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Introduction Multiple sclerosis (MS) is an inflammatory, demyelinating, and neurodegenerative disease that affects the central nervous system. Adherence to treatment is essential to modify the course of the disease. Cognitive impairment affects up to 70% of these patients and is a limitation for administration and adherence to treatment. Objective The main objective was to assess the degree of adherence to treatment in patients with MS and cognitive impairment. Secondary objectives were to describe the tools that can influence adherence to treatment and to evaluate the effectiveness of the technological devices used to alert the patient that he/she must self-inject. Method The method consisted of a descriptive, retrospective, and cross-sectional pilot study. It was carried out in the MS clinic of the Torrecardenas University Hospital from December 2018 to September 2019. The sample included 20 patients diagnosed with MS currently treated with immunomodulatory injectable drugs for at least 6 months. The Symbol Digit Modalities Test (SDMT) was used to assess cognitive impairment and to determine adherence, patients answered the Morisky-Green test (MG). Results Twenty patients (8 men and 12 women) were included over 10 months with MS and cognitive impairment (SDMT score less than 50th percentile). Regarding gender-differentiated adherence, 75% of men were not adherent to treatment; by contrast, 66.6% of women were com-pliant with the dosage schedule. There were no statistically significant differences in terms of differentiated adherence by type of treatment. The main methods used to promote adherence were: 10% calendar, 20% family members, and 30% alarms as reminder. Discussion and conclusion Adherence results show a predominance of adherence in women, even with cognitive impairment. This reinforces our initial hypothesis that relates good therapeutic adherence to lesser progression of cognitive impairment in MS. As a preventive measure, we would like to emphasize the importance of the role of the nursing team in detecting cognitive impairment and in assessing adherence to treatment.

BackgroundImplementation factors are hypothesised to moderate the implementation of innovations. Although individual barriers and facilitators have been identified for the implementation of different evidence-based services in pharmacy, relationships between implementation factors are usually not considered.ObjectivesTo examine how a network of implementation factors and the position of each factor within this network structure influences the implementation of a medication review service in community pharmacy.MethodsA mixed methods approach was used. Medication review with follow-up service was the innovation to be implemented over 12 months in community pharmacies. A network analysis to model relationships between implementation factors was undertaken. Two networks were created.ResultsImplementation factors hindering the service implementation with the highest centrality measures were time, motivation, recruitment, individual identification with the organization and personal characteristics of the pharmacists. Three hundred and sixty-nine different interrelationships between implementation factors were identified. Important causal relationships between implementation factors included: workflow-time; characteristics of the pharmacy-time; personal characteristics of the pharmacists-motivation. Implementation factors facilitating the implementation of the service with highest centrality scores were motivation, individual identification with the organization, beliefs, adaptability, recruitment, external support and leadership. Four hundred and fifty-six different interrelationships were identified. The important causal relationships included: motivation-external support; structure-characteristics of the pharmacy; demographics-location of the pharmacy.ConclusionNetwork analysis has proven to be a useful technique to explore networks of factors moderating the implementation of a pharmacy service. Relationships were complex with most implementation factors being interrelated. Motivation and individual identification with the organisation seemed critical factors in both hindering and facilitating the service implementation. The results can inform the design of implementation programs and tailored strategies to promote faster implementation of innovations in pharmacy.

Several descriptive cohort studies of patients affected by COVID-19 have been published.To describe the characteristics of patients with SARS-CoV-2 infection who were admitted to Hospital Universitario la Plana, Castellón, Spain.Retrospective, observational cohort study that included 18-year-old or older patients who were consecutively admitted with SARS-CoV2 confirmed infection. Demographic characteristics, comorbidities, clinical symptoms, laboratory results and radiological tests are described.The study included 255 patients with a mean age of 70 years; 54.9 % were males. Most common comorbidities were high blood pressure (58 %), dyslipidemia (42.4 %), diabetes (25.5 %) and obesity (24.3 %). Median number of days from the onset of clinical symptoms prior to hospital admission was seven. Most common manifestations prior to admission were fever (74.5 %), dry cough (61.2 %), malaise (51.8 %) and dyspnea (51.0 %); 19 patients (7.4 %) were admitted to the intensive care unit, where mortality was 50 %; overall mortality was 16.9 %.Our cohort reflects similar characteristics to those of other European series. Mortality was lower than that in similar studies.Se han publicado varios estudios descriptivos de cohortes de pacientes afectados por COVID-19.Describir las características de pacientes con infección por SARS-CoV-2 que ingresaron al Hospital Universitario de La Plana, Castellón, España.Estudio observacional de cohortes retrospectivo, que incluyó pacientes de 18 años o mayores que ingresaron en forma consecutiva con infección confirmada por SARS-CoV2; se describen características demográficas, comorbilidades, síntomas clínicos, resultados de laboratorio y pruebas radiológicas.El estudio incluyó 255 pacientes con edad promedio de 70 años; 54.9 % fue del sexo masculino. Las comorbilidades más frecuentes fueron hipertensión arterial (58 %), dislipemia (42.4 %), diabetes (25.5 %) y obesidad (24.3 %). La mediana de días del inicio de síntomas clínicos antes del ingreso fue de siete. Las manifestaciones más frecuentes previas al ingreso fueron fiebre (74.5 %), tos seca (61.2 %), malestar general (51.8 %) y disnea (51.0 %); 19 pacientes (7.4 %) ingresaron a la unidad de cuidados intensivos, donde la mortalidad fue de 50 %; la mortalidad total fue de 16.9 %.Nuestra cohorte refleja características similares a las de otras series europeas. La mortalidad fue inferior a la de estudios similares.

