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In communities with higher social inequality, tracking the progression and remission of cognitive dysfunction (PR-CD) and its associated factors provides an epidemiological overview of dementia risk. To investigate the incidence and factors associated with PR-CD in older adults (OAs) at three clinics of the Mexican Social Security Institute in an industrial area of Western Mexico State. A two-year longitudinal study of 231 OAs (≥ 60 years) assessed cognitive function using the Montreal Cognitive Assessment (MoCA). After 2 years, outcomes were categorized into three groups: healthy cognitive function (MoCA scores > 20 on all three measurements), remitting cognitive impairment (one or two measurements with MoCA scores < 20), and progressive cognitive impairment (MoCA scores < 20 on all three measurements). Additionally, sociodemographic, clinical, and functional data were collected. Cumulative incidence and relative risk factors were analyzed using regression. The sample consisted of individuals with six or fewer years of schooling, and 70% identified as female. The incidence of P-CD was 28.1%, while that of R-CD was 32.5%. Factors associated with R-CD included low cognitive reserve and diminished physical performance. In contrast, factors linked to P-CD included age, low educational attainment, low cognitive reserve, age-related sarcopenia, education-related sarcopenia, age-related instrumental Activities of Daily Living (IADLs), and the interaction among age, cognitive reserve, IADLs, and SPBB. In a region of social inequality in Western Mexico State, there is a high incidence of R-CD and P-CD, associated with risk factors that contribute to cognitive dysfunction among OAs. la incidencia de la progresión y la remisión del deterioro cognitivo (PR_DC), junto con los factores asociados (FR), ofrece un panorama epidemiológico del riesgo de demencia en la comunidad, especialmente en zonas con mayor desigualdad social. determinar la incidencia y los factores asociados a la PR_DC en personas adultas mayores (PAM) en tres clínicas del Instituto Mexicano del Seguro Social ubicadas en una zona industrial al poniente del Estado de México. estudio longitudinal de dos años con 231 PAM de ≥ 60 años. Se evaluó la función cognitiva global mediante la Escala Cognitiva de Montreal (MoCA). Los desenlaces a dos años fueron: función cognitiva saludable (MoCA > 20 en las tres mediciones), remitente (DC-R: una o dos mediciones < 20) y progresivo (DC-P: tres mediciones < 20). Se obtuvieron datos sociodemográficos, clínicos y funcionales. Se calcularon las incidencias acumuladas y los FR mediante regresión. la muestra presentó una escolaridad de ≤ 6 años y 70% de mujeres. La incidencia de DC-P fue del 28.1% y la de DC-R del 32.5%. Los factores asociados a DC-R fueron la reserva cognitiva y el rendimiento físico. Para DC-P: edad, escolaridad baja, reserva cognitiva baja, edad-sarcopenia, escolaridad-sarcopenia, edad-AVD instrumentales y edad-reserva cognitiva-AVD instrumentales-SPPB. existe una alta incidencia de deterioro cognitivo progresivo y remitente en una muestra de personas que viven en zonas con desigualdad social, vinculada a factores de riesgo que incrementan el deterioro cognitivo.
