Resumen Este artículo de reflexión aborda el tema de la digitalización de la educación superior. Por medio de una aproximación cualitativa se presenta una revisión de literatura en la última década, la cual se analiza alrededor de referentes conceptuales y la experiencia docente de las autoras en cuatro programas educativos a distancia y virtual. Entre los hallazgos se destacan los espejismos pedagógicos del nuevo "locus" digital, enmarcados en paisajes tecnológicos, así como la interacción y el sentido pedagógico en tensión con la "plataformización" de la educación superior.

Abstract This reflection article addresses the issue of digitization of higher education. Through a qualitative approach, a review of literature in the last decade is presented, which is analyzed around conceptual references and the teaching experience of the authors in four distance and virtual educational programs. Among the findings, the pedagogical illusions of the new digital "locus" stand out, framed in technological landscapes, as well as the interaction and the pedagogical sense in tension with the "platformization" of higher education.

Resumo Este artigo de reflexão trata o tema da digitalização da educação superior. Por meio de uma aproximação qualitativa se apresenta uma revisão de literatura na última década, a qual é analisada ao redor de referentes conceptuais e a experiência docente das autoras em quatro programas educativos a distância e virtuais. Entre os resultados se destacam as miragens pedagógicas do novo "locus" digital, emolduradas nas paisagens tecnológicas, assim como a interação e o sentido pedagógico em tensão com a "plataformização" da educação superior.

Resumen Objetivo principal: Relacionar el síndrome de burnout académico con el riesgo suicida en los estudiantes de enfermería de una universidad del norte de Chile. Metodología: enfoque cuantitativo, correlacional, y de corte transversal, de diseño no experimental. Resultados principales: los participantes reportaron un 10 % de la muestra con riesgo suicida moderado y severo, y ambas variables presentaron relaciones estadísticamente significativas (r=,501, p<,000). Conclusión principal: Existe relación entre el burnout académico y el riesgo suicida. Asimismo, la detección oportuna y precoz de la relación entre el burnout académico y el riesgo suicida puede ayudar a prevenir el comportamiento suicida e incluso el suicidio en estudiantes de enfermería. Urge que las universidades busquen estrategias de pesquisa precoz del síndrome de burnout y así evitar tragedias como las de un suicidio asociado.

Abstract Objective: To relate the academic burnout syndrome with the suicide risk in nursing students at a university in the north of Chile. Methodology: quantitative, correlational, and cross-sectional approach, of non-experimental design. Main results: the participants reported 10 % of the sample with moderate and severe suicide risk, and both variables presented statistically significant relationships (r = ,501; p<,000). Main conclusion: There is a relationship between academic burnout and suicide risk. Likewise, the timely and early detection of the relationship between academic burnout and suicidal risk can help prevent suicidal behavior and even suicide in nursing students. It is urgent that universities seek early screening strategies for burnout syndrome and thus avoid tragedies such as associated suicide.

Most triatomine bugs (Hemiptera: Reduviidae: Triatominae) are hematophagous, though Belminus species can live off of cockroach hemolymph to complete their life cycle. In this work we described the fixed action pattern (FAP) employed by B. ferroae to identify, approach and suck on a living cockroach. The FAP described here is composed of the following stereotyped behaviors: 1) visual and/or olfactory detection of the cockroach, 2) reaching, 3) cautious approach, 4) antennal exploration, 5) extension of the proboscis, 3) piercing to sedate, 5) walking &nbsp;away and waiting (post sedation behavior), 6) second cautious approach, 7) extension of the proboscis, 8) piercing to suck hemolymph. In order to identify chemicals cues that could elicit such FAP, we examined the behavior of B. corredori, B. ferroae and B. herreri in response to the cockroaches’ odor, fresh cockroach feces and fresh rodent wastes. The last two sources were tested based on the assumption that abundant chemicals near host refuges could serve as cues for host orientation. We found the cockroach odor emanating from a box significantly attracted B. herreri in a still air olfactometer. The three Belminus species approached the captive cockroach after one hour, but avoided to climb the box. Odors emanating from the cockroach feces attracted B. corredori and B. ferroae in a Y-olfactometer. The FAP sequence observed suggests Belminus bugs are not predators like the rest of reduviids (assassin bugs) —but are kleptophagous ectoparasites, since they do not attack and kill a prey but rather steal hemolymph from its invertebrate host. Triatomines and their hosts have intimately shared the same refuge for millions of years. Similar odors occur across invertebrate and vertebrate refuges, and are recurrent in human abodes, thus plausibly explaining how these kleptophagous bugs can readily switch to the domestic habitat.

