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Introduction: évaluer la faisabilité du traitement médical des fausses couches par misoprostol en ambulatoire et préciser ses avantages en comparaison avec la révision utérine instrumentale classique. Méthodes: étude prospective comparative au service B du centre de maternité de Tunis (CMNT) s´étalant sur une période de 12 mois (Juillet 2015-Juin 2016), colligeant 50 patientes sélectionnées ayant des constantes hémodynamiques stables et ayant consulté pour fausses couches incomplètes et traitées par misoprostol en ambulatoire, à un groupe de 50 patientes qui avaient eu une révision utérine pour le même motif au cours de la même période d´étude. Le misoprostol a été administré à la dose de 400 µg, soit 2 comprimés, par voie sublinguale (25 cas) et par voie vaginale (25 cas). Résultats: chez les 25 patientes qui avaient reçu 400 µg (soit 2 cp) de misoprostol par voie vaginale, le taux d´expulsion complète de la grossesse avait atteint 88% (22 patientes). Chez les 25 femmes ayant reçu le misoprostol par la voie sublinguale, le taux d´expulsion a chuté à 84% (21 patientes), la différence n´est pas statistiquement significative. Six patientes ont eu secondairement une aspiration utérine et une patiente a expulsé suite à une dose supplémentaire de misoprostol 400 µg. Dans le groupe des 50 patientes ayant eu une aspiration chirurgicale pour fausse couche incomplète, nous avons noté des complications hémorragiques chez 5 patientes (10% des cas) et 3 cas de rétention trophoblastique. La durée moyenne d´hospitalisation a varié de 1 à 3 jours; 80% des patientes ont été hospitalisées pendant 48 heures. La révision instrumentale a coûté en moyenne 73 Dinar tunisien (DT) soit environ 3 fois plus cher en comparaison avec le traitement de la fausse couche incomplète par misoprostol. Ainsi, cette approche médicale s´est avérée plus économique en termes de coût de santé publique. Conclusion: le traitement des fausses couches incomplètes par misoprostol est une méthode efficace, sûre, à condition qu´elle soit prescrite chez des femmes sélectionnées au préalable.

Erik Briffault,1,2 Ricardo Reyes,2,3 Patricia Garcia-Garcia,1,2 Helena Rouco,1 Luis Diaz-Gomez,4 Maria Rosa Arnau,2,5 Carmen Evora,1,3 Patricia Diaz-Rodriguez,2,4 Araceli Delgado1,2 1Department of Chemical Engineering and Pharmaceutical Technology, Universidad de La Laguna, La Laguna, 38206, Spain; 2Institute of Biomedical Technologies (ITB), Universidad de La Laguna, La Laguna, 38320, Spain; 3Department of Biochemistry, Microbiology, Cell Biology and Genetics, Universidad de La Laguna, La Laguna, 38200, Spain; 4Department of Pharmacology, Pharmacy and Pharmaceutical Technology, I+D Farma Group (GI-1645), Facultad de Farmacia, Instituto de Materiales (iMATUS) and Health Research Institute of Santiago de Compostela (IDIS), Universidade de Santiago de Compostela, Santiago de Compostela, 15782, Spain; 5Servicio de Estabulario, Universidad de La Laguna, La Laguna, 38206, SpainCorrespondence: Patricia Diaz-Rodriguez; Araceli Delgado, Email patricia.diaz.rodriguez@usc.es; adelgado@ull.edu.esIntroduction: Osteoporosis is a metabolic disorder characterized by the loss of bone mass and density. Nucleic acid-based therapies are among the most innovative approaches for osteoporosis management, although their effective delivery to bone tissue remains a challenge. In this work, SFRP1-silencing GampeR loaded-nanoparticles were prepared and functionalized with specific moieties to improve bone targeting and, consequently, therapeutic efficacy. SFRP1-silencing would promote osteoblastic differentiation by enhancing the WNT/β-catenin pathway and thus diminishing the progression of osteoporosis.Methods: A nucleic acid-based delivery system consisting of lipid-polymer hybrid nanoparticles (LPNPs) loading a GapmeR for SFRP1 silencing was developed and further functionalized with two bone-targeting moieties: a specific aptamer (Apt) for murine mesenchymal stem cells and an antiresorptive drug, namely alendronate (ALD). These systems were tested in vivo in osteoporotic mice at different dosage regimens to analyze dose dependence in bone-forming activity and potential toxicity. The quality of trabecular and cortical bone was assessed by both micro computed tomography (micro-CT) and histological and histomorphometric analyses. Early and late osteogenesis were quantified by immunohistochemistry.Results: Results showed that functionalizing LPNPs loaded with an SFRP1-silencing GapmeR using both Apt and ALD improved bone quality and enhanced osteogenesis following a dose–effect relationship, as revealed by micro-CT, histological and immunohistochemical analyses. In contrast, non-functionalized LPNPs did not produce these effects.Conclusion: These findings highlight the relevance of proper targeting and dosage in nucleic acid-based therapeutics, proving to be crucial for exerting their therapeutic effect: a deficient targeting strategy and/or dosage may result in the therapeutic failure of an adequate gene therapy agent. Keywords: osteoporosis, bone targeting, nanoparticle dose-effect, gene therapy, aptamer, alendronate, micro-CT

Juan Jesús García-Iglesias,1 Francesco Chirico,2,3 Amelia Rizzo,4,5 Lukasz Szarpak,6,7 Hicham Khabbache,8,9 Murat Yildirim,10– 12 Javier Fagundo-Rivera,13 Juan Gómez-Salgado1,14 1Department of Sociology, Social Work and Public Health, Faculty of Labour Sciences, University of Huelva, Huelva, Spain; 2Post-Graduate School of Occupational Health, Catholic University of the Sacred Heart, Rome, Italy; 3Health Service Department, Italian State Police, Ministry of the Interior, Milan, Italy; 4Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy; 5Department of Cognitive Sciences, Psychological, Educational, and Cultural Studies, University of Messina, Messina, Italy; 6Department of Clinical Research and Development, LUXMED Group, Warsaw, Poland; 7Centre for Development, Commercialisation and Technology Transfer, Collegium Medicum, The John Paul II Catholic University of Lublin, Lublin, Poland; 8Director of the UNESCO Chair “Lifelong Learning Observatory” (UNESCO/UMSBA), Rabat, Morocco; 9Department of Psychology, Laboratory of «Morocco: History, Theology and Languages», Faculty of Arts and Human Sciences Fès-Saïss, Sidi Mohamed Ben Abdellah University, Fez, Morocco; 10Department of Psychology, Faculty of Science and Letters, Agri Ibrahim Cecen University, Ağrı, Türkiye; 11Department of Social and Educational Sciences, Lebanese American University, Beirut, Lebanon; 12Department of Psychology, School of Humanities, Education and Social Sciences, Khazar University, Baku, Azerbaijan; 13Centro Universitario de Enfermería Cruz Roja, Sevilla, Spain; 14Safety and Health Postgraduate Programme, University of Espíritu Santo, Guayaquil, EcuadorCorrespondence: Juan Gómez-Salgado, Department of Sociology, Social Work and Public Health, Faculty of Labour Sciences, University of Huelva, Avda. Tres de Marzo, Huelva, S/N, 21007, Spain, Tel +34 959219700, Email salgado@uhu.es Javier Fagundo-Rivera, Centro Universitario de Enfermería Cruz Roja, Avda. de la Cruz Roja, 1, duplicado, Sevilla, 41009, Spain, Tel +34 954350997, Email javier.fagundo@cruzroja.esObjective: The aim of this review was to assess the factors influencing the occupational stress of state security forces during the COVID-19 pandemic.Methods: We conducted a scoping review using the Pubmed, Scopus, and Web of Science databases, adhering to the PRISMA statement standards and the guidelines for narrative syntheses.Results: We included a total of 26 studies. The prevalence of stress varied from 22% to 87.2%. Factors that may have influenced the stress levels of police officers during the pandemic include not having basic personal protective equipment, having little or no rest periods between tasks, long working hours, fear of contagion to themselves or others, pressure to maintain law and order, emotion regulation and preparedness, sex, marital status, work experience, age, presence of chronic underlying illnesses, family-work conflict, lack of psychological support, and others. The long working hours, the fear of infecting themselves or others, the pressure to maintain law and order, sex, and age are the six main factors evaluated for more studies.Conclusion: Organisational, situational, and personal factors may have influenced the stress levels of police officers during the pandemic, and measures need to be taken to minimise their impact.Keywords: COVID-19, police, state security forces, stress, occupational health

Marcin Karcz,1 Alaa Abd-Elsayed,2 Krishnan Chakravarthy,3 Aman Mansoor,4 Natalie Strand,5 Mark N Malinowski,6 Usman Latif,7 David Dickerson,8 Tolga Suvar,9 Timothy Lubenow,9 Evan Peskin,10 Ryan D’Souza,5 Eric Cornidez,11 Andrew Dudas,12 Christopher Lam,7 Michael Farrell II,13 Geum Yeon Sim,14 Mohamad Sebai,15 Rosa Garcia,16 Lucas Bracero,1 Yussr Ibrahim,17 Syed Jafar Mahmood,18 Marco Lawandy,19 Daniel Jimenez,20 Leili Shahgholi,15 Kamil Sochacki,21 Mohamed Ehab Ramadan,15 Vinny Francio,22 Dawood Syed,7 Timothy Deer1 1The Spine and Nerve Centers of the Virginias, Charleston, WV, USA; 2Department of Anesthesiology, University of Wisconsin, Madison, WI, USA; 3Innovative Pain Treatment Solutions, San Diego, CA, USA; 4Aurora Pain Management, Aurora Health Care, Oshkosh, WI, USA; 5Anesthesiology and Perioperative Medicine, Mayo Clinic, Phoenix, AZ, USA; 6Department of Anesthesiology, Ohio Health System, Columbus, OH, USA; 7Department of Anesthesiology, University of Kansas Medical Center, Kansas City, KS, USA; 8Department of Pain Medicine, Northshore University Health System, Skokie, IL, USA; 9Department of Anesthesiology and Pain Medicine, Rush University Medical Center, Oak Park, IL, USA; 10Department of Pain Management, Insight Institute of Neurosurgery & Neuroscience, Flint, MI, USA; 11Pain Institute of Southern Arizona, Tucson, AZ, USA; 12Mays and Schnapp Neurospine and Pain, Memphis, TN, USA; 13Department of Pain Management, Erie County Medical Center, Buffalo, NY, USA; 14Department of Anesthesiology and Critical Care Medicine, Johns Hopkins Bayview Medical Center, Baltimore, MD, USA; 15Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA; 16Department of Physical Medicine & Rehabilitation, Larkin Hospital Health System, Miami, FL, USA; 17Department of Pain Management at Northern Light Health – Eastern Maine Medical Center, Bangor, ME, USA; 18Department of Pain Medicine, University of California Davis Health System, Sacramento, CA, USA; 19Department of Physical Medicine & Rehabilitation, Montefiore Medical Center, Bronx, NY, USA; 20Department of Physical Medicine & Rehabilitation, Michigan State University, Lansing, MI, USA; 21Department of Anesthesiology and Perioperative Medicine, Rutgers Robert Wood Johnson, New Brunswick, NJ, USA; 22Department of Anesthesiology, Washington University School of Medicine in St. Louis, St. Louis, MO, USACorrespondence: Marcin Karcz, The Spine and Nerve Centers of the Virginias, Charleston, WV, USA, Email drmarcinkarcz@gmail.comAbstract: Pain serves as a vital innate defense mechanism that can significantly impact an individual’s quality of life. Understanding the physiological effects of pain well plays an important role in developing novel pain treatments. Nociceptor neurons play a key role in pain and inflammation. Interactions between nociceptors and the immune system occur both at the site of injury and within the central nervous system. Modulating chemical mediators and nociceptor activity offers promising new approaches to pain management. Essentially, the sensory nervous system is essential for modulating the body’s protective response, making it critical to understand these interactions to discover new pain treatment strategies. New innovations in neuromodulation have led to alternatives to opioids individuals with chronic pain with consequent improvement in disease-based treatment and nerve targeting. New neural targets from cellular and structural perspectives have revolutionized the field of neuromodulation. This narrative review aims to elucidate the mechanisms of pain transmission and processing, examine the characteristics and properties of nociceptors, and explore how the immune system influences pain perception. It further provides an updated overview of the physiology of pain and neuromodulatory mechanisms essential for managing acute and chronic pain. We assess the current understanding of different pain types, focusing on key molecules involved in each type and their physiological effects. Additionally, we compare painful and painless neuropathies and discuss the neuroimmune interactions involved in pain manifestation.Keywords: neurons, nociceptive pain, neuropathic pain, nociplastic pain, physiological effects, pain pathways, sensitization

This article establishes the functional average as an important estimand for causal inference. The significance of the estimand lies in its robustness against traditional issues of confounding. We prove that this robustness holds even when the probability distribution of the outcome, conditional on treatment or some other vector of adjusting variables, differs almost arbitrarily from its counterfactual analogue. This article also examines possible estimators of the functional average, including the sample mid-range, and proposes a new type of bootstrap for robust statistical inference: the Hoeffding bootstrap. After this, the article explores a new class of variables, the U{\mathcal{U}} class, that simplifies the estimation of functional averages. This class of variables is also used to establish mean exchangeability in some cases and to provide the results of elementary statistical procedures, such as linear regression and the analysis of variance, with causal interpretations. Simulation evidence is provided. The methods of this article are also applied to a National Health and Nutrition Survey data set to investigate the causal effect of exercise on the blood pressure of adult smokers.

