Pub Date : 2025-09-05DOI: 10.1016/j.arcmed.2025.103303
Sofía Bernal-Vega , Gabriela Cruz-Carrillo , Orlando Flores-Maldonado , Miguel Becerril-García , Juan Carlos Corona-Castillo , Alberto Camacho-Morales
Background
Long-chain ceramides have been implicated in anxiety-like behavior and in priming microglial activation, suggesting a possible lipid–immune crosstalk in emotional regulation.
Methods
We systemically administered a mixture of C16:0, C18:0, C22:0, C24:0, and C24:1 ceramides to adult male and female mice. Anxiety-like behavior was assessed with behavioral tests. Microglial phenotypes in the cortex, hippocampus, and striatum were evaluated via flow cytometry. Regression models examined associations between behavior and immune markers. In vitro assays assessed phagocytosis, gene expression, mitochondrial potential, and ROS production in microglia after ceramide exposure.
Results
Female, but not male, mice showed anxiety-like behavior after ceramide treatment. CD86+ microglia increased in the cortex, while CD206+ microglia decreased across brain regions. Behavioral scores correlated with CD86+ cells in cortex and CD206+ cells in hippocampus. In vitro, ceramides enhanced phagocytosis and induced NLRP3 and TNF-α expression. Ceramides also reduced mitochondrial potential and increased ROS in microglia.
Conclusions
Ceramide administration was associated with anxiety-like behavior in female mice, along with changes in microglial activation. These effects appear to be associated with mitochondrial dysfunction and oxidative stress, suggesting a lipid–immune interaction that could contribute to anxiety vulnerability.
{"title":"Long chain ceramides promote Anxiety-like behavior and microglia activation in female mice","authors":"Sofía Bernal-Vega , Gabriela Cruz-Carrillo , Orlando Flores-Maldonado , Miguel Becerril-García , Juan Carlos Corona-Castillo , Alberto Camacho-Morales","doi":"10.1016/j.arcmed.2025.103303","DOIUrl":"10.1016/j.arcmed.2025.103303","url":null,"abstract":"<div><h3>Background</h3><div>Long-chain ceramides have been implicated in anxiety-like behavior and in priming microglial activation, suggesting a possible lipid–immune crosstalk in emotional regulation.</div></div><div><h3>Methods</h3><div>We systemically administered a mixture of C16:0, C18:0, C22:0, C24:0, and C24:1 ceramides to adult male and female mice. Anxiety-like behavior was assessed with behavioral tests. Microglial phenotypes in the cortex, hippocampus, and striatum were evaluated via flow cytometry. Regression models examined associations between behavior and immune markers. <em>In vitro</em> assays assessed phagocytosis, gene expression, mitochondrial potential, and ROS production in microglia after ceramide exposure.</div></div><div><h3>Results</h3><div>Female, but not male, mice showed anxiety-like behavior after ceramide treatment. CD86+ microglia increased in the cortex, while CD206+ microglia decreased across brain regions. Behavioral scores correlated with CD86+ cells in cortex and CD206+ cells in hippocampus. <em>In vitro</em>, ceramides enhanced phagocytosis and induced NLRP3 and TNF-α expression. Ceramides also reduced mitochondrial potential and increased ROS in microglia.</div></div><div><h3>Conclusions</h3><div>Ceramide administration was associated with anxiety-like behavior in female mice, along with changes in microglial activation. These effects appear to be associated with mitochondrial dysfunction and oxidative stress, suggesting a lipid–immune interaction that could contribute to anxiety vulnerability.</div></div>","PeriodicalId":8318,"journal":{"name":"Archives of Medical Research","volume":"57 2","pages":"Article 103303"},"PeriodicalIF":3.4,"publicationDate":"2025-09-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144997470","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-09-05DOI: 10.1016/j.arcmed.2025.103298
XIAOYU LIU, YANG YANG, YUEHUA YAN
{"title":"Comment on: Evaluation of Multimorbidity Burden in Frailty Transitions in Costa Rican Older Adults Using Multistate Markov Models","authors":"XIAOYU LIU, YANG YANG, YUEHUA YAN","doi":"10.1016/j.arcmed.2025.103298","DOIUrl":"10.1016/j.arcmed.2025.103298","url":null,"abstract":"","PeriodicalId":8318,"journal":{"name":"Archives of Medical Research","volume":"57 2","pages":"Article 103298"},"PeriodicalIF":3.4,"publicationDate":"2025-09-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144997471","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-09-04DOI: 10.1016/j.arcmed.2025.103290
Jesús Hernandez-Juarez , Guillermo Espejo-Godinez , Julieta Espinoza-Islas , Victor Manuel Dominguez Reyes , Jaime Garcia-Chavez , Berenice Fernandez-Rojas , Abraham Majluf-Cruz
Introduction
Treatment of patients with severe hemophilia A requires the replacement of deficient factor VIII. To reach the international standards of care, an optimal dose of factor VIII should be administered based on pharmacokinetic analysis. However, in Mexico factor VIII pharmacokinetics is not used. Therefore, this study aimed to determine, for the first time, the pharmacokinetic parameters of factor VIII in Mexican patients with severe hemophilia A.
