Application of the laboratory risk indicator for necrotizing fasciitis score for patients with hand infection in Mexican population

Background: Necrotizing fasciitis (NF) is a severe form of soft tissue infection, early diagnosis, and surgical intervention are direct factors in mortality, it may arise from many infectious aetiologies, at our hospital in Mexico city, it is not uncommon that hand infection patients progress to NF, that in many cases its recognition and treatment may also be delayed, resulting in fatal outcomes. Wong et al in 2004 introduced a laboratory risk indicator for necrotizing fasciitis (LRINEC score) that utilizes common laboratory values of patients with clinical infection and stratifies them by their risk of developing NF, so the aim of our study was to validate this tool in Mexican population. Methods: We reviewed all patients with an initial diagnosis of hand infection admitted at the emergency department of our hospital in Mexico City, from April 2020 to March 2022 and examined the LRINEC score at admission, post-debridement, and at the end of the hospitalization to evaluate its usefulness in our population. Results: The LRINEC score at cut-off ≥6 reported sensitivity for the diagnosis of NF of 35.71% (95% CI 12.76-64.86%), specificity of 100% (95% CI 78.2-100%), positive predictive value of 100% (95% CI 71-100%), and negative predictive value of 62.5% (95% CI 53.01-71.12%). Conclusions: The LRINEC score is a useful tool to distinguish NF from other soft tissue infections, but it is not helpful for early recognition of NF alone, LRINEC score could predict worse hospital outcomes in patients with NF and identify the high-risk patients.

3D printing for surgical planning in bone grafts for cleft-palate: a case report

3D printing has been used for teaching purposes. Creating models for simulating surgeries. Gong et al presented a workflow for digital planning for surgery and Rendon et al previously presented a low-cost method with acceptable precision.  This paper aims to present a case where 3D printing surgical planning was applied for bone graft shape and dimensions. A 16-year-old female patient with a history of bilateral cleft lip and palate has received 6 surgical interventions to treat her congenital pathology. She begins orthodontic management at the age of 6 years and is referred to the plastic surgery service 10 years later, presenting oral and nasal fistula on the nasal floor with mainly liquid leakage. A bone graft was taken and applied from the patient's left iliac crest. the iliac crest is taken and the bone graft is molded Assisted with 3D printed model which is fixed in the premaxilla with a 14-hole linear plate. We proposed a new application for low-cost 3D printed models. Patient specific models have applications in cleft palate bone grafting. We present a case and more studies are required to measure variables as time, graft integration, and patient satisfaction

A Regional Red List of Montane Tree Species of the Tropical Andes: Trees at the top of the world

Andean montane forests are a major global conservation priority owing to their biological richness and high level of species endemism. Botanically the Andes are very rich in species but they remain relatively unstudied. In common with montane forests elsewhere in the world, Andean forests are of great value for the provision of ecosystem services relating to water supply, regulation of regional climate and the capture and storage of carbon. The forests and their component species are however under threat. This report summarises information drawn from a wide variety of sources to provide a regional Red List of trees of Andean tropical montane forests. The species evaluation process has drawn on published national red lists of threatened species, botanical literature, specimen databases, forestry information and expert knowledge. The IUCN Red List Categories and Criteria have been used for the evaluation and a component of Natalia?s PhD study has been to evaluate their use for species with limited and dispersed data. Understanding the geographical distribution of the species is very important in conservation assessment. The maps produced for this study are a valuable starting point for the Red Listing and a baseline for monitoring impacts of climate change. In this assessment 70 species are recorded as globally threatened based on the IUCN Red List of Categories and Criteria out of 127 tree species evaluated. In addition 165 national endemic trees of the region have previously been evaluated as globally threatened based on the same IUCN process. In total therefore 235 tree species are currently considered to be threatened with extinction within the Andean montane forests.Fil: Tejedor Garavito , Natalia. Bournemouth University; Reino UnidoFil: Álvarez Dávila, Esteban. Jardín Botánico de Medellín; ColombiaFil: Caro, Sandra Arango. Missouri Botanical Garden; Estados UnidosFil: Murakami, Alejandro Araujo. Museo de Historia Natural Noel Kempff Mercado; BoliviaFil: Baldeón, Severo. Universidad Nacional Mayor de San Marcos; PerúFil: Beltrán, Hamilton. Universidad Nacional Mayor de San Marcos; PerúFil: Blundo, Cecilia Mabel. Universidad Nacional de Tucumán. Facultad de Ciencias Naturales e Instituto Miguel Lillo; Argentina. Universidad Nacional de Tucumán. Facultad de Ciencias Naturales e Instituto Miguel Lillo. Laboratorio de Investigaciones Ecológicas de las Yungas; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Tucumán; ArgentinaFil: Boza Espinoza, Tatiana Erika. Missouri Botanical Garden; Estados UnidosFil: Fuentes Claros, Alfredo. Herbario Nacional de Bolivia; BoliviaFil: Gaviria, Juan. Universidad de Los Andes; VenezuelaFil: Gutiérrez, Néstor. Universidad de Los Andes; VenezuelaFil: Khela, Sonia. Botanic Gardens Conservation International; Reino UnidoFil: León, Blanca. University of Texas at Austin; Estados UnidosFil: la Torre Cuadros, Maria De Los Angeles. Universidad Nacional Agraria; PerúFil: López Camacho, René. Universidad Distrital; ColombiaFil: Malizia, Lucio Ricardo. Universidad Nacional de Jujuy. Facultad de Ciencias Agrarias. Centro de Estudios Ambientales Territoriales y Sociales; ArgentinaFil: Millán, Betty. Universidad Nacional Mayor de San Marcos; PerúFil: Moraes R., Mónica. Herbario Nacional de Bolivia; BoliviaFil: Newton, Adrian C.. Bournemouth University; Reino UnidoFil: Pacheco, Silvia. Fundación Proyungas; ArgentinaFil: Reynel, Carlos. Universidad Nacional Agraria; PerúFil: Ulloa Ulloa, Carmen. Missouri Botanical Garden; Estados UnidosFil: Vacas Cruz,Omar. Pontificia Universidad Católica del Ecuador; Ecuado