Yair Humberto González-Tuyub,1 Karla Daniela González-Iñiguez,1 Paula Catalina Lizarazo-Guiza,2 Sergio Ricardo García-García3 1Clinical Immunology and Allergy Service, ISSSTE Hospital Regional General, Ignacio Zaragoza, Ciudad de México, México; 2Medical Scientific Liaison, AstraZeneca, Ciudad de México, México; 3Clinical Research, HS Estudios Farmacoeconómicos SA de CV, Ciudad de México, MéxicoCorrespondence: Yair Humberto González-Tuyub, Clinical Immunology and Allergy Service, ISSSTE Hospital Regional General, Calz, Ignacio Zaragoza, 1840, Juan Escutia, Iztapalapa, 09100 Iztapalapa, Ciudad de México, México, Email yair.gonzalezz@gmail.comBackground: Asthma is a health condition with worldwide relevance, evaluated based on the necessary treatment to control symptoms and exacerbations. Severe asthma is uncontrolled despite high doses of ICS-LABA and treatment for triggering factors. Severe eosinophilic asthma is characterized by an increase in eosinophils in the peripheral circulation, walls, and passages of the respiratory tract. Biologic treatments such as benralizumab have demonstrated effectiveness as aids in decreasing respiratory tract inflammation and improving the management of symptoms in patients living with asthma.Objective: To assess the efficacy and safety of benralizumab as an add-on therapy for patients with severe, uncontrolled asthma and elevated blood eosinophil counts.Methods: Observational, analytic and ambispective study in 21 patients diagnosed with severe eosinophilic asthma treated with benralizumab, to determine the treatment’s effectiveness through the change in estimated respiratory function by spirometry through the forced expiratory volume in one second (FEV1) value, reduction in second controlling treatment, serum eosinophil reduction, change in the Asthma Control Test score and the Asthma Control Questionnaire test at 6 and 16 months of treatment.Results: An average difference of 241.43 mL (± 461.43) in FEV1 at 6 months was found, as well as an average FeNO reduction of 49.8 ppm and eosinophil reduction of 612.78 cells at 12 months of treatment, additionally, CSI requirements were reduced in 95% of patients.Conclusion: Benralizumab improved respiratory function as well as key biomarkers such as eosinophil count, exhaled nitric oxide fraction (FeNO), which reflected in a decreased requirement of inhaled corticosteroids and improved symptom control.Keywords: asthma, eosinophils, benralizumab, biologics, CSI-LABA therapy

Anthony Giuffrida,1 Christy Saia-Owenby,2 Chris Andriano,3,* Douglas Beall,4,* Ashley Bailey-Classen,5,* Patrick Buchanan,6,* Ryan Budwany,7,* Mehul J Desai,8,* Ashley Comer,9,* Andrew Dudas,10,* Vinicius Tieppo Francio,11,* Warren Grace,12,* Benjamin Gill,13,* Betsy Grunch,14,* Andrew Goldblum,13,* Rosa A Garcia,15,* David W Lee,16,* Chad Lavender,17,* Marco Lawandy,18,* Lyric Mandell,2,* Robin Mata,19,* Morteza Rabii,20,* Kiran Patel,21,* Raj G Patel,22,* Ankur A Patel,23,* Dawood Sayed,24,* Gurtej Singh,25,* Natalie Strand,26,* Jordan Tate,27,* Michael E Schatman,28 Timothy Deer29 1Cantor Spine Center, Paley Orthopedic and Spine Institute, Fort Lauderdale, FL, USA; 2MOXY Company, Covington, LA, USA; 3Georgia Pain Care, Stockbridge, GA, USA; 4Oklahoma Spine Hospital, Oklahoma City, OK, USA; 5Trinity Pain Medicine Associates, Fort Worth, TX, USA; 6Spanish Hills Interventional Pain Specialists, Camarillo, CA, USA; 7Center for Pain Relief, Charleston Area Medical Center, Charleston, WV, USA; 8International Spine, Pain, and Performance Center, Washington, DC, USA; 9The Spine and Nerve Centers of the Virginias, Charleston, WV, USA; 10Maya & Schnapp, Neurospine and Pain, Memphis, TN, USA; 11Anesthesiology and Pain Medicine, University of Kansas, Kansas City, KS, USA; 12Redefine Healthcare, Orthopedic Pain and Spine Center, Edison, NJ, USA; 13Physical Medicine and Rehabilitation, University of Missouri, Columbia, MO, USA; 14Longstreet Clinic, Gainesville, GA, USA; 15Larkin Hospital Health Systems, Miami, FL, USA; 16Interventional Pain and Spine, Fullerton Orthopedics, Yorba Linda, CA, USA; 17Department of Orthopaedics, Marshall University, Huntington, WV, USA; 18Physical Medicine and Rehabilitation, Montefiore Medical Center, New York, NY, USA; 19Department of Physical Medicine and Rehabilitation, University of Miami, Miami, FL, USA; 20Crimson Pain Management, Overland Park, KS, USA; 21Pain Medicine and Anesthesiology, Northwell Health, New York, NY, USA; 22Central Texas Interventional Pain Doctor, Capitol Pain Institute, Austin, TX, USA; 23Department of Neurological Surgery, UT Southwestern Medical Center, Dallas, TX, USA; 24Department of Pain Medicine and Neurology, University of Kansas Health System, Kansas City, KS, USA; 25Department of Pain Medicine, Rehabilitation, and Pain Medicine, the Center for Advance Orthopaedics, Cantonsville, MD, USA; 26Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Phoenix, AZ, USA; 27Department of Pain Medicine and Physical Medicine and Rehabilitation, Southern Pain and Spine, Jasper, GA, USA; 28Department of Anesthesiology, Perioperative Care, and Pain Medicine at NYU Grossman School of Medicine, New York, NY, USA; 29Department of Pain Management, Spine and Nerve Centers of the Virginias, Charleston, WV, USA*These authors contributed equally to this workCorrespondence: Lyric Mandell, MOXY Company, Covington, LA, USA, Email lyric@moxycompany.comPurpose: The American Society of Pain and Neuroscience (ASPN) identified a significant gap in resources and guidelines that aim to educate healthcare providers for best practices when engaging on social media. As part of the broader initiatives on Spine and Nerve practice, the executive board of ASPN has decided it would be beneficial to include comprehensive guidance for healthcare providers when engaging on social media.Methods: A panel of experts was chosen based on expertise, publications, diversity, and their social media presence. Along with expert guidance, the committee conducted an extensive analysis of peer-reviewed literature in communication and medical journals to determine best practices for healthcare practitioners on social media.Results: Social media messages significantly impact patients’ and colleagues’ perceptions and actions regarding medical issues. As such, providers and their teams must be aware of legal and ethical considerations in healthcare while maintaining a consistent, educational, and digestible persona online.Conclusion: The advancement of communication and medical technologies and systems necessitates continued education and resources to adapt to our rapidly changing media and medical landscape.Keywords: digital communication, social networking sites, healthcare providers, best practices, physician communication, social media, medical marketing, spine

Ada Regina Trindade de Almeida,1 Patricia E Garcia,2 Raul Banegas,3 Silvia Zimbres,4 Carolina Martinez,5 Jan Frolik,6 Camila Cazerta de Paula Eduardo7 1Clínica Dermatológica, São Paulo, Brazil; 2Private Practice, Puerto Vallarta, Mexico; 3Banegas Estética Médica, Buenos Aires, Argentina; 4Clinica Doux, São Paulo, Brazil; 5Private Practice, Bogotá, Colombia; 6Allergan Aesthetics, an AbbVie Company, Irvine, CA, USA; 7Allergan Aesthetics, an AbbVie Company, São Paulo, BrazilCorrespondence: Ada Regina Trindade de Almeida, Clínica Dermatológica, Hospital do Servidor Público Municipal de São Paulo, Rua Turiassu, 390 - 11 Andar - Cj. 113/114, Perdizes, São Paulo/Sp - Cep, 05005-000, Brazil, Tel +55 11 3864-1816, Email artrindal@uol.com.brAbstract: The rich and diverse heritage of Latin American people contributes to a large variety of physical features, which translates to a patient population with a range of motivations for seeking cosmetic procedures and unique perspectives that influence their aesthetic preferences. As there is no one standard of beauty, it is important for physicians to understand the various factors that influence their patients’ perceptions of beauty and desires to seek cosmetic treatment, especially because patient preference may differ from the physician perspective. Physicians in Latin America must consider the demographic, ethnic, and cultural factors that influence their patients to ensure culturally sensitive treatment approaches, natural-looking results, and patient satisfaction. This review includes a discussion of published literature, combined with the expert opinion of the authors, to provide a detailed description of the elements that impact aesthetic perceptions of patients living across the Latin American diaspora and highlights important gaps in research for future studies to address.Keywords: aging, beauty, ethnicity, Hispanic, Latino, Latinx, physiology

Eduardo Garcia-Pachon, Isabel Padilla-Navas Section of Respiratory Medicine, Hospital General Universitario de Elche, Elche, Alicante, SpainCorrespondence: Eduardo Garcia-Pachon, Section of Respiratory Medicine, Hospital General Universitario de Elche, Elche, Alicante, 03203, Spain, Email egpachon@gmail.comPurpose: Anemia is a risk factor for mortality within the general population and is notably prevalent among individuals with chronic obstructive pulmonary disease (COPD). Our objective was to investigate the impact of anemia on the long-term mortality risk of hospitalized COPD patients. Additionally, we aimed to identify the cause of mortality to assess whether it was different in relation to the presence of anemia.Patients and Methods: This was an observational retrospective analysis of prospectively collected data of consecutive patients admitted because of COPD exacerbation. Clinical characteristics, the presence of anemia, months of survival and cause of death if occurred, were recorded. Patients were categorized into two groups: anemic (for women hemoglobin level < 12 g/dL and for men hemoglobin level < 13 g/dL) and non-anemic. Survival analysis was conducted using Kaplan-Meier curves and Cox proportional hazard regression analysis.Results: A total of 125 patients (20% women) were included in the study. Among them, 31 (25%) were identified as anemic, By the conclusion of the study, 59 patients (47%) had died: 27 out of 31 anemic patients (87%) and 32 out of 94 non-anemic patients (34%) (p< 0.001). Anemia was a robust predictor of mortality one year after admission (adjusted hazard ratio HR; 5.20 [1.86– 14.55]); three years after admission (HR 4.30 [2.03– 9.10]), and at the study’s termination (with a follow-up period ranging from a minimum of 38 months to a maximum of 56 months) (HR; 3.80 [1.96– 7.38]). Mortality in the group of patients with anemia was of 27 individuals (87%) and 32 (34%) in patients without anemia (p< 0.001). The causes of mortality in patients with or without anemia were similar.Conclusion: The detection of anemia upon admission for COPD exacerbation serves as a robust predictor of mortality in the subsequent years.Keywords: anemia, COPD, hospitalization, mortality, prognosis

Dulce Dajheanne Garcia-de la Cruz,1,2 Isela Esther Juarez-Rojop,2 Carlos Alfonso Tovilla-Zarate,3 Humberto Nicolini,4 Alma Delia Genis-Mendoza4,5 1Unidad de Enseñanza e Investigación, Hospital Regional de Alta Especialidad de Salud Mental Villahermosa, Tabasco, México; 2Laboratorio de Metabolismo de Lípidos, Universidad Juárez Autónoma de Tabasco, División Académica de Ciencias de la Salud, Villahermosa, Tabasco, México; 3Universidad Juárez Autónoma de Tabasco, División Académica Multidisciplinaria de Comalcalco, Tabasco, México; 4Laboratorio de Genómica de las Enfermedades Psiquiátricas y Neurodegenerativas, Instituto Nacional de Medicina Genómica, Ciudad de México, México; 5Hospital Psiquiátrico Infantil, Dr. Juan N. Navarro, Ciudad de México, MéxicoCorrespondence: Alma Delia Genis-Mendoza, Email adgenis@inmegen.gob.mxPurpose: Cognitive domains are affected in patients with schizophrenia. Mitochondrial dysfunction has been proposed as a possible origin of these symptoms. Cell-free mitochondrial DNA (cf-mtDNA) is an indicator of cellular stress, and it can be identified in individuals with age-associated disorders, this study aimed to explore the presence of cf-mtDNA in plasma of schizophrenia patients and its association with cognitive deficit.Patients and Methods: Ninety-nine subjects were clinically evaluated; the case group included 60 patients diagnosed with schizophrenia and 39 randomly-individuals without psychiatric disorders were included in the comparison group. Cognitive status (MoCA scale) and cell-free mtDNA in blood plasma were assessed and quantified in both groups.Results: From the original sample, cf-mtDNA was identified in 43 subjects, 40 patients with schizophrenia and 3 controls (&KHgr;2 = 31.10, p-value < 0.0001). Thirty-nine out of forty patients with schizophrenia had a cognitive deficit.Conclusion: According to our findings, cognitive impairment and presence of cf-mtDNA were related in subjects with schizophrenia. Thus, while the cognitive deficit might reflect an accelerated aging process, the cf-mtDNA plays a role as a potential biomarker in this mechanism.Keywords: schizophrenia, cell free mitochondrial DNA, cognitive impairment, mitochondrial dysfunction

