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Key Clinical Message Several electrocardiographic alterations due to hypokalemia have been described, but the electrocardiographic presentation meeting criteria for occlusion of the left main coronary artery is very rare. We describe a case of hypokalemia simulating it.

Abstract Background Nurses are frequently exposed to chronic stress in the workplace generating harmful effects such as job strain and burnout. On the contrary, resilience has been shown to be a beneficial variable. The objective of this study was to analyze the relationship between dimensions of the Job Demand Control-Support model, resilience and burnout in nurses, and examine the mediating role of resilience between job strain and burnout. Methods A descriptive, cross-sectional study reported in line with the STROBE guidelines. Active nurses were invited to complete an online questionnaire in September, 2020. With snowball sampling, 1013 nurses, with a mean age of 34.71, filled out the Job Content Questionnaire, the Maslach Burnout Inventory and the Resilience Scale. Results The results showed the existence of four groups of professionals based on job strain. The nurses in the “High Strain” group (high demands and low control) showed higher scores in emotional exhaustion and cynicism, while those in the “Active Job” group scored higher in personal realization and resilience. The findings showed that job strain affects burnout in nurses, and this effect is mediated by resilience. Conclusions The findings of this study showed that a high level of resilience could exert a fundamental role in ensuring well-being and proper job performance by nurses. Nursing managers should see to the personable variables or competencies that provide and favor an opportunity for nurses to widen and improve their practice, in pursuance of satisfying and responding better to people’s needs and the systems they work for.

Introducción: El Trabajo Emocional deteriora la salud mental de los colaboradores, quienes, en interacción con usuarios, regulan sus emociones para expresar las prescritas en la organización. Objetivo: Mapear sistemáticamente los hallazgos principales sobre el Trabajo Emocional en grupos ocupacionales de Latinoamérica a partir de la revisión de artículos científicos publicados entre 2009 y 2020, mediante una revisión de alcance. Materiales y métodos: A partir de la metodología PRISMA-ScR, se realizó la búsqueda en las bases de datos LILACS, Redalyc, Dialnet, DOAJ, BVS, Gale One File: Psychology y EBSCOhost; con las palabras clave “trabajo emocional” (español), “emotional labor”/“emotional work” (inglés) y “trabalho emocional” (portugués); y una matriz de registro documental como formulario de gráfico de datos. Resultados: De 186 artículos, se seleccionó 17, con las siguientes características: la mayoría fueron de Brasil; grupos de trabajadores en salud y docentes; con definición de trabajo emocional en 6 categorías; y se utilizaron 11 instrumentos de medición. Conclusiones: Existe amplia concepción sobre el trabajo emocional, sin embargo, la evidencia en Latinoamérica aún es limitada, por ello es necesario continuar investigación de su incidencia en diferentes escenarios laborales, para obtener una comprensión global del constructo.

Introducción: la ocurrencia de eventos adversos (EA) es una problemática de salud pública que impacta el estado de salud del paciente y produce riesgo en el personal sanitario afectando el bienestar laboral y dando lugar a accidentes, enfermedades laborales y acciones inseguras en la atención. Objetivo: determinar los factores más frecuentes al reportar EA y sus implicaciones para la gestión del talento humano (GTH) en el contexto hospitalario Latinoamericano. Materiales y métodos: realizado bajo la metodología de revisión sistemática, mediante la búsqueda de artículos publicados entre los años 2009 y 2019, en las bases de datos: BVS, Dialnet, DOAJ, LILACS, MedlinePlus, PubMed, SciELO, ScienceDirect, Redalyc y EBSCOhost. Resultados: Se analizó 41 artículos donde se identificó factores de riesgo y protectores relacionados con la ocurrencia de EA, los cuales se agrupan en tres categorías: referidas al paciente, la organización y al personal sanitario. Conclusiones: Los EA son fenómenos complejos que afectan el sistema de salud. Sus causas se relacionan con la aparición de múltiples factores que tienen que ver tanto con la organización como con el desempeño del personal de salud, inclusive, hasta con el actuar del mismo paciente y su familia.