ABSTRACT Fish mariculture from the genus Seriola spp. can present high mortalities due to parasites. In Mexico, the mortality yellowtail Seriola dorsalis caused by parasites is low, and there are no reports of massive mortality events. However, as the aquaculture activity of yellowtail intensifies, parasites will be increasingly conspicuous. Therefore, the present study is an aim to know S. dorsalis’s susceptibility to a monogenean infection mixed under RAS experimental conditions and their intensity and spatial distribution on the skin and gills. In this study, a parasitic mix induction was performed using two monogenean species such as Zeuxapta seriolae and Benedenia seriolae besides the Amyloodinium ocellatum, a dinoflagellate that was naturally presented. At the end of the experiment after 45 days, B. seriolae prevalence was 100% with a mean intensity of 122 parasites and showed a preference for the head and body of the fish. Zeuxapta seriolae prevalence was 100% with a mean intensity of 40 parasites preferentially found in the second branchial arch. In the case of A. ocellatum prevalence was of 100% with a mean intensity greater than 200 trophozoites per fish. The fish mortality reached 90% at the end of the experiment. During the infection, the fish weight decreased a 14% at the end of the experiment. Therefore, it will be necessary to carry out prophylactic and control strategies, to reduce the impact of these parasites under culture conditions.

Abstract Marine fish culture, both in hatchery and grow-out systems, is prone to parasitic infestations, which lead to fish health impairment and generally high mortality rates. The most frequent disease in these cultures, amyloodiniosis, is caused by the dinoflagellate Amyloodinium ocellatum, the parasite considered to inflict the most considerable damage on commercial marine fish ventures. In recent years, the yellowtail Seriola dorsalis cultured in Baja California has undergone recurrent parasitic infections. Thus, the objective of the present work was to evaluate the effects of a parasitic infection (A. ocellatum) in juvenile yellowtail in terms of mortality, gill histology, and blood parameters. Fish exposed to parasitic infection exhibited 100% prevalence, with mean intensity of 766 ± 500 parasites per fish (grand mean ± SD). Gill histological analyses indicated damage characterized by inflammation, epithelial detachment, hyperplasia, fusion of secondary lamellae, telangiectasia, and proliferation of mucous cells. Regarding blood parameters, red blood cell count, mean corpuscular hemoglobin concentration, and hemoglobin, glucose, and triglyceride concentrations were significantly higher (P < 0.05) in infected fish (parasite prevalence of 100% with a mean intensity of 882.19 ± 265.05 parasites per fish) than in healthy ones. Also, mean corpuscular volume, total protein, albumin, and globulin were significantly lower (P < 0.05) in infected fish than in healthy fish. No differences were found in the hematocrit, mean corpuscular hemoglobin, and white blood cell count (P > 0.05). This study demonstrated that A. ocellatum infection caused severe gill damage, affecting gas exchange efficiency, which resulted in blood parameter changes and, consequently, high mortality rates in a short-term period.

Resumen El cultivo de peces marinos, tanto en el criadero como en el cultivo para engorda, es vulnerable a la incidencia de parásitos, lo que afecta la salud de los peces y, en general, conduce a altas tasas de mortalidad. La enfermedad más frecuente en estos cultivos, la amiloodiniosis, es causada por el dinoflagelado Amyloodinium ocellatum, considerado el parásito que inflige el daño más considerable a las empresas comerciales de peces marinos. En los últimos años, el jurel Seriola dorsalis cultivado en Baja California ha padecido infestaciones parasitarias recurrentes. Por lo tanto, el objetivo del presente trabajo fue evaluar los efectos de una infestación parasitaria (A. ocellatum) en juveniles de jurel en términos de mortalidad, histología de las branquias y parámetros sanguíneos. Los peces expuestos a la infestación parasitaria exhibieron una prevalencia del 100% con una intensidad media de 766 ± 500 parásitos por pez (gran promedio ± desviación estándar). El análisis histológico de las branquias indicó daño caracterizado por inflamación, desprendimiento epitelial, hiperplasia, fusión de las lamelas secundarias, telangiectasia y proliferación de células del mucus. Con respecto a los parámetros sanguíneos, el recuento de glóbulos rojos, la concentración de la hemoglobina corpuscular media, y las concentraciones de hemoglobina, glucosa y triglicéridos fueron significativamente mayores (P < 0.05) en peces infestados (prevalencia parasitaria del 100% con una intensidad media de 882.19 ± 265.05 parásitos por pez) que en peces sanos. Además, el volumen corpuscular medio, la proteína total, la albúmina y la globulina fueron significativamente más bajos (P < 0.05) en los peces infestados que en los peces sanos. No se encontraron diferencias en el hematocrito, la hemoglobina corpuscular media y los recuentos de glóbulos blancos (P > 0.05). Este estudio demostró que la infestación por A. ocellatum causó daños severos en las branquias que afectaron la eficiencia del intercambio de gases, lo que resultó en cambios en los parámetros sanguíneos y, en consecuencia, altas tasas de mortalidad en un corto periodo de tiempo.