Methods
Fifteen samples from patients with severe hemophilia A under prophylactic treatment were analyzed. Factor VIII activity was determined before infusion at 0.25, 0.5, 1.0, 4.0, 8.0, 12, and 48 h after infusion of a standardized dose of factor VIII (40 UI/kg). WinNolin software was used to establish a mono- and bi-compartmental models to obtain the following parameters: area under the curve, maximum activity, in vivo recovery, distribution volume, half-life time, mean residence time, clearance, minimum activity, and elimination constant.
Results
Factor VIII pharmacokinetics was highly variable among our patients who frequently received overdosage of factor VIII. The bi-compartmental model better explained the behavior of factor VIII in patients with hemophilia A.
Conclusions
Compared with the regimens based on body weight, factor VIII pharmacokinetics shows that the response to factor VIII treatment differs greatly among our patients. Our results strongly suggest that factor VIII treatment must be personalized, regardless of body weight. The lack of evidence and experience on factor VIII pharmacokinetics in our country may represent an obstacle to the future use of extended half-life recombinant factor VIII products.
{"title":"Factor VIII Pharmacokinetics in Mexican Patients With Hemophilia A","authors":"Jesús Hernandez-Juarez , Guillermo Espejo-Godinez , Julieta Espinoza-Islas , Victor Manuel Dominguez Reyes , Jaime Garcia-Chavez , Berenice Fernandez-Rojas , Abraham Majluf-Cruz","doi":"10.1016/j.arcmed.2025.103290","DOIUrl":"10.1016/j.arcmed.2025.103290","url":null,"abstract":"<div><h3>Introduction</h3><div>Treatment of patients with severe hemophilia A requires the replacement of deficient factor VIII. To reach the international standards of care, an optimal dose of factor VIII should be administered based on pharmacokinetic analysis. However, in Mexico factor VIII pharmacokinetics is not used. Therefore, this study aimed to determine, for the first time, the pharmacokinetic parameters of factor VIII in Mexican patients with severe hemophilia A.</div></div><div><h3>Methods</h3><div>Fifteen samples from patients with severe hemophilia A under prophylactic treatment were analyzed. Factor VIII activity was determined before infusion at 0.25, 0.5, 1.0, 4.0, 8.0, 12, and 48 h after infusion of a standardized dose of factor VIII (40 UI/kg). WinNolin software was used to establish a mono- and bi-compartmental models to obtain the following parameters: area under the curve, maximum activity, <em>in vivo</em> recovery, distribution volume, half-life time, mean residence time, clearance, minimum activity, and elimination constant.</div></div><div><h3>Results</h3><div>Factor VIII pharmacokinetics was highly variable among our patients who frequently received overdosage of factor VIII. The bi-compartmental model better explained the behavior of factor VIII in patients with hemophilia A.</div></div><div><h3>Conclusions</h3><div>Compared with the regimens based on body weight, factor VIII pharmacokinetics shows that the response to factor VIII treatment differs greatly among our patients. Our results strongly suggest that factor VIII treatment must be personalized, regardless of body weight. The lack of evidence and experience on factor VIII pharmacokinetics in our country may represent an obstacle to the future use of extended half-life recombinant factor VIII products.</div></div>","PeriodicalId":8318,"journal":{"name":"Archives of Medical Research","volume":"57 2","pages":"Article 103290"},"PeriodicalIF":3.4,"publicationDate":"2025-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144989548","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-09-04DOI: 10.1016/j.arcmed.2025.103289
Blanca Taboada , Selene Zárate , José Esteban Muñoz-Medina , Alejandro Sanchez-Flores , Alfredo Herrera-Estrella , Bruno Gómez-Gil , Joel Armando Vazquez-Perez , Angel Gustavo Salas-Lais , Alida Zárate , Carlos F. Arias
Background
As of September 2024, Mexico had reported over 7.6 million confirmed cases of COVID-19 and 334,785 deaths. Genomic surveillance has been essential, with 94,799 SARS-CoV-2 genomes sequenced nationwide, 38.5% by the Mexican Consortium for Genomic Surveillance (CoViGen-Mex).
Aims
Analyze the genomic diversity and geographic distribution of SARS-CoV-2 across Mexico’s nine pandemic waves, with an emphasis on the seventh to ninth waves.
Methods
Data from 94,799 SARS-CoV-2 genomes spanning from February 2020 to September 2024 were analyzed. Sublineages with a prevalence of at least 5% were tracked, and their temporal and regional trends were evaluated using diversity indices and statistical models.