In Peru, there are few reports on pharmacological adherence in patients with arterial hypertension. In this context, the present study aimed to determine adherence to antihypertensive treatment in patients treated at a tertiary-level social security hospital in Lima. A cross-sectional study was conducted in 250 hospitalized patients, over 18 years of age, with a diagnosis of primary arterial hypertension on pharmacological treatment. Adherence was evaluated using the Morisky questionnaire (MMAS-8), and variables such as prescribed medication, age, sex, marital status, and educational level were collected. 56.4% of the participants were male and 86.4% were over 60 years old. It was observed that 42% presented low pharmacological adherence and 58% medium adherence, with no cases of high adherence recorded. Monotherapy was the most frequent regimen (48%), with losartan, nifedipine, and enalapril being the most prescribed drugs. Finally, significant differences were identified between adherence to antihypertensive treatment and educational level and the number of drugs. En Perú existen escasos reportes sobre la adherencia farmacológica en pacientes con hipertensión arterial. En este contexto, el presente estudio tuvo como objetivo determinar la adherencia al tratamiento antihipertensivo en pacientes atendidos en un hospital de nivel terciario de la seguridad social en Lima. Se realizó un estudio transversal en 250 pacientes hospitalizados, mayores de 18 años, con diagnóstico de hipertensión arterial primaria en tratamiento farmacológico. La adherencia se evaluó mediante el cuestionario de Morisky (MMAS-8), y se recolectaron variables como medicación indicada, edad, sexo, estado civil y nivel educativo. El 56,4% de los participantes fueron varones y el 86,4% tenía más de 60 años. Se observó que el 42% presentó baja adherencia farmacológica y el 58% adherencia media, sin registrarse casos de adherencia alta. La monoterapia fue el esquema más frecuente (48%), siendo losartán, nifedipino y enalapril los fármacos más prescritos. Finalmente, se identificaron diferencias significativas entre la adherencia al tratamiento antihipertensivo con el nivel educativo y el número de fármacos. En Perú existen escasos reportes sobre la adherencia farmacológica en pacientes con hipertensión arterial. En este contexto, el presente estudio tuvo como objetivo determinar la adherencia al tratamiento antihipertensivo en pacientes atendidos en un hospital de nivel terciario de la seguridad social en Lima. Se realizó un estudio transversal en 250 pacientes hospitalizados, mayores de 18 años, con diagnóstico de hipertensión arterial primaria en tratamiento farmacológico. La adherencia se evaluó mediante el cuestionario de Morisky (MMAS-8), y se recolectaron variables como medicación indicada, edad, sexo, estado civil y nivel educativo. El 56,4% de los participantes fueron varones y el 86,4% tenía más de 60 años. Se observó que el 42% presentó baja adherencia farmacológica y el 58% adherencia media, sin registrarse casos de adherencia alta. La monoterapia fue el esquema más frecuente (48%), siendo losartán, nifedipino y enalapril los fármacos más prescritos. Finalmente, se identificaron diferencias significativas entre la adherencia al tratamiento antihipertensivo con el nivel educativo y el número de fármacos.
Individuals with psychosis face persistent barriers to care. Peru's recent mental health reform expanded services nationwide but coincided with the COVID-19 pandemic. We hypothesized that service utilization among individuals with psychosis would increase between 2018 and 2024, particularly in underserved regions. We analyzed outpatient morbidity data from the Peruvian National Superintendence of Health (2018-2024). Sex was available as binary male/female coding; gender identity and race/ethnicity data were not available. Service utilization was compared across three groups: psychosis, non-psychotic mental disorders, and general medical conditions. We examined changes in access (rate ratios, rate differences), the impact of the pandemic (interrupted time series), and decentralization trends (Poisson regression), separately for each disorder group. In 2024 compared with 2018, monthly service utilization per 100,000 declined for psychosis (28.2 in 2018-19.2 in 2024; rate ratio 0.68), rose for non-psychotic mental disorders (225.2 in 2018-304.6 in 2024; 1.35), and slightly fell for general medical conditions (12,688.1 in 2018-12,370.4 in 2024; 0.97). The pandemic caused a comparable immediate drop in service utilization, with rates falling to 37.9%, 37.0%, and 35.3% of expected levels for the three groups in March 2020, followed by gradual monthly increases (psychosis 1.3%, non-psychotic mental disorders 2.6%, general medical conditions 2.2%). A shift from tertiary to primary and regional facilities was seen for both mental disorder groups, but greater utilization in underserved regions was observed only for non-psychotic mental disorders. Despite nationwide expansion of mental health services, individuals with psychosis did not experience higher service use. The pandemic's impact was acute and enduring for this group. Findings underscore the need to examine reasons for this stagnation in service utilization and evaluate the acceptability and appropriateness of Peru's current service model for psychosis. Canadian Institutes of Health Research, Canada Research Chairs program. Las personas con psicosis enfrentan barreras