Renewable energy systems have a relevant land footprint, and their development can lead to land-use conflicts and trade-offs between energy supply and ecosystem services. Accordingly, this work identified the more suitable renewable energy development areas and discussed the potential trade-offs between energy supply and priority ecosystem services, combining the Geographic Information System-based suitability analysis and ecosystem service approach. The expert consultations were carried out to assess and identify the supply capacities of priority ecosystem services in South-Central Chile. The suitability maps for four renewable energy types were generated and spatially overlapped with priority ecosystem service maps to assess the trade-offs resulting from energy development. The results showed that suitable sites for solar, wind and biomass energy showed limited capacities to supply relevant provisioning and regulatory services and medium-to-low capacity to deliver cultural services. More than half of potential hydropower stations can be located on zones with a medium capacity to supply provisioning services and a high capacity for regulation and maintenance and cultural services. In most cases, sitting energy plants on areas of cultural relevance and other adverse impacts may cause social rejection toward their installation. This work provides valuable spatial information to support land-renewable energy planning, minimizing the environmental and social conflicts on ecosystem services.

In the last decades, microbiology laboratories have undergone unprecedented technological changes which have revolutionized the diagnosis of infectious diseases. They have last generation technology which allows precise, rapid and effective diagnosis of a wide range of infectious diseases, while also providing valuable information on the antibiotic sensitivity/resistance of the causal microorganism, thereby notably reducing the morbidity and mortality of the patients and at the same time improving in-hospital patient management. Several studies have shown that with the increase in the use of rapid diagnostic techniques this technological advancement has a greater impact when accessibility to the microbiology laboratory is possible beyond the usual 7 h workday. This document discusses the need for clinical microbiology services to work 24 h a day, 7 days a week (24/7).

Alterations in saliva, temporomandibular joint disorders, dysphagia, Sjogrens syndrome, dental caries, periodontal disease, and tooth loss have been identified in patients with Rheumatoid Arthritis. The aims of this research were 1) to study the association between newly diagnosed rheumatoid arthritis and dental caries and 2) to identify most frequent teeth with caries in study groups. A descriptive pilot study was performed. A total of 620 participants were evaluated, 29 met the selection criteria. The subjects were divided into 2 groups: 13 subjects with newly diagnosed rheumatoid arthritis and 16 subjects without rheumatoid arthritis. Salivary parameters, DMFT index, care index, FS-T index and Treatment Needs Index were evaluated in all participants. The Fishers Exact test and Mann-Whitney U test we used to establish the differences between groups. Low mean in all salivary parameters and a high caries frequency were observed in subjects with newly diagnosed rheumatoid arthritis compared to a control group (p

The posterior condylar offset (PCO) has been proposed as a determinant of a postoperative range of motion after total knee arthroplasty, although there is no consensus. This study aimed to demonstrate the error introduced by forcing the femoral rotation to overlap both condyles for the "true" lateral X-ray projection for the PCO measurement. We hypothesize that the angular discrepancy between the posterior femoral cortical reference plane and the posterior condylar axis plane due to rotation invalidates the acquisition of reliable measurements on X-rays. We have measured the PCO in 50 "true" lateral X-rays and compared it with the medial and lateral condyles PCO's assessed on a computed tomography-scan-based three-dimensional (3D) model of each knee. PCO based on the 3D imaging differed significantly between the medial (25.8 ± 3.67 mm) and lateral (16.59 ± 2.92 mm) condyle. Three-dimensional PCO values differ significantly from those determined in the radiographic studies. Also, the mean values of the medial and lateral condyle PCO measurements differed significantly (p < 0.001) with all PCO measurements on radiographs. We have identified a difference between the posterior cortical plane and the posterior condylar axis projections, both on the axial plane with a mean value of 11.23° ± 3.64°. Our data show an interplane discrepancy angle between the posterior femoral diaphyseal cortical and the posterior condylar axis plane (due to the femur's necessary rotation to overlap both condyles) may invalidate the 2D X-ray PCO assessment as a reliable measurement.

Background Catecholaminergic polymorphic ventricular tachycardia (CPVT) is a severe hereditary channelopathy characterized by the presence of ventricular arrhythmias triggered by adrenergic stimuli, usually diagnosed in the first two decades of life. Genetic variants in the cardiac ryanodine receptor gene are the most frequently occurring that cause an increase in intracellular calcium concentration and thus induce ventricular arrhythmias due to a delayed after depolarisation-induced triggered activity. Case presentation We present the case of a 74-year-old male, a regular athlete with no relevant family history who suffered from sinus dysfunction and frequent premature ventricular complexes with no symptoms. A treadmill test revealed severe polymorphic ventricular arrhythmias which led to the suspicion of CPVT. A genetic study was undertaken, and it identified a rare genetic variant in the RYR2 gene which was possibly associated with its development in heterozygosity: c.14465G > A, p.Arg4822His. While evaluating the co-segregation, we observed that most of his relatives exhibit polymorphic ventricular arrhythmias with exertion without symptoms and carried the same variant. Conclusions We described, for the first time, the clinical characteristics and co-segregation of a family diagnosed with CPVT secondary to a little-known genetic variant of the RYR2 gene. It is a variant that, in our case study, suggests an association with a very good prognosis.

The high density of iodine, and its storage in solid form with no pressurization requirements, have driven the increase on the use of the halogen for space propulsion systems. This paper presents the design and development process of a miniaturized propellant management system which can supply iodine at a stable mass flow rate to the thrusters. This system approach has been adapted to produce the flow control units of the NPT30-I2 gridded ion propulsion system and the I2T5 cold gas thruster, both of which have performed their first in-orbit demonstration flights. The paper is dedicated to the description of the design process, with a focus on the particularities of the use of iodine for space propulsion systems, mainly related to chemical interaction and deposition. The numerical analysis of rarefied flows serves as a base for the design of the flow path elements of the system. A performance characterization of the system obtained on ground and the challenges tackled during the development process are evaluated with the in-orbit data from the first flight missions of both propulsion systems.

