Mapping bridges between anxiety, depression, and somatic symptoms in primary care patients: a network perspective

In primary care centers, emotional disorders (EDs; depression, anxiety, and somatoform disorders) frequently appear to be associated. However, there is no previous information on the key (bridge) symptoms that maintain comorbidity. The current study aimed to identify symptoms that may play a linking role in bridging comorbidity among EDs from a network analysis perspective. A sample of adult primary care patients (N = 1704) with symptoms of EDs was assessed using the Patient Health Questionnaire (PHQ). Network analysis was applied to examine the network structure, communities, expected influence, and bridge symptoms between depressive, anxiety, and somatic symptoms. Sad mood and low energy were the most central symptoms. Furthermore, low energy, fainting spells, sad mood, and restlessness were detected as prominent bridge symptoms between anxiety, depression, and somatic symptoms. These bridge symptoms could be therapeutic targets for early intervention and prevent the development of comorbidity among EDs. The results of this research highlight the importance of symptom-specific functional properties for the activation of communities within EDs, providing new insights on a complex phenomenon such as comorbidity

Cirugía combinada cardiaca y pulmonar en un paciente con un histoplasmoma

ResumenLa histoplasmosis pulmonar y su diseminación hemática con el desarrollo de una endocarditis sobre la válvula pulmonar son extremadamente infrecuentes. Presentamos un niño de 10 años que, como complicaciones de una histoplasmosis pulmonar, desarrolló una caverna en la base del pulmón derecho que se fistulizó a un vaso sanguíneo pulmonar y que además presentaba vegetaciones en la válvula pulmonar con peligro de causar infartos pulmonares e insuficiencia valvular pulmonar severa, que obligaron a realizar una compleja intervención quirúrgica cardiopulmonar en un solo tiempo, donde se realizó la resección completa del lóbulo inferior del pulmón derecho, se cerró la comunicación interventricular y se reconstruyó la válvula pulmonar con 3 velos de pericardio autólogo. Seis meses después, el paciente está asintomático, con reexpansión de los lóbulos restantes del pulmón derecho, y la ecocardiografía transtorácica muestra un buen funcionamiento de la neoválvula pulmonar construida con el pericardio autólogo.AbstractIsolated pulmonary valve endocarditis is extremely rare in a patient with histoplasmosis. The case is presented of a ten year-old child, who, as complications of histoplasmosis, developed a cavern at the base of the right lung that fistulised into a pulmonary blood vessel, as well as presenting with vegetations in the pulmonary valve. As there was a danger of pulmonary infarctions and sever pulmonary valve insufficiency, a complete resection of the lower right lung lobe was necessary. The interventicular communication was closed and the pulmonary valve was reconstructed with three autologous pericardial flaps. Six months later, the patient is symptomatic, with re-expansion of the remaining right lung lobes, and the trans-thoracic echocardiography showed good functioning of the newly pulmonary valve constructed with autologous pericardial flaps

Partidos políticos, campañas electorales y redes sociales en lo local. Elecciones 2015 en el Estado de México

El propósito de este libro es indagar en qué medida y cómo fueron utilizadas las redes sociales en una campaña electoral a nivel local, con las elecciones municipales y legislativas de 2015 en el Estado de México como estudio de caso. La idea central es saber si dichas redes están formando ya parte de las estrategias electorales para informar, persuadir y movilizar a los ciudadanos o si, en general, su utilización como canal de información y comunicación político-electoral por parte de los partidos políticos y candidatos es aún limitada. En este sentido, nos interesa conocer con fuentes de primera mano el uso político de Facebook y Twitter, utilizando las estrategias de recopilación, sistematización e interpretación de los mensajes de candidatos locales durante la elección. Los resultados son muy clarificadores. En México, no son todavía las redes sociales el principal vehículo de información y comunicación política a nivel local, ya que aún se siguen empleando los métodos tradicionales de campaña electoral vía contacto directo con electores, así como la asistencia personal de los candidatos a las comunidades. Una parte de la explicación está en el hecho de que el llamado modelo de comunicación política (establecido en la reforma electoral de 2007-2008 y replicado en las entidades federativas) definió como elemento distintivo el que los tiempos del Estado son la vía exclusiva para que partidos y candidatos se comuniquen directamente con el electorado a través de los medios electrónicos. El cambio ha sido evidente: los órganos electorales y los partidos políticos ya no tienen que gastar dinero en la contratación de tiempo aire en radio y televisión; sin embargo, los partidos destinan la mayor parte de sus spots en radio y televisión a sus campañas nacionales y en menor medida a las campañas de los candidatos individuales a puestos federales (Díaz Jiménez y Alva Rivera, 2016), dejando un muy limitado (si no es que nulo) acceso a medios para los candidatos que compiten en elecciones locales. Además, la reforma no redujo de manera significativa el financiamiento público de los partidos políticos respecto al pasado, por lo que una buena parte del financiamiento a las campañas de los partidos y candidatos se canaliza ahora a las estrategias de contacto directo y movilización territorial del voto. Por otro lado, no se legisló en la reforma el uso político de Internet, muy probablemente debido a las complicaciones políticas, jurídicas, financieras y técnicas que ello representa.Universidad Autónoma del Estado de México Universidad de Guanajuato Editorial Fontamar