para acceder a la atención en salud. La reforma de salud mental en Perú incrementó los servicios de salud mental a nivel nacional, pero coincidió con la pandemia de COVID-19. Hipotetizamos que la utilización de servicios de salud por personas con psicosis podría aumentar entre el 2018 y el 2024, particularmente en regiones desatendidas. Analizamos datos de morbilidad ambulatoria de la Superintendencia Nacional de Salud del Perú (2018–2024). La variable sexo fue categorizada de forma binaria (hombre/mujer); no se contó con información sobre identidad de género ni raza/etnicidad. La utilización de servicios de salud se comparó entre tres grupos diagnósticos: psicosis, trastornos mentales no psicóticos y condiciones médicas generales. Examinamos cambios en el acceso (razones de tasas, diferencias de tasas), el impacto de la pandemia (series de tiempo interrumpidas) y las tendencias de descentralización (regresión de Poisson), por separado para cada grupo diagnóstico. En el 2024, en comparación con el 2018, la utilización mensual de servicios de salud por cada 100,000 habitantes disminuyó para psicosis (28.2 en 2018-19.2 en 2024; razón de tasas 0.68), aumentó para trastornos mentales no psicóticos (225.2 en 2018-304.6 en 2024; 1.35) y disminuyó ligeramente en condiciones médicas generales (12,688.1 en 2018-12,370.4 en 2024; 0.97). La pandemia causó una caída inmediata similar en la utilización de servicios de salud para los tres grupos en marzo de 2020, con tasas que descendieron al 37.9%, 37.0% y 35.3% de los niveles esperados, seguida de aumentos mensuales graduales en la utilización de servicios (psicosis 1.3%, trastornos mentales no psicóticos 2.6%, condiciones médicas generales 2.2%). Se observó un desplazamiento desde establecimientos terciarios hacia la atención primaria y regional en ambos grupos de trastornos mentales, pero el incremento en regiones desatendidas solo se evidenció para los trastornos mentales no psicóticos. A pesar de la expansión de los servicios de salud mental a nivel nacional, las personas con psicosis no tuvieron una mayor utilización de servicios. El impacto de la pandemia fue agudo y persistente para este grupo. Los hallazgos subrayan la necesidad de examinar las razones de este estancamiento en la utilización de servicios y de evaluar la aceptabilidad y adecuación del modelo actual de atención para los trastornos psicóticos en Perú. Institutos Canadienses de Investigación en Salud, Programa de Cátedras de Investigación de Canadá. Trastornos psicóticos; esquizofrenia; servicios de salud mental, servicios comunitarios de salud mental, macrodatos, Perú.
Major depressive disorder (MDD) is a highly prevalent and disabling condition, and although conventional treatments focused on monoaminergic neurotransmission have been helpful for many individuals, a substantial proportion of patients fail to achieve adequate symptom remission. Over the past decade, accumulating evidence has highlighted systemic inflammation as a central component in the pathophysiology of MDD, suggesting that immune dysregulation may characterize a distinct subgroup of patients. Activation of the immune system can adversely influence neurotransmission, impair neuroplasticity, disrupt the hypothalamic-pituitary-adrenal (HPA) axis, and promote glial cell activation, all of which can contribute to chronicity and resistance to standard therapies. This understanding has led to the proposal of "inflammatory depression" as a specific endotype within the broader depressive spectrum. Recognizing this profile is essential for advancing precision medicine and improving clinical decision-making. It is increasingly postulated that these patients may benefit from targeted anti-inflammatory strategies, including pharmacologic agents, nutraceuticals, structured physical exercise, and dietary interventions with immunomodulatory effects. Despite these promising avenues, more rigorous clinical trials are needed to establish standardized protocols and refine patient selection based on inflammatory biomarkers, ensuring more effective and personalized treatment approaches. El trastorno depresivo mayor (TDM) es un trastorno altamente prevalente y, aunque los tratamientos convencionales enfocados en los neurotransmisores han sido útiles, muchos pacientes no responden adecuadamente. En los últimos años, diversas investigaciones han señalado a la inflamación sistémica como un componente central en la fisiopatología del TDM. La activación del sistema inmune puede influir de forma negativa en la neurotransmisión, la neuroplasticidad y el eje hipotálamo-hipófisis-adrenal (HHA), además de inducir la activación de células gliales, todo lo cual puede contribuir a la resistencia terapéutica. Este fenómeno ha llevado a proponer el concepto de “depresión inflamatoria” como un subtipo específico dentro del espectro depresivo. Reconocer este endotipo inflamatorio resulta fundamental para avanzar hacia una medicina de precisión y optimizar la toma de decisiones clínicas. Se postula que estos pacientes podrían beneficiarse de intervenciones antiinflamatorias, incluyendo fármacos, nutracéuticos, ejercicio físico regular y estrategias dietéticas con impacto inmunomodulador. A pesar de su potencial terapéutico, aún se requieren estudios clínicos más robustos que permitan establecer protocolos estandarizados y mejorar la selección de pacientes con base en su perfil inflamatorio, asegurando así intervenciones más eficaces y personalizadas.