To analyze compliance with dietary recommendations (DR) based on the Mediterranean Diet among natives and immigrants in Spain. A cross-sectional study was carried out using the Platform of Longitudinal Studies of Immigrant Families comparing immigrant workers from Colombia, Ecuador and Morocco with Spanish workers. Adjusted odds ratios (ORa) of sufficient compliance with DR were obtained by sociodemographic variables. We also obtained the adjusted difference in means (DMa) for foods for which there was compliance with DR. Moroccans had greater compliance for meat (ORa = 7.22), eggs (ORa = 5.03) and cured-meats (ORa = 89.78). Ecuadorians for sweets (ORa = 4.03) and Spaniards for natural-juices and dairy-products. Moroccans had the greatest compliance in terms of the number of foods (DMa = 1.53), while Colombians had the least (DMa = − 0.95). Men (DMa = − 0.98), those with primary or incomplete primary education (DMa = − 0.83) and single-parent families (DMa = − 0.58) showed lower compliance. Compliance with DR was low among both Spaniards and immigrants, despite differences in levels of compliance, especially between Moroccans and Colombians. This work was supported by the Instituto de Salud Carlos III [PI14/00146] (Co-funded by European Regional Development Fund/European Social Fund "Investing in your future").

Objectives To evaluate the efficacy of oral colistin-neomycin in preventing multidrug-resistant Enterobacterales (MDR-E) infections in solid organ transplant (SOT) recipients. Methods Multicentre, open-label, parallel-group, controlled trial with balanced (1:1) randomization in five transplant units. SOT recipients were screened for MDR-E intestinal colonization (extended-spectrum β-lactamase or carbapenemase producing) before transplantation and +7 and + 14 days after transplantation and assigned 1:1 to receive treatment with colistin sulfate plus neomycin sulfate for 14 days (decolonization treatment (DT) group) or no treatment (no decolonization treatment (NDT) group). The primary outcome was diagnosis of an MDR-E infection. Safety outcomes were appearance of adverse effects, mainly diarrhoea, rash, nausea and vomiting. Patients were monitored weekly until 30 days after treatment. Intention-to-treat analysis was performed. Results MDR-E rectal colonization was assessed in 768 SOT recipients; 105 colonized patients were included in the clinical trial, 53 receiving DT and 52 NDT. No significant decrease in the risk of infection by MDR-E was observed in the DT group (9.4%, 5/53) compared to the NDT group (13.5%, 7/52) (relative risk 0.70; 95% confidence interval 0.24–2.08; p 0.517). Four patients (5.6%), three (5.6%) in the DT group and one (1.9%) in the NDT group, developed colistin resistance. Twelve patients (22.7%) in the DT group had diarrhoea, eight related to treatment (15.0%); one patient (1.8%) developed skin rash and another (1.8%) nausea and vomiting. Two patients (3.8%) in the NDT group developed diarrhoea. Conclusions DT does not reduce MDR-E infections in SOT. Colistin resistance and adverse effects such as diarrhoea are a potential issue that must be taken seriously.

Background In our population, anti-thymocyte globulin (ATG) of 1 mg/Kg/day for 4 days is used; which permits not using valgancyclovir (VGC) prophylaxis in some renal transplant recipients (RTR) with moderate risk (R+), to reduce costs. This study aimed to determine the incidence and risk of developing cytomegalovirus (CMV), with or without prophylaxis, when exposed to low doses of ATG or basiliximab (BSL). Patients and methods A retrospective cohort included 265 RTR with follow-up of 12 months. Prophylaxis was used in R-/D+ and some R+. Tacrolimus (TAC), mycophenolate mofetil, and prednisone were used in all patients. Logistic regression analysis was performed to estimate the risk of CMV in RTR with or without VGC. Results Cytomegalovirus was documented in 46 (17.3%) patients: 20 (43.5%) with CMV infection, and 26 (56.5%) with CMV disease. Anti-thymocyte globulin was used in 39 patients (85%): 32 R+, six D+/R-, and one D-/R-. ATG was used in 90% (27 of 30) of patients with CMV and without prophylaxis. The multivariate analysis showed an association of risk for CMV with the absence of prophylaxis (RR 2.29; 95% CI 1.08–4.86), ATG use (RR 3.7; 95% CI 1.50–9.13), TAC toxicity (RR 3.77; 95% CI 1.41–10.13), and lymphocytes at the sixth post-transplant month (RR 1.77; 95% CI 1.0–3.16). Conclusions Low doses of ATG favored the development of CMV and a lower survival free of CMV compared with BSL. In scenarios where resources for employing VGC are limited, BSL could be an acceptable strategy.

Research has shown that an intervention process with adolescents involving the parents may achieve better results since the interaction with the parents is a protective factor itself. The brief intervention program for adolescents starting substance use is an intervention used in Mexican clinical centers with adolescents who have experienced problems with their substance use but do not present dependency symptoms. The family context is key to the genesis and progression of behavior problems, including substance use, among children and adolescents. An intervention process that involves parents may achieve better results in preventing substance use problems in adolescents

Implementing Evidence-based practices entails a demand not only on the clinician and professional training but also a demand on the institutional economic, material, and human resources. Such demands can be either facilitator of the processor, in some cases, major barriers. La implementación de la Práctica con Base en la Evidencia implica una demanda no solo en la formación profesional y clínica, sino también en recursos institucionales económicos, materiales y humanos.

Objective A consistent line of investigation proposes fibromyalgia as a dysautonomia-associated neuropathic pain syndrome. Comorbid anxiety or depression amplifies fibromyalgia symptoms. The recent recognition of small fiber neuropathy in fibromyalgia patients supports the neuropathic nature of the illness. Corneal confocal microscopy accurately identifies small nerve fiber pathology. The newly developed Small-Fiber Symptom Survey captures the spectrum of small fiber neuropathy symptoms. We aimed to correlate corneal nerve density with different fibromyalgia disease severity questionnaires including the Small-Fiber Symptom Survey. We defined the possible confounding role of comorbid anxiety or depression severity in the clinical-pathological association. Methods This is a case series of 28 women with fibromyalgia. A single ophthalmologist quantified corneal subbasal plexus nerve density. Corneal innervation was correlated (Spearman ρ) with the following clinical questionnaires scores: Small-Fiber Symptom Survey, Revised Fibromyalgia Impact Questionnaire, and COMPASS-31 (Composite Autonomic Symptom Survey 31-Item Score). Validated inquiry forms assessed the comorbid anxiety and/or depression severity. Results There were no clinical-pathological correlations in the group as a whole. In the subgroup of fibromyalgia women without severe anxiety or depression (n = 13), there was a strong negative correlation between corneal nerve density with the Small-Fiber Symptom Survey score (ρ = -0.771, p = 0.002) and COMPASS-31 score (ρ = -0.648, p = 0.017). Patients with profound anxiety or depression (n = 15) had more intense symptoms but had not clinical-pathological correlations. Conclusions Small fiber neuropathy and dysautonomia symptoms correlate with corneal denervation in women with fibromyalgia without severe anxiety or depression. This clinical-pathological association reinforces fibromyalgia as a dysautonomia-related neuropathic pain syndrome. Severe anxiety or depression distorts fibromyalgia symptoms. Practical point Corneal confocal microscopy may become a useful procedure to study fibromyalgia patients.

