To determine whether gait and balance dysfunction are present in young urbanites exposed to fine particular matter PM 2.5 ≥ annual USEPA standard, we tested gait and balance with Tinetti and Berg tests in 575 clinically healthy subjects, age 21.0±5.7y who were residents in Metropolitan Mexico City, Villahermosa and Reynosa. The Montreal Cognitive Assessment was also applied to an independent cohort n:76, age 23.3± 9.1y. In the 575 cohort, 75.4% and 34.4% had abnormal total Tinetti and Berg scores and high risk of falls in 17.2% and 5.7% respectively. BMI impacted negatively Tinetti and Berg performance. Gait dysfunction worsen with age and males performed worse than females. Gait and balance dysfunction were associated with mild cognitive impairment MCI (19.73%) and dementia (55.26%) in 57/76 and 19 cognitively intact subjects had gait and balance dysfunction. Seventy-five percent of urbanites exposed to PM 2.5 had gait and balance dysfunction. For MMC residents-with historical documented Alzheimer disease (AD) and CSF abnormalities, these findings suggest Alzheimer Continuum is in progress. Early development of a Motoric Cognitive Risk Syndrome ought to be considered in city dwellers with normal cognition and gait dysfunction. The AD research frame in PM 2.5 exposed young urbanites should include gait and balance measurements. Multicity teens and young adult cohorts are warranted for quantitative gait and balance measurements and neuropsychological and brain imaging studies in high vs low PM 2.5 exposures. Early identification of gait and balance impairment in young air pollution-exposed urbanites would facilitate multidisciplinary prevention efforts for modifying the course of AD.

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Introducción: El aprendizaje autodirigido es una habilidad del estudiante que le permite obtener mayor desempeño académico a través de poner en práctica sus capacidades metacognitivas, motivacionales y conductuales, enfocadas en metas de adquisición de conocimientos y destrezas.Objetivo: Determinar la asociación del nivel de aprendizaje autodirigido con características sociodemográficas y académicas de estudiantes de medicina.Método: Se realizó una encuesta transversal comparativa en estudiantes de medicina, mediante la aplicación de la escala de autoevaluación del aprendizaje autodirigido y un cuestionario estructurado para recabar características sociodemográficas y académicas. También se efectuó un análisis con estadística descriptiva, pruebas de correlación, inferenciales y de asociación.Resultados: Se incluyeron en el estudio a 247 estudiantes de medicina con edad de 21.3 ± 1.9 años, 147 (51.4%) fueron de sexo femenino. La puntuación de aprendizaje autodirigido fue moderada en 116 (47.0%) estudiantes, y quienes tuvieron promedio superior a 9 alcanzaron puntuación de 120.1 ± 12.4 en comparación con 114.5 ± 12.5 de aquellos con promedio escolar de 8.00 a 8.99, y 110.7 ± 12.1 con los de 7.00 a 7.99 (p < 0 .001), r = 0.230. El promedio inferior a 7 obtuvo OR 2.3, IC 95% (1.01 - 5.27) para baja competencia de aprendizaje autodirigido. No hubo diferencia entre grados académicos (p > 0.05).Conclusiones: Estudiantes de medicina presentan desarrollo medio o semiestructurado de aprendizaje autodirigido, que se asoció con estatus académico y promedio escolar, pero no con características sociodemográficas ni grado académico.

Background and objective: Diabetic kidney disease (DKD) is the most common microvascular chronic complication of diabetes mellitus. Hyperbaric oxygen (HBO2) therapy will increase the partial pressure of oxygen (PaO2) and may improve cell repair processes, which can lead to better renal function. The objective of this study was to quantify the efficacy of adjuvant HBO2 to increase the glomerular filtration rate and urinary albumin excretion in diabetic patients, as well as determine its effectiveness to modify the clinical course of DKD. Materials and methods: An experimental study was performed on patients with stage 3 and 4 DKD. Twenty sessions of HBO2 or ambient air in a hyperbaric chamber were administered. Estimated glomerular filtration rate, urine albumin:creatinine ratio calculation and clinical stage stratification were made prior to and after HBO2 administration. A descriptive, inferential and clinical efficacy analysis was performed. Results: Urinary albumin/creatinine (UACR) mean values prior to HBO2 were 1452.9 ± 644.3 mg/g and decreased to 876.1 ± 504.0 mg/g at the end of the study (p=0.06). The patients in the control group showed a UACR mean of 2784.5 ± 2128.6 mg/g and 2861.4 ± 2424.2 mg/g at baseline and at the end of the study, respectively (p=0.82). Patients in the experimental/HBO2 group showed an estimated GFR of 27.3 ± 9.5 mL/min /1.73m2 before HBO2, with a 34.4 ± 6.9 mL/min/1.73m2 after treatment (p=0.017); control group eGFR was 30.1 ± 9.2 mL/min/1.73m2, decreasing to 22.2 ± 6.8 mL/min/1.73m2 (p=0.004). Relative risk 0.00, relative risk reduction -100%, absolute risk reduction -71.4%, 95% CI (-104.9% to -38.0%), NNT 1, 95% CI (1 to 3). Conclusions: Management with HBO2 for DKD was associated with decreased excretion urinary albumin, improved GFR and clinical stage of patients in stages 3 and 4 of kidney damage unlike those receiving ambient air.

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