Summary: Background: The application of cold exposure has emerged as an approach to enhance whole-body lipid catabolism. The global effect of cold exposure on the lipidome in humans has been reported with mixed results depending on intensity and duration of cold. Methods: This secondary study was based on data from a previous randomized cross-over trial (ClinicalTrials.gov ID: NCT03012113). We performed sequential lipidomic profiling in serum during 120 min cold exposure of human volunteers. Next, the intracellular lipolysis was blocked in mice (eighteen 10-week-old male wild-type mice C57BL/6J) using a small-molecule inhibitor of adipose triglyceride lipase (ATGL; Atglistatin), and mice were exposed to cold for a similar duration. The quantitative lipidomic profiling was assessed in-depth using the Lipidyzer platform. Findings: In humans, cold exposure gradually increased circulating free fatty acids reaching a maximum at 60 min, and transiently decreased total triacylglycerols (TAGs) only at 30 min. A broad range of TAG species was initially decreased, in particular unsaturated and polyunsaturated TAG species with ≤5 double bonds, while after 120 min a significant increase was observed for polyunsaturated TAG species with ≥6 double bonds in humans. The mechanistic study in mice revealed that the cold-induced increase in polyunsaturated TAGs was largely prevented by blocking adipose triglyceride lipase. Interpretation: We interpret these findings as that cold exposure feeds thermogenic tissues with TAG-derived fatty acids for combustion, resulting in a decrease of circulating TAG species, followed by increased hepatic production of polyunsaturated TAG species induced by liberation of free fatty acids stemming from adipose tissue. Funding: This work was supported by the Netherlands CardioVascular Research Initiative: ‘the Dutch Heart Foundation, Dutch Federation of University Medical Centers, the Netherlands Organisation for Health Research and Development and the Royal Netherlands Academy of Sciences’ [CVON2017-20 GENIUS-II] to Patrick C.N. Rensen. Borja Martinez-Tellez is supported by individual postdoctoral grant from the Fundación Alfonso Martin Escudero and by a Maria Zambrano fellowship by the Ministerio de Universidades y la Unión Europea – NextGenerationEU (RR_C_2021_04). Lucas Jurado-Fasoli was supported by an individual pre-doctoral grant from the Spanish Ministry of Education (FPU19/01609) and with an Albert Renold Travel Fellowship from the European Foundation for the Study of Diabetes (EFSD). Martin Giera was partially supported by NWO XOmics project #184.034.019.

Summary: Background: Fatty acid-derived lipid mediators including oxylipins, endocannabinoids (eCBs), and their analogues, have emerged as key metabolites in the inflammatory and immune response to physiological stressors. Methods: This report was based on a sub-study and secondary analyses the ACTIBATE single-center unblinded randomized controlled trial (ClinicalTrials.gov ID: NCT02365129). The study was performed in the Sport and Health University Research Institute and the Virgen de las Nieves University Hospital of the University of Granada. Eligible participants were young, sedentary adults with no chronic diseases. Here, we performed both an acute endurance and resistance exercise sub-studies (n.ß=.ß14 and 17 respectively), and a 24-week supervised exercise intervention, combining endurance and resistance exercise training at moderate-intensity (MOD-EX) or vigorous-intensity (VIG-EX) exercise groups, in young sedentary adults. Randomization was performed by unrestricted randomization. Plasma levels of oxylipins, eCBs, and their analogues were measured using liquid chromatography-tandem mass spectrometry. Findings: Both endurance and resistance exercise increased by.ß+50% the plasma levels of dihomo-..-linolenic acid and arachidonic acid (AA) omega-6 derived oxylipins, as well as eicosapentaenoic acid and docosahexaenoic acid omega-3 derived after 3 and 120.ßmin of the bout of exercise (all ..2.ß....ß0.219 and P.ß..±.ß0.039). These exercise modalities also increased the levels of anandamide and eCBs analogues (+25%). 145 young sedentary adults were assigned to a control (CON, n.ß=.ß54), a MOD-EX (n.ß=.ß48) or a VIG-EX (n.ß=.ß43). 102 participants were included in the final long-term analyses (CON, n.ß=.ß36; MOD-EX, n.ß=.ß33; and VIG-EX, n.ß=.ß33) of the trial. After 24-week of supervised exercise, MOD-EX decreased plasma levels of omega-6 oxylipins, concretely linoleic acid (LA) and adrenic acid derived oxylipins, and the eCBs analogues OEA and LEA in comparison to the CON (all P.ß..±.ß0.021). VIG-EX decreased LA-derived oxylipins and LEA compared to CON. No relevant adverse events were recorded. Interpretation: Endurance and resistance exercises acutely increased plasma levels of oxylipins, eCBs, and their analogues, whereas 24 weeks of exercise training decreased fasting plasma levels of omega-6 oxylipins, and eCBs analogues in young, sedentary adults. Funding: See Acknowledgments section.