Correspondence between two people reveals their subjectivity and promotes knowledge acquisition beyond the academic realm. Abraham Maslow is a well-known figure in the academic world, and much has been written about his life, but little is known about his epistolary relationship with Walter Blumenfeld, a German psychologist who settled in Peru in 1935 and is considered the founder of scientific psychology in that country. This article analyzes the content of the 13 letters that Maslow and Blumenfeld wrote to each other between 1955 and 1959. It begins by presenting the life and work of each of them, and then reviews the letters in chronological order. This analysis reflects the personal and academic motivations of the two correspondents, who never met in person. They shared common interests, despite coming from different schools of thought (although not polar opposites), as they agreed on their holistic and molar perspective of psychology.
Long-term outcome data for focal therapy using high-intensity focused ultrasound (HIFU) or cryotherapy for nonmetastatic prostate cancer are needed. We report 10-yr cancer control outcomes. Patients with nonmetastatic prostate cancer who underwent primary focal HIFU or cryotherapy and had at least 6 mo follow-up were identified from the UK HIFU Evaluation and Assessment of Treatment (HEAT) and International Cryotherapy Evaluation (ICE) prospectively maintained registries. The intervention included up to two focal ablative sessions. The primary outcome was cancer-specific mortality. Secondary outcomes were all-cause mortality, metastasis, local retreatment, radical treatment, and androgen-deprivation therapy (ADT) use. A total of 3477 patients (HIFU: n = 2897; cryotherapy: n = 580) were included from 14 UK centres (2004-2024). A total of 48%, 23%, and 25% had European Association of Urology (EAU) 2025-version favourable intermediate-, unfavourable-intermediate-, and high-risk disease, respectively. Ten-yr cancer-specific mortality was 0.13% (95% confidence interval [CI] = 0.027-0.45%). Ten-yr all-cause mortality and metastases were 12% (95% CI = 8.8-15%) and 3.3% (95% CI = 2.1-4.9%), respectively. Ten-yr ADT use was 14% (95% CI = 11-17%). Ten-yr local retreatment and radical treatment were 33% (95% CI = 30-37%) and 30% (95% CI = 27-34%), respectively, on an intention-to-treat basis. In a post hoc per-protocol analysis, undertaken to estimate outcomes under stricter adherence to the two focal ablative session protocol, patients who underwent radical treatment despite being potentially eligible for a further focal ablative session were censored at the time of radical treatment; 10-yr local retreatment and radical treatment were 13% (95% CI = 11-16%) and 8.9% (95% CI = 6.9-11%), respectively. The observational study design is the main limitation. Focal therapy using up to two sessions of focal HIFU or cryotherapy could be considered as a first-line treatment for well-selected patients of nonmetastatic prostate cancer alongside radical treatment. Future research priorities should include the development of a dedicated prognostic risk calculator, further prospective assessment of focal therapy for high-risk disease, and improvements in the detection and management of locally recurrent disease.
