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Deforming nodular lesions in an indigenous person from western Mexico compatible with leishmaniasis. Graphical Abstract Graphical Abstract Deforming nodular lesions in an indigenous person from western Mexico compatible with leishmaniasis.

Calciphylaxis, also known as calcific uremic arteriolopathy and uremic small artery disease with medial wall calcification and intimal hyperplasia, is a multifactorial cutaneous vascular disease characterized by chronic, painful, non-healing wounds that occur frequently in patients with chronic kidney disease, predominantly in those with end-stage renal disease. The pathogenesis remains unclear, and the development of calciphylaxis lesions depends on medial calcification, intimal fibrosis of arterioles and thrombotic occlusion. Despite an increase in reports of calciphylaxis in the literature and clinical recognition of demographic characteristics and risk factors associated with calciphylaxis, it remains a poorly understood disease with high morbidity and mortality. In this review, we analyze and summarize the clinical manifestations, pathogenesis and pathophysiology, histopathology, differential diagnosis, diagnostic workup and treatment modalities for calciphylaxis. Because of the lack of consensus regarding the optimal approach to and treatment of this disorder, a high degree of clinical suspicion, early diagnosis, and multimodal and multidisciplinary treatment in collaboration with dermatology, nephrology, wound care, nutrition and pain management specialties may improve survival in patients with calciphylaxis.

A 58-year-old female with a medical history of type 2 diabetes mellitus and arterial hypertension, presented with 3 months history of multiple hyperpigmented macules in the labial mucosa, hard palate, and tongue without any associated symptoms [Figure 1]a and [Figure 1]b. The patient was a nonsmoker and denied the use of any new medication that could cause the pigmentation. Diagnosis Due to the clinical findings of multiple hyperpigmented macules in oral and labial mucosa associated with longitudinal melanonychia in the absence of systemic disease, the patient was diagnosed with LHS. Differential diagnoses of this entity include Peutz-Jeghers syndrome (PJS), Addison's disease, Albright syndrome, Bandler syndrome, Cronkhite-Canada syndrome, melanoma, drug induced pigmentation (phenytoin, zidovudine, antimalarials, clofazimine and phenothiazine), hiperpigmentation due to smoking or heavy metal exposure and oral lichen planus.

The use of renewable energies in the transportation industry has prompted the development of higher power electric motors and intelligent electronic traction systems. However, the typical coupling between the two continues to be mechanical, which reduces its efficiency and useful life. On the other hand, permanent magnet axial flux motor configurations make it possible to dispense with mechanical couplings, due to their high torque at low speeds due to their direct application on the wheels of vehicles. In this work, the design of a digital pole commutation system is presented, applied to an axial flux motor with permanent magnets for speed and torque control at a constant speed. The performance of the system is evaluated with experimental measurements; proving the effectiveness of the design, obtaining torques of up to 1784 Nm without extra mechanical couplings and maximum speed regulation errors of 8.43%.

Background: Bacterial lysates are known to modulate the immune response against respiratory infections. However, the effects of the commercial bacterial lysate Pulmonarom® on dendritic cells—particularly human monocyte-derived dendritic cells (moDCs)—have not been studied. Additionally, limited data are available on the expression of Toll-like receptors (TLRs) and cytokines following stimulation with bacterial lysates. Methods: Human monocytes were isolated from buffy coats and differentiated into moDCs. Pulmonarom® was lyophilized, quantified, and used to stimulate moDCs. Ultrastructural changes were evaluated using transmission electron microscopy. The expression of TLRs and selected cytokines was analyzed by flow cytometry. Results: Pulmonarom® stimulation induced morphological changes in moDCs, including an increased number of dendrites and lysosomes. It also led to the upregulation of MHC class II molecules and TLRs 2, 3, 6, and 7. Additionally, the production of IL-4, IL-6, IL-8, and MCP-1 was significantly increased. Conclusions: Pulmonarom® promotes moDC maturation, characterized by enhanced antigen presentation capabilities and lysosomal activity, along with increased expression of specific TLRs and cytokines. These features suggest a trained immunity phenotype in moDCs, potentially improving their ability to initiate adaptive immune responses against respiratory pathogens. To our knowledge, this is the first study to investigate the immunomodulatory effects of Pulmonarom® on human moDCs, providing novel insights into its potential as an immunotherapeutic adjuvant.

A hybrid Linear Quadratic Regulator (LQR) and Proportional-Integral (PI) control for a MicroGrid (MG) under unbalanced linear and nonlinear loads was presented and evaluated in this paper. The designed control strategy incorporates the microgrid behavior, low-cost LQR, and error reduction in the stationary state by the PI control, to reduce the overall energetic cost of the classical PI control applied to MGs. A Genetic Algorithm (GA) calculates the parameters of LQR with high-accuracy fitness function to obtain the optimal controller parameters as settling time and overshoot. The gain values of the classical PI controller were determined through the improved LQR values and geometrical root locus. When MG operates in the grid-tied mode under unbalanced conditions, the controller performance of the Current Source Inverter (CSI) of the MG is considerably affected. Consequently, the CSI operates in a negative-sequence mode to compensate for unbalanced current at the Point of Common Coupling (PCC) between the MG and the utility grid. The study cases involved the reduction of the negative-sequence percentage in the current at the PCC, mitigation of harmonics in the current signal injected by the MG, and close related power quality issues. All these cases have been analyzed by implementing an MG connected at the PCC of a low-voltage distribution network. A numerical model of the MG in Matlab/Simulink was implemented to verify the performance of the designed LQR-PI control to mitigate or overcome the power quality concerns. The extensive simulations have permitted verifying the robustness and effectiveness of the proposed strategy.

El servicio de cirugía de las instituciones prestadoras de salud, según estudios resientes, presentan alto riesgo por carga física postural. El objetivo de la presente investigación fue determinar el nivel de carga física postural del personal de cirugía de una institución de salud ubicada en la ciudad de Cali. La metodología utilizada fue de tipo descriptivo y de corte transversal. Como resultado se obtuvo que, el 48% del personal se encuentran en un rango de edad entre los 22 y 29 años y el 58% pertenece al sexo femenino; el 35% labora 7 días de la semana y el 22% más de 48 horas por semana. Concluyendo que los instrumentadores quirúrgicos y los médicos cirujanos son los profesionales con mayor nivel de riesgo por carga física postural y las especialidades quirúrgicas de cirugía general, ginecología, ortopedia y urología son las más expuestas.