Procesos educativos sobre enfermedad de Chagas con escolares de nivel básico de escuelas públicas de México

Se presentan los cambios en conocimientos y prácticas sobre el vector y la enfermedad de Chagas con escolares de México posterior a una intervención educativa. La identificación del vector aumentó posterior a las sesiones educativas (pre=36,15% vs post=79,30%). Aumentaron los conocimientos acerca de la enfermedad de Chagas (30,90% vs 64,72%, valor de p< 0,0001) y de las acciones preventivas para evitar que el vector habite dentro de sus entornos (14,29% vs 61,81%, valor de p< 0,0001). Los escolares pueden jugar un papel fundamental en la prevención de esta problemática

Effect of Hydrocortisone on Mortality and Organ Support in Patients With Severe COVID-19: The REMAP-CAP COVID-19 Corticosteroid Domain Randomized Clinical Trial.

Importance: Evidence regarding corticosteroid use for severe coronavirus disease 2019 (COVID-19) is limited. Objective: To determine whether hydrocortisone improves outcome for patients with severe COVID-19. Design, Setting, and Participants: An ongoing adaptive platform trial testing multiple interventions within multiple therapeutic domains, for example, antiviral agents, corticosteroids, or immunoglobulin. Between March 9 and June 17, 2020, 614 adult patients with suspected or confirmed COVID-19 were enrolled and randomized within at least 1 domain following admission to an intensive care unit (ICU) for respiratory or cardiovascular organ support at 121 sites in 8 countries. Of these, 403 were randomized to open-label interventions within the corticosteroid domain. The domain was halted after results from another trial were released. Follow-up ended August 12, 2020. Interventions: The corticosteroid domain randomized participants to a fixed 7-day course of intravenous hydrocortisone (50 mg or 100 mg every 6 hours) (n = 143), a shock-dependent course (50 mg every 6 hours when shock was clinically evident) (n = 152), or no hydrocortisone (n = 108). Main Outcomes and Measures: The primary end point was organ support-free days (days alive and free of ICU-based respiratory or cardiovascular support) within 21 days, where patients who died were assigned -1 day. The primary analysis was a bayesian cumulative logistic model that included all patients enrolled with severe COVID-19, adjusting for age, sex, site, region, time, assignment to interventions within other domains, and domain and intervention eligibility. Superiority was defined as the posterior probability of an odds ratio greater than 1 (threshold for trial conclusion of superiority >99%). Results: After excluding 19 participants who withdrew consent, there were 384 patients (mean age, 60 years; 29% female) randomized to the fixed-dose (n = 137), shock-dependent (n = 146), and no (n = 101) hydrocortisone groups; 379 (99%) completed the study and were included in the analysis. The mean age for the 3 groups ranged between 59.5 and 60.4 years; most patients were male (range, 70.6%-71.5%); mean body mass index ranged between 29.7 and 30.9; and patients receiving mechanical ventilation ranged between 50.0% and 63.5%. For the fixed-dose, shock-dependent, and no hydrocortisone groups, respectively, the median organ support-free days were 0 (IQR, -1 to 15), 0 (IQR, -1 to 13), and 0 (-1 to 11) days (composed of 30%, 26%, and 33% mortality rates and 11.5, 9.5, and 6 median organ support-free days among survivors). The median adjusted odds ratio and bayesian probability of superiority were 1.43 (95% credible interval, 0.91-2.27) and 93% for fixed-dose hydrocortisone, respectively, and were 1.22 (95% credible interval, 0.76-1.94) and 80% for shock-dependent hydrocortisone compared with no hydrocortisone. Serious adverse events were reported in 4 (3%), 5 (3%), and 1 (1%) patients in the fixed-dose, shock-dependent, and no hydrocortisone groups, respectively. Conclusions and Relevance: Among patients with severe COVID-19, treatment with a 7-day fixed-dose course of hydrocortisone or shock-dependent dosing of hydrocortisone, compared with no hydrocortisone, resulted in 93% and 80% probabilities of superiority with regard to the odds of improvement in organ support-free days within 21 days. However, the trial was stopped early and no treatment strategy met prespecified criteria for statistical superiority, precluding definitive conclusions. Trial Registration: ClinicalTrials.gov Identifier: NCT02735707

Spatial abundance models and seasonal distribution for guanaco (Lama guanicoe) in central Tierra del Fuego, Argentina.

