There is a need for implementation and maturation of an inclusive trauma system in every country in Europe, with patient centered care by dedicated surgeons. This process should be initiated by physicians and medical societies, based on the best available evidence, and supported and subsequently funded by the government and healthcare authorities. A systematic approach to organizing all aspects of trauma will result in health gain in terms of quality of care provided, higher survival rates, better functional outcomes and quality of life. In addition, it will provide reliable data for both research, quality improvement and prevention programs. Severely injured patients need surgeons with broad technical and non-technical competencies to provide holistic, inclusive and compassionate care. Here we describe the philosophy of the surgical approach and define the necessary skills for trauma, both surgical and other, to improve outcome of severely injured patients. As surgery is an essential part of trauma care, surgeons play an important role for the optimal treatment of trauma patients throughout and after their hospital stay, including the intensive care unit (ICU). However, in most European countries, it might not be obvious to either the general public, patients or even the physicians that the surgeon must assume this responsibility in the ICU to optimize outcomes. The aim of this paper is to define key elements in terms of trauma systems, trauma-specific surgical skills and active critical care involvement, to organize and optimize trauma care in Europe.
Alzheimer’s disease (AD) has been associated with cardiovascular and cerebrovascular risk factors (CVRFs) during middle age and later and is frequently accompanied by cerebrovascular pathology at death. An interaction between CVRFs and genetic variants might explain the pathogenesis. Genome-wide, gene by CVRF interaction analyses for AD, in 6568 patients and 8101 controls identified FMNL2 ( p = 6.6 × 10 –7 ). A significant increase in FMNL2 expression was observed in the brains of patients with brain infarcts and AD pathology and was associated with amyloid and phosphorylated tau deposition. FMNL2 was also prominent in astroglia in AD among those with cerebrovascular pathology. Amyloid toxicity in zebrafish increased fmnl2a expression in astroglia with detachment of astroglial end feet from blood vessels. Knockdown of fmnl2a prevented gliovascular remodeling, reduced microglial activity and enhanced amyloidosis. APP/PS1dE9 AD mice also displayed increased Fmnl2 expression and reduced the gliovascular contacts independent of the gliotic response. Based on this work, we propose that FMNL2 regulates pathology-dependent plasticity of the blood–brain-barrier by controlling gliovascular interactions and stimulating the clearance of extracellular aggregates. Therefore, in AD cerebrovascular risk factors promote cerebrovascular pathology which in turn, interacts with FMNL2 altering the normal astroglial-vascular mechanisms underlying the clearance of amyloid and tau increasing their deposition in brain.
We described a rare case of vaccine‐induced acalculous cholecystitis (ACC). A 52‐year‐old female developed ACC after 8 h of receiving a 3rd dose of the Pfizer‐BioNTech COVID‐19 vaccination. The symptoms subsided completely with conservative treatment for 12 days, and the ultrasound and laboratory findings went back to normal. A 52‐year‐old female developed vaccine–induced acalculous cholecystitis (ACC) 8 h after receiving a 3rd dose of Pfizer BioNtech COVID‐19 vaccination. The symptoms subsided completely with conservative treatment for 12 days and the ultrasound and laboratory findings went back to normal. A high index of suspicion is needed for diagnosis as well as further studies.
El poder predecir la lesión renal aguda severa puede optimizar el tiempo de detección y el tratamiento y con ello la posibilidad de mejorar desenlaces a corto y largo plazo. Con ese objetivo, en 2010, se diseñó un modelo conceptual para identificar tempranamente a los pacientes en estado crítico con riesgo de sufrir una lesión renal aguda grave al ingresar en la unidad de cuidados intensivos; este modelo se denominó índice de angina renal (IAR). El IAR desde sus trabajos iniciales ha mostrado ser clínicamente factible y fácilmente aplicable para identificar a los pacientes pediátricos en estado crítico con riesgo de lesión renal aguda grave que persiste más allá de la lesión funcional. Si bien en sus orígenes el IAR se diseñó en población pediátrica, su aplicación en adultos críticamente enfermos es enteramente factible. Para familiarizar a intensivistas y nefrólogos con esta herramienta diagnóstica y facilitar su aplicación en pacientes adultos, se realizó una revisión de la literatura y se convocó a ocho especialistas a una reunión de consenso, que dio como resultado 10 recomendaciones para la aplicación del IAR en pacientes adultos en estado crítico. Estas recomendaciones se elaboraron teniendo en cuenta las características de los sistemas de salud no solo de República Dominicana, sino también de Latinoamérica.