Measurement of the cosmic ray spectrum above 4×10184{\times}10^{18} eV using inclined events detected with the Pierre Auger Observatory

A measurement of the cosmic-ray spectrum for energies exceeding $4{\times}10^{18}$ eV is presented, which is based on the analysis of showers with zenith angles greater than $60^{\circ}$ detected with the Pierre Auger Observatory between 1 January 2004 and 31 December 2013. The measured spectrum confirms a flux suppression at the highest energies. Above $5.3{\times}10^{18}$ eV, the "ankle", the flux can be described by a power law $E^{-\gamma}$ with index $\gamma=2.70 \pm 0.02 \,\text{(stat)} \pm 0.1\,\text{(sys)}$ followed by a smooth suppression region. For the energy ($E_\text{s}$) at which the spectral flux has fallen to one-half of its extrapolated value in the absence of suppression, we find $E_\text{s}=(5.12\pm0.25\,\text{(stat)}^{+1.0}_{-1.2}\,\text{(sys)}){\times}10^{19}$ eV.Comment: Replaced with published version. Added journal reference and DO

Energy Estimation of Cosmic Rays with the Engineering Radio Array of the Pierre Auger Observatory

The Auger Engineering Radio Array (AERA) is part of the Pierre Auger Observatory and is used to detect the radio emission of cosmic-ray air showers. These observations are compared to the data of the surface detector stations of the Observatory, which provide well-calibrated information on the cosmic-ray energies and arrival directions. The response of the radio stations in the 30 to 80 MHz regime has been thoroughly calibrated to enable the reconstruction of the incoming electric field. For the latter, the energy deposit per area is determined from the radio pulses at each observer position and is interpolated using a two-dimensional function that takes into account signal asymmetries due to interference between the geomagnetic and charge-excess emission components. The spatial integral over the signal distribution gives a direct measurement of the energy transferred from the primary cosmic ray into radio emission in the AERA frequency range. We measure 15.8 MeV of radiation energy for a 1 EeV air shower arriving perpendicularly to the geomagnetic field. This radiation energy -- corrected for geometrical effects -- is used as a cosmic-ray energy estimator. Performing an absolute energy calibration against the surface-detector information, we observe that this radio-energy estimator scales quadratically with the cosmic-ray energy as expected for coherent emission. We find an energy resolution of the radio reconstruction of 22% for the data set and 17% for a high-quality subset containing only events with at least five radio stations with signal.Comment: Replaced with published version. Added journal reference and DO

Measurement of the Radiation Energy in the Radio Signal of Extensive Air Showers as a Universal Estimator of Cosmic-Ray Energy

We measure the energy emitted by extensive air showers in the form of radio emission in the frequency range from 30 to 80 MHz. Exploiting the accurate energy scale of the Pierre Auger Observatory, we obtain a radiation energy of 15.8 \pm 0.7 (stat) \pm 6.7 (sys) MeV for cosmic rays with an energy of 1 EeV arriving perpendicularly to a geomagnetic field of 0.24 G, scaling quadratically with the cosmic-ray energy. A comparison with predictions from state-of-the-art first-principle calculations shows agreement with our measurement. The radiation energy provides direct access to the calorimetric energy in the electromagnetic cascade of extensive air showers. Comparison with our result thus allows the direct calibration of any cosmic-ray radio detector against the well-established energy scale of the Pierre Auger Observatory.Comment: Replaced with published version. Added journal reference and DOI. Supplemental material in the ancillary file

