Análisis estadístico de la variación morfológica en el complejo Gymnopodium floribundum (Polygonaceae): definición de tres subespecies

Background and Aims: Morphological variability in Gymnopodium floribundum along its distribution area has been the source of taxonomic and nomenclatural inconsistencies, sometimes recognizing up to three species and two varieties. In this paper we present morphometric analyses of variation in 224 specimens of G. floribundum in order to determine the existence of morphological patterns that correspond to geographically structured phenotypic diversity.Methods: The data matrix consisted of 224 specimens and 32 characters, 21 were quantitative and 11 qualitative. A dendrogram was estimated with UPGMA’s algorithm and the Gower´s coefficient. The 21 quantitative characters were subjected to principal components analysis. With the groups identified in the dendrogram, we performed a PERMANOVA using all quantitative characters. Canonical Variate Analyses of leaf shape and perianth segment shape of all specimens were executed.Key results: The results of multivariate analyses suggest the existence of three phenetic groups, which mostly correspond to three geographic regions: Belize, the Pacific Coastal Plain and the Yucatán Peninsula. These groups are distinguished by the presence or absence of indument on leaf blade, ochrea and petiole, the distances between the floral fascicles, and the length and width of the external and internal segments of the perianth. Two of the geographic groups correspond to infraspecific taxa previously recognized by Standley and Steyermark. Our distances and shape morphometric analyses uncover a third group from the southern Pacific region which presents novel characters.Conclusions: Based on these results we raise the rank of two varieties G. floribundum var. antigonoides and G. floribundum var. floribundumto subspecies, and propose to recognize a new third subspecies: Gymnopodium floribundum subsp. chiapensis.Antecedentes y Objetivos: La variabilidad morfológica en Gymnopodium floribundum a lo largo de su área de distribución ha sido la fuente de inconsistencias taxonómicas y nomenclaturales, a veces reconociendo hasta tres especies y dos variedades. En este trabajo se presentan análisis morfométricos de variación en 224 especímenes de G. floribundum para determinar la existencia de patrones morfológicos que correspondan a una diversidad fenotípica geográficamente estructurada.Métodos: La matriz de datos consistió en 224 especímenes y 32 caracteres, 21 fueron cuantitativos y 11 cualitativos. El dendrograma obtenido se construyó usando el algoritmo UPGMA y el coeficiente de Gower. Los 21 caracteres cuantitativos se sometieron a un análisis de componentes principales. Con los grupos identificados en el dendograma se realizaron ánalisis PERMANOVA utilizando caracteres cuantitativos. Se hicieron Análisis de Variación Canónica de la forma de la hoja y de la forma del segmento del perianto con todos los especímenes.Resultados clave: Los resultados de los análisis multivariados sugieren la existencia de tres grupos fenéticos que en su mayoría corresponden a tres regiones geográficas: Belice, Costa del Pacífico y Península de Yucatán. Estos grupos se distinguen por la presencia o ausencia de indumento en la lámina de la hoja, ócrea y pecíolo, las distancias entre los fascículos florales y la longitud y anchura de los segmentos externos e internos del perianto. Dos de los grupos geográficos corresponden a taxones infraespecíficos previamente reconocidos por Standley y Steyermark. Los análisis morfométricos efectuados de distancias y formas descubren un tercer grupo de la región del Pacífico sur que presenta caracteres novedosos.Conclusiones: Con base en estos resultados se eleva el rango de las variedades G. floribundum var. antigonoides y G. floribundum var. floribundum a subespecies, y se propone reconocer una nueva tercera subespecie: Gymnopodium floribundum subsp. chiapensis

Clinical Factors Associated with C - Reactive Protein in Chronic Spinal Cord Injury