Muhammad B Qureshi,1 Jose O Garcia,1 Jaxon Quillen,2 Carolyn Mead-Harvey,2 Christina Wentz,3 Cherie B Nau,4 Muriel Schornack,4 Keith Baratz,4 Sanjay V Patel,4 Joanne Shen5 1Mayo Clinic Alix School of Medicine, Scottsdale, AZ, USA; 2Department of Quantitative Health Sciences, Mayo Clinic, Scottsdale, AZ, USA; 3Illinois College of Optometry, Chicago, IL, USA; 4Department of Ophthalmology, Mayo Clinic, Rochester, MN, USA; 5Department of Ophthalmology, Mayo Clinic, Scottsdale, AZ, USACorrespondence: Joanne Shen, Department of Ophthalmology, Mayo Clinic, 13400 E Shea Blvd, Scottsdale, AZ, USA, 85259, Tel +1 480-301-8085, Fax +1 480-301-7326, Email shen.joanne@mayo.eduPurpose: To compare baseline characteristics and treatment of chronic ocular graft-versus-host disease (oGVHD) patients in two treatment locations.Patients and Methods: Patients diagnosed with definite chronic oGVHD between September 1, 2014 and September 20, 2021 at two locations were identified. IRB-approved retrospective chart review was conducted for the following data: demographic information, ocular surface disease index (OSDI), corneal fluorescein staining (CFS), and treatment(s) used. Differences by site were assessed using Pearson’s Chi-Square tests and two-sample t-tests; differences by time were assessed using paired t-tests.Results: At baseline, Clinic 1 (C1) patients had a worse mean OSDI score (47.8 vs 36.3, p = 0.011) and CFS in both OD (1.3 vs 0.8, p = 0.005) and OS (1.3 vs 0.6, p < 0.001) compared to Clinic 2 (C2). Comparing baseline to endpoint, C1 patients experienced an improvement in OSDI (− 17.26, p < 0.001), CFS OD (− 0.50, p < 0.001), and CFS OS (− 0.51, p < 0.001) at C1. Change in OSDI, CFS OD, or CFS OS was not statistically significant at C2. Despite similar follow-up length, C1 demonstrated more clinic visits (10.4 vs 3.4, p < 0.001) and more treatment trials (4.9 vs 2.4, p < 0.001) compared to C2. Punctal plugs (85.5% vs 61.2%, p = 0.002), punctal cautery (69.7% vs 28.6%, p < 0.001), topical steroids (72.4% vs 22.4%, p < 0.001), and autologous serum tears (AST) (52.6% vs 8.2%, p < 0.001) were used more frequently at C1 than at C2.Conclusion: oGVHD patients at C1 experienced significant improvement in OSDI and corneal fluorescein staining and compared to patients at C2, had more frequent follow-up and use of punctal plugs, punctal cautery, topical steroids, and AST.Keywords: graft-versus-host disease, GVHD, chronic GVHD, dry eye disease, ocular GVHD, keratoconjunctivitis sicca, KCS

Thinning is an expensive and time-consuming management practice used in peach orchards to improve resource distribution among plants and improve production quality. Determining the right time and intensity for thinning is challenging and involves expertise. Furthermore, it generally consumes many hours of work, which makes, in some cases, unfeasible to analyze an entire orchard. For this reason, information that can assist in making making decisions about thinning can improve the cost–benefit ratio of the technique. To mitigate these problems, an electronic nose system, the e-nose, that explores the relationship between the smell of peach trees outdoors and the different growth phases was developed. Twenty-two composed volatile samples were collected from around peach trees (open environment) during its reproductive period (around 39 days) and five supervised machine learning classification algorithms (k-nearest neighbors (KNN), multilayer perceptron (MLP), random forest (RF), logistic regression (LR), and support vector machine (SMV)) were used to analyze the data, to evaluate the possibility of estimating phenological stages from odor environment. The result showed that all models achieved a balanced accuracy greater than 97.5%. As a secondary contribution, the importance of sensors was also analyzed for this application, and a combination of three sensors achieved a classification rate of 100% with the KNN classifier. The e-nose system was successful in distinguishing between petal drop, initial fruit formation, advanced fruit formation, and formed fruit. These results demonstrate the potential of using an electronic nose in a remote system to assist in decision-making in orchard practices as thinning.

João Guerreiro,1 Laura Schulze,1 Albert Garcia i Tormo,1 Amanda J Henwood,1 Luc Schneider,1,2 Elise Krob,1 Sarah Salvilla,3 Kelly MY Chan,3 Sarah Deedat,3 Aleksandar Matic1 1R&D, Koa Health, Barcelona, Spain; 2Department of Management, LSE, London, UK; 3FWD Group, FWD Group, Hong Kong, People’s Republic of ChinaCorrespondence: João Guerreiro, R&D, Koa Health, Carrer de la Ciutat de Granada 121, Barcelona, 08018, Spain, Email joao.leitaoguerreiro@koahealth.comAbstract: Sleep, an intrinsic aspect of human life, is experienced by individuals differently which may be influenced by personality traits and characteristics. Exploring how these traits influence behaviors and sleep routines could be used to inform more personalized and effective interventions to promote better sleep. Our objective was to summarize the existing literature on the relationship between personality traits and sleep patterns through a systematic review. An abstract and keyword search was conducted in PsycINFO, Cochrane and PubMed, collecting relevant literature, published between January 1980 and June 2024. A total of 1713 records were found, of which 18 studies were analyzed in the descriptive synthesis. Relevant studies covered populations in 11 different countries, Australia, China, Estonia, Finland, Germany, Italy, Japan, Poland, Turkey, the United Kingdom, and the United States, comprising a total of 58,812 subjects. All studies reported an association between a sleep pattern with at least one of the Big Five personality traits (agreeableness, conscientiousness, extraversion, neuroticism, openness to experience). Ten studies found associations between personality and sleep quality, all of which reported a link between neuroticism and sleep quality (effect sizes 0.183-0.40). Five studies found an association between conscientiousness and morningness (effect sizes 0.16-0.35). Other sleep patterns linked to personality traits included sleep duration, nightmare frequency and distress, sleep deficiency, sleep continuity, insomnia severity and sleep problems, sleep hygiene, sleep latency and daytime sleepiness. This novel systematic review confirms that sleep and personality traits are related, suggesting that those traits should be considered when trying to understand or change one’s sleep behavior.Keywords: personality traits, sleep patterns, big five, sleep quality, chronotype

Abel Ramirez-Estudillo,1,2 Sergio Rojas-Juarez,2 Ximena Ramirez-Galicia,1 Angel Garcia-Vasquez,2 Silvia Medina-Medina,2 Rosario Gulias-Cañizo1,3 1Centro Oftalmológico Mira, Mexico City, Mexico; 2Retina Department, Fundación Hospital Nuestra Señora de la Luz, Mexico City, Mexico; 3Centro de Investigación en Ciencias de la Salud, Universidad Anahuac, Estado de Mexico, MexicoCorrespondence: Abel Ramirez-Estudillo, Rosario Gulias-Cañizo, Centro Oftalmológico Mira, Taxco 35, Col. Roma Sur, C.P. 06760, Mexico City, Mexico, Email ramirezestudillo@gmail.com; rosariogulias@gmail.comIntroduction: Maculopathy secondary to pathologic myopia (PM) is increasingly causing visual impairment and blindness worldwide. PM is associated with tractional maculopathy that ranges from macular foveoschisis to macular hole. These disorders are treated with different options that offer variable results, reflecting the need for new techniques that address myopic maculopathy with consistent outcomes.Methods: Since human amniotic membrane (HAM) has been reported to be safe for intraocular use and to promote retinal healing, it was incorporated as an adjuvant in pars plana vitrectomy in patients with different tractional disorders related to myopia. This work presents a prospective, consecutive case series of seven patients with high myopia who underwent a 25-gauge vitrectomy with ILM peeling and HAM transplantation.Results and Discussion: Our six-month results show that this novel technique delivers functional success related to tissue permanence without recurrence of traction that translates into visual acuity gain and maintenance that are superior to other techniques.Keywords: retinal surgery, macular surgery, lyophilized amniotic membrane, amniotic membrane patch, LAMPatch, myopic traction maculopathy, macular hole, retinal detachment

Désirée Larenas-Linnemann,1 Blanca María Morfín-Maciel,2 Victor Gonzalez-Uribe,3 Claudia Ivonne Gallego-Corella,4 Germán Agustín Rico-Solís,5 Luiana Hernández-Velázquez,6 Daniel García-Imperial,7 Chrystopherson Gengyny Caballero-Lopez,8 Ondina Marlene Garibay-Vargas,9 José Luis Gálvez-Romero,10 Daniela García Fajardo,11 Joel Barroso-Santos,12 Herberth de Jesús Pérez-Áviles,13 Jorge Agustín Luna-Pech,14 Cecilia Yvonne García-Cobas,15 Kareli Guadalupe Coronado-Hernández,16 Margarita Ortega-Cisneros,17 Carlos Humberto González-Gutiérrez,18 Daniela Rivero-Yeverino,8 Elsy Maureen Navarrete-Rodríguez,19 Leticia Lezama-Vázquez,20 Karen Lilian Rivera-Alvarado,21 Georgina Guadalupe Ochoa-López,22 Sara Elizabeth Covarrubias-Ramírez,23 Claudia Patricia Reyes-Galindo,24 Beatriz Bayardo-Gutiérrez,25 María del Carmen Calderón-Ezquerro26 1Centro de Excelencia en Asma y Alergia Larenas, Hospital Médica Sur, Mexico City, DF, Mexico; 2Private practice, Mexico City, DF, Mexico; 3AlergiaMx, Mexico City, DF, Mexico; 4Centro de Alergia y Asma de Tijuana, Tijuana, BCN, Mexico; 5Hospital Regional Valentín Gómez Farías, Department of Allergy and Clinical Immunology, Colima, COL, Mexico; 6IMSS Hospital General de Zona Número 8, Ensenada, BCN, Mexico; 7Private Practice, Querétaro, QRO, Mexico; 8Hospital Universitario de Puebla, Benemérita Universidad Autónoma de Puebla, Puebla, PUE, Mexico; 9Private practice, Uruapan, MICH, Mexico; 10Jefatura de investigación, Hospital Regional ISSSTE, Puebla, PUE, Mexico; 11Private Practice, San Luis Potosí, SLP, Mexico; 12Private practice, Pachuca, HGO, Mexico; 13Private Practice, Mérida, YUC, Mexico; 14Departamento de Disciplinas Filosófico, Metodológico e Instrumentales, CUCS, Universidad de Guadalajara, JAL, Mexico; 15Alergia e Inmunología, HGR 46, Instituto Mexicano del Seguro Social, Guadalajara, JAL, Mexico; 16Centro Médico Nacional del Occidente Pediatrics, Guadalajara, JAL, Mexico; 17Centro Médico Nacional de Occidente UMAE Hospital de Especialidades, Department of clinical immunology and allergy, Guadalajara, JAL, Mexico; 18HGZ &num; 1 IMSS, Zacatecas, ZAC, Mexico; 19Hospital Infantil de México ‘Federico Gómez’, Mexico City, DF, Mexico; 20Private practice, Tuxtla-Gutiérrez, CHIS, Mexico; 21IMSS UMAE 14, Veracruz, VER, Mexico; 22Private practice, Ciudad Juárez, CHIH, Mexico; 23Plebitos, Especialidades Pediátricas, Mazatlán, SIN, Mexico; 24ISSSTE, Ciudad Victoria, TAMPS, Mexico; 25Centro Médico Nacional de Occidente UMAE Hospital de Especialidades, Departamento de Inmunología Clínica y Alergia, Hospital Regional ISSSTE, Puebla, PUE, Mexico; 26Instituto de Ciencias de la Atmósfera y Cambio Climático, Universidad Autónoma de México, Mexico City, DF, MexicoCorrespondence: Désirée Larenas-Linnemann, Centro de Excelencia en Asma y Alergia Larenas, Hospital Médica Sur, Torre 2 cons. 602, Puente de Piedra 150, Col. Toriello Guerra, Del. Tlalpan, Ciudad de México, 14050, Mexico, Tel +52-55-5171-2248 ; +5606-6222 Ext.4372 ; +52-55-8509-5950, Email marlar1@prodigy.net.mxIntroduction: Aeroallergen exposure has an intra- and extra-domiciliary component and varies according to climatological zones. Mexico is a large country with a great variety of climates. A previous study (2009) evaluated skin prick test results (SPT) in different regions. In this study, we compare previous sensitization patterns from 14y ago with current ones and compare them between different climatological zones.Methods: Mexican allergists were asked to share their last 100 SPT results in patients with respiratory allergy. Clinics were grouped in (semi)humid vs (semi)dry zones. Results were analyzed nationwide and compared to the 2009 results, calculating odds ratio (OR) and 95% confidence intervals (95% CIs), with p < 0.05 as cut-off. Similarly, we compared (semi)humid versus dry zones.Results: We collected 2915 SPT results from 28 clinics (19 cities). Dermatophagoides was the most frequently sensitizing allergen. There was a significant increase in SPT positivity from 2009 to 2023 in both in- and outdoor aeroallergens (OR 1.26– 2.65, 95% CI from 1.06– 1.50 to 1.99– 3.52). Comparing dry-humid zones, sensitization to pollen from Oleaceae, Fagaceae (p < 0.0001 all) and most weeds is more frequent in humid zones, as are Dermatophagoides and cockroach (both p < 0.0001). Eucalyptus, mesquite, and all grass pollen sensitizations predominate in dry zones (p < 0.05– 0.0001). There are no differences in sensitization to cat or dog between zones.Conclusion: We found a general increase in SPT sensitization over the past fourteen years, suggesting that this is probably not only due to climate change. The different sensitization profile throughout the country was mainly related to humidity. Repeating epidemiologic SPT studies over the years could help tracking changes in allergen sensitization over time.Keywords: allergy, diagnosis, skin prick testing, aeroallergen, climate change, pollen allergy, allergic rhinitis, allergic asthma

Microsporum canis is a dermatophyte that mainly affects dogs and cats. However, it can be transmitted to humans by direct contact. This makes it one of the most frequent causative agents of dermatophytosis in humans, reflecting the frequent human close relationships with pets. Conventional treatment relies on antifungal pharmacological agents. However, errors in application have led to the occurrence of fungal resistance and toxic effects. Consequently, new therapeutic alternatives are needed for M. canis infections. Plant extracts have been explored as phytotherapeutics for the treatment of dermatophyte infections, which prompted an attempt to apply extracts of the ethnopharmacologically important plants Artemisia ludoviciana and Cordia boissieri.