Resumen En este artículo analizo el cuento "Valle alto" (1946) de la escritora costarricense Yolanda Oreamuno (1916-1956) atendiendo al trata miento de la sexualidad femenina que realiza la autora en el marco general de los planteamientos feministas de la primera mitad del siglo XX en Latinoamérica, y en consideración de la problemática identitaria público-nacional que observaremos en la Generación del Cuarenta en Costa Rica. En este análisis veremos cómo esta pro blemática identitaria es cuestionada en el cuento de Oreamuno al presentar una subjetividad inserta en otra dimensión de existencia: lo privado-nacional.

Abstract This paper analyzes the short story "Valle alto" [High Valley] (1946) by the Costa Rican writer Yolanda Oreamuno (1916-1956), focusing on the treatment of feminine sexuality explored by the author, framed by feminist theories of the first half of the XX century in Latin America, and in consideration of the discussion on public-national identity that can be observed in the Generation of the Forties in Costa Rica. In this analysis we will observe how this issue of identity is questioned in Oreamunos short story, presenting a form of subjectivity inserted in another dimension of existence: the private-national.

Résumé dans cet article nous analyserons de quelle manière l'écrivain costaricienne Yolanda Oreamuno (1916 1956) construit dans la nouvelle "Valle alto" (1946) la sexualité féminine dans le cadre des idées fé ministes de la première moitié du XX siècle en Amérique Latine, et de la problématique identitaire publique-nationale que nous observons dans la Génération du Quarante au Costa-Rica. Nous étudierons comment cette problématique identitaire est remise en question dans la nouvelle d'Oreamuno en présen tant une subjectivité inscrite dans une autre dimension de l'existence: la privée-nationale.

Introducción. Se han propuesto clasificaciones de las extensiones cuticulares de los insectos para utilizarlas como herramienta taxonómica. A pesar de los diversos estudios morfológicos adelantados en triatominos, el conocimiento que se tiene sobre la distribución y los tipos morfológicos de estas estructuras en la subfamilia aún es escaso y fragmentario. Objetivo. Describir las setas de diferentes regiones de la cutícula externa de varias especies de triatominos mediante microscopía electrónica de barrido. Materiales y métodos. Se lavaron y se secaron especímenes de Eratyrus mucronatus, Triatoma maculata, Panstrongylus geniculatus y Belminus ferroae, y a continuación se disecaron diferentes regiones de sus cuerpos y se montaron sobre cinta adhesiva de grafito de doble faz en soportes metálicos. Se metalizaron con oro y se tomaron las micrografías para su posterior análisis. Resultados. Se describieron nueve tipos de setas cuticulares. En B. ferroae y T. maculata se encontraron cinco tipos de setas, en P. geniculatus, cuatro, y en E. mucronatus, un solo tipo. Según la tipología propuesta, la seta de tipo 3 fue la más común en cada especie, excepto en B. ferroae, en la cual predominó la seta de tipo 1a. Conclusión. La seta más común en las especies de la tribu Triatomini (T. maculata, E. mucronatus y P. geniculatus) fue la de tipo 3; la seta de tipo 1a fue específica para la especie B. ferroae, taxón de la tribu Bolboderini, lo cual permite suponer que la morfología superficial de las setas podría tener valor taxonómico a nivel de tribu.