Results
Of the 996 sublineages identified, 72 had a prevalence greater than 5%, and 33 exceeded 10%. Each wave featured dominant sublineages, some of which emerged locally and prevailed during one or more waves, but were later displaced by new ones. Regional differences were identified in all waves, driven by population density, mobility, and variant introductions.
Conclusions
Our findings highlight the dynamic evolution of SARS-CoV-2 in Mexico, the emergence of locally relevant variants, and the critical need for sustained genomic surveillance to guide public health strategies during the transition to an endemic state.
{"title":"Genomic Diversity and Geographic Distribution of SARS-CoV-2 in Mexico: Insights From 4 Years of Genomic Surveillance","authors":"Blanca Taboada , Selene Zárate , José Esteban Muñoz-Medina , Alejandro Sanchez-Flores , Alfredo Herrera-Estrella , Bruno Gómez-Gil , Joel Armando Vazquez-Perez , Angel Gustavo Salas-Lais , Alida Zárate , Carlos F. Arias","doi":"10.1016/j.arcmed.2025.103289","DOIUrl":"10.1016/j.arcmed.2025.103289","url":null,"abstract":"<div><h3>Background</h3><div>As of September 2024, Mexico had reported over 7.6 million confirmed cases of COVID-19 and 334,785 deaths. Genomic surveillance has been essential, with 94,799 SARS-CoV-2 genomes sequenced nationwide, 38.5% by the Mexican Consortium for Genomic Surveillance (CoViGen-Mex).</div></div><div><h3>Aims</h3><div>Analyze the genomic diversity and geographic distribution of SARS-CoV-2 across Mexico’s nine pandemic waves, with an emphasis on the seventh to ninth waves.</div></div><div><h3>Methods</h3><div>Data from 94,799 SARS-CoV-2 genomes spanning from February 2020 to September 2024 were analyzed. Sublineages with a prevalence of at least 5% were tracked, and their temporal and regional trends were evaluated using diversity indices and statistical models.</div></div><div><h3>Results</h3><div>Of the 996 sublineages identified, 72 had a prevalence greater than 5%, and 33 exceeded 10%. Each wave featured dominant sublineages, some of which emerged locally and prevailed during one or more waves, but were later displaced by new ones. Regional differences were identified in all waves, driven by population density, mobility, and variant introductions.</div></div><div><h3>Conclusions</h3><div>Our findings highlight the dynamic evolution of SARS-CoV-2 in Mexico, the emergence of locally relevant variants, and the critical need for sustained genomic surveillance to guide public health strategies during the transition to an endemic state.</div></div>","PeriodicalId":8318,"journal":{"name":"Archives of Medical Research","volume":"57 2","pages":"Article 103289"},"PeriodicalIF":3.4,"publicationDate":"2025-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144989556","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-09-04DOI: 10.1016/j.arcmed.2025.103288
Niels H. Wacher , Rita A. Gómez-Díaz , Ivan De Jesús Ascencio-Montiel , José Esteban Fernández-Garate , Leticia A. Valdez-González , Claudio Quinzaños Fresnedo
Aim
To describe the annual incidence of gestational diabetes mellitus (GDM) among women beneficiaries of the Mexican Institute of Social Security (IMSS) in Mexico from 2008 to 2023.
Methods
Data from the IMSS’s Institutional Automated System for Epidemiological Surveillance (SIAVE) from 2008 to 2023 were used. GDM cases during pregnancy were identified using ICD-10 O24.4 diagnostic codes. Changes in annual incidence were evaluated using the Join-Point program version 5.1.0 to calculate the annual percentage change (APC) and the average annual percentage change (AAPC).
Results
A total of 103,749 cases of diabetes during pregnancy were recorded and the annual incidence rate of GDM increased over the time. The incidence of GDM peaked in 2021 among those 19 years old or younger, and in 2022 among those 20 years old or older, with a higher incidence in the latter group. There was a considerably higher incidence of GDM in the North region compared to the other regions. The estimated AAPC for the 2008–2023 period was 21.1 (16.8–25.6) per 1000 live births, and was higher in the West region.
Conclusions
This study demonstrates a nationwide substantial upward trend in GDM incidence between 2008 and 2023. Both teenage and adult women reported a higher incidence in recent years (2021 and 2022, respectively). The North region had the highest incidence, while the West had the highest AAPC.