Introduction: Positive dysphotopsia (PD) is a topic of great interest in intraocular lens (IOL) field. Several approaches have been developed from the physics, psychophysics and psychometry fields to measure PD. However, the complexity of characterizing this phenomenon and the lack of standardization have resulted in a considerable bias between studies that avoid its inclusion in systematic reviews and meta-analysis. Areas Covered: The purposes of this review were first to suggest a definition and classification of PD that minimize the bias between studies that use different questions to rate PD prevalence. Second, to describe the limitations found in psychophysical studies. Finally, to identify the associations between photic phenomena (PP) and the design of monofocal and multifocal IOLs. A non-systematic literature review was conducted from the last 30 years. Expert Opinion: PD can be defined as any bothering bright artifact perceived by patients along or around direct bright lights or reflected over objects located in the visual field. If the patient is not bothered by the artifact, the term PP should be used instead. Psychophysical approaches measure PP and not PD. Whereas LED approaches are preferable, these really measure Light Disturbance because the classification of PP cannot be differentiated.

This investigation focusses on the environment of socialisation needed to mitigate internal environmental knowledge barriers. The research instrument is a questionnaire distributed to 87 Spanish Kn...

Previous studies have described the clinical, serological and pathological features of patients with chronic inflammatory demyelinating polyradiculoneuropathy (CIDP) and antibodies directed against the paranodal proteins neurofascin-155, contactin-1 (CNTN1), contactin-associated protein-1 (Caspr1), or nodal forms of neurofascin. Such antibodies are useful for diagnosis and potentially treatment selection. However, antibodies targeting Caspr1 only or the Caspr1/CNTN1 complex have been reported in few patients with CIDP. Moreover, it is unclear if these patients belong to the same pathophysiological subgroup. Using cell-based assays in routine clinical testing, we identified sera from patients with CIDP showing strong membrane reactivity when both CNTN1 and Caspr1 were co-transfected (but not when CNTN1 was transfected alone). Fifteen patients (10 male; aged between 40 and 75) with antibodies targeting Caspr1/CNTN1 co-transfected cells were enrolled for characterization. The prevalence of anti-Caspr1/CNTN1 antibodies was 1.9% (1/52) in the Sant Pau CIDP cohort, and 4.3% (1/23) in a German cohort of acute-onset CIDP. All patients fulfilled European Federation of Neurological Societies/Peripheral Nerve Society (EFNS/PNS) definite diagnostic criteria for CIDP. Seven (47%) were initially diagnosed with Guillain-Barré syndrome due to an acute-subacute onset. Six (40%) patients had cranial nerve involvement, eight (53%) reported neuropathic pain and 12 (80%) ataxia. Axonal involvement and acute denervation were frequent in electrophysiological studies. Complete response to intravenous immunoglobulin was not observed, while most (90%) responded well to rituximab. Enzyme-linked immunosorbent assay (ELISA) and teased nerve fibre immunohistochemistry confirmed reactivity against the paranodal Caspr1/CNTN1 complex. Weaker reactivity against Caspr1 transfected alone was also detected in 10/15 (67%). Sera from 13 of these patients were available for testing by ELISA. All 13 samples reacted against Caspr1 by ELISA and this reactivity was enhanced when CNTN1 was added to the Caspr1 ELISA. IgG subclasses were also investigated by ELISA. IgG4 was the predominant subclass in 10 patients, while IgG3 was predominant in other three patients. In conclusion, patients with antibodies to the Caspr1/CNTN1 complex display similar serological and clinical features and constitute a single subgroup within the CIDP syndrome. These antibodies likely target Caspr1 primarily and are detected with Caspr1-only ELISA, but reactivity is optimal when CNTN1 is added to Caspr1 in cell-based assays and ELISA.

espanolLos avances terapeuticos en la artritis reumatoide obligan a revision periodica de las guias de tratamiento. Objetivo Actualizar las guias del Colegio Mexicano de Reumatologia del tratamiento farmacologico de la artritis reumatoide. Metodo Participaron reumatologos certificados de diferentes instituciones de salud y regiones del pais. Se conformaron equipos de trabajo que revisaron las guias previas, elaboraron nuevas preguntas, revisaron la literatura y calificaron la evidencia, que fue presentada y discutida en sesion plenaria. Las conclusiones se comentaron con infectologos, ginecobstetras y pacientes. Se emiten recomendaciones basadas en niveles de evidencia de acuerdo con la metodologia GRADE. Resultados Se presentan recomendaciones actualizadas para el empleo de los medicamentos disponibles en Mexico hasta 2017 para el tratamiento de la artritis reumatoide. Se enfatiza la importancia del control adecuado y sostenido de la enfermedad y se describen aspectos relevantes de seguridad. Se incluyen conflictos bioeticos y se invita a la accion gubernamental para fortalecer el tratamiento adecuado de la enfermedad. Conclusiones La actualizacion de las recomendaciones del Colegio Mexicano de Reumatologia del tratamiento farmacologico de la artritis reumatoide integra la mejor informacion disponible para ser utilizada en el sistema de salud de Mexico. EnglishTherapeutic advances in rheumatoid arthritis require periodic review of treatment guidelines. Objective To update the Mexican College of Rheumatology guidelines on the pharmacological treatment of rheumatoid arthritis. Method Board certified rheumatologists from different health institutions and regions of the country participated. Work teams were formed that reviewed the previous guidelines, elaborated new questions, reviewed the literature, and scored the evidence that was presented and discussed in plenary session. The conclusions were presented to infectologists, gynaecologists and patients. Recommendations were based on levels of evidence according to GRADE methodology. Results Updated recommendations on the use of available medications for rheumatoid arthritis treatment in Mexico up to 2017 are presented. The importance of adequate and sustained control of the disease is emphasized and relevant safety aspects are described. Bioethical conflicts are included, and government action is invited to strengthen correct treatment of the disease. Conclusions The updated recommendations of the Mexican College of Rheumatology on the pharmacological treatment of rheumatoid arthritis incorporate the best available information to be used in the Mexican health care system.