Study Design Cross-sectional study. Objectives: Determine clinical factors associated with plasma C-reactive protein (CRP) in persons with chronic spinal cord injury (SCI). Setting: Veterans Affairs Medical Center in Boston, MA. Methods: Participants provided a blood sample, completed a respiratory health questionnaire, and underwent dual x-ray absorptiometry (DXA) to assess total and regional body fat. Linear regression models were used to assess cross-sectional associations with plasma CRP. Results: In multivariable models, factors associated with a higher CRP included a greater BMI, urinary catheter use, a respiratory illness in the past week, and non-white race. Mean CRP also increased with decreasing mobility (motorized wheel chair >hand propelled wheel chair > walk with an assistive device > walk independently). Results were similar when adjusting for % android, gynoid, trunk, or total fat mass in place of BMI. Level and completeness of SCI was not associated with CRP in multivariable models. Conclusions: Clinical characteristics common in chronic SCI are associated with plasma CRP. These factors are more important than level and completeness of SCI and some are potentially modifiable

Filogenia de Lysiloma (Fabaceae), un género restringido a Megaméxico con especies atípicas en las Antillas y Florida

Background and Aims: Lysiloma is a Neotropical genus in the Fabaceae family that comprises eight species, six of which are widely distributed in Mexico, and two more that occur in the Antilles and Florida. Lysiloma is frequent in Megamexico’s dry forests. A previous phylogenetic study included three species of Lysiloma and Hesperalbizia occidentalis. Both genera are closely related, but their divergence has weak support. Our objectives were to test the monophyly of the genus, evaluate the sister relationships within the genus, and estimate the divergence times. Methods: A phylogenetic analysis based on morphological characters, molecular markers (ETS, matK, and trnK), as well as a combined analysis (morphology + molecules) was performed. The data matrices were analyzed both individually and concatenated (total evidence approach) with Bayesian inference and Maximum Parsimony. In addition, molecular divergence times were estimated from the ETS dataset with a Bayesian uncorrelated lognormal relaxed clock. Key results: The morphological analysis supports the monophyly of Lysiloma with Hesperalbizia as sister group. However, the individual and the combined molecular analyses do not provide resolution to clarify the relationships between Hesperalbizia occidentalis, Lysiloma sabicu, and core Lysiloma. The total evidence analysis (including morphology) supports the monophyly of Lysiloma, yet with low support. According to our molecular clock model, the clade Lysiloma+Hesperalbizia diverged from other members of the tribe Acacieae+Ingeae about 32 million years ago, and the diversification of the core of Lysiloma occurred during the Miocene. Conclusions: Lysiloma+Hesperalbizia is an early divergent clade of tribes Acacieae+Ingeae. There are enough morphological differences to recognize both linages. Morphological characters informally used for taxonomic delimitation seem to have evolved homoplasiously. The clade Lysiloma and Hesperalbizia separated from other members of the tribe Acacieae+Ingeae in the Oligocene, but the diversification of the core of the genus coincides with the expansion of the dry forest at the beginning of the Miocene.Antecedentes y Objetivos: Lysiloma es un género neotropical de la familia Fabaceae que comprende ocho especies, seis de las cuales se distribuyen ampliamente en México y dos más que ocurren en las Antillas y La Florida. Lysiloma es frecuente en los bosques secos de Megaméxico. Un estudio filogenético previo incluyó tres especies de Lysiloma y Hesperalbizia occidentalis. Ambos géneros están estrechamente relacionados, pero su divergencia tiene un apoyo débil. Nuestros objetivos fueron probar la monofilia del género, evaluar las relaciones de grupo hermano dentro del género y estimar los tiempos de divergencia. Métodos: Se realizó un análisis filogenético basado en caracteres morfológicos, marcadores moleculares (ETS, matK y trnK), así como un análisis combinado (morfología + moléculas). Las matrices de datos se analizaron tanto individualmente como concatenadas (enfoque de evidencia total) con inferencia Bayesiana y máxima parsimonia. Además, los tiempos de divergencia molecular se estimaron a partir del conjunto de datos ETS con un modelo de reloj bayesiano relajado lognormal no correlacionado. Resultados clave: El análisis morfológico respalda la monofilia del Lysiloma con Hesperalbizia como grupo hermano. Sin embargo, los análisis moleculares individuales y combinado no proporcionan resolución para aclarar las relaciones entre Hesperalbizia occidentalis, Lysiloma sabicu y el núcleo de Lysiloma. El análisis de evidencia total (incluida la morfología) respalda la monofilia de Lysiloma, pero con un bajo soporte. Según nuestro modelo de reloj molecular, el clado Lysiloma+Hesperalbizia se separó de otros miembros de la tribu Acacieae+Ingeae hace unos 32 millones de años y la diversificación del núcleo del Lysiloma se produjo a lo largo del Mioceno.Conclusiones: Lysiloma+Hesperalbizia es un clado de divergencia temprana de las tribus Acacieae+Ingeae. Existen suficientes diferencias morfológicas para reconocer ambos linajes. Los caracteres morfológicos utilizados informalmente para la delimitación taxonómica parecen haber evolucionado de manera homoplásica. El clado de Lysiloma y Hesperalbizia se separó de otros miembros de la tribu Acacieae+Ingeae en el Oligoceno, pero la diversificación del núcleo del género coincidió con la expansión del bosque seco a principios del Mioceno