Assessing loneliness is essential to better understand older adults' mental health needs and to inform timely and appropriate interventions. The De Jong Gierveld Loneliness Scale (DJGLS) is one of the most widely used measures of loneliness worldwide. However, there is no evidence regarding its psychometric adequacy for older adults in Portugal. This study analysed the psychometric properties (validity and reliability) of the Portuguese version of the DJGLS (both the 11-item and 6-item versions) for community-dwelling older adults. A cross-sectional study was conducted with 466 participants. Construct, convergent and divergent validity were evaluated, and test-retest reliability was assessed using intraclass correlation coefficients (ICC) and Bland-Altman plots. The 11-item DJGLS showed a bifactor structure with a general loneliness factor and two specific factors (social and emotional loneliness), with good model fi, whereas the 6-item DJGLS demonstrated excellent fit. Both versions showed a significant correlation with ULCA-16 (r ≥ 0.6), adequate internal consistency (Cronbach's alpha = 0.8 (11 item) and 0.67 (6 item)), excellent test-retest (two-weeks) reliability (ICC ≥ 0.9) and acceptable agreement on the Bland-Altman plots, without evidence of proportional biases. The Portuguese versions of the DJGLS-11 and DJGLS-6 are valid and reliable instruments for assessing loneliness in Portuguese community-dwelling older adults, supporting their use in research and screening contexts. The validated version of the DJGLS enable the assessment of social and emotional loneliness, expanding the range of loneliness measures currently available in Portugal.
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Malaria prevalence measured among pregnant women at the first antenatal care (ANC1) visit provides longitudinal estimates of malaria burden in pregnancy and correlates well with cross-sectional community prevalence, but additional analysis is required to estimate community incidence. We aimed to test whether ANC1-based malaria prevalence can, via an open-source, mechanistic, model-based framework, recover seasonal patterns of clinical incidence suitable for subnational programmatic decision making. We conducted a modelling study using monthly ANC1 malaria prevalence data from six previously published studies of malaria in pregnancy in six sub-Saharan African countries between May, 2010, and August, 2014. An extended, validated, age-structured malaria transmission model was fitted to monthly ANC1 malaria prevalence using particle Markov chain Monte Carlo (pMCMC) to infer monthly clinical incidence and seasonality metrics. Agreement between model-derived incidence and independently observed time series was assessed using the Markham Seasonality Index (MSI) and peak timing with concordance correlation coefficients (CCCs) and 95% CIs. Across the six intermittent screening and treatment in pregnancy (ISTp) datasets, total ANC1 sample sizes and positivity were Ghana, 622 (47·9%) of 1298; Burkina Faso, 592 (41·9%) of 1413; Mali, 284 (21·7%) of 1308; The Gambia, 105 (8·8%) of 1194; Kenya, 323 (21·1%) of 1528; and Malawi, 291 (15·9%) of 1825. Strong agreement was observed between model-derived incidence and independent cohort data for MSI (CCC 0·82 [95% CI 0·31-0·97]) and for peak timing (CCC 0·98 [95% CI 0·87-1·00]). A mechanistic pMCMC framework applied to routine ANC1 data can recover clinically relevant seasonality in incidence for the broader community, enabling subnational timing of seasonal interventions (such as seasonal malaria chemoprevention). These capabilities are especially valuable when high-quality case surveillance is scarce and household surveys are underfunded. Our work operationalises WHO guidance, highlighting ANC1 as an opportunity to strengthen malaria surveillance. Bill & Melinda Gates Foundation and MRC Centre for Global Infectious Disease Analysis.
Determine the statistical report quality of articles published in dental journals according to the level of impact of the journal and the study design. A random sample of original articles published in four journals of General Dentistry indexed in Scopus was evaluated, two high-impact (quartile 1) and two medium-impact (quartile 3). The study design was recorded as observational, experimental, or other. The quality of each report was assessed through seven statistical error indicators. Two statisticians independently evaluated the articles and then contrasted their results; in the case of discrepancies in the ratings, they reached an agreement to establish a consensual criterion. Chi-square, Fisher's exact, Mann-Whitney U, and Kruskal-Wallis tests were applied with post hoc Dunn-Bonferroni correction. The presence of at least one statistical error was high (85.6%), with 123 (83.7%) and 44 (91.7%) articles in high- and medium-impact journals, respectively. Two statistical errors were more common (32.3%). We found a relationship between the presence of some errors (P = 0.009) and the number of statistical errors (P = 0.011) with the study design. There is a low-quality statistical report of the evaluated dental articles, as errors are very common; among these errors, inaccurate descriptions of the P values and a lack of justification for the sample size were the most common. The observational studies were also of higher quality than the experimental studies.