{"title":"Incidence of Gestational Diabetes Mellitus in Mexico from 2008 to 2023","authors":"Niels H. Wacher , Rita A. Gómez-Díaz , Ivan De Jesús Ascencio-Montiel , José Esteban Fernández-Garate , Leticia A. Valdez-González , Claudio Quinzaños Fresnedo","doi":"10.1016/j.arcmed.2025.103288","DOIUrl":"10.1016/j.arcmed.2025.103288","url":null,"abstract":"<div><h3>Aim</h3><div>To describe the annual incidence of gestational diabetes mellitus (GDM) among women beneficiaries of the Mexican Institute of Social Security (IMSS) in Mexico from 2008 to 2023.</div></div><div><h3>Methods</h3><div>Data from the IMSS’s Institutional Automated System for Epidemiological Surveillance (SIAVE) from 2008 to 2023 were used. GDM cases during pregnancy were identified using ICD-10 O24.4 diagnostic codes. Changes in annual incidence were evaluated using the Join-Point program version 5.1.0 to calculate the annual percentage change (APC) and the average annual percentage change (AAPC).</div></div><div><h3>Results</h3><div>A total of 103,749 cases of diabetes during pregnancy were recorded and the annual incidence rate of GDM increased over the time. The incidence of GDM peaked in 2021 among those 19 years old or younger, and in 2022 among those 20 years old or older, with a higher incidence in the latter group. There was a considerably higher incidence of GDM in the North region compared to the other regions. The estimated AAPC for the 2008–2023 period was 21.1 (16.8–25.6) per 1000 live births, and was higher in the West region.</div></div><div><h3>Conclusions</h3><div>This study demonstrates a nationwide substantial upward trend in GDM incidence between 2008 and 2023. Both teenage and adult women reported a higher incidence in recent years (2021 and 2022, respectively). The North region had the highest incidence, while the West had the highest AAPC.</div></div>","PeriodicalId":8318,"journal":{"name":"Archives of Medical Research","volume":"57 2","pages":"Article 103288"},"PeriodicalIF":3.4,"publicationDate":"2025-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144989555","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-09-04DOI: 10.1016/j.arcmed.2025.103293
Sebastiano Ravenda , Virginia Beretta , Elena Scarpa , Chiara Petrolini , Valentina Dell’Orto , Luca Carnevali , Andrea Sgoifo , Serafina Perrone
Background
Gestational diabetes mellitus (GDM) affects intrauterine glucose regulation and influences heart rate variability (HRV) and cortisol levels in newborns, which are markers of autonomic and hypothalamic-pituitary-adrenal axis function. This study aimed to evaluate HRV and cortisol levels in newborns of healthy mothers and those with GDM within the first 24 h of life, and to compare these measures between sexes.
Methods
A total of 59 newborns were monitored for heart rate (HR) and HRV from the 6 h of life. Salivary cortisol levels were measured 3–6 h (T1) and 20–24 h (T2) after birth. HRV parameters included the root mean square of successive differences (RMSSD), the high (HF) and low (LF) band power of HRV, and the LF/HF ratio.
Results
GDM newborns showed lower HR, higher RMSSD, and a lower LF/HF ratio compared to controls. GDM females had lower HR than control females and GDM males, while GDM males had higher RMSSD and HF than control males. Cortisol levels decreased from T1–T2 in both groups with no sex differences.
Conclusions
Newborns from mothers with GDM exhibited lower HR and higher cardiac vagal modulation, with sex-specific differences. GDM females showed a decrease in HR without changes in HRV, whereas GDM males showed an increase in vagally mediated HRV without changes in HR. GDM does not seem to affect cortisol levels in newborns. These findings highlight sex-specific cardiac autonomic responses to birth stress in GDM-exposed newborns across the first day of life, which play an important role in shaping different behavioral, resilience, and well-being trajectories in early infancy.