Spatially explicit modelling allows to estimate population abundance and predict species' distribution in relation to environmental factors. Abiotic factors are the main determinants of a herbivore´s response to environmental heterogeneity on large spatiotemporal scales. We assessed the influence of elevation, geographic location and distance to the coast on the seasonal abundance and distribution of guanaco (Lama guanicoe) in central Tierra del Fuego, by means of spatially explicit modelling. The estimated abundance was 23,690 individuals for the non-breeding season and 33,928 individuals for the breeding season. The factors influencing distribution and abundance revealed to be the elevation for the non-breeding season, and the distance to the coast and geographic location for the breeding season. The southwest of the study area presented seasonal abundance variation and the southeast and northeast presented high abundance during both seasons. The elevation would be the driving factor of guanaco distribution, as individuals move to lower areas during the non-breeding season and ascend to high areas during the breeding season. Our results confirm that part of the guanaco population performs seasonal migratory movements and that the main valleys present important wintering habitats for guanacos as well as up-hill zones during summer. This type of study would help to avoid problems of scale mismatch and achieve better results in management actions and is an example of how to assess important seasonal habitats from evaluations of abundance and distribution patterns

Guanaco Sighting

Data sets corresponding to "Spatial abundance models and seasonal distribution for guanaco (Lama guanicoe) in central Tierra del Fuego, Argentina" publication

Sample effort, photographic records and number of guanacos registered by aerial survey.

<p>Sample effort, photographic records and number of guanacos registered by aerial survey.</p

The estimated smooth term of the best model for guanaco abundance in the non-breeding season.

<p>The solid line represents the smoother for average elevation (expressed in meters) and the dotted lines are 95% point-wise confidence bands. The number in brackets in “s” is the estimated degree of freedom of the smooth term.</p

Map of seasonal abundance distribution and uncertainty for guanaco.

<p>Abundance distribution maps for the (A) non-breeding season and (B) breeding season. Distribution of coefficient of variation (CV) by the selected model in the (C) non-breeding season and in the (D) breeding season. In all panels, each cell corresponds to 1,96 km² according to obtained in prediction grid.</p

Plexus 2023: Identity

Editor's NotePLEXUS is a student-organized journal of the arts and humanities that showcases creative work by medical students, physicians, faculty, and others in the UC Irvine medical community. Through the universal language of art, the journal aspires to connect those who seek to heal and be healed.We hope that PLEXUS will always serve as a creative and welcoming space in which we can all reflect and express our various emotional journeys in medicine and in life. Medicine, especially in recent years, may feel like a solitary endeavor. Now, more than ever, we hope PLEXUS provides solace and community to all who contribute to and view its pages.Identity is the fact of being or knowing what and who we are – an intrinsic property of ourselves and our world that can be challenged, taken for granted, and ultimately shaped by how we choose to live. This year's 24th edition of PLEXUS, Identity, focuses on the experiences and reflections that make us who are. We are moved by forces and convictions that define our individual identities, our motivations in healthcare, and our society. Let us celebrate the triumphs and mourn the losses that carry us to the present and remember the hopes and ambitions we have for the future.We are incredibly grateful to our amazing community for their support in sustaining PLEXUS. We would like to give special thanks to our faculty advisors Drs. Juliet McMullin, Tan Nguyen, and Frank Meyskens. As well as the Endowed Program in Medical Humanities &amp; Arts and the Department of Family Medicine. This journal would not have been possible without their continuous support and guidance.We hope you enjoy PLEXUS 2023: Identity.Kenneth Schmitt (MS4), Celina Yang (GR1), Ashley Hope (MS4)Editors in Chief(Front cover) Tower, Clifford Danza, MS1(Background image) Salt of the Earth. Ashley Hope, MS