IntroductionEven though emotional intelligence and self-esteem are truly important variables in healthcare, the fact is that there are few studies on these constructs in Spanish physicians. The objective was to analyze the relationship between self-esteem and emotional intelligence in Spanish physicians, and their relationship with sociodemographic and employment variables.MethodsThe study included a sample of 180 physicians with a mean age of 34.61, 76.7% of whom were women. The physician completed the Rosenberg self-esteem scale, the Brief Emotional Intelligence Inventory for Senior Citizens and a questionnaire on sociodemographic and work characteristics through a CAWI (Computer Assisted Web Interviewing).ResultsThe results showed that the interpersonal factor of emotional intelligence diminished with age and number of children. Furthermore, women scored significantly higher in interpersonal emotional intelligence and men in adaptability. Physicians with stable contracts (46.1%) scored higher in all the emotional intelligence variables, with almost a small effect size. In the relationship between self-esteem and emotional intelligence, it was found that global self-esteem of physicians was positively related to the Stress Management, Adaptability and Mood dimensions. Physicians with high self-esteem (72.8%) showed better Stress Management and Mood than those with low self-esteem (6.1%), while in the Adaptability factor, physicians with high global self-esteem scored higher than those with medium levels (21.1%).ConclusionThe need for a stable employment strategy was demonstrated, since this has repercussions on personal competencies of physicians as well as training in developing those consequences, since they improve physicians' quality of care and leadership, especially women with temporary contracts or with medium or low self-esteem.

Abstract Background Possible cases of SARS-CoV-2 infection were diagnosed in primary care in Madrid, some of these cases had pneumonia. Most of the SARS-CoV-2 pneumonia published data came from hospitalised patients. This study set out to describe clinical characteristics of patients with SARS-CoV-2 pneumonia diagnosed in primary care across age groups and type of pneumonia. Methods Observational retrospective study obtaining clinical data from the electronic health records of patients who were followed-up by SARS-CoV-2 possible infection in a primary care practice in Madrid. All the cases were collected by in-person or remote consultation during the 10th March to the 7th of April. Exposure: Diagnosis of SARS-CoV-2 pneumonia by chest X-ray ordered by the GP. Main outcomes and measures: Symptoms of SARS-CoV-2 pneumonia, physical examination and diagnostic tests as a blood test, nasopharyngeal swab results for RT-PCR (Reverse transcriptase-polymerase chain reaction) and chest X-ray results. Results The overall SARS-CoV-2 pneumonias collected were 172 (female 87 [50.6%], mean age 60.5 years standard deviation [SD] 17.0). Comorbidities were body mass index ≥ 25 kg/m2 (90 [52.3%]), hypertension (83 [48.3%]), dyslipidaemia (68 [39.5%]) and diabetes (33 [19.2%]). The sample was stratified by age groups (

Introducción: En producción avícola el uso de antibióticos promotores del crecimiento es limitado, debido al incremento de resistencia bacteriana. Una alternativa evalúa los probióticos microencapsulados y su efecto en la salud intestinal. Objetivo: Determinar el efecto de Lactobacillus plantarum microencapsulado sobre parámetros intestinales e inmunológicos en pollos de engorde. Materiales y métodos: A 240 pollos Ross-308-AP de un día de nacidos se suministró alimento con o sin adición de probiótico bajo el siguiente modelo: sin probiótico-(T0), con probiótico comercial-(T1), con Lactobacillus plantarum microencapsulado-(T2) y sin microencapsular-(T3). Lactobacillus plantarum ATCC-8014 se microencapsuló mediante secado por aspersión, determinando su viabilidad en (%). Se evaluaron parámetros intestinales, morfo-histopatológicos e inmunológicos por Azul de Alcian, microscopia de barrido e inmunohistoquímica y la abundancia microbial por UFC/mL. Resultados: El microencapsulado confirió una viabilidad in vivo de Lactobacillus plantarum del 88,1%. El tratamiento T2 mejoró los parámetros inmunológicos y confirió beneficios intestinales con una abundancia de bacterias benéficas (Lactobacillus) de (9,13x105-UFC/mL), significativamente mayor a la encontrada en los tratamientos T1 (8,91x105) y T3 (8,23x105) y el control T0 (9,18x104), (p

El año 2020 ha transformado la vida de la mayoría de los habitantes del planeta. Hace un año hubiera sido inimaginable pensar que una situación como la actual pudiera ser real y no fruto de una película perteneciente al género de catástrofes. Con este artículo queremos dejar constancia de la repercusión emocional e intelectual que supuso la coincidencia de la pandemia con el desarrollo de una asignatura optativa transversal para los grados de Ciencias de la Salud centrada en el uso del cine y la literatura como recursos docentes. La coincidencia temporal del inicio del confinamiento al que se vio sometida toda la población española, con el desarrollo del módulo de catástrofes y, más concretamente con el tema de las epidemias, revistió el progreso del resto de la asignatura de un ambiente especial que tal vez no volvamos a vivir, al menos con las mismas características.