Patricia Muñoz-Villegas,1,2 Gisela García-Sánchez,1 Ricardo O Jauregui-Franco,1 Sebastian Quirarte-Justo,1 Alejandra Sánchez-Ríos,1 Oscar Olvera-Montaño1 1Regional Medical Affairs Department, Laboratorios Sophia, S.A. de C.V., Zapopan, Jalisco, Mexico; 2Centro de Investigación en Matemáticas, A.C., Unidad Aguascalientes (CIMAT), Aguascalientes, Aguascalientes, MexicoCorrespondence: Patricia Muñoz-Villegas, Laboratorios Sophia, S.A. de C.V., Paseo del Norte 5255, Technology Park, Zapopan, Jalisco, 45010, México, Tel +52 33 3001 4200, Email patricia.munoz@sophia.com.mxBackground: This research aims to investigate the influence of environmental factors on the treatment efficacy of ocular lubricants in patients from urban areas with dry eye disease (DED).Methods: A phase IV clinical trial, which included 173 patients from major cities in Mexico, was randomly assigned to use ocular lubricants four times a day for 30 days. Ocular Surface Disease Index (OSDI), noninvasive tear film break-up time (NIBUT), ocular staining, and conjunctival hyperemia (CH) among other factors like weather, and air pollution as covariates were analysed.Results: After 30 days, OSDI score decreased by 14.8 points (p< 0.001), and NIBUT increased by 2.9 seconds (p< 0.001), with longer values observed in patients recruited in autumn and winter (additional 1.8 seconds, p< 0.05) compared to those recruited in spring. Patients living in cities with cooler weather and high humidity, but low air quality had higher OSDI and conjunctival stain scores of up to 4.4 and 0.3 points, respectively, as compared to those living in cities with similar pollution and humidity levels but with higher temperatures (p-values= 0.019 and 0.050). Patients with moderate CH had an increase of up to 0.8 points in their corneal stain score (p< 0.010). We also found that ozone levels were related to the predicted changes in OSDI and NIBUT.Conclusion: This study demonstrated the impact of environmental factors on the signs and symptoms of DED and suggests that patients residing in cities with inadequately controlled air pollution can benefit from using ocular lubricants to alleviate their symptoms.Trial Registration: Trial is registered at clinicaltrials.gov (NCT04702776).Keywords: Dry eye disease, dry eye symptoms, dry eye signs, environmental factors, ocular lubricants

La participación de las mujeres en la vida pública ha visibilizado la violencia que estas experimentan debido al predominio de un modelo social patriarcal. El objetivo del artículo es analizar el nivel de exigencia normativa de la Ley 10235 Para prevenir, atender, sancionar y erradicar la violencia contra las mujeres en la política en Costa Rica; con base en la aplicación del índice de exigencia normativa (IEN) Lo anterior con el propósito de dilucidar el funcionamiento del derecho en una de las democracias más sólidas de la región latinoamericana como es la costarricense. Los resultados muestran que en la norma hay cuestiones centrales para el tratamiento de la violencia contra las mujeres en la política ausentes o no especificadas. Únicamente respecto a la tipificación de la violencia política en razón de género esta ley se apega a lo establecido por la Ley Modelo Interamericana para Prevenir, Sancionar y Erradicar la Violencia contra las Mujeres en la Vida Política (2017). Concluye que la exigencia normativa de la Ley 10235 es baja, por lo que es indispensable profundizar el análisis de los procesos jurídicopolíticos y las implicaciones de su limitado alcance para el fortalecimiento de la democracia en el país.

Xabier Aizpurua-Arruti,1,2 Shalom Charlie I Benrimoj,3 Estibaliz Goyenechea,1 Arantxa Isla,2,4 Ainhoa Oñatibia-Astibia,1 Amaia Malet-Larrea,1 Miguel Ángel Gastelurrutia,1,3 Olatz Cuevas,1 Julen Rodríguez-Castejón,2,4 Saioa Domingo-Echaburu,5 María Ángeles Solinís,2,4 Montserrat García,6 Ana del Pozo-Rodríguez2,4 1Official Pharmacist Association of Gipuzkoa, Donostia / San Sebastián, Spain; 2Pharmacy Practice Research Group, PharmaNanoGene Group, Faculty of Pharmacy, University of the Basque Country UPV/EHU, Vitoria-Gasteiz, Spain; 3Pharmaceutical Care Research Group, Faculty of Pharmacy, University of Granada, Granada, Spain; 4Bioaraba, Microbiology, Infectious Disease, Antimicrobial Agents, and Gene Therapy, Vitoria-Gasteiz, Spain; 5Osakidetza Basque Health Service, Debagoiena Integrated Health Organisation, Pharmacy Service, Arrasate, Spain; 6Basque Country Pharmacovigilance Unit, Osakidetza Basque Health Service, Galdakao-Usansolo Hospital, Galdakao, SpainCorrespondence: Ana del Pozo-Rodríguez, Pharmacy Practice Research Group, PharmaNanoGene Group, Faculty of Pharmacy, University of the Basque Country UPV/EHU, Vitoria-Gasteiz, Spain, Email ana.delpozo@ehu.eusPurpose: Additional monitoring (AM) medicines include (i) medicines containing a new active substance; (ii) biological medicines; (iii) medicines with conditional approval or authorized in special situations; (iv) medicines which require further studies; (v) medicines that have specific requirements regarding the reporting of suspected adverse drug reactions (ADRs). When AM medicines are marketed, their most common ADRs are known, but safety information is limited because relatively rare ADRs are often not detected in clinical trials. Their AM status warrants real-world studies to identify other safety issues; however, such studies are lacking. Correct use and adherence to dosage regimen by patients are key factors for the evaluation of the safety and efficacy of medicines. The objective of this work was assessing the impact on safety, adherence, use and knowledge (U&K) about medicines and patient’s quality of life (QOL), of community pharmacist (CP)-led interventions in a new service focused on AM medicines targeted at three prevalent chronic diseases: diabetes mellitus type 2, chronic obstructive pulmonary disease and cardiovascular disease.Patients and Methods: A prospective interventional cohort study was conducted with a 6-month follow-up in 27 community pharmacies (145 patients). Safety, adherence to treatment, patient U&K and QOL were assessed at follow-up visits (months 0, 3 and 6).Results: The number of detected ADRs was 163 with 41 patients referred to the doctor. At baseline, 24.1% of the patients were non-adherent, mainly due to unintentional causes. After six months and 130 interventions by CPs on adherence, a significant reduction to lower than 5.8% was achieved. The inadequate U&K of medicines also decreased, from 47.6% to 7.9% after 182 interventions. Also, the patient’s QOL improved.Conclusion: A new patient-centered pharmacy service provides some evidence on the important role of CP in assisting the proper and safe use of AM medicines, improving patient health outcomes. Keywords: community pharmacy, medicines under additional monitoring, safety, adherence, use and knowledge, pharmaceutical care

Rafael Pichardo-Rodriguez,1 Valeria Altuna-Moscoso,1 Karen Aviles-Antezana,1 Alondra Lorena Cahuana-Mendoza,1 Antonio André Challco Alvarado,1 Cristhian Gonzales-Rospigliosi,1 Shirley Oscco-Coila,1 Enzo Rafael-Tarazona,1 Marcos Saavedra-Velasco,1 Liz Cordova-Cueva,1 Jhony A De La Cruz-Vargas,1 Fernando Munayco-Guillen,1,2 Herney Andrés García-Perdomo3 1Instituto de Investigaciones en Ciencias Biomédicas (INICIB), Universidad Ricardo Palma, Lima, Perú; 2Instituto Nacional de Oftalmología (INO), Lima, Peru; 3Division of Urology/Uro oncology, Department of Surgery, School of Medicine, Universidad del Valle, Cali, ColombiaCorrespondence: Rafael Pichardo-Rodriguez, Email rafael_martin1352@hotmail.comObjective: To determine the quality of systematic reviews submitted as a thesis in the Medical School of Ricardo Palma University.Methods: We conducted a systematic review. We included systematic reviews submitted as theses from Ricardo Palma University, and we excluded narrative reviews, editorials, clinical experiments, and those with incomplete data. We performed a structured search on EMBASE, PubMed, Scopus, and Institutional Repository from the Ricardo Palma University and RENATI. The risk of bias assessment was performed through the AMSTAR-2 and the modified AMSTAR-2 tools. The primary outcome was review quality. A qualitative synthesis of the information was performed.Results: One thousand four hundred eighty-seven theses were identified, and exclusion criteria were applied, whereby 11 theses were selected for review and thorough consultation. Of the 11 selected theses, and through the AMSTAR-2 and modified AMSTAR-2 tools, the findings reached were that 90.9% of the included theses presented critically low quality that was not modified even when the quality was reevaluated after its publication as a scientific article.Conclusion: The systematic reviews presented as undergraduate thesis in the Medical School of Ricardo Palma University showed low and critically low quality. Improvement in systematic review training is required for both students and institutional advisors.Keywords: thesis, systematic review, medical school

Vaikunthavasan Thiruchenthooran,1 Marta Espina,2,3 Marta &Sacute;witalska,4 Lorena Bonilla-Vidal,2,3 Joanna Wietrzyk,4 Maria Luisa Garcia,2,3 Eliana B Souto,5 Elena Sánchez-López,2,3,6,&ast; Anna Gliszczy&nacute;ska1,&ast; 1Department of Food Chemistry and Biocatalysis, Wroc&lstrok;aw University of Environmental and Life Sciences, Wroc&lstrok;aw, Poland; 2Department of Pharmacy, Pharmaceutical Technology and Physical Chemistry, University of Barcelona, Barcelona, Spain; 3Institute of Nanoscience and Nanotechnology (IN2UB), University of Barcelona, Barcelona, Spain; 4Department of Experimental Oncology, Ludwik Hirszfeld Institute of Immunology and Experimental Therapy, Polish Academy of Sciences, Wroc&lstrok;aw, Poland; 5Laboratory of Pharmaceutical Technology, Department of Drug Sciences, Faculty of Pharmacy, University of Porto, Porto, Portugal; 6Unit of Synthesis and Biomedical Applications of Peptides, IQAC-CSIC, Barcelona, Spain&ast;These authors contributed equally to this workCorrespondence: Anna Gliszczy&nacute;ska; Elena Sánchez-López, Email anna.gliszczynska@upwr.edu.pl; esanchezlopez@ub.eduPurpose: The anticancer potential of indomethacin and other nonsteroidal anti-inflammatory drugs (NSAIDs) in vitro, in vivo, and in clinical trials is well known and widely reported in the literature, along with their side effects, which are mainly observed in the gastrointestinal tract. Here, we present a strategy for the application of the old drug indomethacin as an anticancer agent by encapsulating it in nanostructured lipid carriers (NLC). We describe the production method of IND-NLC, their physicochemical parameters, and the results of their antiproliferative activity against selected cancer cell lines, which were found to be higher compared to the activity of free indomethacin.Methods: IND-NLC were fabricated using the hot high-pressure homogenization method. The nanocarriers were physicochemically characterized, and their biopharmaceutical behaviour and therapeutic efficacy were evaluated in vitro.Results: Lipid nanoparticles IND-NLC exhibited a particle size of 168.1 nm, a negative surface charge (– 30.1 mV), low polydispersity index (PDI of 0.139), and high encapsulation efficiency (over 99%). IND-NLC were stable for over 60 days and retained integrity during storage at 4 °C and 25 °C. The potential therapeutic benefits of IND-NLC were screened using in vitro cancer models, where nanocarriers with encapsulated drug effectively inhibited the growth of breast cancer cell line MDA-MB-468 at dosage 15.7 μM.Conclusion: We successfully developed IND-NLC for delivery of indomethacin to cancer cells and confirmed their antitumoral efficacy in in vitro studies. The results suggest that indomethacin encapsulated in lipid nanoparticles possesses high anticancer potential. Moreover, the presented strategy is highly promising and may offer a new alternative for future therapeutic drug innovations. Keywords: lipid nanoparticles, indomethacin, antitumoral activity, tumor-targeting