Introduction: Apolipoprotein E (APOE) is considered the major susceptibility gene for developing Alzheimer's disease. However, the strength of this risk factor is not well established across diverse Hispanic populations. Methods: We investigated the associations among APOE genotype, dementia prevalence, and memory performance (immediate and delayed recall scores) in Caribbean Hispanics (CH), African Americans (AA), Hispanic Americans (HA) and non-Hispanic White Americans (NHW). Multivariable logistic regressions and negative binomial regressions were used to examine these associations by subsample. Results: Our final dataset included 13,516 participants (5198 men, 8318 women) across all subsamples, with a mean age of 74.8 years. Prevalence of APOE ε4 allele was similar in CHs, HAs, and NHWs (21.8%-25.4%), but was substantially higher in AAs (33.6%; P < 0.001). APOE ε4 carriers had higher dementia prevalence across all groups. Discussion: APOE ε4 was similarly associated with increased relative risk of dementia and lower memory performance in all subsamples.
Tumor interface dynamics is a complex process determined by cell proliferation and invasion to neighboring tissues. Parameters extracted from the tumor interface fluctuations allow for the characterization of the particular growth model, which could be relevant for an appropriate diagnosis and the correspondent therapeutic strategy. Previous work, based on scaling analysis of the tumor interface, demonstrated that gliomas strictly behave as it is proposed by the Family-Vicsek ansatz, which corresponds to a proliferative-invasive growth model, while for meningiomas and acoustic schwannomas, a proliferative growth model is more suitable. In the present work, other morphological and dynamical descriptors are used as a complementary view, such as surface regularity, one-dimensional fluctuations represented as ordered series and bi-dimensional fluctuations of the tumor interface. These fluctuations were analyzed by Detrended Fluctuation Analysis to determine generalized fractal dimensions. Results indicate that tumor interface fractal dimension, local roughness exponent and surface regularity are parameters that discriminate between gliomas and meningiomas/schwannomas.
Background: Age and gender specific prevalence rates for parkinsonism and Parkinson's disease (PD) are important to guide research, clinical practice, and public health planning; however, prevalence estimates in Latin America (LatAm) are limited. We aimed to estimate the prevalence of parkinsonism and PD and examine related risk factors in a cohort of elderly individuals from Latin America (LatAm). Methods: Data from 11,613 adults (65+ years) who participated in a baseline assessment of the 10/66 study and lived in six LatAm countries were analyzed to estimate parkinsonism and PD prevalence. Crude and age-adjusted prevalence were determined by sex and country. Diagnosis of PD was established using the UK Parkinson's Disease Society Brain Bank's clinical criteria. Findings: In this cohort, the prevalence of parkinsonism was 8.0% (95% CI 7.6%-8.5%), and the prevalence of PD was 2.0% (95% CI 1.7%-2.3%). PD prevalence increased with age from 1.0 to 3.5 (65-69vs. 80 years or older, p < 0.001). Age-adjusted prevalence rates were lower for women than for men. No significant differences were found across countries, except for lower prevalence in urban areas of Peru. PD was positively associated with depression (adjusted prevalence ratio [aPR] 2.06, 95% CI 1.40-3.01, I 2 = 56.0%), dementia (aPR 1.57, 95% CI 1.07- 2.32, I 2 = 0.0%) and educational level (aPR 1.14, 95% CI 1.01- 1.29, I 2 = 58.6%). Interpretation: The reported prevalence of PD in LatAm is similar to reports from high-income countries (HIC). A significant proportion of cases with PD did not have a previous diagnosis, nor did they seek any medical or neurological attention. These findings underscore the need to improve public health programs for populations currently undergoing rapid demographic aging and epidemiological transition. Funding: The funding source had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.