Abstract Ceramic restorations could be an acceptable treatment choice for fractured central incisors. A successful esthetic and conservative result to restore damaged anterior teeth can be obtained through proper evaluation, diagnostic wax‐up, guided minimal preparations, ceramic selection, and bonding protocols. Handcrafted glass‐based restorations can mimic contours and shape of natural teeth.

Resumen: El sistema sanitario falló a la hora de garantizar la seguridad tanto de los profesionales como de las personas que acudieron a los centros al inicio de la pandemia.La falta de materiales y directrices para la prevención de infecciones provocó en España la peor catástrofe de la historia de la seguridad del paciente y de la salud laboral en el ámbito sanitario. Sucedió también en otros países, pero España tuvo las mayores tasas de sanitarios infectados del mundo. Fue una catástrofe, en buena parte, evitable.Revisamos qué medidas se han tomado para la prevención de infecciones en los centros de atención primaria, como la higiene de manos, las mascarillas y el material de protección personal o el mantenimiento de la distancia interpersonal, entre otras. Actualizamos las recomendaciones y planteamos las perspectivas en una situación que exige flexibilidad y capacidad de adaptación para mantener una atención de calidad y segura. Abstract: The health system failed to guarantee the safety of both professionals and citizens who came to the centers at the beginning of the pandemic.The lack of materials and guidelines for the prevention of infections caused in Spain the worst catastrophe in the history of patient safety and occupational health in healthcare. It also happened in other countries but Spain had the highest rates of infected health workers in the world. It was a largely avoidable event.We review what measures have been taken to prevent infections in primary care centers, such as hand hygiene, masks and personal protection material or the maintenance of social distance, among others. We update the recommendations and raise the perspectives in a situation that requires flexibility and adaptability to maintain quality and safe care.

Resumen: La pandemia por COVID-19 ha forzado la adopción de cambios drásticos en Atención Primaria, modificando la organización y las dinámicas de trabajo establecidas hasta entonces. De un día para otro los profesionales tuvieron que adaptarse a la nueva situación para atender el aluvión de casos y contactos, evitar contagios y mantener la atención a otros problemas de salud. Al inicio de la pandemia los profesionales hubieron de instaurar en Atención Primaria nuevas prácticas y circuitos asistenciales de manera improvisada, por falta de orientaciones actualizadas, sin los medios de protección adecuados, evaluando sobre la marcha sus riesgos y beneficios. Abordamos cuáles han sido los principales cambios organizativos en el primer nivel asistencial y describimos, desde el punto de vista de la seguridad del paciente, las consecuencias para pacientes y profesionales de la atención prioritaria a la COVID-19. Finalmente, nos planteamos cómo incorporar el conocimiento adquirido durante la pandemia, analizando las ventajas e inconvenientes de las medidas adoptadas, para mantener en lo posible una Atención Primaria segura, accesible y de calidad.CE: Single paragraph Abstract see JSS Abstract: The COVID-19 pandemic has forced the adoption of drastic changes in primary care, modifying the organization and work dynamics previously established. From one day to the next, professionals had to adapt to the new situation to be able to attend cases and contacts tracing, to avoid contagion and to maintain attention to other health problems. At the beginning of the pandemic, professionals had to establish new practices and care circuits in primary care in an improvised way, due to lack of updated guidelines, without adequate means of protection, evaluating their risks and benefits on the fly. We present the main organizational changes in the first level of care and describe, from the point of view of patient safety and the consequences for patients and professionals of the priority care for COVID-19. Finally, we consider how to incorporate the knowledge acquired during the pandemic, analyzing the advantages and disadvantages of the adopted measures to maintain as much as possible a safe, accessible and quality primary care.