Pedro Tañá-Rivero,1 José J Muñoz-Tomás,1,2 Paz Orts-Vila,1 Enrique Artiaga-Elordi,1 Francisco Pastor-Pascual,2 José María Marín-Sánchez,3 Christian García-Elskamp3 1Cataract and Refractive Surgery Department, Oftalvist Alicante, Alicante, Spain; 2Cataract and Refractive Surgery Department, Oftalvist Valencia, Valencia, Spain; 3Cataract and Refractive Surgery Department, Oftalvist Murcia, Murcia, SpainCorrespondence: Pedro Tañá-Rivero, Email rdi@oftalvist.esPurpose: To assess the refractive and visual outcomes of hyperopic and astigmatic eyes implanted with a monofocal, aspheric, bitoric intraocular lens (IOL) with plate haptics following cataract surgery.Methods: The study evaluated 51 eyes implanted with the AT TORBI 709M IOL (Carl Zeiss Meditec AG, Jena, Germany) during a follow-up of 12-months. Refractive error, rotational stability, monocular uncorrected distance visual acuity (UDVA), monocular corrected distance visual acuity (CDVA), and contrast sensitivity were analyzed at 1-, 6-, and 12-months post-surgery.Results: At 12 months, the cumulative CDVA was 20/25 in 94.12% of eyes and 20/32 or better in 98.04%. The UDVA was the same as, or better than, the CDVA in 88.24% of eyes. The mean logMAR UDVA and CDVA values were 0.06 ± 0.11 and 0.00 ± 0.08, respectively. In addition, 92.16% of eyes were within ± 0.50 D and 98.04% were within ± 1.00 D of a spherical equivalent, and 86.27% of eyes had refractive astigmatism ≤ 0.50D and 100% were ≤ 1.00D. The mean spherical equivalent was 0.21 ± 0.31D and the mean refractive cylinder 0.34 ± 0.27D. The IOL rotation was 1.18 ± 1.35 degrees and all eyes had a rotation ≤ 5 degrees. The log contrast sensitivity functions were good and similar for all spatial frequencies during follow-up.Conclusion: Our results demonstrate that implantation of the AT TORBI 709M IOL in hyperopic and astigmatic eyes is effective and safe. The visual and refractive outcomes were good, showing excellent rotational stability.Keywords: cataract, intraocular lens, aspheric, bitoric, plate haptics

The COVID-19 pandemic influenced a paradigm shift in Philippine higher education. Educational institutions were challenged and impacted, compelling them to restrict physical interactions and transition to flexible learning modalities. This study investigates the impacts of COVID-19 on the education of private university students in the Davao Region, Southeastern Philippines. One hundred eighty-eight students participated in the survey via Google Forms, which was later analyzed using descriptive statistics. From them, a selected few were also invited to participate in qualitative inquiries to obtain an in-depth understanding of the problem under study. Although internet connectivity challenges emerge as a significant impediment, students prefer synchronous lectures and video conferences as learning modalities. Most of them are anxious, dealing with mental health and study habit issues. Interestingly, some respondents revealed that the pandemic positively impacted their lives. Students’ adaptive and creative skills helped them cope with the challenges of the new learning modalities. The administrators and faculty members may benefit from these findings in formulating online learning policies and teaching-learning strategies. These findings are helpful baseline to ensure educational sustainability during and after the health crisis.

María del Carmen García-Mendoza,1 Susana Coimbra,2 Inmaculada Sánchez-Queija,1 Águeda Parra1 1Department of Developmental and Educational Psychology, Universidad de Sevilla, Seville, Spain; 2Department of Psychology, Faculdade de Psicologia e de Ciências da Educação da Universidade do Porto, Porto, PortugalCorrespondence: Águeda Parra; Inmaculada Sánchez-Queija, Department of Developmental and Educational Psychology, Universidad de Sevilla, Calle Pirotecnia s/n, Sevilla, 41013, Spain, Tel +34955420527 ; +34955420528, Email aparra@us.es; queija@us.esBackground: Intergenerational solidarity between parents and emerging adult offspring requires more substantial attention at the present time. Changing demographic structures and transformations in family dynamics over recent decades have increased both opportunities and the need for parent-child interactions and exchanges of support and affection during emerging adulthood.Purpose: The study had two aims: first, to explore patterns in intergenerational solidarity in accordance with different sociodemographic characteristics of emerging adults; and second, to analyse associations between intergenerational solidarity and emerging adults’ psychological distress and satisfaction with life.Methods: Participants were 644 emerging adult university students from Southern Europe (Spain and Portugal), aged between 18 and 29 years, who completed a self-report questionnaire designed to assess variables linked to sociodemographic aspects (gender, country of residence, sexual orientation, living status, family income), intergenerational solidarity, psychological distress and satisfaction with life.Results: The results indicated some differences in intergenerational solidarity patterns in accordance with a range of sociodemographic characteristics. They also revealed significant associations between intergenerational solidarity dimensions and emerging adults’ satisfaction with life and psychological distress. Moreover, affective solidarity was found to fully mediate the relationship between associational, functional and normative solidarity and emerging adults’ adjustment. In the case of conflictual solidarity, affective solidarity was found to partially mediate the relationship between this dimension of intergenerational solidarity and emerging adults’ distress and to fully mediate the relationship between this same dimension and emerging adults’ satisfaction with life.Conclusion: The results indicate that it is important to take sociodemographic diversity into account when exploring relationships between emerging adults and their parents. They also suggest that affective solidarity acts as a protective factor in promoting emerging adults’ adjustment.Keywords: intergenerational solidarity, psychological distress, satisfaction with life, emerging adults, cross-cultural study

La ética periodística ha entrado en los espacios de discusión pública como uno de los temas de mayor importancia en el momento político actual. La dura competencia que los medios tradicionales han mantenido con los nuevos actores digitales y con los grandes poderes fácticos e ideológicos que los sostienen ha llevado a que las nociones de ética en general, de moral en particular y de deberes concretos en el accionar diario, se diluyan en una marea de intereses privados que en muchas ocasiones son directamente contrarios al bien general. Se impone por tanto una tarea de reflexión sobre las visiones éticas que históricamente han guiado el ejercicio periodístico y sobre las visiones éticas que las realidades del siglo XXI reclaman.

Objectives: To evaluate the quality of leukodepleted red cell concentrates (LD-RCC) obtained with top and bottom systems from the whole blood collected and processed in the GSH blood bank Sao Paulo, during 22 – 26 April 2024, verifying local and the European Directorate for the Quality of Medicines & HealthCare (EDQM) Blood Guide. Material and methods: The study was performed following European guidelines for blood processing during collection day, after resting at 22°C. Whole blood (WB) was collected using Top and bottom (T&B) quadruple CDP/SAGM with in-line filter bags (n = 60, 450 ml), (LQT610L® system Macopharma; France) in GSH blood bank between April 22 - 26 2024. WB was centrifuged on day 0 at 3,500 rpm (Sorval RC 3C Plus) for 15 min. Blood components were separated with Fractiomatic Plus 2 separator (Grifols, Spain) to obtain pre-filtered red cell concentrate (RCC), plasma (PL), and buffy coat (BC). After T&B separation process, the RCC prefilter system was hung to ensure the transfer of SAGM solution into the RCC before filtration (priming). After priming, the system was put upside down, so the complete content of RCC was filtered by gravity and stored at 4ºC in the final bag. All Leukodepleted Red Cell Concentrates (LD-RCC) were tested for cell blood count (Cell Dyn- Esmerald, Abbot), residual leucocytes (rWBC) (n = 58) (Nageotte camera, Blaubrand), and microbiological culture. Samples excluded due to incomplete data (n = 2). Results: LD-RCC average volume was 262.8 ml (> 220 ml). The average Hemoglobin (Hb) content and hematocrit (Ht) per unit were 50.64 grams (gr) and 58.21%, respectively, surpassing minimum threshold of 40gr and 50% per unit. The average rWBC count per unit was 0.0264 × 106, below the maximum allowable limit of 1x106 wbc/unit. All samples showed negative results in microbiological culture (compliance 100%), indicating an effective and safe product. According to local and European standards (EDQM), these results presented more than 90% compliance, as follows: Volume: 99.98%, Hb: 99.95%, rWBC: 100%. Discussion: The production of blood components each day faces a significant challenge: meeting the community's transfusion demands while ensuring that the blood products maintain the high quality necessary to support the recovery of all recipients. Through this validation, GSH demonstrates that the quality of blood components with top and bottom technique is a methodology applicable to the reality of blood banks in Brazil, not only increasing the quality of the components but also optimizing resources, since meeting quality standards can reduce wastage due to rejected units and improves the efficient use of blood bank reserves. Conclusion: These results demonstrate that In-line T&B process produces high-quality RCC, with low concentration of leukocytes (cells responsible for transmission of cell-associated infectious agents, febrile non-hemolytic transfusion reactions, etc.), which can lead to significant benefits by reducing adverse transfusion reactions, potentially shortening hospital stays, and decreasing the potential additional costs related to complications. In summary, LD-RCC preparation met or exceeded local and international quality control standards.

Objectives: This study aims to identify infection etiology in febrile neutropenia (FN) is vital. This study explores different microbiological approaches and their impact on diagnosing infections in patients with hematologic malignancies and FN. Methods: This is a retrospective analysis conducted at the Hospital Clinic of Barcelona details microbiological testing strategies used to diagnose infections at FN onset between January 2020 and July 2022. Results: A total of 4520 microbiological tests were ordered in 462 FN episodes, achieving a 10% test positivity rate, with 200 (43.3%) episodes showing microbiological documentation of infection. Blood cultures (40.4%), non-culture blood tests (21.2%), and respiratory tract samples (16.2%) were the most requested. Blood cultures exhibited the highest (16.9%) test positivity rates, whereas non-culture blood tests showed the lowest (3.3%). Bacterial infections were present in 149 of 462 (32.3%) FN episodes. Viral infections (66 of 462, 14.3%)—notably, respiratory viruses—were also frequent. Mortality rate at 60 days was 9.1%; documented infections were associated with a higher risk (15%). Conclusions: In the current landscape of antimicrobial diagnostics, our findings revealed the highest reported rate of microbiologically documented infections at FN onset. Bacterial infections are common; however, our data reiterate the significance of viral infections in causing fever. Optimizing FN management during respiratory viral infections remains a challenge for antimicrobial de-escalation. The low positivity rates observed in certain diagnostic tests emphasize the need for cost-effective diagnostic stewardship.

Las malformaciones vasculares representan un heterogéneo espectro de lesiones que suelen presentarse como un reto diagnóstico y terapéutico, por lo cual se requiere de un alto índice de sospecha clínica para llegar al diagnóstico definitivo. El síndrome Cloves es un trastorno de sobrecrecimiento poco común y de etiología genética asociada a una mutación somática activadora de PIK3CA, que forma parte de la vía de señalización intracelular PI3K-Akt-mTOR. Clínicamente, se caracteriza por un sobrecrecimiento lipomatoso congénito de cualquier parte del cuerpo (principalmente el tórax), acompañado de malformaciones vasculares y linfáticas, nevus epidermal y anomalías estructurales del sistema óseo como escoliosis y alteraciones de la columna vertebral. Actualmente el pilar terapéutico de este síndrome es la terapia con rapamicina, un inhibidor de la vía mTOR. Por su parte, el síndrome de Klippel-Trenaunay, de igual manera, es una afección vascular compleja asociada al sobrecrecimiento, resultado de mutaciones somáticas en el gen PIK3CA con presencia de traslocaciones cromosómicas y alteraciones en el gen vascular VG5Q. Como características clínicas, posee una tríada clásica compuesta por hemihipertrofia de los tejidos blandos y los huesos de una extremidad, hemangiomas cutáneos y várices en posiciones anatómicamente anormales. Las principales características distintivas de este síndrome residen en la presencia de anomalías vasculares de tipo lento, desprovistas de fístulas arteriovenosas significativas, en comparación con el síndrome Cloves. En ambos casos, la presencia de características clínicas coincidentes relacionadas con los síndromes de sobrecrecimiento con alteraciones en el gen PIK3CA pone en manifiesto el reto de un diagnóstico certero.

Two-dimensional materials give access to the ultimate physical limits of photonics with appealing properties for ultracompact optical components such as waveguides and modulators. Specifically, in monolayer semiconductors, a strong excitonic resonance leads to a sharp oscillation in permittivity from positive to even negative values. This extreme optical response enables surface exciton–polaritons to guide visible light bound to an atomically thin layer. However, such ultrathin waveguides support a transverse electric (TE) mode with low confinement and a transverse magnetic (TM) mode with short propagation. Here, we propose that realistic semiconductor–insulator–semiconductor superlattices comprising monolayer WS2 and hexagonal boron nitride (hBN) can improve the properties of both TE and TM modes. Compared to a single monolayer, a heterostructure with a 1-nm hBN spacer separating two monolayers enhances the confinement of the TE mode from 1.2 to around 0.5 μm, while the out-of-plane extension of the TM mode increases from 25 to 50 nm. We propose two simple additivity rules for mode confinement valid in the ultrathin film approximation for heterostructures with increasing spacer thickness. Stacking additional WS2 monolayers into superlattices further enhances the waveguiding properties. Our results underscore the potential of monolayer-based superlattices as a platform for visible-range nanophotonics with promising optical, electrical, and magnetic tunability.

