions in volume in U.S. facilities in a multivariable analysis. Conclusions: We observed marked reductions in U.S. cardiovascular testing in the early phase of the pandemic and significant variability between U.S. regions. The association between reductions of volumes and COVID-19 prevalence in the United States highlighted the need for proactive efforts to maintain access to cardiovascular testing in areas most affected by outbreaks of COVID-19 infection

Maternal dietary patterns and acute leukemia in infants: results from a case control study in Mexico

BackgroundChildhood cancer is the leading cause of disease-related mortality among children aged 5–14 years in Mexico, with acute leukemia being the most common cancer among infants. Examining the overall dietary patterns allows for a comprehensive assessment of food and nutrient consumption, providing a more predictive measure of disease risk than individual foods or nutrients. This study aims to evaluate the association between maternal dietary patterns during pregnancy and the risk of acute leukemia in Mexican infants.MethodsA hospital-based case–control study was conducted, comparing 109 confirmed acute leukemia cases with 152 age-matched controls. All participants (≤24 months) were identified at hospitals in Mexico City between 2010 and 2019. Data on a posteriori dietary patterns and other relevant variables were collected through structured interviews and dietary questionnaires. Multivariate logistic regression was employed to estimate the association between maternal dietary patterns during pregnancy and the risk of acute leukemia in infants.ResultsThe “Balanced &amp; Vegetable-Rich” pattern, characterized by a balanced consumption of various food groups and higher vegetable intake, exhibited a negative association with acute leukemia when compared to the “High Dairy &amp; Cereals” Pattern (adjusted odds ratio [OR] = 0.51; 95% confidence interval [CI]: 0.29, 0.90). We observed that mothers who gave birth to girls and adhered to a healthy dietary pattern during pregnancy exhibited significantly lower odds of their children developing AL compared to those who gave birth to boys [OR = 0.32 (95% CI 0.11, 0.97)]. Our results underscore the significance of maternal nutrition as a modifiable factor in disease prevention and the importance of prenatal health education

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Abstract Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

Efecto del tabaquismo: los síntomas respiratorios y el asma sobre la espirometría de adultos de la Ciudad de México

Evaluar el efecto del tabaquismo, los síntomas respiratorios y el asma sobre la función pulmonar espirométrica en población adulta mexicana. Material y métodos. Se generaron ecuaciones de predicción basadas en modelos de regresión lineal múltiple para la capacidad vital forzada (FVC), el vollumen espiratorio forzado al primer segundo (FEV1) y FEV1/FVC de espirometrías obtenidas de adultos que acuden a evaluación de salud y se determinó el efecto del tabaquismo, los síntomas respiratorios y el asma sobre los modelos de estos parámetros. Resultados. Se estudiaron 919 sujetos de entre 14 y 86 años de edad. El asma disminuye la FVC y el FEV1 en hombres con un cambio en la R2 <1%. Los síntomas respiratorios reducen FEV1/FVC en ambos sexos. El tabaquismo disminuye significativamente el FEV1 en las mujeres. Conclusiones. El antecedente de asma disminuyó discretamente la función pulmonar en hombres, mientras que la historia de tabaquismo redujo el FEV1, particularmente en las mujeres de la población que se estudi