Previous studies indicate that the alkali-induced oxidation of quercetin (Que) or kaempferol (Kae) converts them into hydroxylated-benzoyl-benzofuranones (BZFs), a type of metabolite whose antioxidant potency is substantially higher. To explore whether the former conversion can take place under a more biologically relevant oxidizing setting, these flavonols were incubated in a nitrite-containing acidic medium. Under such condition, the concentrations of Que or Kae rapidly decayed, simultaneously generating their corresponding BZFs. When Que and Kae were co-incubated, the depletion of the parent flavonols accelerated without changes in BZF formation. Similar results were observed when either Que or Kae were incubated with some of their corresponding 3-O-glycosides. In turn, when Que was co-incubated with certain flavanols or phenolic acids, the latter compounds nearly doubled not only the oxidative disappearance of Que but also its BZF formation. Interestingly, the concentrations of Que-BZF and Kae-BZF reached under all former incubation scenarios are greater than those previously reported to be needed to protect intestinal epithelial cells against the oxidative and lytic damage induced by ROS. We suggest that, if these conversions also took place in vivo, the gastric fluid could be potentially seen as a chemical milieu where the antioxidant properties of Que and Kae could be enormously amplified.
Treatment selection for patients with relapsed Multiple Myeloma (MM) is highly individualized and characterized by diverse treatment patterns. While substantial evidence exists regarding relapsed MM in high-income settings, data on treatment patterns and clinical outcomes at second relapse in Latin American populations remain limited. This study describes the clinical characteristics, treatment patterns, effectiveness, and safety of third-line therapy in patients with MM experiencing a second relapse in routine clinical practice across five Colombian institutions. This multicenter retrospective observational study included medical records from five specialized institutions in Colombia. Patients with MM who experienced a second relapse and initiated third-line therapy between 2013 and 2022 were included. Baseline characteristics, treatment patterns, and the effectiveness and safety of third-line therapy were analyzed descriptively. The study included 84 participants with multiple myeloma who experienced a documented second relapse. The median age at diagnosis was 63.5 years (IQR 57.0 - 70.0), 56% were male, and bone disease and anaemia were the most frequent presenting features. The median time from diagnosis to second relapse was 3.2 years (IQR 1.8 - 4.9). First-line therapy was mainly bortezomib-based, most frequently the combination of bortezomib, cyclophosphamide, and dexamethasone (36.9%). Second-line treatment shifted toward lenalidomide-based regimens, with lenalidomide plus dexamethasone administered to 29.8% of patients. Autologous stem cell transplantation was performed in 36.9% of patients. Third-line treatment patterns were diverse, with greater use of novel agent-based combinations, including regimens containing daratumumab and carfilzomib. In the third-line setting, the overall response rate was 47.1%. The median overall survival from initiation of treatment at second relapse was 27.5 months, while the median progression-free survival and time to treatment failure were 14.6 months and 5.94 months, respectively. Treatment-emergent adverse events (TEAEs) occurred in 11.9% of patients, mostly moderate. In this real-world study of patients with multiple myeloma treated in the third-line setting after second relapse, treatment patterns were heterogeneous, with increasing use of novel agent-based combinations. An objective response was achieved in nearly half of the patients, with a median overall survival of 27.5 months and a median progression-free survival of 14.6 months. Treatment-emergent adverse events were infrequently reported and predominantly hematologic. No health-related quality of life data were available, highlighting an important gap in routine clinical practice.