Resumen: La pandemia ha expuesto la vulnerabilidad de los centros residenciales y la fragilidad de la población que en ellos viven. En la Región de Murcia la atención a este grupo poblacional se convirtió en una prioridad y se elaboró un plan regional para atender las necesidades de los residentes desde el marco ético de la justicia procedimental. La inmediatez impuesta por la crisis sanitaria ha hecho que toda esta intervención no esté exenta de riesgos. A partir del modelo de Reason hemos realizado un análisis causal de los factores que llevaron a las residencias a sufrir un impacto devastador. La pandemia ha evidenciado la urgencia de fortalecer el modelo de cuidados que ofrecemos a nuestros mayores. Un modelo que garantice la cobertura de unas necesidades a unos pacientes extremadamente frágiles que van más allá de una atención sanitaria y biomédica y que tenga en cuenta sus preferencias y sus valores. Abstract: The pandemic has exposed the vulnerability of residential centers and the fragility of the population that lives there. In the Region of Murcia, care for this population group became a priority and a regional plan was drawn up to attend the needs of residents from the ethical framework of procedural justice. The immediacy imposed by the health crisis has meant that all this intervention is not without risks. Based on the Reason model, we have carried out a root cause analysis of the contributing factors that led the nursing homes to suffer a devastating impact, categorizing the security failures at three levels: infection control, social health environment and health-clinical environment. The pandemic has shown the urgency of strengthening the care model that we offer to our elders. A model that guarantees the coverage of the needs of extremely fragile patients that go beyond health and biomedical care and that considers their preferences and values.

Abstract The reported clinical scenarios presented two patients, one managed with a prefabricated abutment and the other with a customized abutment, and both patients were pleased with the outcome. However, from a professional viewpoint, the esthetic outcome using the custom zirconia abutment was superior to that using the prefabricated titanium abutment.

Little literature exists about critically ill patients with coronavirus disease 2019 (COVID-19) from Latin America. Here, we aimed to describe the clinical characteristics and mortality risk factors in mechanically ventilated COVID-19 patients from Mexico. For this purpose, we recruited 67 consecutive mechanically ventilated COVID-19 patients which were grouped according to their clinical outcome (survival vs. death). Clinical risk factors for mortality were identified by machine-learning and logistic regression models. The median age of participants was 42 years and 65% were men. The most common comorbidity observed was obesity (49.2%). Fever was the most frequent symptom of illness (88%), followed by dyspnea (84%). Multilobe ground-glass opacities were observed in 76% of patients by thoracic computed tomography (CT) scan. Fifty-two percent of study participants were ventilated in prone position, and 59% required cardiovascular support with norepinephrine. Furthermore, 49% of participants were coinfected with a second pathogen. Two-thirds of COVID-19 patients developed acute kidney injury (AKIN). The mortality of our cohort was 44.7%. AKIN, uric acid, lactate dehydrogenase (LDH), and a longitudinal increase in the ventilatory ratio were associated with mortality. Baseline PaO2/FiO2 values and a longitudinal recovery of lymphocytes were protective factors against mortality. Our study provides reference data about the clinical phenotype and risk factors for mortality in mechanically ventilated Mexican patients with COVID-19.

A pesar de que hoy en día el concepto de Humanización está muy presente en el entorno de los cuidados, no existe una definición clara sobre qué puede entenderse por humanización de los cuidados. Con el objetivo de colaborar en la concreción de un término que posee una clara composición multifactorial, se plantea la creación de un modelo que permita explicar las competencias y actitudes que debe desarrollar un profesional sanitario para incorporar la Humanización en el ejercicio de su profesión. En el modelo propuesto, la Humanización se define como un conjunto de competencias personales que permiten desarrollar la actividad profesional, dentro del ámbito sanitario, velando por la dignidad y el respeto hacia el ser humano. Es, por tanto, una actividad enfocada a la mejora del cuidado de la salud, tanto física como mental y emocional, dirigida tanto a pacientes y familiares, como a los propios profesionales sanitarios. El modelo teórico propuesto HUMAS, está centrado en los procesos psicológicos, en las competencias personales que capacitan a los profesionales sanitarios para ofrecer al paciente una atención de calidad. Así, el profesional, contando con todos los recursos disponibles en el sistema sociosanitario y en el entorno del paciente, además requiere de la adquisición y el desarrollo de competencias personales entre las que se encuentra la disposición al optimismo, la sociabilidad, la compresión emocional, la autoeficacia y la afectación, entendidas como esenciales para contribuir a un desempeño profesional positivo, basado en la humanización, como es el modelo HUMAS.