Introduction: The classification of the cuticular extensions of insects has been proposed as a taxonomic tool; however, the internal and external processes of the cuticular extensions of the Triatominae subfamily have not been fully analyzed and categorized. Objective: To describe the setae from different regions of the outer cuticle of several triatomine species by scanning electron microscopy. Materials and methods: Triatomines were washed and dried, after which different regions of the body from Eratyrus mucronatus, Triatoma maculata, Panstrongylus geniculatus and Belminus ferroae specimens were dissected, mounted on graphite double-sided adhesive tape over metal supports, metalized with gold and micrographed for further analysis. Results: We described nine types of cuticular setae. We found five types of setae in B. ferroae and T. maculata, four in P. geniculatus and only one in E. mucronatus. According to the proposed typology, type 3 seta was the most common in T. maculata, P. geniculatus and E. mucronatus, whereas type 1a predominated in B. ferroae. Conclusion: Type 3 seta was the most common in the Triatomini tribe (T. maculata, E mucronatus and P. geniculatus), whereas type 1a seta was specific to B. ferroae (tribe Bolboderini), suggesting that the surface morphology of the setae may have taxonomic value at tribe taxonomic level.

Introducción. Lutzomyia evansi es un reconocido vector de Leishmania infantum en Colombia y Venezuela. Objetivo. Describir e ilustrar las anomalías morfológicas presentes en el cibario de hembras de Lu. evansi capturadas en un foco rural de leishmaniasis visceral en Trujillo, Venezuela. Materiales y métodos. Para la captura de los flebótomos se utilizaron tres diferentes métodos (trampa Shannon, trampas de luz del tipo CDC y capturas en reposo). En la identificación taxonómica se siguió la clave de Young & Duncan (1994) y los diseños biológicos se hicieron utilizando un microscopio óptico con cámara clara. Resultados. En 3.477 especímenes de Lu. evansi se detectaron cuatro (0,12 %) hembras con diferentes anomalías en el cibario. Conclusión. Algunos especímenes de Lu. evansi pueden presentar anomalías morfológicas relacionadas con aumento del número de los dientes en el cibario y con su disposición. La detección de estas anomalías en poblaciones naturales de Lu. evansi puede evitar dificultades y confusiones en el momento de la identificación taxonómica de los especímenes teratomorfos, reduciendo así el riesgo de incurrir en errores taxonómicos.

Introduction: Lutzomyia evansi is a recognized vector of Leishmania infantum in Colombia and Venezuela. Objective: To describe and illustrate the morphological abnormalities in Lu. evansi females captured in a rural focus of visceral leishmaniasis in Trujillo, Venezuela. Materials and methods: Phlebotomine sand flies were collected using CDC light traps, Shannon traps and aspiration in resting places. The identification was performed according to Young & Duncan (1994) and drawings were made using a microscope with camara lucida . Results: Abnormalities in the cibarium of Lu. evansi were detected in 4 (0.12%) females of the 3,477 adults that were studied. Conclusion: Lutzomyia evansi can have uncommon morphological variants associated with an increase in the number of teeth in the cibarium and their arrangement, which may lead to errors in the taxonomic identification of anomalous specimens. The study of such deformities can serve to avoid taxonomic identification errors.

All members of Triatominae subfamily (Heteroptera: Reduviidae), potential vectors of Trypanosoma cruzi etiologic agent of the Chagas disease, feed on blood. Through evolution, these bugs have fixed special morphological, physiological, and behavioral aptations (adaptations and exaptations) adequate to feed on blood. Phylogeny suggests that triatomines evolved from predator reduvids which in turn descended from phytophagous hemipterans. Some pleisiomorphic traits developed by the reduvid ancestors of the triatomines facilitated and modeled hematophagy in these insects. Among them, mouthparts, saliva composition, enzymes, and digestive symbionts are the most noticeable. However, the decisive step that allowed the shift from predation to hematophagy was a change of behavior. The association of a predator reduvid with nesting vertebrate (≈110 to 32 Ma) permitted the shift from an arthropod prey to a vertebrate host. In this work, we review the phylogeny and dispersion of triatomines and the current controversy over the monophyly or polyphyly of this group. We also discuss how these insects were able to overcome, and even have taken advantage of, diverse ancestral and physical barriers to adapt to sucking blood of nidicolous vertebrates. We provide a Spanish version of this work.