Polyphenolic Profile, Sugar Consumption and Organic Acids Generation along Fermentation of Infusions from Guava (Pisidium guajava) by the Kombucha Consortium

The kombucha beverage is typically prepared from black tea, sweetened with sucrose, inoculated with previously fermented liquid broth and/or tea fungus pellicle, and incubated. Alternative sources have been used for kombucha beverages. Guava leaves have been used for long time as traditional medicine. It is found in many commercially available botanical supplements in form of decoction, milled and used as comprises. They are rich in polyphenolic compounds. Several changes are produced during fermentation of the beverages. The main objective of the present work is to characterize fermentation process of guava leaves infusions by kombucha and studying possible chemical changes in their polyphenolic profile. Infusions from guava leaves were prepared and fermented by the kombucha consortium. The pH, titrable acidity, polyphenolic compounds, sugar consumption, organic acid along the fermentation was made by UPLC-ESI-MS. Kombucha from Camellia sinensis (CS) was made as a control. Higher rate of sucrose consumption was observed for Kombucha made with CS, also, higher production of organic acids (acetic and succinic acid) was observed too. Both behaviors were related to the content of glucose. The flavan-3-ols were diminishing along the fermentation time, with the exception of epigallocatechin in Camellia sinensis, Flavan-3-ol content in Guava leaves was low. Higher content of dicaffeoyl quinnic acid was observed for both systems in special for CS, falling after a maximum peak; minor constituents of hydroxycinnamic acids were stable along the fermentation for both systems

Macrobioerosión de corales constructores de arrecifes y su impacto en la dinámica de carbonatos en los arrecifes de Huatulco, México

Background. Coral reefs exist thanks to the delicate balance between calcification and erosion processes. However, due to anthropogenic pressures, bioerosive processes have become the main forcing factors in reef growth patterns. Nevertheless, due to the morphology of the reefs located in the Mexican South Pacific (extensive plates of pociloporids), estimating internal macrobioerosion is a challenge, resulting in a critical gap in bioerosion processes, particularly those occurring inside corals. Objectives. To measure the internal macrobioerosion of the main coral species and to know its impact on carbonate production in reefs. Methods. We used a computed tomography (CT) based approach to measure the volume of CaCO3 removed by different groups of macrobioeroders. Results. We estimated percentages of internal macrobioerosion between 16.80 % and 26.67 % of the total volume of the colonies. We observed that sponges and mollusks are the guilds that most bioerode species of branching and massive morphology, respectively. We found macrobioerosion rates of 1.51 ± 0.11 kg CaCO3 m-2 yr-1 for branched species and 0.53 ± 0.03 kg CaCO3 m-2 yr-1 for massive species. The measured bioerosion processes accounted for 39.02 % and 43.86 % of CaCO3 production. Conclusions. Although CT scanning represents higher costs than other approaches (i.e., X-rays), it is the only approach capable of measuring the internal macrobioerosion that occurs within the entire coral skeleton. This approach will allow us to produce more accurate carbonate balances than those that do not consider internal macrobioerosion, improving our estimates of the state of health of the reefs.Antecedentes. Los arrecifes de coral subsisten gracias al delicado balance entre procesos de acreción y de erosión. No obstante, debido a presiones antropogénicas, los procesos bioerosivos se han convertido en los principales factores que condicionan los patrones de crecimiento de los arrecifes. Debido a la morfología de los arrecifes ubicados en el Pacífico sur mexicano (placas extensas de pocilopóridos), estimar la macrobioerosión interna se convierte en un reto, lo que resulta en una importante brecha sobre los procesos de bioerosión, particularmente los que ocurren al interior de los corales. Objetivo. Medir la macrobioerosión interna de las principales especies de coral y conocer el impacto que ejerce sobre la producción de carbonatos en los arrecifes. Métodos. Empleamos un enfoque basado en tomografía computarizada (TC) que permite medir el volumen de CaCO3 removido por diferentes grupos de macrobioerosionadores. Resultados. Estimamos porcentajes de macrobioerosión interna entre el 16.80 % y el 26.67 % del volumen total de las colonias de coral. Observamos que las esponjas y moluscos son los grupos que más bioerosionan las especies de coral con morfología ramificada y masiva, respectivamente. Encontramos tasas de macrobioerosión de 1.51 ± 0.11 kg CaCO3 m-2 año-1 para las especies ramificadas y de 0.53 ± 0.03 de kg CaCO3 m-2año-1 para las especies masivas. Los procesos de bioerosión representaron entre el 39.02 % y 43.86 % de la producción de CaCO3, que fue calculada mediante la metodología ReefBudget. Conclusiones. A pesar que emplear TC representa costos más elevados que otros enfoques (p. ej., rayos-X), hasta ahora es el único enfoque capaz de medir la macrobioerosión interna de todo el esqueleto de coral. Este enfoque permitirá producir balances de carbonatos más certeros que aquellos que no consideran la macrobioerosión interna, mejorando nuestras estimaciones del estado de salud en que se encuentran los arrecifes