Individualized pre-operative assessment of the patterns of the lower extremity anatomy and deformities in patients undergoing total knee arthroplasty seems essential for a successful surgery. In the present study, we investigated the relationship among the coronal alignment and the rotational profile of the lower extremities in the Caucasian population with end-stage knee osteoarthritis. We conducted a prospective study of 385 knees that underwent a pre-operative three-dimensional computed tomography-based model. The lower extremity alignment was determined (mechanical tibiofemoral or hip-knee-ankle angle, supplementary angle of the femoral lateral distal angle, and proximal medial tibial angle). For each case, the femoral distal rotation (condylar twist angle), the femoral proximal version, and the tibial torsion were determined. As the coronal alignment changed from varus to valgus, the femoral external rotation increased (r = 0.217; p

Methotrexate is the gold standard treatment in rheumatoid arthritis. Once absorbed, it is internalized in cells, where glutamate residues are added to produce polyglutamated forms, which are responsible for the effect of methotrexate. The aim of the current study is to determine the relationship between methotrexate triglutamate concentrations and the clinical evolution in rheumatoid arthritis patients, as well as to characterize the variability in both features to propose strategies for low-dose methotrexate optimization. The quantification of methotrexate triglutamate concentration in red blood cells was performed through ultra-performance liquid chromatography coupled with mass spectrometry. Polymorphisms of genes involved in the formation of polyglutamates were determined by real-time polymerase chain reaction. A multivariate regression was performed to determine the covariates involved in the variability of methotrexate triglutamate concentrations and a population pharmacokinetics model was developed through nonlinear mixed-effects modeling. Disease activity score changed according to methotrexate triglutamate concentrations; patients with good response to treatment had higher concentrations than moderate or nonresponding patients. The methotrexate triglutamate concentrations were related to time under treatment, dose, red blood cells, and body mass index. A 1-compartment open model was selected to estimate the pharmacokinetic parameters; the typical total clearance (L/day) was determined as 1.45 * (body mass index/28 kg/m2 ) * (red blood cells/4.6 × 106 cells/μL) and the volume of distribution was 52.4 L, with an absorption rate of 0.0346/day and a fraction metabolized of 1.03%. Through the application of the model, the initial dose of methotrexate is proposed on the basis of stochastic simulations and considering methotrexate triglutamate concentrations found in responders patients.

The current study sets out to investigate the relationships among three interconnected dimensions, that is hiding knowledge by the Government, the realized absorptive capacity (RACAP) and citizen engagement, giving way to a context‐driven approach. Emphasis is laid on the effects engendered by the lack of official information transparency in the critical context of COVID‐19 outbreak at the global level, through the lens of the Spanish example. The relationships among the variables are analyzed by means of an empirical study conducted with 151 Spanish subjects with a view to identify whether the impact of knowledge hiding by the Government on citizen engagement can be mitigated and to acknowledge how the presence of RACAP impacts citizens in limiting the spread of COVID‐19 information disorders.

PurposeThis paper addresses the link between earnings management (EM) and corporate social responsibility (CSR) in small and medium-sized enterprises (SMEs).Design/methodology/approachData were collected from 317 Spanish SMEs to perform: (1) bivariate analysis between EM, CSR and some firm-factors (i.e. size, sector, sector life cycle stage, corporate age, family ownership, profitability and financial risk); and (2) multiple regression analysis for a better understanding of EM behavior and test the influence of sector life cycle stage variable.FindingsResults emphasize the relevance of the sector life cycle stage as an explanatory factor. Firms operating in sectors that are growing or declining in terms of sales are more proactive to EM than those with consolidated sales levels. Stratified regression analysis also confirms that the stage of the industry life cycle influences the EM-CSR relationship. Only for SMEs with stable sales in maturity sectors, lower interest in EM can be significantly explained by higher CSR performance. Firms with regular sales levels show a more outstanding socially responsible commitment and are less pressured to legitimize their operational decisions and therefore show lower levels of EM involvement.Originality/valueThis paper makes a twofold contribution. On the one hand, it examines the relationship between EM and CSR, focusing on SMEs' context, in which EM study could be considered incipient. On the other hand, the controversial empirical evidence on the significance and sign of EM and social responsibility link could be explained by the stage of the life cycle of the sector in which each company operates.

Risk-sharing agreements(RSA) allow decision-makers to manage the uncertainty associated with effectiveness and costs of treatments. Our objective was to estimate the economic impact of RSA implementation on treatment of patients diagnosed with rheumatoid arthritis(RA) with certolizumab pegol(CZP) and assess the potential impact of alternative RSA.Under original RSA, treatment with CZP was reimbursed when the response was optimal (DAS28 score3.2) or satisfactory (DAS28 score ≥3.2 and reduction from baseline ≥1.2) at 12 weeks. Alternative RSA would additionally include a 50 % reimbursement for moderate responders(DAS28 score3.2 and ≤5.1, and reduction from baseline between 0.6 and 1.2). We estimated average savings per patient for hospital's pharmacy service(HPS) at 12 weeks, taking into account the pharmacological cost of CZP. Uncertainty associated with effectiveness of CZP was assessed through 1000 Monte Carlo simulations.After 12 weeks of treatment, 57.8 % (n = 52) and 22.2 %(n = 20) of patients had optimal and satisfactory responses, respectively, and average disease activity improved by 1.77 points. Average savings for HPS amounted to 876.9€ and 706.4€ per patient under original and alternative RSA, respectively. Savings in simulated cohort reached 846.2€ and 681.8€ per patient, respectively, leading to estimated net savings for HPS of 846,209€ and 681,790€, respectively.RSA implementation on patients with RA treated with CZP has generated savings and improved efficiency within HPS.