Introduction: Obesity is a serious public health problem because its association with the risk to develop various chronic diseases. Atherogenic dyslipidemia that often accompany obesity is also associated to the metabolic syndrome and to cardiovascular diseases. The transition from adolescence to young adulthood appears to be a period where major changes occur in the lifestyle which contributes to the development of obesity, however, little attention has been given to this transition stage. The inclination to adopt unhealthy behaviors which occurs during early adulthood may be increased on university students because their lifestyle, which is characterized by lack of time to eat a healthy diet, which can make them susceptible to obesity. Objective: To determine the prevalence of obesity and lipid levels abnormalities and their relationship in a group of university students. Methods: Transversal study of university students aged between 18 and 24 years. Body mass index, waist circumference and blood lipid profile where evaluated. Results: Of the 620 students surveyed about one-third have either overweight or obesity. 86% of students had at least one alteration in the evaluated parameters. Lipid profile results show a high prevalence of minor alterations in levels, particularly in cholesterol linked to low density lipoproteins levels. Conclusions: University young students have a high prevalence of overweight and plasma lipid levels above the norm, but most are in the low-risk categories. It is necessary to establish early preventive measures aimed at promoting in the university student good eating habits and increased physical activity.

Introducción: La obesidad constituye un grave problema de salud pública por su asociación con los riesgos a desarrollar enfermedades crónicas. La dislipidemia aterogénica que acompaña con frecuencia a la obesidad también está asociada al síndrome metabólico y a las enfermedades cardiovasculares. La transición entre la adolescencia y el adulto es un periodo con modificaciones importantes en el estilo de vida que contribuyen al desarrollo de la obesidad, sin embargo es poca la atención brindada a esta etapa. La tendencia a adoptar comportamientos poco saludables durante esta transición puede incrementarse en los universitarios que llevan un estilo de vida caracterizado por la falta de tiempo para llevar una dieta saludable, haciéndolos susceptibles a desarrollar obesidad. Objetivo: Determinar la prevalencia de la obesidad y de las anormalidades en los niveles de lípidos y su relación en un grupo de universitarios. Métodos: Estudio transversal que evalúa Índice de Masa Corporal, diámetro de cintura y perfil de lípidos en universitarios con un rango de edad de 18 a 24 años. Resultados: De los 620 jóvenes estudiados, aproximadamente un tercio tienen sobrepeso u obesidad. El 86% presentó al menos una alteración en los parámetros evaluados. Los resultados del perfil lipídico muestran alta prevalencia de alteraciones leves, particularmente en los niveles de colesterol ligado a lipoproteínas de baja densidad. Conclusiones: Los jóvenes Universitarios presentan alta prevalencia de lípidos plasmáticos por encima de la norma y exceso de peso. Es necesario establecer medidas preventivas dirigidas a promover en los universitarios buenos hábitos alimenticios y mayor actividad física.

Triatominae are widely recognised for their role as vectors of Trypanosoma cruzi. One of the main biological characteristics of this subfamily is their obligate haematophagous condition. However, previous studies on Belminus herreri and Belminus ferroae suggested that cockroaches are their principal hosts in domiciles. Due to this peculiar behaviour, the aim of this study was to analyse several demographic and reproductive parameters of B. ferroae fed on three different hosts (mice, cockroaches and Rhodnius prolixus) and relate B. ferroae fitness to these alternative hosts. The cohorts were reared under constant conditions. The egg hatching rate was similar for cohorts fed on cockroaches (69.4%) and R. prolixus (63.8%), but was much lower for the cohort fed on mice (16%). The development time from the nymph to adult stage and the average age of first reproduction (α) presented lower values in the cohort fed on cockroaches, which is consistent with the higher population growth rate associated with this host. Demographic parameters [intrinsic rate of natural increase, finite rate of population growth, net reproductive rate and damping ratio] showed statistically significant differences between the cohorts. Analysis of the life history of B. ferroae revealed a higher fitness related to the cockroach. The implications of these results for the origin of the subfamily are discussed.