The electrochemical reduction of CO2 to multicarbon (C2+) products offers a promising pathway to replace fossil fuels in the chemical and transportation sectors. However, achieving high C2+ selectivity requires precisely engineered structures, which, in turn, necessitate advanced synthetic strategies and in situ characterization. Herein, we leverage microfluidic technologies to rationally design and synthesize Cu2O nanoparticles with tunable features under laminar flow conditions, thereby providing a previously inaccessible level of control over catalyst structure. By tuning flow parameters within the microfluidic platform, we precisely regulate the reaction-diffusion interface, enabling fine control over nanoparticle size, morphology, and defect density. The resulting Cu2O nanoparticles exhibit a high defect density and intrinsic nanoporosity, two properties known to enhance C2+ selectivity during CO2 electroreduction. In contrast, Cu2O nanoparticles synthesized via conventional batch methods under identical stoichiometric conditions exhibit larger pore sizes, lower defect densities, and lower C2+ selectivity. Using in situ liquid-phase transmission electron microscopy and operando X-ray absorption spectroscopy, we further elucidate the evolution of both catalyst systems. Finally, we demonstrate that surface modification with polyaromatic films further promotes C2+ formation. This work highlights microfluidic synthesis as a powerful platform for designing advanced electrocatalysts with tunable structural features and enhanced CO2 conversion performance to C2+ products.
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Cataracts continue to be the leading cause of preventable blindness worldwide and represent a significant public health challenge, particularly in rural and underserved regions where access to ophthalmology specialists and diagnostic infrastructure is limited. Early detection plays a crucial role in preventing visual impairment and improving treatment outcomes; however, large-scale screening programs are often constrained by the availability of trained professionals and specialized equipment. The purpose of this research was to develop and evaluate an automated cataract detection system based on deep learning using retinal fundus images in order to support early screening and improve accessibility to ophthalmological diagnosis. The proposed methodology followed an experimental quantitative approach that included dataset preparation, image preprocessing, model training, and performance evaluation. A labeled subset of 2,658 retinal fundus images extracted from the ODIR-5K dataset was used as the primary data source. The images underwent preprocessing procedures including normalization and noise reduction, followed by data augmentation techniques such as random rotations (±10°), scaling (90%-110%), and brightness and contrast adjustments. These transformations allowed the creation of a balanced dataset of 4,840 images, enhancing model generalization and reducing overfitting. Six deep neural network architectures were trained and evaluated: ResNet152, EfficientNet-v2S, Inception v3, MobileNet v3, DenseNet201, and Vision Transformer (ViT). Transfer learning with ImageNet pre-trained weights was applied together with selective fine-tuning of deeper layers and optimization using the Adam algorithm combined with a Cosine Annealing learning rate scheduler. The results obtained indicate that ResNet152 is the bestperforming architecture with an accuracy of 99.10%, precision of 99.72%, sensitivity of 98.46%, and F1 score of 99.08%. It is concluded that deep convolutional neural network architectures, particularly ResNet152, provide highly effective performance for automated cataract detection from retinal fundus images. The proposed system demonstrates strong potential as a clinical decision-support tool for large-scale screening programs, especially in resource-limited settings, as it can facilitate early diagnosis, improve access to ophthalmological care, and reduce the diagnostic workload of specialized medical personnel.
Colobanthus quitensis (Caryophyllaceae) is one of only two vascular plants native to Antarctica and a model species for studying adaptation to extreme environments. We report a chromosome-scale reference genome generated from PacBio HiFi and Hi-C sequencing. The final assembly spans 887.1 Mb and resolves into 40 chromosome-scale scaffolds (2n = 80), with a scaffold N50 of 20.4 Mb and a maximum scaffold length of 35.1 Mb. Assembly completeness was high, with 99.0% of embryophyta BUSCOs recovered, the majority as duplicated (95.7%), consistent with the species' putative tetraploid origin. The genome exhibits a GC content of 36.3%. We further assembled the complete chloroplast genome (151,314 bp; 113 genes) and a draft mitochondrial assembly comprising two partial contigs totaling ∼289 kb. Repeat annotation identified 69.9% of the genome as repetitive, with long terminal repeat retrotransposons as the dominant class (34.8%), primarily of the Ty1/Copia and Gypsy/DIRS1 superfamilies. A total of 40,762 protein-coding genes were predicted, of which 95% were functionally annotated. Combined with transcriptomic resources, this genome enables functional annotation and comparative studies. This is the first chromosome-scale assembly for an Antarctic angiosperm and a resource for investigating polyploidy, genome organization, and adaptive evolution in polar environments. The C. quitensis genome will also support ecological and applied studies, including the development of crops resilient to cold and other abiotic stresses.