Extraarticular synovial osteochondromatosis is a very rare benign disease whose aetiology may be primary or secondary to pre-existing pathology or after trauma. The diagnosis can be made with plain radiography and CT, and MRI is necessary to evaluate the non-mineralized soft tissue component and assess extension. It must be confirmed with a pathological study by biopsy or resection. There is up to a 5% chance of malignant transformation. The treatment of choice for the extensive extra-articular form is surgery by open resection. The case presented illustrates an atypical form of secondary extraarticular OCS with multiple involvement of the leg, ankle and foot.

Los programas de educación ambiental con enfoque de cuenca se caracterizan por ser no formales y carecer de una línea base para su implementación, la cual surge conforme se realiza el proceso de gestión. El objetivo del trabajo fue la definición de una línea base para un programa de educación ambiental no formal en la microcuenca Xichú, Guanajuato. La metodología consistió en aplicar encuestas dirigidas a la población y entrevistas a informantes claves de instituciones, la academia y organizaciones no gubernamentales. En los resultados se determinaron nueve temas ambientales, se priorizaron las zonas funcionales alta y baja de la microcuenca, se seleccionó el Venado Cola Blanca como especie bandera y se definieron estrategias de enseñanza. No existe suficiente información ambiental pero sí motivación para participar en actividades del programa de educación ambiental. Se concluye con un trabajo que puede ser replicado y que funcione de apoyo en programas, proyectos y evaluaciones territoriales.

Inferior alveolar nerve block in the mandibular technique is the blockade that presents most failures in the dental practice, so this technique is considered the less effective of those used in Dentistry and the most frustrating to the dentist. This study aimed to determine pain intensity during dental procedures after using 4% articaine with epinephrine 1:100000 in the inferior alveolar nerve block with buccal infiltration in patients who were attended in the dental clinic of the University of Cartagena, Colombia. A clinical randomized trial was performed. The sample was of patients who required dental procedures in the jaw with local anesthesia. After standardization of the anesthetic technique, and use of 4% articaine with epinephrine 1:100000, the inferior alveolar nerve was blocked with 0.9 mL (half cartridge) followed by buccal infiltration with 0.9 mL in the first mandibular molar. Fifty patients (30 men - 60% and 20 women - 40%), with an average age of 25.3 years old (mean ± standard deviation [SD]: 25.3 ± 6.6) were included in the study. When assessing the pain puncture and during the injection, 92% of patients classified it as mild pain according to VAS. When evaluating the latency period, the average time was less than two minutes and the perioral soft tissue anesthesia was 97%. Only a small percentage of patients required complementary anesthesia. The authors recommend the use of 4% of articaine with epinephrine in mandibular procedures that require deep pulp anesthesia, using this with a buccal infiltration.

The urgent need of caring for COVID-19 patients has prompted doctors around the world to come up with innovative strategies to safeguard their health. The response of health care institutions to this pandemic is unprecedented, as is the shortage of personal protective equipment. Without it, the chances of health workers to become ill and die increase. In patients infected with SARS CoV-2, the Aerosol-Generating Procedures are considered to be those with the highest exposure to the virus in the care rooms. In this article we expose the available information regarding additional protection provided by some barrier devices during the intubation-extubation process, in order to create the need for Mexican physicians to investigate the consequences of their use further on. © 2021, Instituto Nacional de Enfermedades Respiratorias. All rights reserved.

Myocardial infarction (MI) is associated with renal alterations resulting in poor outcomes in patients with MI. Renal fibrosis is a potent predictor of progression in patients and is often accompanied by inflammation and oxidative stress; however, the mechanisms involved in these alterations are not well established. Endoplasmic reticulum (ER) plays a central role in protein processing and folding. An accumulation of unfolded proteins leads to ER dysfunction, termed ER stress. Since the kidney is the organ with highest protein synthesis fractional rate, we herein investigated the effects of MI on ER stress at renal level, as well as the possible role of ER stress on renal alterations after MI. Patients and MI male Wistar rats showed an increase in the kidney injury marker neutrophil gelatinase-associated lipocalin (NGAL) at circulating level or renal level respectively. Four weeks post-MI rats presented renal fibrosis, oxidative stress and inflammation accompanied by ER stress activation characterized by enhanced immunoglobin binding protein (BiP), protein disulfide-isomerase A6 (PDIA6) and activating transcription factor 6-alpha (ATF6α) protein levels. In renal fibroblasts, palmitic acid (PA; 50-200 µM) and angiotensin II (Ang II; 10−8 to 10−6M) promoted extracellular matrix, superoxide anion production and inflammatory markers up-regulation. The presence of the ER stress inhibitor, 4-phenylbutyric acid (4-PBA; 4 µM), was able to prevent all of these modifications in renal cells. Therefore, the data show that ER stress mediates the deleterious effects of PA and Ang II in renal cells and support the potential role of ER stress on renal alterations associated with MI.

Para la evaluación de la Postioplastía Horizontal Alta (PHA) para corrección de estenosis prepucial posquirúrgica en toros para su reingreso a la empresa bovina se realizó un estudio de tipo descriptivo no probabilístico. Los pacientes quirúrgicos fueron dos toros Brahman/Sardo Negro con estenosis prepucial posquirúrgica. Se realizó una incisión horizontal por arriba del conducto fibroso. Para la hemostasia de los vasos pequeños fue suficiente el pinzamiento y torsión. La divulsión se realizó en 360° hasta conseguir el desprendimiento de todo el conducto fibroso, hasta observar nuevamente la luz normal del conducto. Se le colocaron 4 puntos de forma cardinal con sutura de nylon monofílico para expandir la mucosa y poder suturarla a la piel, esos mismos puntos de sujeción se fijaron con punto de cirujano y posteriormente se colocaran los puntos necesarios entre ellos. Como resultado, los toros operados con la técnica descrita tuvieron recuperación en un período de 90 días posoperatorio. La RB-C fue de 4.2 significa que por cada peso invertido, dicho peso fue recuperado y además se obtuvo una ganancia extra de $3.2 pesos M/N. Se concluye que la Postioplastia Horizontal Alta fue eficiente, siendo de 4.2 pesos M/N, al mismo tiempo que los toros en un lapso de 90 días empezaron con su función zootécnica.