Objective: The objective of this study was to determine cut-off points that can be used to differentiate measures of empathy, which would then be classified as high, medium, or low. To do so, we used data from students from 7 medical schools in Colombia, El Salvador, and the Dominican Republic, after determining the psychometric properties of the 3-dimensional model of empathy in the Jefferson Scale of Empathy, S-version (for medical students). Materials and methods: This non-experimental descriptive study had a sample that consisted of 6291 students. The structure and factor invariance were analyzed by country and sex. A hierarchical cluster analysis and a bifactorial analysis of variance were applied. Results: The measure of empathy was reliable on the global scale (α = .82; ω = .88). A confirmatory factor analysis showed that the original model was replicable and adjusted to the data (comparative fit index [CFI] = .90; goodness of fit index = .94), while the multigroup analysis allowed to assume an invariant factor structure by country and gender (ΔCFI < .01). Tables were constructed with cut off points for empathy and its dimensions. Discussion and conclusion: Our study solves the problem of comparing the scores and the levels of empathy observed in the medical students at different schools of medicine, making said comparisons within and between countries and between genders. The instrument used has adequate psychometric properties and the cut-off values obtained allow the classifying of people with lower or higher levels of empathy.
Introduction: Progranulin (GRN) mutations occur in frontotemporal lobar degeneration (FTLD) and in Alzheimer's disease (AD), often with TDP-43 pathology. Methods: We determined the frequency of rs5848 and rare, pathogenic GRN mutations in two autopsy and one family cohort. We compared Braak stage, β-amyloid load, hyperphosphorylated tau (PHFtau) tangle density and TDP-43 pathology in GRN carriers and non-carriers. Results: Pathogenic GRN mutations were more frequent in all cohorts compared to the Genome Aggregation Database (gnomAD), but there was no evidence for association with AD. Pathogenic GRN carriers had significantly higher PHFtau tangle density adjusting for age, sex and APOE ε4 genotype. AD patients with rs5848 had higher frequencies of hippocampal sclerosis and TDP-43 deposits. Twenty-two rare, pathogenic GRN variants were observed in the family cohort. Discussion: GRN mutations in clinical and neuropathological AD increase the burden of tau-related brain pathology but show no specific association with β-amyloid load or AD.
Introduction and Aim In the Dominican Republic, there is an important number of individuals affected by nonsyndromic cleft lip with or without cleft palate (NS CL/P); in the search for the etiology, this study sought to determine the inheritance pattern of NS CL/P and to establish possible associations with clinical and socioenvironmental characteristics in a group of affected patients. Materials and Methods The type of cleft was characterized according to the general phenotypic category, the family trees were built according to Bennett et al. (2008, 10.1007/s10897-008-9169-9), the socioenvironmental factors analyzed were tobacco consumption, alcohol, and radiation exposure. Results Seventy-eight patients were analyzed, among whom severe phenotypes were more prevalent, including complete cleft lip and palate (CLP) (61.53%) and bilateral clefts (64%). In the analysis of genealogies, it was determined that 81.5% of the families were sporadic cases, 12.3% were autosomal dominant inheritance, and 6.2% were presented with a multifactorial inheritance. The consumption of alcohol was the most common socioenvironmental factor. There were no reports on the evaluated socioenvironmental factors in cases where heredity was determined as autosomal dominant. No inbred relationships were observed. Conclusion There were diverse inheritance models for NS CL/P in patients from the Dominican Republic. Sporadic cases constituted the most frequent condition, followed by the existing families with autosomal dominance, and multifactorial inheritance. The absence of socioenvironmental factors commonly associated with pathology in families with autosomal dominant inheritance supports the hypothesis of a more significant genetic influence in this type of inheritance.
Alzheimer's disease (AD) is clinically characterized by a progressive loss of cognitive functions and short-term memory. AD patients present two distinctive neuropathological lesions: neuritic plaques and neurofibrillary tangles (NFTs), constituted of beta-amyloid peptide (Aβ) and phosphorylated and truncated tau proteins. Aβ deposits around cerebral blood vessels (cerebral amyloid angiopathy, CAA) is a major contributor to vascular dysfunction in AD. Vascular amyloid deposits could be early events in AD due to dysfunction in the neurovascular unit (NVU) and the blood–brain barrier (BBB), deterioration of the gliovascular unit, and/or decrease of cerebral blood flow (CBF). These pathological events can lead to decreased Aβ clearance, facilitate a neuroinflammatory environment as well as synaptic dysfunction and, finally, lead to neurodegeneration. Here, we review the histopathological AD hallmarks and discuss the two-hit vascular hypothesis of AD, emphasizing the role of neurovascular dysfunction as an early factor that favors vascular Aβ aggregation and neurodegeneration. Addtionally, we emphasize that pericyte degeneration is a key and early element in AD that can trigger amyloid vascular accumulation and NVU/BBB dysfunction. Further research is required to better understand the early pathophysiological mechanisms associated with NVU alteration and CAA to generate early biomarkers and timely treatments for AD.