To evaluate the impact of a proton pump inhibitor (PPI) prescription review and optimization program in patients ≥65 years of age treated at the Caspe health center (Aragon, Spain). A prospective, observational, quasi-experimental study was conducted between June 2024 and December 2025 in a rural primary care area (n=12,081 inhabitants). Patients ≥65 years of age with active PPI prescriptions were included. The STOPP/START criteria were applied to identify potentially inappropriate prescriptions, and deprescribing or substitution with omeprazole was promoted based on efficiency and clinical appropriateness criteria. In each period, 7,623 and 7,734 patients with active PPI prescriptions were evaluated, of whom 2,456 and 2,222 were ≥65 years old. The application of the STOPP/START criteria increased from 8.6% to 44.1%, meeting quality standards. Discontinuation of PPIs without indication increased from 0.12% to 0.79%, showing a favorable trend due to the low baseline prevalence. The substitution of non-omeprazole PPIs with omeprazole showed a slight increase (from 0.41% to 0.47%), but did not reach the target level. The systematic implementation of STOPP/START criteria in rural primary care is an effective strategy to improve the appropriateness of PPI prescribing in the elderly population, promoting a more rational and efficient use of resources. The results suggest that these interventions are replicable in other rural settings, although the substitution of more expensive drugs requires coordination between levels of care and additional implementation strategies.
Minthostachys mollis (Benth.) Griseb., an aromatic medicinal plant widely used in traditional medicine in Peru, was investigated using an integrated chemical, enantioselective, and acetylcholinesterase (AChE) inhibitory approach. To characterize the chemical and enantiomeric composition of M. mollis essential oil by GC-MS, evaluate its AChE inhibitory activity in vitro, and explore the molecular interactions of its volatile constituents with human AChE through molecular docking and molecular dynamics simulations. The essential oil (EO) collected from the leaves via steam distillation was analyzed using Gas Chromatography-Mass Spectrometry (GC-MS). Enantioselective GC-MS analysis was performed for the first time on this species. AChE inhibitory activity was evaluated in vitro using Ellman's assay, and molecular docking and molecular dynamics studies were performed on human AChE (PDB: 4EY7). GC-MS analysis revealed 33 volatile compounds, of which 30 were structurally identified, accounting for 100% of the total EO composition. Oxygenated monoterpenes were the predominant chemical class (86.24%), with pulegone (63.82%) as the major constituent, followed by carvacrol (5.52%), 1,8-cineole (5.50%), and (E)-isocitral (4.98%). Enantioselective analysis revealed a marked stereochemical preference, including enantiomerically pure (S)-(-)-limonene and (1R,5R)-(+)-sabinene, as well as the predominance of (1S,5S)-(-)-α-pinene (92.54%, e.e. = 84.97%) and (1S,5S)-(-)-β-pinene (80.63%, e.e. = 61.86%). The AChE inhibitory activity showed a moderate inhibitory effect of the EO, with an IC50 value of 466.4 ± 1.01 μg/mL. Sesquiterpenes such as γ-muurolene, δ-amorphene, and β-bourbonene exhibited the most favorable binding affinities (ΔG values ranging from -7.3 to -7.0 kcal/mol), mainly mediated by hydrophobic interactions within the catalytic and peripheral anionic sites. This study provides a comprehensive chemical and stereochemical characterization of M. mollis EO, supporting its relevance as a source of bioactive volatile compounds with moderate AChE inhibitory activity.