This study was conducted to identify the sandfly fauna and the anthropophilic species in a coffee-growing area of Villanueva, Norte de Santander, Colombia, a focus of American cutaneous leishmaniasis, and to analyse the relationship between the most frequent species and rainfall, relative humidity and temperature, with the aim of contributing to epidemiological surveillance in the area. Sandfly collections were performed fortnightly between February 2006-September 2007 using automatic light traps, Shannon traps, protected human bait and aspiration in resting places. A total of 7,051 sandflies belonging to 12 species were captured. Pintomyia spinicrassa (95.7%) predominated. Pintomyia oresbia and Lutzomyia sp. of Pichinde were found in the state of Norte de Santander for the first time. Pi. spinicrassa, Pintomyia nuneztovari, Micropygomyia venezuelensis, Lutzomyia (Helcocyrtomyia) scorzai and Lu. (Helcocyrtomyia) sp. were captured on the protected human bait. A significant association between Pi. spinicrassa abundance and the total rainfall and the average temperature and humidity 10 days before the collection was observed. The dominance of Pi. spinicrassa, a recognised vector of Leishmania braziliensis, especially during the dry periods, indicates that the risk of parasite transmission may increase.

The cave organ is a sensory receptor in the antenna pedicel of some Reduviidae. This paper describes this organ for the first time in three species of the genus Belminus, Belminus corredori, Belminus ferroae and Belminus herreri, by optical and scanning electron microscopy. The structures presented a general pattern similar to one reported for other species of Triatominae.

After the progress made during the genomics era, bioinformatics was tasked with supporting the flow of information generated by nanobiotechnology efforts. This challenge requires adapting classical bioinformatic and computational chemistry tools to store, standardize, analyze, and visualize nanobiotechnological information. Thus, old and new bioinformatic and computational chemistry tools have been merged into a new sub-discipline: nanoinformatics. This review takes a second look at the development of this new and exciting area as seen from the perspective of the evolution of nanobiotechnology applied to the life sciences. The knowledge obtained at the nano-scale level implies answers to new questions and the development of new concepts in different fields. The rapid convergence of technologies around nanobiotechnologies has spun off collaborative networks and web platforms created for sharing and discussing the knowledge generated in nanobiotechnology. The implementation of new database schemes suitable for storage, processing and integrating physical, chemical, and biological properties of nanoparticles will be a key element in achieving the promises in this convergent field. In this work, we will review some applications of nanobiotechnology to life sciences in generating new requirements for diverse scientific fields, such as bioinformatics and computational chemistry.

El objetivo de este estudio fue consolidar y analizar información referente a los aspectos clínicos y epidemiológicos de pacientes con leishmaniasis visceral en el estado Trujillo, Venezuela, a través de un estudio retrospectivo que incluyó los ingresos hospitalarios durante 1975 - 2007. Ochenta y dos historias clínicas fueron seleccionadas, de las cuales 55 correspondieron a niños y adolescentes entre los 0-17 años y 27 adultos entre 18 y 60 años. El 53,7% de los pacientes fueron niños en el rango de edad de 0-5 años. Se observó predominio del sexo masculino en los adultos (P=0,002). En cuanto a los signos y síntomas se encontró diferencia significativa entre niños-adolescentes y adultos en las variables astenia (P=0,01) y pérdida de peso (P = 0,001) siendo ambas más frecuentes entre adultos. El tiempo promedio de hospitalización fue 31,17±14 días y la tasa de mortalidad de 4,9 %. Se concluye que la LVA en el estado de Trujillo, se comporta persistentemente endémica con casuística baja y esporádica y debe ser descartada en pacientes adultos con pérdida de peso y astenia que provengan de áreas endémicas.

The objective of this study was to consolidate and analyze information in reference to clinical and epidemiological aspects of patients with Visceral Leshismaniasis in Trujillo State, Venezuela through a retrospective study which included interned patients from 1975-2007. 82 clinical records were reviewed: 55 children and teenagers between 0- 17 years, and 27 adults between 18 and 60 years. 53.7% of them were children between 0 and 5 years. Among adults, the male sex was dominant (P=0. 002). In reference to the signs and symptoms, a significant difference was found between children/teenagers and adults in the variables of astenia (P=0.001) and loss of weight (P=0.001) which were more frequent among adults. The average ingression to the hospital was 31.17 ±14 days and the rate of mortality was 4.9%. In conclusion the LVA in Trujillo state is persistently endemic with a low and sporadic cases, which must be discarded in adult patients who come from endemic areas with weight loss and asthenia.