Introducción. La magnitud de la lipemia postprandial es un indicador de riesgo cardiovascular, en especial en mujeres con actividad hormonal reducida. Los ejercicios resistidos (ER) podrían ser un factor que influencie las concentraciones de lípidos después de consumir alimentos. Objetivo. Determinar los efectos agudos sobre la lipemia postprandial de mujeres postmenopáusicas que tiene la realización de sesiones de ER de alto y bajo volumen, en comparación a un grupo control. Materiales y métodos. Después de una evaluación inicial (antropometría, perfil lipídico y fitness muscular), 32 mujeres fueron divididas aleatoriamente en tres grupos: uno con ER de alto volumen (n=11), otro con ER de bajo volumen (n=11) y un grupo control sin ER (n=10). 12 horas después de los ejercicios se suministró un compuesto nutricional hiperlipídico y se analizó la lipemia postprandial cada hora durante 5 horas. Resultados. Los diferentes volúmenes de ER no redujeron de manera importante los marcadores lipémicos (colesterol total, triglicéridos, LDL y VLDL) (p>0.05) ni aumentaron las concentraciones plasmáticas de HDL (p>0.05). Conclusiones. Las sesiones de ER no afectaron los marcadores lipémicos postprandiales, aunque sí mostraron resultados clínicos relevantes en los grupos experimentales (reducción de LDL-VLDL y aumento de HDL en momentos específicos).

Background and Objectives: The report describes a technique using a diagnostic mock-up as a crown-lengthening surgical guide to improve the gingival architecture. Materials and Methods: The patient’s primary concern was improving her smile due to her “gummy smile” and short clinical crowns. After clinical evaluation, surgical crown lengthening accompanied by maxillary central full-coverage single-unit prostheses and lateral incisor veneers was recommended. The diagnostic mock-up was placed in the patient’s maxillary anterior region and used as a soft tissue reduction guide for the gingivectomy. Once the planned gingival architecture was achieved, a flap was reflected to proceed with ostectomy in order to obtain an appropriate alveolar bone crest level using the overlay. After six months, all-ceramic crowns and porcelain veneers were provided as permanent restorations. Results: A diagnostic mock-up fabricated with a putty guide directly from the diagnostic wax-up can be an adequate surgical guide for crown-lengthening procedures. The diagnostic wax-up was used to fabricate the diagnostic mock-up. These results suggested that it can be used as a crown-lengthening surgical guide to modify the gingival architecture. Several advantages of the overlay used in the aesthetic complex case include: (1) providing a preview of potential restorative outcomes, (2) allowing for the appropriate positioning of gingival margins and the desired alveolar bone crest level for the crown-lengthening procedure, and (3) serving as a provisional restoration after surgery. Conclusions: The use of a diagnostic mock-up, which was based on a diagnostic wax-up, as the surgical guide resulted in successful crown lengthening and provisional restorations. Thus, a diagnostic overlay can be a viable option as a surgical guide for crown lengthening.

Biological therapies, such as TNF inhibitors (TNFi), are increasing remission (REM) rates in rheumatoid arthritis (RA) patients, although these are still limited. The aim of our study was to analyze changes in the profile of peripheral blood mononuclear cells (PBMC) in patients with RA treated with TNFi in relation to the clinical response. This is a prospective and observational study including 78 RA patients starting the first TNFi. PBMC were analyzed by flow cytometry both at baseline and at 6 months. Disease activity at the same time points was assessed by DAS28, establishing DAS28 ≤ 2.6 as the criteria for REM. Logistic regression models were employed to analyze the association between the changes in PBMC and REM. After 6 months of TNFi treatment, 37% patients achieved REM by DAS28. Patients who achieved REM showed a reduction in the percentage of naive B cells, but only when patients had received concomitant methotrexate (MTX) (OR: 0.59; 95% CI: 0.39–0.91). However, no association was found for patients who did not receive concomitant MTX (OR: 0.85; 95% CI: 0.63–1.16). In conclusion, PBMC, mainly the B-cell subsets, are modified in RA patients with TNFi who achieve clinical REM. A significant decrease in naive B-cell percentage is associated with achieving REM after 6 months of TNFi treatment in patients who received concomitant therapy with MTX.