背景妊娠期糖尿病（GDM）影响新生儿的宫内血糖调节，并影响心率变异性（HRV）和皮质醇水平，这是自主神经和下丘脑-垂体-肾上腺轴功能的标志。本研究旨在评估健康母亲和GDM患者出生后24小时内新生儿的HRV和皮质醇水平，并比较这些指标在性别之间的差异。方法对59例新生儿从出生后6 h开始监测心率（HR）和HRV。出生后3-6 h （T1）和20-24 h （T2）分别测定唾液皮质醇水平。HRV参数包括连续差均方根（RMSSD）、HRV高（HF）和低（LF）波段功率、LF/HF比值。结果与对照组相比，gdm新生儿HR较低，RMSSD较高，LF/HF比值较低。GDM女性的HR低于对照组女性和GDM男性，而GDM男性的RMSSD和HF高于对照组男性。两组皮质醇水平均从T1-T2下降，无性别差异。结论GDM母亲所生的新生儿心率较低，心脏迷走神经调节较高，且存在性别差异。GDM女性患者HR降低，HRV无变化，而GDM男性患者迷走神经介导HRV升高，HR无变化。GDM似乎不影响新生儿的皮质醇水平。这些发现强调了gdm暴露的新生儿在出生第一天对出生压力的性别特异性心脏自主神经反应，这在婴儿早期形成不同的行为、恢复力和幸福轨迹中起着重要作用。
{"title":"Neonatal Autonomic and Adrenocorticotropic Features in the Offspring of Mothers With Gestational Diabetes","authors":"Sebastiano Ravenda , Virginia Beretta , Elena Scarpa , Chiara Petrolini , Valentina Dell’Orto , Luca Carnevali , Andrea Sgoifo , Serafina Perrone","doi":"10.1016/j.arcmed.2025.103293","DOIUrl":"10.1016/j.arcmed.2025.103293","url":null,"abstract":"<div><h3>Background</h3><div>Gestational diabetes mellitus (GDM) affects intrauterine glucose regulation and influences heart rate variability (HRV) and cortisol levels in newborns, which are markers of autonomic and hypothalamic-pituitary-adrenal axis function. This study aimed to evaluate HRV and cortisol levels in newborns of healthy mothers and those with GDM within the first 24 h of life, and to compare these measures between sexes.</div></div><div><h3>Methods</h3><div>A total of 59 newborns were monitored for heart rate (HR) and HRV from the 6 h of life. Salivary cortisol levels were measured 3–6 h (T1) and 20–24 h (T2) after birth. HRV parameters included the root mean square of successive differences (RMSSD), the high (HF) and low (LF) band power of HRV, and the LF/HF ratio.</div></div><div><h3>Results</h3><div>GDM newborns showed lower HR, higher RMSSD, and a lower LF/HF ratio compared to controls. GDM females had lower HR than control females and GDM males, while GDM males had higher RMSSD and HF than control males. Cortisol levels decreased from T1–T2 in both groups with no sex differences.</div></div><div><h3>Conclusions</h3><div>Newborns from mothers with GDM exhibited lower HR and higher cardiac vagal modulation, with sex-specific differences. GDM females showed a decrease in HR without changes in HRV, whereas GDM males showed an increase in vagally mediated HRV without changes in HR. GDM does not seem to affect cortisol levels in newborns. These findings highlight sex-specific cardiac autonomic responses to birth stress in GDM-exposed newborns across the first day of life, which play an important role in shaping different behavioral, resilience, and well-being trajectories in early infancy.</div></div>","PeriodicalId":8318,"journal":{"name":"Archives of Medical Research","volume":"57 2","pages":"Article 103293"},"PeriodicalIF":3.4,"publicationDate":"2025-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144989549","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-09-04DOI: 10.1016/j.arcmed.2025.103294
Juliana Pascualote Lemos de Almeida , Marina Figueiredo Moreira , David Nadler Prata , Paulo Henrique de Souza Bermejo
Background
The COVID-19 pandemic prompted rapid adaptations in healthcare systems worldwide. Academic medical centers, pivotal in healthcare education and research, rapidly adopted innovations. Brazilian state-owned university hospitals experienced unprecedented pressure on their services and were compelled to adopt new approaches to education and care delivery.
Aims
Analyze the organizational agility and resilience of two Brazilian federal university hospitals during the pandemic. Identify crisis-driven innovations and propose a quantitative indicator framework to measure agility, resilience, and the embedding of innovations post-crisis.
Methods
We conducted a document analysis of the COVID-19 contingency plans, managerial reports and news items from the two hospitals, both managed by the Brazilian Hospital Services Company. Actions were inductively coded and synthesized into measurable indicators.
Results
The hospitals implemented tactical and operational adjustments, relocated resources, and improved patient care strategies. Telemedicine and strategic patient transfers empowered users during critical phases. Virtual care technologies promoted self-care and improved treatment efficacy, while staff well-being programs supported clinical teams. We present an indicator framework comprising 26 metrics, organized into pandemic-phase (agility and resilience) and post-COVID (innovation) blocks.
Conclusions
The contingency plans demonstrate strong organizational agility and resilience. The proposed framework offers a practical toolkit for benchmarking crisis readiness and tracking the institutionalization of pandemic-era innovations, thereby supporting Brazil’s universal healthcare system and guiding future research.