Relación entre la sobrecarga y el índice depresivo de cuidadores primarios de pacientes con enfermedades neuromusculoesqueléticas

Resumen Introducción: Una enfermedad neuromusculoesquelética no solo afecta a la persona que la padece, sino que también repercute de manera directa en la familia y en particular al cuidador primario informal. Las labores de cuidado incrementan la morbilidad psicológica y el estrés de los cuidadores primarios. El objetivo del presente estudio consistió en identificar la relación entre la sobrecarga y el índice de depresión presente en los cuidadores primarios informales de pacientes con enfermedad neuromusculoesquelética. Material y Métodos: Se realizó un estudio exploratorio que incluyó a 18 cuidadores primarios informales de pacientes con enfermedad neuromusculoesquelética, y que asistieron a consulta en la Unidad Universitaria de Rehabilitación de la Universidad Autónoma de Yucatán. Resultados: Entre las características sociodemográficas predominaron las cuidadoras del sexo femenino (83%) con parentesco familiar con el paciente. Además, predomino entre los cuidadores primarios el estado civil casado y un nivel de estudios de licenciatura. La relación entre la sobrecarga y el índice de depresión fue elevada y significativa (r=0.72, p=0.0007). En conclusión, estos resultados sugieren que, a mayor sobrecarga producida por las labores del cuidado, mayor será el grado de afectación en el estado anímico del cuidador primario informal.  Este estudio ayudará en la elaboración de un programa de intervención para prevenir la sobrecarga en cuidadoras primarias informales. Titulo corto: Relación sobrecarga y depresión Palabras clave: Enfermedad neuromusculoesquelética, sobrecarga, depresión, cuidador primario informal

Registros destacados de Spilogale angustifrons en la Reserva de la Biosfera Calakmul

Spilogale angustifrons has a wide distribution in southeastern Mexico, however, knowledge is scarce for the Calakmul region. New spotted records are reported S. angustifrons in the Calakmul region, Campeche, Mexico. With a cumulative effort of 9000 trap-nights, 18 photographs of southern spotted skunks corresponding to 15 independent events were obtained at four photo-trapping stations in the Calakmul region. At the photo-trapping stations, four photographic events were recorded in which solitary male individuals were observed, but it was not possible to identify whether the records correspond to one or more individuals. The few records of S. angustifrons in the Yucatan Peninsula may be due to the lack of mastozoological surveys in the region. The records reported in this note provide knowledge on the distribution, habitat, use of artificial watering places and interspecific relationships of S. angustifrons. Being a carnivore, it is likely that the ecological role of S. angustifrons in the Calakmul region is relevant, however the population and ecological aspects of the species are unknown, so it is necessary to conduct studies focused on the status of the populations of S. angustifrons.Spilogale angustifrons cuenta con una amplia distribución en el sureste de México, sin embargo, para la región de Calakmul el conocimiento es escaso. Se reportan nuevos registros de S. angustifrons en la región de Calakmul, Campeche, México. Con un esfuerzo acumulado de 9000 noches-trampa, se obtuvieron 18 fotografías de S. angustifrons que corresponden a 15 eventos independientes, en cuatro estaciones de fototrampeo colocadas en la región de Calakmul. En las estaciones de fototrampeo se registraron cuatro eventos fotográficos en los que se observan a individuos machos, solitarios, pero no fue posible identificar si los registros corresponden a uno o más individuos. Los pocos registros de S. angustifrons en la Península de Yucatán puede deberse a la falta de prospecciones mastozoológicas en la región. Los registros reportados en esta nota, aportan conocimiento sobre la distribución, hábitat, uso de bebederos artificiales y relaciones interespecíficas de S. angustifrons. Al ser un carnívoro es probable que el papel ecológico de S. angustifrons en la región de Calakmul sea relevante, sin embargo los aspectos poblacionales y ecológicos de la especie se desconocen, por lo que es necesario realizar estudios enfocados a conocer el estado de las poblaciones de S. angustifron