Wojciech G Lesniak,1 Srikanth Boinapally,1 Gabriela Lofland,1 Zirui Jiang,1 Catherine A Foss,1 Babak Behman Azad,1 Anna Jablonska,1,2 Mauro A Garcia,1 Maria Brzezinski,1 Martin G Pomper1,3 1Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University, Baltimore, MD, 21287, USA; 2Institute for Cell Engineering, Johns Hopkins University, Baltimore, MD, 21218, USA; 3Department of Radiology, University of Texas Southwestern Medical Center, Dallas, TX, 75390, USACorrespondence: Wojciech G Lesniak, Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University, 600 N. Wolfe Street, Baltimore, MD, 21287, USA, Email wlesnia1@jhmi.eduIntroduction: Prostate cancer (PC) is the second most common cancer and the fifth most frequent cause of cancer death among men. Prostate-specific membrane antigen (PSMA) expression is associated with aggressive PC, with expression in over 90% of patients with metastatic disease. Those characteristics have led to its use for PC diagnosis and therapies with radiopharmaceuticals, antibody-drug conjugates, and nanoparticles. Despite these advancements, none of the current therapeutics are curative and show some degree of toxicity. Here we present the synthesis and preclinical evaluation of a multimodal, PSMA-targeted dendrimer-drug conjugate (PT-DDC), synthesized using poly(amidoamine) (PAMAM) dendrimers. PT-DDC was designed to enable imaging of drug delivery, providing valuable insights to understand and enhance therapeutic response.Methods: The PT-DDC was synthesized through consecutive conjugation of generation-4 PAMAM dendrimers with maytansinoid-1 (DM1) a highly potent antimitotic agent, Cy5 infrared dye for optical imaging, 2,2′,2”-(1,4,7-triazacyclononane-1,4,7-triyl)triacetic acid (NOTA) chelator for radiolabeling with copper-64 and positron emission tomography tomography/computed tomography (PET/CT), lysine-urea-glutamate (KEU) PSMA-targeting moiety and the remaining terminal primary amines were capped with butane-1,2-diol. Non-targeted control dendrimer-drug conjugate (Ctrl-DDC) was formulated without conjugation of KEU. PT-DDC and Ctrl-DDC were characterized using high-performance liquid chromatography, matrix assisted laser desorption ionization mass spectrometry and dynamic light scattering. In vitro and in vivo evaluation of PT-DDC and Ctrl-DDC were carried out in isogenic human prostate cancer PSMA+ PC3 PIP and PSMA− PC3 flu cell lines, and in mice bearing the corresponding xenografts.Results: PT-DDC was stable in 1×PBS and human blood plasma and required glutathione for DM1 release. Optical, PET/CT and biodistribution studies confirmed the in vivo PSMA-specificity of PT-DDC. PT-DDC demonstrated dose-dependent accumulation and cytotoxicity in PSMA+ PC3 PIP cells, and also showed growth inhibition of the corresponding tumors. PT-DDC did not accumulate in PSMA− PC3 flu tumors and did not inhibit their growth. Ctrl-DDC did not show PSMA specificity.Conclusion: In this study, we synthesized a multimodal theranostic agent capable of delivering DM1 and a radionuclide to PSMA+ tumors. This approach holds promise for enhancing image-guided treatment of aggressive, metastatic subtypes of prostate cancer. Keywords: prostate cancer, PSMA, PAMAM dendrimer, targeted cancer treatment, theranostics

Maria González-Cao,1 Xueting Cai,2 Jilian Wilhelmina Paulina Bracht,3 Xuan Han,2 Yang Yang,2 Carlos Pedraz-Valdunciel,4 Teresa Morán,5 Javier García-Corbacho,6 Andrés Aguilar,1 Reyes Bernabé,7 Pedro De Marchi,8,9 Luciane Sussuchi da Silva,8 Leticia Ferro Leal,8 Rui Manuel Reis,8,10,11 Jordi Codony-Servat,4 Eloisa Jantus-Lewintre,12– 14 Miguel Angel Molina-Vila,4 Peng Cao,2,15 Rafael Rosell1,16 1Translational Cancer Research Unit, Instituto Oncológico Dr Rosell, Dexeus University Hospital, Barcelona, Spain; 2Integrated Traditional Chinese and Western Medicine Department of Affiliated Hospital, Nanjing University of Chinese Medicine, Nanjing, Jiangsu, People’s Republic of China; 3Amsterdam University Medical Center (UMC), Amsterdam, The Netherlands; 4Laboratory of Oncology, Pangaea Oncology, Quirón Dexeus University Hospital, Barcelona, Spain; 5Medical Oncology Department, Catalan Institute of Oncology (ICO), Germans Trias i Pujol Hospital, Badalona, Spain; 6Medical Oncology Department (Hospital Clinic)/Translational Genomics and Targeted Therapies in Solid Tumors (IDIBAPs), Barcelona, Spain; 7Medical Oncology Department, Hospital Universitario Virgen del Rocío, Sevilla, Spain; 8Molecular Oncology Research Center; Barretos Cancer Hospital, Barretos, Brazil; 9Oncoclinicas, Rio de Janeiro, Brazil; 10Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Braga, Portugal; 11ICVS/3b’s – PT Government Associate Laboratory, Braga/Guimarães, Portugal; 12Valencian Community Foundation Principe Felipe Research Center, Laboratory of Molecular Oncology, Valencia, Spain; 13Centro de Investigación Biomédica en Red (CIBERONC), Madrid, Spain; 14Universitat Politècnica de Valencia, Biotechnology Department, Valencia, Spain; 15College of Pharmacy, Nanjing University of Chinese Medicine, Nanjing, Jiangsu, People’s Republic of China; 16Laboratory of Molecular Biology, Germans Trias i Pujol Health Sciences Institute and Hospital (IGTP), Badalona, SpainCorrespondence: Rafael Rosell, Laboratory of Molecular Biology, Germans Trias i Pujol Health Sciences Institute and Hospital (IGTP), Camí de les Escoless/n, Badalona, Barcelona, 08916, Spain, Tel +34 930330520, Email rrosell@iconcologia.net Peng Cao, College of Pharmacy, Nanjing University of Chinese Medicine, Nanjing, 210023, People’s Republic of China, Tel +86 85608666, Email cao_peng@njucm.edu.cnPurpose: High-mobility group box 1 protein (HMGB1) is subject to exportin 1 (XPO1)-dependent nuclear export, and it is involved in functions implicated in resistance to immunotherapy. We investigated whether HMGB1 mRNA expression was associated with response to immune checkpoint inhibitors (ICI) in non-small cell lung cancer (NSCLC).Patients and Methods: RNA was isolated from pretreatment biopsies of patients with advanced NSCLC treated with ICI. Gene expression analysis of several genes, including HMGB1, was conducted using the NanoString Counter analysis system (PanCancer Immune Profiling Panel). Western blotting analysis and cell viability assays in EGFR and KRAS mutant cell lines were carried out. Evaluation of the antitumoral effect of ICI in combination with XPO1 blocker (selinexor) and trametinib was determined in a murine Lewis lung carcinoma model.Results: HMGB1 mRNA levels in NSCLC patients treated with ICI correlated with progression-free survival (PFS) (median PFS 9.0 versus 18.0 months, P=0.008, hazard ratio=0.30 in high versus low HMGB1). After TNF-α stimulation, HMGB1 accumulates in the cytoplasm of PC9 cells, but this accumulation can be prevented by using selinexor or antiretroviral drugs. Erlotinib or osimertinib with selinexor in EGFR-mutant cells and trametinib plus selinexor in KRAS mutant abolish tumor cell proliferation. Selinexor with a PD-1 inhibitor with or without trametinib abrogates the tumor growth in the murine Lewis lung cancer model.Conclusion: An in-depth exploration of the functions of HMGB1 mRNA and protein is expected to uncover new potential targets and provide a basis for treating metastatic NSCLC in combination with ICI.Keywords: HMGB1, immunotherapy, non-small cell lung cancer, Lewis lung cancer murine model, K-Ras mutations

Las redes sociales de internet han influido en la política y concretamente en la democracia. Asimismo, pueden cambiar muchos aspectos de manera que contribuyan a una democracia más plena y efectiva. En este estudio comprobamos si la existencia y optimización de las redes sociales de internet influye en la efectividad democrática en los países latinoamericanos. Realizamos un estudio estadístico, cuantitativo e inferencial con datos de 2023, utilizando encuestas representativas, para demostrar que el internet y las redes sociales inciden en la democratización de los países antes mencionados. Partimos de la hipótesis propuesta por Lipset: la prosperidad económica de una nación contribuye a fortalecer la democracia.

El objetivo de esta investigación fue analizar la relación del compromiso deportivo y la fortaleza mental en tenistas de alta competición de Ecuador y Portugal. La investigación incluyó 265 atletas (127 de Ecuador y 138 de Portugal), con edades entre los 15 y 30 años (Medad = 18.81; DT = 3.73) y pertenecientes a las categorías más avanzadas del ranking nacional de ambos países. Se utilizaron dos cuestionarios: Mental Toughness Index y Athlete Engagement Questionnaire. Se realizó un análisis estadístico ANOVA de medidas repetitivas unidireccionales, correlación de Pearson (ρ) y el alfa de Cronbach (α), los cuales apoyaron el análisis. Los resultados mostraron que los tenistas de ambos países poseen altos niveles de compromiso deportivo y de fortaleza mental. Además, se evidenció una relación positiva entre el compromiso deportivo y la fortaleza mental, indicando que los jugadores para tornarse en individuos más fuertes mentalmente necesitan ser dedicados y entusiasmados con el deporte. Por su parte, no se evidenciaron diferencias significativas entre ambos géneros y países. Este estudio refuerza la importancia de desarrollar programas psicológicos, basados en el compromiso deportivo y en la fuerza mental en el sentido de desenvolver atletas determinados, fuertes y competentes para superar las adversidades.

Carlos Mario Balcázar-Valencia,1 Andrés Felipe García-Ramos,2– 5 Luis Miguel Osorio-Toro,2,3,6 Yessica Alejandra Ordoñez-Guzmán,3 Nathalia Buitrago-Gómez,4 William Fernando Cabarcas-López,7 Carlos Javier Vizcaino-Guerrero,8 Jorge Enrique Daza-Arana,2,9 Alex Ramírez-Rincón,4 Katherine Restrepo-Erazo2,10 1Specialization in Internal Medicine, Faculty of Health Sciences, Universidad Libre, Santiago de Cali, Colombia; 2Specialization in Internal Medicine, Faculty of Health, Universidad Santiago de Cali, Santiago de Cali, Colombia; 3Research and Education Department, Clínica de Occidente S.A., Santiago de Cali, Colombia; 4Specialization in Endocrinology, Faculty of Health Sciences, Universidad Pontificia Bolivariana, Medellín, Colombia; 5Specialization in Internal Medicine, Faculty of Health, Universidad del Valle, Santiago de Cali, Colombia; 6Genetics, Physiology and Metabolism Research Group (GEFIME), Faculty of Health Sciences, Universidad Santiago de Cali, Santiago de Cali, Colombia; 7Master in Epidemiology, Faculty of Health, Universidad de Caldas, Manizales, Colombia; 8Specialization in Endocrinology, Faculty of Health, Fundación Universitaria Ciencias de la Salud FUCS, Bogotá, Colombia; 9Health and Movement Research Group, Faculty of Health Sciences, Universidad Santiago de Cali, Santiago de Cali, Colombia; 10Specialization in Endocrinology, Faculty of Health, Universidad Nacional de Colombia, Bogotá D.C., ColombiaCorrespondence: Jorge Enrique Daza-Arana, Specialization in Internal Medicine, Faculty of Health, Universidad Santiago de Cali, Calle 5 &num; 62-00, Santiago de Cali, Colombia, Tel/Fax +57 3108923676, Email jorge.daza01@usc.edu.coPurpose: Diabetes is a public health problem that requires strategies to impact glycemic control and reduce the risk of long-term medical complications. Pharmacological management is a necessary treatment for this disease. Therefore, semaglutide is an essential tool to achieve the treatment targets. The present study aimed to evaluate the semaglutide effects on a cohort with type 2 diabetes mellitus (T2DM) in Colombia.Materials and Methods: The cohort included 49 patients with T2DM that have been treated in a specialized care center. Their glycemic outcomes, weight, renal function, and adverse events were evaluated through a 3-, 6- and 12-month follow-up.Results: Significant differences were observed in the outcome evaluation: reduction of glycated hemoglobin levels (MD − 2.74 CI − 1.95 to − 3.52 in 6 months), fasting plasma glucose levels, body weight (MD − 7.11 CI − 5.97 to − 8.24), and the albumin-to-creatinine ratio. The results were maintained throughout the treatment period. The adverse event rate was 16.3%, predominating gastrointestinal events.Conclusion: This real-world evidence shows the efficacy of semaglutide in achieving treatment goals in patients with T2DM.Keywords: semaglutide, diabetes mellitus, glycated hemoglobin A, obesity, glycemic control

Abstract Background Non-Technical Skills (NTS) are cognitive, social, and personal resource skills that are crucial in complex and high-risk environments. The aims of our research are to determine the prevalence and content of NTS in the surgical rotation teaching guides of the Medicine Degree programs in Spanish Universities, to identify the most prevalent types and subtypes of NTS, and to analyze factors associated with the prevalence of surgical NTS in Medical Schools in Spain. Methods Descriptive observational cross-sectional study involving the identification and collection of competencies outlined in the surgical rotation teaching guides of Spanish Medical Schools. Information regarding university performance was obtained from the Foundation for Knowledge and Development Ranking webpage. The “Non-Technical Skills for Surgeons” (NOTSS) system was used to classify each competency in the teaching guides as NTS (categories and elements) and technical skills. Disagreements were resolved through group consensus. Results A total of 1,846 competencies were analyzed in surgical rotations of the Medicine Degree programs across 40 Spanish Universities, with 99 competencies identified as surgical NTS, accounting for 5% of the total. The most frequently identified surgical NTS were “Decision Making” (46%), “Communication & Teamwork” (25%), and “Leadership” (19%). Additionally, several NOTSS were not identified in any institution. Public universities and those including a greater number of competencies had a higher rate of surgical NTS competencies, and we did not find a correlation between surgical NTS competencies and quality indices of University Centers. Conclusions There is a limited presence of surgical NTS in the educational plans of Spanish Universities.