Los Lactobacillus inhiben múltiples agentes patógenos causales de toxiinfecciones alimentarias, relacionándose su mecanismo de acción con la modulación del sistema inmune. Por su parte, E. coli O157:H7 es considerado un microorganismo causal de alteraciones, principalmente, a nivel intestinal y renal y es encontrado, por lo general, en matrices alimentarias contaminadas o en mal estado. La incidencia de este tipo de problemática se ha relacionado a la resistencia a los antibióticos, que limita su control y mitigación de manera eficaz. Por lo tanto, el objetivo del trabajo fue evaluar el efecto inhibitorio de Lactobacillus plantarum microencapsulado in vitro sobre Escherichia coli O157:H7, con el fin de encontrar estrategias inocuas para el control de agentes patógenos. Se determinó la cinética de fermentación, evaluando variables, como consumo de azúcar, producción de proteínas, acidez, pH y fase logarítmica (UFC/mL). La microencapsulación, se realizó mediante la técnica de spray drying, utilizando inulina y maltodextrina, como materiales encapsulantes. Se determinó la viabilidad de L. plantarum bajo condiciones gastrointestinales simuladas. Además, se evaluaron las características físicas del microorganismo microencapsulado y el efecto inhibitorio de L. plantarum y su sobrenadante sobre E. coli O157:H7. Posteriormente, se valoró la susceptibilidad de ambas cepas a diferentes antibióticos. Como resultado, se encontró resistencia de ambas cepas a algunos antibióticos evaluados, como penicilina. La cepa láctica y el sobrenadante inhibieron el crecimiento de E. coli O157:H7. L. plantarum presentó una viabilidad óptima a condiciones gastrointestinales simuladas después de 45 días de almacenamiento (1,4x107-3,0x1010UFC/150µL). La microencapsulación incrementa su vialidad y su establecimiento en el huésped.

Resumen: La aprobación de la ley de eutanasia supone un reto para la medicina y culmina un proceso de maduración cívica de la sociedad ante el morir. Existen desafíos que la aplicación de la ley deberá solventar. Buscar una solución médica objetiva e irreversible a un sufrimiento subjetivo, donde pueden existir determinantes sociales condicionantes, implica un grave riesgo de inequidad que requiere políticas que establezcan un marco pre-decisional garantista. La eutanasia debería ser una excepción gracias a la existencia de fuertes salvaguardas clínicas, informativas y relacionales que solo pueden garantizarse en el contexto de una atención primaria solvente que acompañe a las personas a lo largo de sus vidas. En este contexto primarista y comunitario, la eutanasia puede ser el último recurso de un profesional comprometido con el no abandono de un paciente con sufrimiento grave e irreversible que la solicita. Abstract: The approval of the euthanasia law represents a challenge for medicine and culminates a process of civic maturation of society in the face of death. There are challenges that the application of the law will have to meet. Seeking an objective and irreversible medical solution to subjective suffering - where there may be conditioning social determinants - implies a serious risk of inequity that requires policies that establish a pre-decisional guaranteeing framework. Euthanasia should be an exception thanks to the existence of strong clinical, informational and relational safeguards that can only be guaranteed in the context of a solvent primary care that accompanies people throughout their lives. In this primarist and community context, euthanasia can be the last resort of a professional committed to not abandoning a patient with severe and irreversible suffering who requests it.

Novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is the etiologic agent of the ongoing coronavirus disease 2019 (COVID-19) pandemic, which has reached 28 million cases worldwide in 1 year. The serological detection of antibodies against the virus will play a pivotal role in complementing molecular tests to improve diagnostic accuracy, contact tracing, vaccine efficacy testing, and seroprevalence surveillance. Here, we aimed first to evaluate a lateral flow assay's ability to identify specific IgM and IgG antibodies against SARS-CoV-2 and second, to report the seroprevalence estimates of these antibodies among health care workers and healthy volunteer blood donors in Panama. We recruited study participants between April 30th and July 7th, 2020. For the test validation and performance evaluation, we analyzed serum samples from participants with clinical symptoms and confirmed positive RT-PCR for SARS-CoV-2, and a set of pre-pandemic serum samples. We used two by two table analysis to determine the test positive and negative percentage agreement as well as the Kappa agreement value with a 95% confidence interval. Then, we used the lateral flow assay to determine seroprevalence among serum samples from COVID-19 patients, potentially exposed health care workers, and healthy volunteer donors. Our results show this assay reached a positive percent agreement of 97.2% (95% CI 84.2–100.0%) for detecting both IgM and IgG. The assay showed a Kappa of 0.898 (95%CI 0.811–0.985) and 0.918 (95% CI 0.839–0.997) for IgM and IgG, respectively. The evaluation of serum samples from hospitalized COVID-19 patients indicates a correlation between test sensitivity and the number of days since symptom onset; the highest positive percent agreement [87% (95% CI 67.0–96.3%)] was observed at ≥15 days post-symptom onset (PSO). We found an overall antibody seroprevalence of 11.6% (95% CI 8.5–15.8%) among both health care workers and healthy blood donors. Our findings suggest this lateral flow assay could contribute significantly to implementing seroprevalence testing in locations with active community transmission of SARS-CoV-2.