Antimicrobial resistance among migrants in Europe: a systematic review and meta-analysis

BACKGROUND: Rates of antimicrobial resistance (AMR) are rising globally and there is concern that increased migration is contributing to the burden of antibiotic resistance in Europe. However, the effect of migration on the burden of AMR in Europe has not yet been comprehensively examined. Therefore, we did a systematic review and meta-analysis to identify and synthesise data for AMR carriage or infection in migrants to Europe to examine differences in patterns of AMR across migrant groups and in different settings. METHODS: For this systematic review and meta-analysis, we searched MEDLINE, Embase, PubMed, and Scopus with no language restrictions from Jan 1, 2000, to Jan 18, 2017, for primary data from observational studies reporting antibacterial resistance in common bacterial pathogens among migrants to 21 European Union-15 and European Economic Area countries. To be eligible for inclusion, studies had to report data on carriage or infection with laboratory-confirmed antibiotic-resistant organisms in migrant populations. We extracted data from eligible studies and assessed quality using piloted, standardised forms. We did not examine drug resistance in tuberculosis and excluded articles solely reporting on this parameter. We also excluded articles in which migrant status was determined by ethnicity, country of birth of participants' parents, or was not defined, and articles in which data were not disaggregated by migrant status. Outcomes were carriage of or infection with antibiotic-resistant organisms. We used random-effects models to calculate the pooled prevalence of each outcome. The study protocol is registered with PROSPERO, number CRD42016043681. FINDINGS: We identified 2274 articles, of which 23 observational studies reporting on antibiotic resistance in 2319 migrants were included. The pooled prevalence of any AMR carriage or AMR infection in migrants was 25·4% (95% CI 19·1-31·8; I2 =98%), including meticillin-resistant Staphylococcus aureus (7·8%, 4·8-10·7; I2 =92%) and antibiotic-resistant Gram-negative bacteria (27·2%, 17·6-36·8; I2 =94%). The pooled prevalence of any AMR carriage or infection was higher in refugees and asylum seekers (33·0%, 18·3-47·6; I2 =98%) than in other migrant groups (6·6%, 1·8-11·3; I2 =92%). The pooled prevalence of antibiotic-resistant organisms was slightly higher in high-migrant community settings (33·1%, 11·1-55·1; I2 =96%) than in migrants in hospitals (24·3%, 16·1-32·6; I2 =98%). We did not find evidence of high rates of transmission of AMR from migrant to host populations. INTERPRETATION: Migrants are exposed to conditions favouring the emergence of drug resistance during transit and in host countries in Europe. Increased antibiotic resistance among refugees and asylum seekers and in high-migrant community settings (such as refugee camps and detention facilities) highlights the need for improved living conditions, access to health care, and initiatives to facilitate detection of and appropriate high-quality treatment for antibiotic-resistant infections during transit and in host countries. Protocols for the prevention and control of infection and for antibiotic surveillance need to be integrated in all aspects of health care, which should be accessible for all migrant groups, and should target determinants of AMR before, during, and after migration. FUNDING: UK National Institute for Health Research Imperial Biomedical Research Centre, Imperial College Healthcare Charity, the Wellcome Trust, and UK National Institute for Health Research Health Protection Research Unit in Healthcare-associated Infections and Antimictobial Resistance at Imperial College London

May Measurement Month 2018: a pragmatic global screening campaign to raise awareness of blood pressure by the International Society of Hypertension