{"title":"Agility and Resilience During COVID-19 and Post-Pandemic Innovation in Brazilian Public University Hospitals","authors":"Juliana Pascualote Lemos de Almeida , Marina Figueiredo Moreira , David Nadler Prata , Paulo Henrique de Souza Bermejo","doi":"10.1016/j.arcmed.2025.103294","DOIUrl":"10.1016/j.arcmed.2025.103294","url":null,"abstract":"<div><h3>Background</h3><div>The COVID-19 pandemic prompted rapid adaptations in healthcare systems worldwide. Academic medical centers, pivotal in healthcare education and research, rapidly adopted innovations. Brazilian state-owned university hospitals experienced unprecedented pressure on their services and were compelled to adopt new approaches to education and care delivery.</div></div><div><h3>Aims</h3><div>Analyze the organizational agility and resilience of two Brazilian federal university hospitals during the pandemic. Identify crisis-driven innovations and propose a quantitative indicator framework to measure agility, resilience, and the embedding of innovations post-crisis.</div></div><div><h3>Methods</h3><div>We conducted a document analysis of the COVID-19 contingency plans, managerial reports and news items from the two hospitals, both managed by the Brazilian Hospital Services Company. Actions were inductively coded and synthesized into measurable indicators.</div></div><div><h3>Results</h3><div>The hospitals implemented tactical and operational adjustments, relocated resources, and improved patient care strategies. Telemedicine and strategic patient transfers empowered users during critical phases. Virtual care technologies promoted self-care and improved treatment efficacy, while staff well-being programs supported clinical teams. We present an indicator framework comprising 26 metrics, organized into pandemic-phase (agility and resilience) and post-COVID (innovation) blocks.</div></div><div><h3>Conclusions</h3><div>The contingency plans demonstrate strong organizational agility and resilience. The proposed framework offers a practical toolkit for benchmarking crisis readiness and tracking the institutionalization of pandemic-era innovations, thereby supporting Brazil’s universal healthcare system and guiding future research.</div></div>","PeriodicalId":8318,"journal":{"name":"Archives of Medical Research","volume":"57 2","pages":"Article 103294"},"PeriodicalIF":3.4,"publicationDate":"2025-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144989557","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
In the developmental origins of health and disease (DOHaD) paradigm, there is a clear link between an adverse prenatal environment and the development of non-hereditary diseases later in life. Exposure to intrauterine inflammation, for example, has been associated with several late-onset conditions, including neurological, cardiovascular, immune, and metabolic disorders. Moreover, maternal and fetal health are compromised under exacerbated inflammation, as it can result in spontaneous abortion, preterm delivery, or intrauterine growth restriction. Prominent gestational pathologies associated with inflammation include preeclampsia, gestational diabetes mellitus, obesity, and infections. The main causes of inflammation can be classified as either infectious or sterile in origin. Thus, triggers of inflammation include microorganisms, viruses, excess fat, placental dysfunction, tissue breakdown products, and unbalanced immunoendocrine factors. Other etiological agents of inflammation include environmental factors (e.g., pollutants), lifestyle factors (e.g., nutrient overload), and behavioral factors (e.g., chronic stress, smoking, alcohol, and drug abuse). The mediators that drive the response to these insults include biochemical effectors (e.g., cytokines), pattern recognition receptors (e.g., toll-like receptors), and immune cells. These trigger a cascade of events leading to the activation of specific nuclear factors such as NF-kB and STATs. Overactivation of these signaling networks can disrupt the homeostasis at the feto-maternal interface, which can jeopardize pregnancy maintenance and influence fetal programming mechanisms. This review examines the key triggers, signaling pathways, and complications associated with inflammation during pregnancy, emphasizing the importance of maternal well-being and adequate prenatal care in mitigating and preventing inflammation-related risks in the short and long term.
{"title":"Inflammation in Pregnancy: Key Drivers, Signaling Pathways and Associated Complications","authors":"Abigail García-Morales , Consuelo Lomas-Soria , Gabriela Granados-Higa , Janice García-Quiroz , Euclides Avila , Andrea Olmos-Ortiz , Lorenza Díaz","doi":"10.1016/j.arcmed.2025.103301","DOIUrl":"10.1016/j.arcmed.2025.103301","url":null,"abstract":"<div><div>In the developmental origins of health and disease (DOHaD) paradigm, there is a clear link between an adverse prenatal environment and the development of non-hereditary diseases later in life. Exposure to intrauterine inflammation, for example, has been associated with several late-onset conditions, including neurological, cardiovascular, immune, and metabolic disorders. Moreover, maternal and fetal health are compromised under exacerbated inflammation, as it can result in spontaneous abortion, preterm delivery, or intrauterine growth restriction. Prominent gestational pathologies associated with inflammation include preeclampsia, gestational diabetes mellitus, obesity, and infections. The main causes of inflammation can be classified as either infectious or sterile in origin. Thus, triggers of inflammation include microorganisms, viruses, excess fat, placental dysfunction, tissue breakdown products, and unbalanced immunoendocrine factors. Other etiological agents of inflammation include environmental factors (e.g., pollutants), lifestyle factors (e.g., nutrient overload), and behavioral factors (e.g., chronic stress, smoking, alcohol, and drug abuse). The mediators that drive the response to these insults include biochemical effectors (e.g., cytokines), pattern recognition receptors (e.g., toll-like receptors), and immune cells. These trigger a cascade of events leading to the activation of specific nuclear factors such as NF-kB and STATs. Overactivation of these signaling networks can disrupt the homeostasis at the feto-maternal interface, which can jeopardize pregnancy maintenance and influence fetal programming mechanisms. This review examines the key triggers, signaling pathways, and complications associated with inflammation during pregnancy, emphasizing the importance of maternal well-being and adequate prenatal care in mitigating and preventing inflammation-related risks in the short and long term.</div></div>","PeriodicalId":8318,"journal":{"name":"Archives of Medical Research","volume":"57 2","pages":"Article 103301"},"PeriodicalIF":3.4,"publicationDate":"2025-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144989655","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-09-04DOI: 10.1016/j.arcmed.2025.103292
Abderrezak Khelfi , Amira Zitout , Housseyn Chekireb , Hadjar Touati , Sarah Oumatouk , Dana Alsayed Ahmad , Houyam Askoufes , Ayoub Rabhi , Randa Talhi , Mohamed Azzouz
Background
Bisphenols are emerging pollutants of health concern. Exposure to bisphenols may impact hormone physiology, particularly during pregnancy, when the body is more vulnerable to disruptions.