En el presenta trabajo se muestran los resultados del estudio sobre los problemas ambientales generados por el uso excesivo de plaguicidas en la actividad agrícola, lo que trae como consecuencia la generación de envases vacíos. Estos envases requieren de un manejo correcto, un destino final preciso y controlado porque son una fuente de contaminación o riesgo tóxico para el ser humano y el medio ambiente. La generación de envases de agroquímicos trae consigo ciertos riesgos, pero pueden ser casi nulos mediante una adecuada gestión de los envases en desuso; aunque la realidad indica que la mayor parte de los productores realiza un inadecuado manejo, ocasionado por ausencia de normas ambientales, falta de políticas públicas sobre este tipo de basura toxica y falta de información sobre cómo realizar el manejo correctamente, así como de las consecuencias perjudiciales que provoca en la salud humana y el medio ambiente. Los principales problemas que se observan en las regiones agrícolas en la actualidad es el abandono de los envases vacíos de plaguicidas en los campos donde cultivan. Algunas prácticas comunes son las siguientes: enterrarlos, quemarlos o reutilizarlos. Sin embargo ninguno de estos métodos son acordes con el cuidado del medio ambiente ni responden a los protocolos internacionales de producción que resguardan la calidad, inocuidad de los alimentos y la salud del trabajador. Para atender este problema se realizó un estudio los productores de la comunidad de Adolfo López Mateos, perteneciente al municipio de Sayula de Alemán. A través de una encuesta aplicada a productores del sector agropecuario, se identificaron las prácticas que realizan con los envases vacíos. Los resultados fueron que tiran los envases vacíos a la superficie donde cultivan, porque desconocen qué hacer con ellos. Sin embargo, están dispuestos a capacitarse sobre la técnica de triple lavado. Los resultados permitieron conocer las formas de percepción y cuidados del medio ambiente. Finalmente se propuso la técnica de triple lavado como una alternativa para mejorar el cuidado del entorno, de tal manera que se pueda contribuir a reducir el consumo de plaguicidas y en su caso de envases vacíos. Así como aprender sobre el uso que se le puede dar a los envases vacíos de plaguicidas, ya que actualmente son unos de los principales problemas en el campo.

The purpose of this article is to carry out an analysis of the triggering elements in the process of deformation and development of vices in language. Determine the influence of smartphones, social networks and the use of foreign words in its transformation. The analysis is important because it is part of the factors that reduce the development of an assertive language among young people who are currently in professional training. This research is carried out from a direct observation of case studies in order to analyze the social networks of a group of people (volunteers) to evaluate their communication processes, the development of language vices or the generation of spelling mistakes. In addition, the application of a survey to evaluate the behavior of people in the face of the elements that are considered triggers for the problem. The main contribution of the research is the approach taken to the analysis of the factors that trigger the deformation of language and its incorrect use, which allows the generation of bases on which to work future research, for the correction of the current problems generated in spelling as a result of this, and that allows to expand the knowledge about future action strategies.

PurposeThe purpose of this paper is to bring the attention of the intellectual capital (IC) research and practice communities to the value of IC in hotels' efforts to resolve or mitigate environmental problems over time. This research has been set to examine the relationships between key KM and IC concepts including environmental knowledge structures and exploitation and exploration of environmental knowledge (EK) as drivers of environmental organisational learning. The research has also examined the relevance of pro-environmental behavioural intention capital (PEBIC) as a component of structural capital and therefore an integral part of the intellectual capital of hotels.Design/methodology/approachThe data analysis technique used to test the proposed conceptual model is partial least squares structural equation modelling (PLS-SEM). Sample received from 87 companies from the Spanish hospitality sector in a longitudinal study (six years).FindingsThe results support that environmental knowledge structures (exploitation and exploration) has a positive impact on PEBIC over time. In other words, environmental organisational learning has the capability to create structural capital in hotel over time.Originality/valueThe research has addressed the challenges of exploration and exploitation of EK and PEBIC from a perspective not previously covered in the extant literature, further improved by the longitudinal nature of this study. Our focus on the hospitality sector makes this research relevant for management structures at numerous of hotels, as well as to their supply chains around the world. In addition, this research highlights the value to create structural capital through EK and organisational learning in the context of take care of our natural resources.

Este artículo se encuentra disponible a texto completo en la siguiente URL: https://archivosdeprevencion.eu/index.php/aprl/article/view/65/51 Objetivo: Estimar la prevalencia de inmunización frente al virus de la Hepatitis B del personal sanitario, vinculado a los Departamentos de Salud de Torrevieja y Elche-Crevillente, de la Comunidad Valenciana Métodos: Estudio descriptivo transversal en todos los trabajadores sanitarios de dos departamentos de Salud. Obtenida la muestra se identificó los niveles de anticuerpos de superficie del virus de la Hepatitis B a través de los resultados serológicos ubicados en las historias clínicas. Se consideró inmunizado a títulos de anti-HBs ≥10mlU/ml. Las variables analizadas fueron categorizadas según: Departamento; Género; Edad (18-34; 35-49; >50años); categoría profesional (facultativos/Enfermería/Otro personal sanitario/Personal no sanitario); Servicio riesgo contagio (Si/No); Inmunidad (≥10mlU/ml /

The main stabilizing element of the distal radioulnar joint (DRUJ) is the triangular fibrocartilage complex (TFCC). Secondary stabilizers include the distal oblique band (DOB), which is inconsistently found. When TFCC repair has failed or cannot be performed, DOB reconstruction is a therapeutic option. Even though distal radioulnar ligamentoplasty remains the technique of choice, recent papers show similar outcomes from both methods. We present two cases of successful DOB repair with the extensor carpi radialis longus (ECRL) hemitendon.