Aims Raised blood pressure (BP) is the biggest contributor to mortality and disease burden worldwide and fewer than half of those with hypertension are aware of it. May Measurement Month (MMM) is a global campaign set up in 2017, to raise awareness of high BP and as a pragmatic solution to a lack of formal screening worldwide. The 2018 campaign was expanded, aiming to include more participants and countries. Methods and results Eighty-nine countries participated in MMM 2018. Volunteers (≥18 years) were recruited through opportunistic sampling at a variety of screening sites. Each participant had three BP measurements and completed a questionnaire on demographic, lifestyle, and environmental factors. Hypertension was defined as a systolic BP ≥140 mmHg or diastolic BP ≥90 mmHg, or taking antihypertensive medication. In total, 74.9% of screenees provided three BP readings. Multiple imputation using chained equations was used to impute missing readings. 1 504 963 individuals (mean age 45.3 years; 52.4% female) were screened. After multiple imputation, 502 079 (33.4%) individuals had hypertension, of whom 59.5% were aware of their diagnosis and 55.3% were taking antihypertensive medication. Of those on medication, 60.0% were controlled and of all hypertensives, 33.2% were controlled. We detected 224 285 individuals with untreated hypertension and 111 214 individuals with inadequately treated (systolic BP ≥ 140 mmHg or diastolic BP ≥ 90 mmHg) hypertension. Conclusion May Measurement Month expanded significantly compared with 2017, including more participants in more countries. The campaign identified over 335 000 adults with untreated or inadequately treated hypertension. In the absence of systematic screening programmes, MMM was effective at raising awareness at least among these individuals at risk

Post-intervention Status in Patients With Refractory Myasthenia Gravis Treated With Eculizumab During REGAIN and Its Open-Label Extension

OBJECTIVE: To evaluate whether eculizumab helps patients with anti-acetylcholine receptor-positive (AChR+) refractory generalized myasthenia gravis (gMG) achieve the Myasthenia Gravis Foundation of America (MGFA) post-intervention status of minimal manifestations (MM), we assessed patients' status throughout REGAIN (Safety and Efficacy of Eculizumab in AChR+ Refractory Generalized Myasthenia Gravis) and its open-label extension. METHODS: Patients who completed the REGAIN randomized controlled trial and continued into the open-label extension were included in this tertiary endpoint analysis. Patients were assessed for the MGFA post-intervention status of improved, unchanged, worse, MM, and pharmacologic remission at defined time points during REGAIN and through week 130 of the open-label study. RESULTS: A total of 117 patients completed REGAIN and continued into the open-label study (eculizumab/eculizumab: 56; placebo/eculizumab: 61). At week 26 of REGAIN, more eculizumab-treated patients than placebo-treated patients achieved a status of improved (60.7% vs 41.7%) or MM (25.0% vs 13.3%; common OR: 2.3; 95% CI: 1.1-4.5). After 130 weeks of eculizumab treatment, 88.0% of patients achieved improved status and 57.3% of patients achieved MM status. The safety profile of eculizumab was consistent with its known profile and no new safety signals were detected. CONCLUSION: Eculizumab led to rapid and sustained achievement of MM in patients with AChR+ refractory gMG. These findings support the use of eculizumab in this previously difficult-to-treat patient population. CLINICALTRIALSGOV IDENTIFIER: REGAIN, NCT01997229; REGAIN open-label extension, NCT02301624. CLASSIFICATION OF EVIDENCE: This study provides Class II evidence that, after 26 weeks of eculizumab treatment, 25.0% of adults with AChR+ refractory gMG achieved MM, compared with 13.3% who received placebo

Minimal Symptom Expression' in Patients With Acetylcholine Receptor Antibody-Positive Refractory Generalized Myasthenia Gravis Treated With Eculizumab

The efficacy and tolerability of eculizumab were assessed in REGAIN, a 26-week, phase 3, randomized, double-blind, placebo-controlled study in anti-acetylcholine receptor antibody-positive (AChR+) refractory generalized myasthenia gravis (gMG), and its open-label extension