Objective
This study aimed to identify bisphenol exposure profiles in pregnant women and to explore associations between urinary levels of these compounds and disruptions in reproductive and thyroid hormone levels during pregnancy.
Methods
This study was conducted on 384 pregnant women. After gathering the necessary information through a questionnaire, blood and urine samples were collected. Reproductive and thyroid hormones were measured by electrochemiluminescence, and bisphenols were detected by Liquid-chromatography tandem mass spectrometry (LC-MS/MS).
Results
BPA, BPS, and BPF were detected in 95.3, 76.3, and 73.9% of the analyzed samples, respectively. The mean concentrations were 6.689, 1.135, and 1.013 µg/g of creatinine for BPA, BPS, and BPF, respectively. A significant positive association was found between plasma levels of estradiol and urinary concentrations of bisphenols, as well as between plasma levels of progesterone and prolactin and urinary concentrations of BPA. Disruption of testosterone levels was associated with elevated BPS concentrations. Besides, no significant association was found between urinary bisphenol concentrations and thyroid hormone levels. Regarding exposure sources, a significant association was observed between the use of fake nails and high urinary BPA concentrations.
Conclusion
In this study, bisphenols were associated with altered levels of certain reproductive hormones during pregnancy. These changes could have adverse effects on maternal health and child development.
{"title":"Exposure Profiles to Bisphenols and Their Impact on Reproductive and Thyroid Hormones in Pregnant Women","authors":"Abderrezak Khelfi , Amira Zitout , Housseyn Chekireb , Hadjar Touati , Sarah Oumatouk , Dana Alsayed Ahmad , Houyam Askoufes , Ayoub Rabhi , Randa Talhi , Mohamed Azzouz","doi":"10.1016/j.arcmed.2025.103292","DOIUrl":"10.1016/j.arcmed.2025.103292","url":null,"abstract":"<div><h3>Background</h3><div>Bisphenols are emerging pollutants of health concern. Exposure to bisphenols may impact hormone physiology, particularly during pregnancy, when the body is more vulnerable to disruptions.</div></div><div><h3>Objective</h3><div>This study aimed to identify bisphenol exposure profiles in pregnant women and to explore associations between urinary levels of these compounds and disruptions in reproductive and thyroid hormone levels during pregnancy.</div></div><div><h3>Methods</h3><div>This study was conducted on 384 pregnant women. After gathering the necessary information through a questionnaire, blood and urine samples were collected. Reproductive and thyroid hormones were measured by electrochemiluminescence, and bisphenols were detected by Liquid-chromatography tandem mass spectrometry (LC-MS/MS).</div></div><div><h3>Results</h3><div>BPA, BPS, and BPF were detected in 95.3, 76.3, and 73.9% of the analyzed samples, respectively. The mean concentrations were 6.689, 1.135, and 1.013 µg/g of creatinine for BPA, BPS, and BPF, respectively. A significant positive association was found between plasma levels of estradiol and urinary concentrations of bisphenols, as well as between plasma levels of progesterone and prolactin and urinary concentrations of BPA. Disruption of testosterone levels was associated with elevated BPS concentrations. Besides, no significant association was found between urinary bisphenol concentrations and thyroid hormone levels. Regarding exposure sources, a significant association was observed between the use of fake nails and high urinary BPA concentrations.</div></div><div><h3>Conclusion</h3><div>In this study, bisphenols were associated with altered levels of certain reproductive hormones during pregnancy. These changes could have adverse effects on maternal health and child development.</div></div>","PeriodicalId":8318,"journal":{"name":"Archives of Medical Research","volume":"57 2","pages":"Article 103292"},"PeriodicalIF":3.4,"publicationDate":"2025-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144989554","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-09-04DOI: 10.1016/j.arcmed.2025.103291
Tongyong Yu , Meilan Chen , Beihui Huang, Junru Liu, Xiaozhe Li, Jingli Gu, Yanjuan Li, Juan Li
Objective
A subset of patients with multiple myeloma (MM) experience early relapse despite the absence of any high-risk features at diagnosis, defined as functional high-risk (FHR) MM with inferior prognosis. This study compared FHR and standard risk (SR) MM cohorts to investigate clinical risk factors and establish a validated prognostic model for early prediction of FHR in patients with MM that were transplanted.