Differences in areal bone mineral density between metabolically healthy and unhealthy overweight/obese children: the role of physical activity and cardiorespiratory fitness

“This manuscript was published by SPRINGERNATURE in Pediatric Research on June 2020, available at: doi: 10.1038/s41390-019-0708-x.”OBJECTIVES: To examine whether areal bone mineral density (aBMD) differs between metabolically healthy (MHO) and unhealthy (MUO) overweight/obese children and to examine the role of moderate-to-vigorous physical activity (MVPA) and cardiorespiratory fitness (CRF) in this association. METHODS: A cross-sectional study was developed in 188 overweight/obese children (10.4 ± 1.2 years) from the ActiveBrains and EFIGRO studies. Participants were classified as MHO or MUO based on Jolliffe and Janssen’s metabolic syndrome cut-off points for triglycerides, glucose, high-density cholesterol and blood pressure. MVPA and CRF were assessed by accelerometry and the 20-m shuttle run test, respectively. Body composition was measured by dual-energy X-ray absorptiometry. RESULTS: In model 1 (adjusted for sex, years from peak high velocity, stature and lean mass), MHO children had significantly higher aBMD in total body less head (Cohen’s d effect size, ES = 0.34), trunk (ES = 0.43) and pelvis (ES = 0.33) than MUO children. These differences were attenuated once MVPA was added to model 1 (model 2), and most of them disappeared once CRF was added to the model 1 (model 3). CONCLUSIONS: This novel research shows that MHO children have greater aBMD than their MUO peers. Furthermore, both MVPA and more importantly CRF seem to partially explain these findings.The authors thank the staff and participants of the ActiveBrains and EFIGRO studies for their important contributions. This study has been partially funded by the University of Granada, UGR Research and Knowledge Transfer Fund (PPIT) 2016, Excellence Actions Programme: Units of Scientific Excellence; Scientific Unit of Excellence on Exercise and Health (UCEES), and by the Regional Government of Andalusia, Regional Ministry of Economy, Knowledge, Enterprises and University and European Regional Development Fund (ERDF), ref. SOMM17/6107/UGR. The ActiveBrains study was funded by the Spanish Ministry of Economy and Competitiveness (Reference DEP2013-47540, DEP2016-79512-R, and DEP2017-91544-EXP). The EFIGRO study was funded by the Spanish Ministry of Health, “Fondo de Investigación Sanitaria del Instituto de Salud Carlos III” (PI13/01335), “Fondos Estructurales de la Unión Europea (FEDER), Una manera de hacer Europa,” and by the University of the Basque Country (GIU14/21). L.G.-M. is supported by “La Caixa” Foundation within the Junior Leader fellowship programme (ID 100010434); M.M. is supported by the Spanish Ministry of Education, Culture and Sport (FPU14/03329) and EST17/00210; L.A. is supported by the Education Department of the Government of the Basque Country (PRE_2016_1_0057, PRE_2017_2_0224 and PRE_2018_2_0057); J.M.-G. and J.H.M. are supported by the Spanish Ministry of Education, Culture and Sport (FPU14/06837 and FPU15/02645, respectively)