Previous research showed that up to 56% of all dementia cases in Latin America could potentially be prevented if all modifiable risk factors were eliminated. Trends of studies in Latin America show, however, that lifestyles are declining. In absence of a cure, prevention is crucial. The aim was to develop a tool that can be used in primary care settings to raise awareness for modifiable risk factors and motivate high‐risk individuals to adopt healthy lifestyles to reduce their risk of dementia. Data were from the Cuban (n=1846, mean age=73.9 ±6.4), Dominican Republic (DR, n=1053, mean age=76.3 ±6.8) and Puerto Rican (PR, n=1166, mean age=76.3 ±7.4) cohorts of the 10/66 Dementia Research Group. Participants completed questionnaires, health examination and cognitive tests at baseline and on average 4.5‐5 years later. Logistic regression was used to identify key modifiable risk factors. The 3 or 4 most important modifiable risk factors were combined into a grid and cells were colour coded to display the levels of risk according to absolute proportions of incident dementia (green/low: <9%, yellow/medium: 9‐<13%, orange/high: 13‐<20%, red/very high: >20%). Physical activity, hypertension and diet were identified as the key modifiable risk factors. Hence, the grid included hypertension (yes/no), diet (composite measure of regular/no fish consumption and <4/4+ serves of vegetables) and physical activity (high, moderate, low) only. The levels of risk varied from low (6.6%) in participants with none of the risk factors to high (18.5%) in participants with all three risk factors. The highest risk was found in participants who were inactive and did not eat fish (24.8%). We have developed a tool that visualises the levels of risk and how each risk factor contributes to the risk of dementia. It also shows how one may lower their risk by addressing the risk factors. The tool can be used in primary care settings to motivate people for adopting healthy behaviours.
Autobiographical memory involves self‐life episodes and generic knowledge that enables the meaning attributed to a lifetime story. The semantic autobiographical memory is related to a general knowledge and the episodic autobiographical memory is associated to the personal experiences at specific time and place related to past experiences among a long period of life (Allen, et al., 2018; Eustache et al., 2013, 2016). Autobiographical events activate an autonomic consciousness related to recovers the past memories, while autobiographical semantic knowledge comprises a noetic familiar awareness and a consciousness of past limited (Markowitsch , & Staniloiu, 2011; Piolino et al., 2003; Tulving, 2002). Progressive loss of self‐consciousness presented in Alzheimer Disease (A.D) is connected to the decline of autobiographical episodic memory. Some studies validate positive effects of olfactory stimulation on autobiographical memory (El Haj et al., 2015; Gachet & El Haj, 2020) but no research has evaluated the influence of familiar olfactory stimulation on A.D related to improve self‐consciousness in Colombia. This study aims to assess if the evoked autobiographical memories from familiar olfactory stimulation has an enforcement or facilitator effect on self‐consciousness. Fifty people will participate, 25 at the control group and 25 at the experimental group. The control group will have an olfactory stimulation without familiar smells, and the experimental grouo, will have it with familiar smells. There will be three phases: 1) After intervention: Evaluation of autobiographical episodic memory; 2) During intervention: Placebo olfactory stimulation with control group, and olfactory familiar stimulation with experimental group. Then there will be an evaluation of autobiographical episodic memory; 3) Before intervention: Post olfactory stimulation of self‐consciousness. More autobiographical memories evoked are expected with the positive valiance of familiar olfactory intervention than the placebo olfactory stimulation in people with A.D. We expect that autobiographical episodic involuntary memories evoked will be more elevated than the voluntary ones on subjective content. We also contemplate that the group of patients with familiar olfactory stimulation will improve their level of self‐consciousness and evoke autobiographical episodic memory. This research will be an important framework for future clinical trials with familiar olfactory intervention in Latin America. Also, for non‐pharmacologic interventions.