Methods
A retrospective cohort study was conducted to analyze the clinical data of patients with MM. Univariate and multivariate analyses were performed to identify independent risk factors for FHR-MM. A prognostic nomogram was developed through logistic regression analysis and internally validated.
Results
The study cohort comprised 357 MM patients. Univariate and multivariate analyses identified the following as independent predictors of FHR-MM: lactate dehydrogenase (LDH) ≥190 U/L, PET-CT SUVmax ≥7.5 at baseline, post-induction ≥80% reduction in PET-CT SUVmax, platelet count <80×109/L, ferritin ≥650 µg/L, Pattern B of M-protein decline, and achieved complete remission (CR) after autologous stem cell transplantation (ASCT). The derived predictive model demonstrated area under the curve (AUC) scores of 0.753 (95% CI 0.666–0.840) for the training set and 0.857 (95% CI 0.759–0.954) for the validation set.
Conclusion
This study established a predictive nomogram for transplanted patients with FHR-MM that demonstrates robust discriminative capacity through internal validation.
目的：一部分多发性骨髓瘤（MM）患者在诊断时没有任何高危特征，但早期复发，定义为预后不良的功能性高风险（FHR） MM。本研究比较了FHR和标准风险（SR） MM队列，以探讨临床危险因素，并建立一个有效的预后模型，用于早期预测MM移植患者FHR的发生。方法采用回顾性队列研究对MM患者的临床资料进行分析，通过单因素和多因素分析确定FHR-MM的独立危险因素。通过逻辑回归分析和内部验证开发了预后nomogram。结果研究队列包括357例MM患者。单因素和多因素分析确定以下为FHR-MM的独立预测因素：乳酸脱氢酶(LDH)≥190 U/L，基线时PET-CT SUVmax≥7.5，诱导后PET-CT SUVmax降低≥80%，血小板计数和lt 80×109/L，铁蛋白≥650µg/L， m蛋白B型下降，自体干细胞移植（ASCT）后达到完全缓解（CR）。导出的预测模型显示，训练集的曲线下面积（AUC）得分为0.753 (95% CI 0.666-0.840)，验证集的AUC得分为0.857 （95% CI 0.759-0.954）。结论本研究建立了FHR-MM移植患者的预测nomogram，该nomogram通过内部验证显示了稳健的判别能力。
{"title":"Clinical Feature and Predictive Model for Transplanted Patients With Functional High-Risk Multiple Myeloma","authors":"Tongyong Yu , Meilan Chen , Beihui Huang, Junru Liu, Xiaozhe Li, Jingli Gu, Yanjuan Li, Juan Li","doi":"10.1016/j.arcmed.2025.103291","DOIUrl":"10.1016/j.arcmed.2025.103291","url":null,"abstract":"<div><h3>Objective</h3><div>A subset of patients with multiple myeloma (MM) experience early relapse despite the absence of any high-risk features at diagnosis, defined as functional high-risk (FHR) MM with inferior prognosis. This study compared FHR and standard risk (SR) MM cohorts to investigate clinical risk factors and establish a validated prognostic model for early prediction of FHR in patients with MM that were transplanted.</div></div><div><h3>Methods</h3><div>A retrospective cohort study was conducted to analyze the clinical data of patients with MM. Univariate and multivariate analyses were performed to identify independent risk factors for FHR-MM. A prognostic nomogram was developed through logistic regression analysis and internally validated.</div></div><div><h3>Results</h3><div>The study cohort comprised 357 MM patients. Univariate and multivariate analyses identified the following as independent predictors of FHR-MM: lactate dehydrogenase (LDH) ≥190 U/L, PET-CT SUVmax ≥7.5 at baseline, post-induction ≥80% reduction in PET-CT SUVmax, platelet count <80×10<sup>9</sup>/L, ferritin ≥650 µg/L, Pattern B of M-protein decline, and achieved complete remission (CR) after autologous stem cell transplantation (ASCT). The derived predictive model demonstrated area under the curve (AUC) scores of 0.753 (95% CI 0.666–0.840) for the training set and 0.857 (95% CI 0.759–0.954) for the validation set.</div></div><div><h3>Conclusion</h3><div>This study established a predictive nomogram for transplanted patients with FHR-MM that demonstrates robust discriminative capacity through internal validation.</div></div>","PeriodicalId":8318,"journal":{"name":"Archives of Medical Research","volume":"57 2","pages":"Article 103291"},"PeriodicalIF":3.4,"publicationDate":"2025-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144989646","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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