Differences in areal bone mineral density between metabolically healthy and unhealthy overweight/obese children: the role of physical activity and cardiorespiratory fitness

Objectives: To examine whether areal bone mineral density (aBMD) differs between metabolically healthy (MHO) and unhealthy (MUO) overweight/obese children and to examine the role of moderate-to-vigorous physical activity (MVPA) and cardiorespiratory fitness (CRF) in this association. Methods: A cross-sectional study was developed in 188 overweight/obese children (10.4 ± 1.2 years) from the ActiveBrains and EFIGRO studies. Participants were classified as MHO or MUO based on Jolliffe and Janssen’s metabolic syndrome cut-off points for triglycerides, glucose, high-density cholesterol and blood pressure. MVPA and CRF were assessed by accelerometry and the 20-m shuttle run test, respectively. Body composition was measured by dual-energy X-ray absorptiometry. Results: In model 1 (adjusted for sex, years from peak high velocity, stature and lean mass), MHO children had significantly higher aBMD in total body less head (Cohen’s d effect size, ES = 0.34), trunk (ES = 0.43) and pelvis (ES = 0.33) than MUO children. These differences were attenuated once MVPA was added to model 1 (model 2), and most of them disappeared once CRF was added to the model 1 (model 3). Conclusions: This novel research shows that MHO children have greater aBMD than their MUO peers. Furthermore, both MVPA and more importantly CRF seem to partially explain these findings.This study has been partially funded by the University of Granada, UGR Research and Knowledge Transfer Fund (PPIT) 2016, Excellence Actions Programme: Units of Scientific Excellence; Scientific Unit of Excellence on Exercise and Health (UCEES), and by the Regional Government of Andalusia, Regional Ministry of Economy, Knowledge, Enterprises and University and European Regional Development Fund (ERDF), ref. SOMM17/6107/UGR. The ActiveBrains study was funded by the Spanish Ministry of Economy and Competitiveness (Reference DEP2013-47540, DEP2016-79512-R, and DEP2017-91544-EXP). The EFIGRO study was funded by the Spanish Ministry of Health, 'Fondo de Investigación Sanitaria del Instituto de Salud Carlos III' (PI13/01335), 'Fondos Estructurales de la Unión Europea (FEDER), Una manera de hacer Europa,' and by the University of the Basque Country (GIU14/21). L.G.-M. is supported by 'La Caixa' Foundation within the Junior Leader fellowship programme (ID 100010434); M.M. is supported by the Spanish Ministry of Education, Culture and Sport (FPU14/03329) and EST17/00210; L.A. is supported by the Education Department of the Government of the Basque Country (PRE_2016_1_0057, PRE_2017_2_0224 and PRE_2018_2_0057); J.M.-G. and J.H.M. are supported by the Spanish Ministry of Education, Culture and Sport (FPU14/06837 and FPU15/02645, respectively)

Influence of single-nucleotide polymorphisms in TLR3 (rs3775291) and TLR9 (rs352139) on the risk of CMV infection in kidney transplant recipients

Risk stratification for cytomegalovirus (CMV) infection after kidney transplantation (KT) remains to be determined. Since endosomal toll-like receptors (TLRs) are involved in viral sensing, we investigated the impact of common single-nucleotide polymorphisms (SNPs) located within TLR3 and TLR9 genes on the occurrence of overall and high-level (≥1,000 IU/ml) CMV infection in a cohort of 197 KT recipients. Homozygous carriers of the minor allele of TLR3 (rs3775291) had higher infection-free survival compared with reference allele carriers (60.0% for TT versus 42.3% for CC/CT genotypes; P-value = 0.050). Decreased infection-free survival was observed with the minor allele of TLR9 (rs352139) (38.2% for TC/CC versus 59.3% for TT genotypes; P-value = 0.004). After multivariable adjustment, the recessive protective effect of the TLR3 (rs3775291) TT genotype was confirmed (adjusted hazard ratio [aHR]: 0.327; 95% CI: 0.167–0.642; P-value = 0.001), as was the dominant risk-conferring effect of TLR9 (rs352139) TC/CC genotypes (aHR: 1.865; 95% CI: 1.170–2.972; P-value = 0.009). Carriers of the TLR9 (rs352139) TC/CC genotypes showed lower CMV-specific interferon-γ-producing CD4+ T-cell counts measured by intracellular cytokine staining compared with the TT genotype (median of 0.2 versus 0.7 cells/μl; P-value = 0.003). In conclusion, TLR3/TLR9 genotyping may inform CMV infection risk after KT