Janinne Ortega-Montiel,1 Luis A Martinez-Juarez,1,2 Alejandra Montoya,1 Linda Morales-Juárez,3 Héctor Gallardo-Rincón,1,4 Victoria Galicia-Hernández,1 Rodrigo Garcia-Cerde,1 María Jesus Ríos-Blancas,1 Diego-Abelardo Álvarez-Hernández,1 Julieta Lomelin-Gascon,1 Gisela Martínez-Silva,1 Lucía M Illescas-Correa,5 Daniel A Diaz Martinez,6 Francisco Javier Magos Vázquez,6 Edwin Vargas Ávila,6 Ma Concepción Carmona-Ramos,7 Ricardo Mújica‐Rosales,1 Enrique Reyes-Muñoz,8 Roberto Tapia-Conyer9 1Carlos Slim Foundation, Mexico City, Mexico; 2Johns Hopkins Center for Humanitarian Health, Bloomberg School of Public Health, Baltimore, MD, USA; 3Institute for Obesity Research, Tecnológico de Monterrey, Mexico City, Mexico; 4Health Sciences University Center, University of Guadalajara, Guadalajara, Jalisco, Mexico; 5Maternal and Childhood Research Center (CIMIGEN), Mexico City, Mexico; 6Ministry of Health of the State of Guanajuato, Tamazuca, Guanajuato, Mexico; 7Ministry of Health of the State of Hidalgo, Pachuca, Hidalgo, Mexico; 8Coordinatión of Gynecological and Perinatal Endocrinology, National Institute of Perinatology Isidro Espinosa de los Reyes, Mexico City, Mexico; 9National Autonomous University of Mexico, School of Medicine, Mexico City, MexicoCorrespondence: Alejandra Montoya, Carlos Slim Foundation, Lago Zurich 245, Presa Falcon Building (Floor 20), Col. Ampliación Granada, Miguel, Hidalgo, Mexico City, 11529, Mexico, Tel +52 55 4976 0344, Email airainmr@fundacioncarlosslim.orgPurpose: This study explores the impact of gestational diabetes mellitus (GDM) subtypes classified by oral glucose tolerance test (OGTT) values on maternal and perinatal outcomes.Patients and Methods: This multicenter prospective cohort study (May 2019–December 2022) included participants from the Mexican multicenter cohort study Cuido mi Embarazo (CME). Women were classified into four groups per 75-g 2-h OGTT: 1) normal glucose tolerance (normal OGTT), 2) GDM-Sensitivity (isolated abnormal fasting or abnormal fasting in combination with 1-h or 2-h abnormal results), 3) GDM-Secretion (isolated abnormal values at 1-h or 2-h or their combination), and 4) GDM-Mixed (three abnormal values). Cesarean delivery, neonates large for gestational age (LGA), and pre-term birth rates were among the outcomes compared. Between-group comparisons were analyzed using either the t-test, chi-square test, or Fisher’s exact test.Results: Of 2,056 Mexican pregnant women in the CME cohort, 294 (14.3%) had GDM; 53.7%, 34.4%, and 11.9% were classified as GDM-Sensitivity, GDM-Secretion, and GDM-Mixed subtypes, respectively. Women with GDM were older (p = 0.0001) and more often multiparous (p = 0.119) vs without GDM. Cesarean delivery (63.3%; p = 0.02) and neonate LGA (10.7%; p = 0.078) were higher in the GDM-Mixed group than the overall GDM group (55.6% and 8.4%, respectively). Pre-term birth was more common in the GDM-Sensitivity group than in the overall GDM group (10.2% vs 8.5%, respectively; p=0.022). At 6 months postpartum, prediabetes was more frequent in the GDM-Sensitivity group than in the overall GDM group (31.6% vs 25.5%). Type 2 diabetes was more common in the GDM-Mixed group than in the overall GDM group (10.0% vs 3.3%).Conclusion: GDM subtypes effectively stratified maternal and perinatal risks. GDM-Mixed subtype increased the risk of cesarean delivery, LGA, and type 2 diabetes postpartum. GDM subtypes may help personalize clinical interventions and optimize maternal and perinatal outcomes.Keywords: Gestational Diabetes, GDM-Mixed, GDM-Secretion, GDM-Sensitivity, macrosomia, cesarean delivery, pre-term delivery

High environmental noise as well as poor biodiversity and air pollution pose significant challenges for the European population, particularly those residing in urban areas, impacting clearly on citizens’ health. The Conscious Walk initiative stands for an innovative hybrid approach to analyse citizens’ perception of their environment. Being a citizen science participative project, Conscious Walks involves both citizens and scientists collecting high-quality acoustic, chemical, biodiversity, and comfort data while walking in pre-analysed urban environments. The main objective of this proposal is to obtain comprehensive data encompassing both subjective and objective aspects related to soundscape, air quality, biodiversity, and urban comfort. All these elements are closely tied to the overall acoustic environmental quality of the places under study. The effectiveness of this methodology has been tested in various locations in Catalonia, including Sabadell and Barcelona. This contribution focuses on the evaluation of the soundscape in the urban centre of Barcelona, with a comprehensive analysis that integrates data collected by both citizens and scientists during Conscious Walks, air quality metrics, biodiversity, and human comfort information.

Juan Francisco Mir-Bonafé,1 Jaime Piquero-Casals,2 Ludmila Prudkin,3 Jesus Delgado,3 Julia Santamaria Martínez,3 Vicente Garcia-Patos Briones4 1Department of Dermatology, Hospital Son Llàtzer, Palma de Mallorca, Spain; 2Department of Aesthetic Dermatology and Laser, Dermik, Clínica Dermatológica Multidisciplinar, Barcelona, Spain; 3Innovation and Development, ISDIN, Barcelona, Spain; 4Department of Dermatology, Hospital Vall d’Hebron, Barcelona, SpainCorrespondence: Jaime Piquero-Casals, Department of Aesthetic Dermatology and Laser, Dermik, Clínica Dermatológica Multidisciplinar, Barcelona, Spain, Tel +34 935464710, Email j.piquero@dermik.esBackground: Noninfectious inflammatory dermatoses of the scalp are common, and their symptomsin particular, those affecting appearance, can have a psychological effect that may be disproportionate to their clinical severity. Effective, cosmetically acceptable treatments are important to manage these conditions. Topical corticosteroids form the cornerstone of acute treatment for many of these conditions. We surveyed practicing dermatologists and dermatology residents to determine the current clinical practice in prescribing topical corticosteroids for these disorders in their various preparation formats.Methods: A Delphi method was used, consisting of 2 questionnaire rounds. The first round contained 34 questions and was completed by 612 dermatologists and dermatology residents via email. The first round of responses was analyzed, and points that had > 70% agreement were used to form a second questionnaire of 21 statements. This second round was completed by 346 participants, and their responses were used to generate a final report. Participants were practicing in both public and private practices.Results: Clobetasol propionate 0.05% topical solution was considered to be the most appropriate treatment for noninfectious inflammatory scalp dermatoses in general, with 75.1% agreement in the second round of questionnaire. The main advantages of clobetasol propionate over other topical corticosteroids were reported as potency, effectiveness, and broad action spectrum (94.8% agreement). The preferred pharmaceutical format was the solution of clobetasol propionate.Conclusion: Clobetasol propionate was the preferred topical treatment for the management of scalp dermatoses, usually as first-line treatment; solution was the preferred preparation.Keywords: seborrheic dermatitis, psoriasis, shampoo, topical, solution, clobetasol, scalp, therapy

Abstract Poa pratensis L. (Poaceae) is a valuable grass across the north hemisphere, inhabiting diverse environments with wide altitudinal span, where ubiquitous various kinds of stresses. Phytohormones would be helpful to improve tolerance to abiotic and biotic stresses, but the responses of transcriptome regulation of P. pratensis to exogenous phytohormones application remain unclear. In this study, we explored the alteration of plant physiological responses by the application of phytohormones. Aiming to achieve this knowledge, we got full-length transcriptome data 42.76 Gb, of which 74.9% of transcripts were completed. Then used 27 samples representing four treatments conducted at two time points (1 h and 6 h after application) to generate RNA-seq data. 371 and 907 common DEGs were identified in response to four phytohormones application, respectively, these DEGs were involved in “plant hormone signal transduction”, “carbon metabolism” and “plant-pathogen interaction”. Finally, P. pratensis basic research can gain valuable information regarding the responses to exogenous application of phytohormones in physiological indicators and transcriptional regulations in order to facilitate the development of new cultivars.

Serratia marcescens is a global opportunistic pathogen. In vitro cytotoxicity of this bacterium is mainly related to metalloprotease serralysin (PrtS) activity. Proteolytic capability varies among the different isolates. Here, we characterized protease production and transcriptional regulators at 37°C of two S. marcescens isolates from bronchial expectorations, HU1848 and SmUNAM836. As a reference strain the insect pathogen S. marcescens Db10 was included. Zymography of supernatant cultures revealed a single (SmUNAM836) or double proteolytic zones (HU1848 and Db10). Mass spectrometry confirmed the identity of PrtS and the serralysin-like protease SlpB from supernatant samples. Elevated proteolytic activity and prtS expression were evidenced in the HU1848 strain through azocasein degradation and qRT-PCR, respectively. Evaluation of transcriptional regulators revealed higher eepR expression in HU1848, whereas cpxR and hexS transcriptional levels were similar between studied strains. Higher eepR expression in HU1848 was further confirmed through an in vivo transcriptional assay. Moreover, two putative CpxR binding motifs were identified within the eepR regulatory region. EMSA validated the interaction of CpxR with both motifs. The evaluation of eepR transcription in a cpxR deletion strain indicated that CpxR negatively regulates eepR. Sequence conservation suggests that regulation of eepR by CpxR is common along S. marcescens species. Overall, our data incorporates CpxR to the complex regulatory mechanisms governing eepR expression and associates the increased proteolytic activity of the HU1848 strain with higher eepR transcription. Based on the global impact of EepR in secondary metabolites production, our work contributes to understanding virulence factors variances across S. marcescens isolates.

A systematic survey of Dehesilla Cave was carried out during 2017 in order to search for traces of rock art. Several panels with paintings were identified in the chamber next to the entrance (consisting of strokes, dots, stains, and remnants of shapes in red and black), which had remained unnoticed up until now and may provide relevant information towards the understanding of the prehistoric use of the cave and its seemingly symbolic topography. However, we cannot assume a priori a relationship between these paintings and the well-known Neolithic sequence of the site. To assess these paintings, we have analysed photomicrographs which have allowed us to determine their detailed characteristics, stroke morphology, and remnant features (for instance, hue, shape, density of paint, pigment grain size, micro-stroke traces left by the tools used). Taphonomic issues have also been considered and several physical and chemical techniques of analysis have been applied in order to identify the pigments and possible binders.

Key Clinical Message Patients affected by chronic inflammatory demyelinating polyradiculoneuropathy require close follow up due to the neuronal demyelination along with axonal degeneration associated with the disease process, giving the opportunity to the medical team of adequating therapeutics and other medical interventions, according to the evolution of the symptoms, to prevent irreversible axonal degeneration.

Este artículo examina los aspectos visuales y materiales presentes en un ejemplar de Marinero en tierra. En los años treinta del siglo XX Rafael Alberti eligió su poemario para realizar un dibujo a modo de dedicatoria que regaló a María Teresa León. La escritora continuó interviniendo el objeto hasta convertirlo en un espacio propio. El volumen, por voluntad del regalador y de la regalada, pasó de ser una copia impresa más de un título importante para su autor a transformarse en una obra de vida capaz de condensar complicidades creativas y realidades históricas como la Guerra Civil o el exilio. A partir de este ejemplar se reflexiona sobre el libro como objeto y el valor de los dibujos en libros.