Clonal chromosomal mosaicism and loss of chromosome Y in elderly men increase vulnerability for SARS-CoV-2

The pandemic caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2, COVID-19) had an estimated overall case fatality ratio of 1.38% (pre-vaccination), being 53% higher in males and increasing exponentially with age. Among 9578 individuals diagnosed with COVID-19 in the SCOURGE study, we found 133 cases (1.42%) with detectable clonal mosaicism for chromosome alterations (mCA) and 226 males (5.08%) with acquired loss of chromosome Y (LOY). Individuals with clonal mosaic events (mCA and/or LOY) showed a 54% increase in the risk of COVID-19 lethality. LOY is associated with transcriptomic biomarkers of immune dysfunction, pro-coagulation activity and cardiovascular risk. Interferon-induced genes involved in the initial immune response to SARS-CoV-2 are also down-regulated in LOY. Thus, mCA and LOY underlie at least part of the sex-biased severity and mortality of COVID-19 in aging patients. Given its potential therapeutic and prognostic relevance, evaluation of clonal mosaicism should be implemented as biomarker of COVID-19 severity in elderly people. Among 9578 individuals diagnosed with COVID-19 in the SCOURGE study, individuals with clonal mosaic events (clonal mosaicism for chromosome alterations and/or loss of chromosome Y) showed an increased risk of COVID-19 lethality

Global, regional, and national burden of disorders affecting the nervous system, 1990–2021: a systematic analysis for the Global Burden of Disease Study 2021

BACKGROUND: Disorders affecting the nervous system are diverse and include neurodevelopmental disorders, late-life neurodegeneration, and newly emergent conditions, such as cognitive impairment following COVID-19. Previous publications from the Global Burden of Disease, Injuries, and Risk Factor Study estimated the burden of 15 neurological conditions in 2015 and 2016, but these analyses did not include neurodevelopmental disorders, as defined by the International Classification of Diseases (ICD)-11, or a subset of cases of congenital, neonatal, and infectious conditions that cause neurological damage. Here, we estimate nervous system health loss caused by 37 unique conditions and their associated risk factors globally, regionally, and nationally from 1990 to 2021. METHODS: We estimated mortality, prevalence, years lived with disability (YLDs), years of life lost (YLLs), and disability-adjusted life-years (DALYs), with corresponding 95% uncertainty intervals (UIs), by age and sex in 204 countries and territories, from 1990 to 2021. We included morbidity and deaths due to neurological conditions, for which health loss is directly due to damage to the CNS or peripheral nervous system. We also isolated neurological health loss from conditions for which nervous system morbidity is a consequence, but not the primary feature, including a subset of congenital conditions (ie, chromosomal anomalies and congenital birth defects), neonatal conditions (ie, jaundice, preterm birth, and sepsis), infectious diseases (ie, COVID-19, cystic echinococcosis, malaria, syphilis, and Zika virus disease), and diabetic neuropathy. By conducting a sequela-level analysis of the health outcomes for these conditions, only cases where nervous system damage occurred were included, and YLDs were recalculated to isolate the non-fatal burden directly attributable to nervous system health loss. A comorbidity correction was used to calculate total prevalence of all conditions that affect the nervous system combined. FINDINGS: Globally, the 37 conditions affecting the nervous system were collectively ranked as the leading group cause of DALYs in 2021 (443 million, 95% UI 378–521), affecting 3·40 billion (3·20–3·62) individuals (43·1%, 40·5–45·9 of the global population); global DALY counts attributed to these conditions increased by 18·2% (8·7–26·7) between 1990 and 2021. Age-standardised rates of deaths per 100 000 people attributed to these conditions decreased from 1990 to 2021 by 33·6% (27·6–38·8), and age-standardised rates of DALYs attributed to these conditions decreased by 27·0% (21·5–32·4). Age-standardised prevalence was almost stable, with a change of 1·5% (0·7–2·4). The ten conditions with the highest age-standardised DALYs in 2021 were stroke, neonatal encephalopathy, migraine, Alzheimer's disease and other dementias, diabetic neuropathy, meningitis, epilepsy, neurological complications due to preterm birth, autism spectrum disorder, and nervous system cancer. INTERPRETATION: As the leading cause of overall disease burden in the world, with increasing global DALY counts, effective prevention, treatment, and rehabilitation strategies for disorders affecting the nervous system are needed