Background: Latinos represent the fastest growing proportion of dementia cases among different ethnic groups. Most of the studies in Alzheimer's Disease (AD) include Latino populations within the same group, failing to sufficiently account for the real richness of linguistic, ethnic, ancestry, cultural, and socioeconomic diversity represented across Latino communities (e.g., Caribbean-Hispanic vs Non Caribbean-Hispanics), yet there is substantial AD disparities and disease heterogeneity among Hispanic groups. Methods: The Caribbean-American Dementia and Aging Study (CADAS) is a multinational initiative aimed to answer key questions regarding dementia determinants and consequences in Caribbean-origin populations in origin communities as well as among emigrant populations in the United States. By building a collaborative team of leading Caribbean and U.S-based dementia researches, CADAS will analyze differences in dementia prevalence and risk factor profiles between Caribbean-Hispanics living in the main Hispanic Caribbean Islands and extend comparisons to Hispanic immigrant groups in the US as well as non-Hispanic whites, exploiting the considerable difference in life course risk exposures across these populations. Results: Preliminary findings from the CADAS study indicate that prevalence of dementia in the older Caribbean population is high, both in the main islands and in U.S. compared to non-Hispanic-whites. We found overall weaker associations between education and dementia probability in the three main Caribbean islands. By contrast, a stronger association between education and dementia probability was found in the US among non-Hispanic whites, Mexican Hispanics, and non-Mexican Hispanics; these persist even after controlling for income and wealth. Conclusions: There are differential associations between SES risk factors, education, and dementia probability between Caribbean islands and the U.S., which may be attributed to differences across societies in risk factors correlated with education. The CADAS study will fill a critical gap in AD knowledge, exploiting rich variation in life-course exposures to better disentangle genetic versus environmental determinants of dementia levels and disparities. Future studies within this populations will focus on early-life socioeconomic status, gene by environment interactions and societal cost.
Background: APOE-ε4 allele is the most significant genetic risk factor for late-onset Alzheimer disease (AD). The magnitude of the association between the APOE-ε4 allele, AD, and cognitive decline has been shown to be stronger in populations of European descent relative to populations of African descent. However, these associations have been understudied in more admixed populations, including Latin American (LatAm) populations. Method: We examine the associations between APOE-ε4, cognitive performance, and dementia prevalence among a sample of 5,953 older adults from LatAm (Cuba, Dominican Republic [DR], Puerto Rico [PR], and Venezuela) drawn from the 10/66 Dementia Research Group study. We further examine whether global ancestry modifies these associations. Dementia diagnosis was established using the previously validated 10/66 diagnostic algorithm and DSM-IV criteria. Results: Mean age was 72.7 in Venezuela and 75.0 years in Cuba, DR, and PR. Dementia prevalence was lower in Venezuela (6.9%) compared to the Caribbean countries (Cuba=10.6%, PR=11.7%, DR=11.8%). The prevalence of the APOE-ε4 allele was higher in DR compared to PR, Venezuela, and Cuba. Using APOE-ε3 allele as a reference category, presence of APOE-ε4 was significantly associated with increased risk of dementia (OR, 2.33; 95% confidence interval [CI], 1.84, 2.81). We found that APOE-ε4 carriers with a higher African ancestry proportion had slower cognitive decline, although this was not statistically significant. Conclusion: Although we found strong association between APOE-ε4 and increased dementia risk; compared to previous reports in European descent populations the effect of APOE-ε4 is attenuated in Caribbean origin populations. The possibility that African ancestry may mediate the effect of APOE-ε4 will require further confirmation using larger samples.