AimsTo assess the impact of the COVID-19 pandemic on the health condition of people ≥75 years of age and on their family caregivers in Spain.DesignMulticentric, mixed method concurrent study.MethodsThis work, which will be conducted within the primary care setting in 11 administrative regions of Spain, will include three coordinated studies with different methodologies. The first is a population-based cohort study that will use real-life data to analyze the rates and evolution of health needs, care provision, and services utilization before, during, and after the pandemic. The second is a prospective cohort study with 18 months of follow-up that will evaluate the impact of COVID-19 disease on mortality, frailty, functional and cognitive capacity, and quality of life of the participants. Finally, the third will be a qualitative study with a critical social approach to understand and interpret the social, political, and economic dimensions associated with the use of health services during the pandemic. We have followed the SPIRIT Checklist to address trial protocol and related documents. This research is being funded by the Instituto de Salud Carlos III since 2021 and was approved by its ethics committee (June 2022).DiscussionThe study findings will reveal the long-term impact of the COVID-19 pandemic on the older adults and their caregivers. This information will serve policymakers to adapt health policies to the needs of this population in situations of maximum stress, such as that produced by the COVID-19 pandemic.Trial RegistrationIdentifier: NCT05249868 [ClinicalTrials.gov].

The full information about the interaction between a quantum emitter and an arbitrary electromagnetic environment is encoded in the so-called spectral density. We present an approach for describing such interaction in any coupling regime, providing a Lindblad-like master equation for the emitter dynamics when coupled to a general nanophotonic structure. Our framework is based on the splitting of the spectral density into two terms. On the one hand, a spectral density responsible for the non-Markovian and strong-coupling-based dynamics of the quantum emitter. On the other hand, a residual spectral density including the remaining weak-coupling terms. The former is treated nonperturbatively with a collection of lossy interacting discrete modes whose parameters are determined by a fit to the original spectral density in a frequency region encompassing the quantum emitter transition frequencies. The latter is treated perturbatively under a Markovian approximation. We illustrate the power and validity of our approach through numerical simulations in three different setups, thus offering a variety of scenarios for a full test, including the ultra-strong coupling regime.

Sebastian Ciro Acosta,1 Lorena Díaz-Ordóñez,1,2 Juan David Gutierrez-Medina,1,3 Yisther Katherine Silva-Cuero,1,2 Luis Guillermo Arango-Vélez,4,5 Andrés Octavio García-Trujillo,4,5 Harry Pachajoa1,2,6 1Centro de Investigaciones en Anomalias Congenitas y Enfermedades Raras (CIACER), Universidad Icesi, Cali, Colombia; 2Departamento de Ciencias Basicas Medicas, Facultad de Salud, Universidad Icesi, Cali, Colombia; 3Centro de Investigaciones Clinicas, Fundacion Valle del Lili, Cali, Colombia; 4Servicio de Endocrinologia, Fundacion Valle del Lili, Cali, Colombia; 5Departamento de Medicina interna, Seccion de Endocrinologia, Universidad Icesi, Cali, Colombia; 6Genetic Division, Fundacion Valle del Lili, Cali, ColombiaCorrespondence: Lorena Díaz-Ordóñez, Centro de Investigaciones en Anomalias Congenitas y Enfermedades Raras (CIACER), Universidad Icesi, Street 18 Number 122-135, Cali, Valle del Cauca, 760031, Colombia, Tel +57 602 5552334, Email lldiaz@icesi.edu.coAbstract: Mutations in the lecithin-cholesterol acyltransferase (LCAT) gene, which catalyzes the esterification of cholesterol, result in two types of autosomal recessive disorders: Familial LCAT deficiency (FLD) and Fish Eye Disease (FED). While both phenotypes are characterized by corneal opacities and different forms of dyslipidemia, such as low levels of high-density lipoprotein-cholesterol (HDL-C), FLD exhibits more severe clinical manifestations like splenomegaly, anemia, and renal failure. We describe the first clinically and genetically confirmed case of FLD in Colombia which corresponds to a 46-year-old woman with corneal opacity, hypothyroidism, and dyslipidemia, who does not have any manifestations of renal failure, with two pathogenic heterozygous missense variants in the LCAT gene: LCAT (NM_000229.2):c.803G>A (p.Arg268His) and LCAT (NM_000229.2):c.368G>C (p.Arg123Pro). In silico analysis of the mutations predicted the physicochemical properties of the mutated protein, causing instability and potentially decreased LCAT function. These compound mutations highlight the clinical heterogeneity of the phenotypes associated with LCAT gene mutations.Keywords: eye, LCAT, cholesterol/trafficking, genomics, VLDL, lecithin cholesterol acyltransferase deficiency, LCAT deficiency, alpha-LCAT deficiency, fish eye disease

Ahmad Haffar,1 Alexander Hirsch,1 Christian Morrill,1 Adelaide Garcia,1 Zachary Werner,2 John P Gearhart,1 Chad Crigger1 1Robert D. Jeffs Division of Pediatric Urology, James Buchanan Brady Urological Institute, Johns Hopkins Hospital, Johns Hopkins Medical Institutions, Charlotte Bloomberg Children’s Hospital, Baltimore, MD, USA; 2West Virginia University School of Medicine, Department of Urology, Division of Pediatric Urology, Morgantown, WV, USACorrespondence: Ahmad Haffar, The Johns Hopkins University School of Medicine, The James Buchanan Brady Urological Institute, Robert D. Jeffs Division of Pediatric Urology, Charlotte Bloomberg Children’s Center, Baltimore, MD, 21287, USA, Tel +1 (304) 993-2237, Email ahaffar1@jh.eduPurpose: This study examines the readability of online medical information regarding cloacal exstrophy (CE). We hypothesize that inappropriate levels of comprehension are required in these resources, leading to poor understanding and confusion amongst caregivers.Methods: The Google and Bing search engines were used to search the terms “cloacal exstrophy” and “cloacal exstrophy treatment”. The first 100 results for each were collected. Each webpage was analyzed for readability using four independent validated scoring systems: the Gunning-Fog index (GFI), SMOG grade (Simple Measure of Gobbledygook), Dale-Chall index (DCI), and the Flesch-Kincaid grade (FKG).Results: Forty-seven unique webpages fit the inclusion criteria. Mean readability scores across all websites were GFI, 14.6; SMOG score, 10.8; DCI, 9.3; and FKG, 11.8, correlating to adjusted grade levels of college sophomore, 11th grade, college, and 11th grade, respectively. There were significant differences across all readability formulas. Non-profit websites were significantly less readable than institutional and commercial webpages (GFI p = 0.012, SMOG p = 0.018, DCI p = 0.021, FKG p = 0.0093).Conclusion: Caregiver-directed health information regarding CE and its treatment available online is written at the 11th grade reading level or above. Online resources pertaining to CE must be simplified to be effective.Plain Language Summary: Cloacal exstrophy is a rare severe birth defect that does not always show up in prenatal screening. Parents are often unfamiliar with this disease and must learn about the disease, procedures, and outcomes their child may have in a short amount of time. Online medical information has been recommended to be written at a 6th grade reading level so that the general public may understand. The authors of this study wanted to investigate if average websites that parents might find using common search engines would be easily understood. The authors used different search phrases on Google and Bing search engines, and used them to look at the top 100 search results for each. The text from each page was graded based on 4 different readability scoring systems. The authors found 47 unique webpages that matched the criteria and found that most pages had reading levels of about 11th grade-college level. Due to its rarity, the information available about cloacal exstrophy are similar and would likely be poorly understood by most parents. Hospital institutions and non-profit exstrophy programs need to make a concerted effort to work together to develop simple yet helpful information regarding this disease.Keywords: cloacal exstrophy, readability, online health information, exstrophy treatment

Cristian Ramos-Vera,1 Angel García O’Diana,1 Dennis Calle,1 Miguel Basauri-Delgado,2 Bruno Bonfá-Araujo,3 Ariela Raissa Lima-Costa,4 Mirko Duradoni,5 Shagufta Nasir,6 Yaquelin E Calizaya-Milla,7 Jacksaint Saintila8 1Faculty of Health Sciences, Universidad César Vallejo, Lima, Peru; 2Postgraduate School, Universidad Femenina del Sagrado Corazón, Lima, Peru; 3Faculty of Social Science, the University of Western Ontario, London, Canada; 4Graduate Program of Psychology, Universidade São Francisco, Campinas, Brazil; 5Department of Education, Literatures, Intercultural Studies, Languages and Psychology, University of Florence, Florence, Italy; 6Department of Psychiatry and Forensic Medicine, School of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain; 7Faculty of Health Sciences, Universidad Peruana Unión, Lima, Peru; 8Faculty of Health Sciences, Universidad Señor de Sipán, Chiclayo, PeruCorrespondence: Jacksaint Saintila, Faculty of Health Sciences, Universidad Señor de Sipán, Carretera a Pimentel, Km 5, Chiclayo, Lambayeque, 14001, Peru, Email jacksaintsaintila@gmail.comBackground: Previous research has suggested that manipulation and callousness are central to Dark Triad traits, but it has not identified which specific manifestations are expressed across various countries.Objective: This study aimed to identify the core and overlapping manifestations of Dark Triad traits across 10 countries.Methods: We used the Short Dark Triad (SD3) scale and assessed a sample of 8093 participants (59.7% women, M(age) = 32.68 years). For graphical representation, the spinglass algorithm was applied to understand the cluster distribution among Machiavellianism, psychopathy, and subclinical narcissism traits. Centrality indices were used to identify the most influential items, and the clique-percolation algorithm was employed to detect shared attributes among multiple Dark Triad items.Results: Straightforward SD3-21 items demonstrated better interpretability as aversive traits within the broader system. Items with higher centrality values were those related to short-term verbal manipulation from the psychopathy domain, clever manipulation, strategic revenge-seeking from Machiavellianism, and narcissistic motivations for connecting with significant individuals. The most predicted items were linked to planned revenge, using information against others from Machiavellianism, short-term psychopathic verbal manipulation, and narcissistic belief of specialness based on external validation. Items like short-term verbal manipulation had overlaps with both psychopathy and narcissism clusters, while clever manipulation overlapped with Machiavellianism and psychopathy.Conclusion: This cross-cultural study highlights the central role of verbal manipulation within the Dark Triad traits, along with identifying overlapping items among traits measured using straightforward SD3 scale items. In line with our findings, future research that incorporates a wide range of cultural contexts is encouraged to establish the consistency of these findings with the SD3 Scale or alternative measures.Keywords: dark triad traits, network analysis, personality, subclinical traits, cross-cultural

Camila Folle,1 Ana M Marqués,2 Natalia Díaz-Garrido,3– 5 Paulina Carvajal-Vidal,1 Elena Sánchez López,1,6 Joaquim Suñer-Carbó,1,6 Lyda Halbaut,1,6 Mireia Mallandrich,1,6 Marta Espina,1,6 Josefa Badia,3– 5 Laura Baldoma,3– 5 Maria Luisa García,1,6 Ana Cristina Calpena1,6 1Department of Pharmacy and Pharmaceutical Technology and Physical Chemistry, Faculty of Pharmacy and Food Sciences, University of Barcelona, Barcelona, Spain; 2Department of Biology, Healthcare and Environment, Faculty of Pharmacy and Food Sciences, University of Barcelona, Barcelona, Spain; 3Department of Biochemistry and Physiology, Faculty of Pharmacy and Food Sciences, University of Barcelona, Barcelona, Spain; 4Institute of Biomedicine of the University of Barcelona (IBUB), Barcelona, Spain; 5Research Institute Sant Joan De Déu (IR‑SJD), Barcelona, Spain; 6Institute of Nanoscience and Nanotechnology (IN2UB), University of Barcelona, Barcelona, SpainCorrespondence: Camila Folle; Elena Sánchez López, Department of Pharmacy and Pharmaceutical Technology and Physical Chemistry, Faculty of Pharmacy and Food Sciences, University of Barcelona, Barcelona, 08028, Spain, Email camilafolle@ub.edu; esanchezlopez@ub.eduPurpose: Acne vulgaris is one of the most prevalent dermal disorders affecting skin health and appearance. To date, there is no effective cure for this pathology, and the majority of marketed formulations eliminate both healthy and pathological microbiota. Therefore, hereby we propose the encapsulation of an antimicrobial natural compound (thymol) loaded into lipid nanostructured systems to be topically used against acne.Methods: To address this issue, nanostructured lipid carriers (NLC) capable of encapsulating thymol, a natural compound used for the treatment of acne vulgaris, were developed either using ultrasonication probe or high-pressure homogenization and optimized using 22-star factorial design by analyzing the effect of NLC composition on their physicochemical parameters. These NLC were optimized using a design of experiments approach and were characterized using different physicochemical techniques. Moreover, short-term stability and cell viability using HaCat cells were assessed. Antimicrobial efficacy of the developed NLC was assessed in vitro and ex vivo.Results: NLC encapsulating thymol were developed and optimized and demonstrated a prolonged thymol release. The formulation was dispersed in gels and a screening of several gels was carried out by studying their rheological properties and their skin retention abilities. From them, carbomer demonstrated the capacity to be highly retained in skin tissues, specifically in the epidermis and dermis layers. Moreover, antimicrobial assays against healthy and pathological skin pathogens demonstrated the therapeutic efficacy of thymol-loaded NLC gelling systems since NLC are more efficient in slowly reducing C. acnes viability, but they possess lower antimicrobial activity against S. epidermidis, compared to free thymol.Conclusion: Thymol was successfully loaded into NLC and dispersed in gelling systems, demonstrating that it is a suitable candidate for topical administration against acne vulgaris by eradicating pathogenic bacteria while preserving the healthy skin microbiome. Keywords: lipid nanoparticles, thymol, acne vulgaris, NLC, gels, antimicrobial