Resumen Introduccion y objetivos Recientemente, la miocardiopatia arritmogenica del ventriculo izquierdo (MCAVI) ha sido reconocida como parte del espectro de la miocardiopatia arritmogenica. Se caracteriza por el reemplazo fibroadiposo de la pared de dicho ventriculo. Se describen las formas de presentacion clinica mas frecuentes, hallazgos de imagen y eventos en el seguimiento, destacando la importancia de la resonancia magnetica cardiaca (RMC). Metodos Registro prospectivo de pacientes con hallazgos compatibles con MCAVI. Se realizo analisis de imagen de RMC y seguimiento clinico. El objetivo primario fue la aparicion de eventos cardiovasculares adversos mayores (MACE) durante el seguimiento, definidos como muerte subita cardiaca, arritmias ventriculares sostenidas y trasplante cardiaco. Resultados Se incluyeron 74 pacientes consecutivos (edad media 48,6 anos, 50 varones [67,6%]). Las indicaciones mas frecuentes para la RMC fueron dolor toracico con coronariografia normal, arritmias ventriculares y sospecha de miocardiopatias. Los principales hallazgos de RMC fueron: realce tardio meso-subepicardico (91,9%), infiltracion grasa subepicardica (83,8%) y anomalias segmentarias de la contractilidad del ventriculo izquierdo (47,9%). En un seguimiento medio de 3,74 anos, 24 pacientes (32,4%) presentaron un MACE (muerte subita cardiaca 8,1%, arritmias ventriculares sostenidas 21,6% y trasplante cardiaco 4,1%). La presencia en RMC de realce tardio grave, predice independientemente la aparicion de MACE, ademas del hecho de ser varon y practicar deporte. Conclusiones La RMC es una herramienta clave para diagnosticar la MCAVI. La infiltracion grasa subepicardica y el realce tardio meso-subepicardico son hallazgos caracteristicos. El pronostico de esta poblacion es pobre con una alta incidencia de muerte subita cardiaca y arritmias ventriculares.

A medida que evoluciona la pandemia COVID-19, se ha encontrado que ciertas comorbilidades están relacionas con esta enfermedad. Estos factores se vuelven importantes, para definir el grupo considerado vulnerable, así como las medidas (confinamiento o distanciamiento) y tratamientos que han de utilizarse de acuerdo con los protocolos establecidos por los gobiernos. Utilizando datos de la Dirección General de Epidemiología del Gobierno Federal, al corte del 5 de agosto, se aplicó un modelo de regresión logit binomial para estimar los efectos de las comorbilidades en los pacientes contagiados por el virus SAR-CoV-2, y con ello, determinar qué factores son lo que tienen mayor probabilidad de ocurrencia asociado al riesgo de muerte por esta enfermedad. Los resultados revelan que padecer diabetes, así como el registro de otras comorbilidades, aumentan la probabilidad de muerte, a la vez que la edad, es una variable que la incrementa potencialmente. Los hallazgos muestran la importancia de la promoción y rediseño de políticas de salud preventivas que incluyan cambios sustanciales en la forma de vida de los pacientes y sus familias como una de las vías para mejorar su bienestar.

Objective The objective of this study was to determine and compare the distribution of fimA genotypes of Porphyromonas gingivalis (P. gingivalis) in systemic lupus erythematosus (SLE) patients compared with control subjects. Material and methods This observational cross-sectional study included 281 patients divided into two groups. Group 1 (G1) consisted of 162 control subjects (30–54 years old) and, group 2 (G2) included 119 subjects (10–69 years old) diagnosed with SLE. The presence of P. gingivalis was detected by PCR. DNA sequences in acquired plaque samples were identified using P. gingivalis specific sequences and further analyzed to differentiate their fimA genotypes using six sets of fimA genotype-specific primers. Results The presence of periodontitis (PE) was similar in both groups; similar measurements were obtained regarding clinical attachment loss (CAL) (G1 1.76 ± 0.72 vs. G2 1.95 ± 0.76). G2 showed the highest frequency of P. gingivalis (94.95%). FimA genotype II is considered the most virulent and, was the most frequently found in the SLE group (53.09%). Conclusion The genotypes associated with PE are more frequently detected in SLE, which could make them susceptible to develop PE.

OBJECTIVES Multiple sclerosis (MS) is a neurodegenerative chronic inflammatory. Mutations in the vitamin D receptor (VDR) gene can substantially affect serum vitamin D levels or alter its functionality, and can consequently increase susceptibility to developing MS. The objective of this study was to evaluate the association between polymorphisms in the VDR gene and risk of MS in a (Spanish) Caucasian population. PATIENTS AND METHODS We conducted a retrospective case-control study comprising 209 patients with relapsing-remitting multiple sclerosis (RRMS) and 836 controls of Caucasian origin from southern Spain. The ApaI (rs7975232), BsmI (rs1544410), Cdx2 (rs11568820), FokI (rs2228570), and TaqI (rs731236) gene polymorphisms were determined by allelic discrimination real-time PCR using TaqMan probes. RESULTS The recessive logical regression model, adjusted for age and sex, revealed that the TT genotype for VDR FokI (rs2228570) polymorphism was associated with higher risk of MS (P = 0.0150; OR = 1.82; 95% CI = 1.12-2.94; TT vs. CT + CC). No association between the other polymorphisms and development of MS was found in any of the models analyzed. The haplotype analysis, adjusted for age, smoking, and sex, did not find any statistically significant association between the haplotypes analyzed and risk of MS. CONCLUSIONS The VDR FokI (rs2228570) polymorphism was significantly associated with developing MS. We found no influence of the ApaI (rs7975232), BsmI (rs1544410), Cdx2 (rs11568820), FokI (rs2228570), and TaqI (rs731236) gene polymorphisms on the risk of developing MS in our patients.