The arrival of Spaniards in the Caribbean islands introduced to the region the practice of applying pigments onto buildings. The pigments that remain on these buildings may provide data on their historical evolution and essential information for tackling restoration tasks. In this study, a 17th-century mural painting located in the Cathedral of Santo Domingo on the Hispaniola island of the Caribbean is characterised via UV–VIS–NIR, Raman and FTIR spectroscopy, XRD and SEM/EDX. The pigments are found in the older Chapel of Our Lady of Candelaria, currently Chapel of Our Lady of Mercy. The chapel was built in the 17th century by black slave brotherhood and extended by Spaniards. During a recent restoration process of the chapel, remains of mural painting appeared, which were covered by several layers of lime. Five colours were identified: ochre, green, red, blue and white. Moreover, it was determined that this mural painting was made before the end of the 18th century, because many of the materials used were no longer used after the industrialisation of painting. However, since both rutile and anatase appear as a white pigment, a restoration may have been carried out in the 20th century, and it has been painted white.
Objective Teleneuropsychology (teleNP) could potentially expand access to services for patients who are confined, have limited personal access to healthcare, or live in remote areas. The emergence of the COVID-19 pandemic has significantly increased the use of teleNP for cognitive assessments. The main objective of these recommendations is to identify which procedures can be potentially best adapted to the practice of teleNP in Latin America, and thereby facilitate professional decision-making in the region. Method Steps taken to develop these recommendations included (1) formation of an international working group with representatives from 12 Latin American countries; (2) assessment of rationale, scope, and objectives; (3) formulation of clinical questions; (4) evidence search and selection; (5) evaluation of existing evidence and summary; and (6) formulation of recommendations. Levels of evidence were graded following the Oxford Centre for Evidence-Based Medicine system. Databases examined included PubMed, WHO-IRIS, WHO and PAHO-IRIS, Índice Bibliográfico Español en Ciencias de la Salud (IBCS), and LILACS. Results Working group members reviewed 18,400 titles and 422 abstracts and identified 19 articles meeting the criteria for level of evidence, categorization, and elaboration of recommendations. The vast majority of the literature included teleNP tests in the English language. The working group proposed a series of recommendations that can be potentially best adapted to the practice of teleNP in Latin America. Conclusions There is currently sufficient evidence to support the use of videoconferencing technology for remote neuropsychological assessments. These recommendations will likely contribute to the advancement of teleNP research and practice in the region.
Neurodegenerative diseases called tauopathies, such as Alzheimer’s disease (AD), frontotemporal dementia, progressive supranuclear palsy, and Parkinson’s disease, among others, are characterized by the pathological processing and accumulation of tau protein. AD is the most prevalent neurodegenerative disease and is characterized by two lesions: neurofibrillary tangles and neuritic plaques. The presence of NFTs in the hippocampus and neocortex in early and advanced stages, respectively, correlates with the patient’s cognitive deterioration. So far, no drugs can prevent, decrease, or limit neuronal death due to abnormal pathological tau accumulation. Among potential non-pharmacological treatments, physical exercise has been shown to stimulate the development of stem cells (SCs) and may be useful in early stages. However, this does not prevent neuronal death from the massive accumulation of NFTs. In recent years, SCs therapies have emerged as a promising tool to repopulate areas involved in cognition in neurodegenerative diseases. Unfortunately, protocols for SCs therapy are still being developed and the mechanism of action of such therapy remains unclear. In this review, we show the advances and limitations of SCs therapy. Finally, we provide a critical analysis of its clinical use for AD.
The steady increase in global temperatures, resulting from the combustion of fossil fuels and the accumulation of greenhouse gases (GHG), continues to destabilize all ecosystems worldwide. Although annual emissions must halve by 2030 and reach net-zero by 2050 to limit some of the most catastrophic impacts associated with a warming planet, the world’s efforts to curb GHG emissions fall short of the commitments made in the 2015 Paris Agreement (1). To this effect, July 2021 was recently declared the hottest month ever recorded in 142 years (2). The ramifications of these changes on global temperatures are complex and further promote outdoor air pollution, pollen exposure, and extreme weather events. Besides worsening respiratory health, air pollution, promotes atopy and susceptibility to infections. The GHG effects on pollen affect the frequency and severity of asthma and allergic rhinitis. Changes in temperature, air pollution, and extreme weather events exert adverse multisystemic health effects and disproportionally affect disadvantaged and vulnerable populations. This article is an update for allergists and immunologists about the health impacts of climate change, already evident in our daily practices. It is also a call to action and advocacy, including integrating climate change-related mitigation, education, and adaptation measures to protect our patients and avert further injury to our planet.
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