Women with breast cancer who receive aromatase inhibitors (AI) are at risk of bone mass loss and bone fracture. Many of these women have been previously treated with chemotherapy and/or tamoxifen, also with known deleterious bone effects. We studied the bone mineral status of a group of postmenopausal women with non-advanced breast cancer about to initiate AI treatment.Between 2007 and 2010, 127 women aged 63 ± 9 years were prospectively included. Clinical, epidemiological, analytical, radiological, and densitometric data were collected.Prior to initiating AI treatment, the patients exhibited a high prevalence of bone mass loss (62.2%): 16.5% had osteoporosis and 45.7% osteopenia by OMS criteria. Besides, 7.4% of their dorso-lumbar spine x-rays revealed one or more vertebral fractures, all of which were found in patients with densitometry-defined osteoporosis or osteopenia. Surprisingly, 25-OH-vitamin D levels were normal (≥30 ng/ml) in 87.4% of the women. Obesity was prevalent (BMI 30 ± 5). Their most common tumour was infiltrating ductal carcinoma (76.4%). The women who had received adjuvant chemotherapy (50%) were younger (59.1 ± 8.3 vs. 66.2 ± 8.2, p

El sector avícola ha disminuido los antibióticos por problemas de resistencia, lo que ha generado interés investigativo en alternativas para el manejo sanitario. Por ello, se evaluó el efecto del suministro de Lactobacillus casei microencapsulado en los parámetros productivos y salud intestinal del pollo de engorde. La investigación incluyó 240 pollos, en 4 tratamientos: alimento sin antibióticos ni anticoccidiales (T0), alimento con probiótico comercial (T1) y T2 y T3 con inclusión de L. casei microencapsulado y sin microencapsular, respectivamente. Se evaluó la eficiencia y la viabilidad de la conservación de la bacteria por parte del microencapsulado, además de sus características físicas. Se valoró in vivo el suministro de la bacteria láctica, mediante los parámetros productivos, bioquímicos en sangre, la morfología intestinal y la respuesta inmunológica. Se observó viabilidad y eficiencia de 75,9 y 89,4%, para el microencapsulado. El grupo de tratamiento con probiótico microencapsulado tuvo incremento significativo en la ganancia de peso y de consumo de alimento (p

Aims: The secreted form of the α-Klotho gene (S-Klotho), which is considered a powerful biomarker of longevity, makes it an attractive target as an anti-ageing therapy against functional decline, sarcopenic obesity, metabolic and cardiovascular diseases, osteoporosis, and neurodegenerative disorders. The S-Klotho plasma levels could be related to physical exercise inasmuch physical exercise is involved in physiological pathways that regulate the S-Klotho plasma levels. FIT-AGEING will determine the effect of different training modalities on the S-Klotho plasma levels (primary outcome) in sedentary healthy adults. FIT-AGEING will also investigate the physiological consequences of activating the klotho gene (secondary outcomes). Methods: FIT-AGEING will recruit 80 sedentary, healthy adults (50% women) aged 45–65 years old. Eligible participants will be randomly assigned to a non-exercise group, i.e. the control group, (n = 20), a physical activity recommendation from World Health Organization group (n = 20), a high intensity interval training group (n = 20), and a whole-body electromyostimulation group (n = 20). The laboratory measurements will be taken at the baseline and 12 weeks later including the S-Klotho plasma levels, physical fitness (cardiorespiratory fitness, muscular strength), body composition, basal metabolic rate, heart rate variability, maximal fat oxidation, health blood biomarkers, free-living physical activity, sleep habits, reaction time, cognitive variables, and health-related questionnaires. We will also obtain dietary habits data and cardiovascular disease risk factors.

Graphical Abstract After 6 years of Growth Hormone (GH) therapy, three patients with a defect in minor spliceosome mRNA processing leading to an incompletely understood GH deficit present with excellent auxological response and improvement in the bone mineral density and trabecular bone structure.

Curriculum transformation in the university majors in Ecuador has generated a growing concern for studying different aspects of interpersonal communication in the teaching-learning process. This paper is aimed at presenting a system of methods for interpersonal communication in the teaching-learning process. The proposed system supports the possibilities offered by the problem methods at different phases of the teaching-learning process, which is achieved by promoting dialogue, cognitive and affective exchange among all those who participate, share and contribute to the learning of others. The system of methods for interpersonal communication in the teaching-learning process suggests a change in the teacher's role and in the way in which this process is conceived and developed. Due to its didactic nature, it is a system which explains interpersonal communication as the center of the teaching-learning process.

Objetivo: Identificar la prevalencia y el tipo de violencia de pareja en mujeres usuarias de una unidad de atención primaria y estimar los riesgos para cada tipo de violencia. Diseño: Casos (incidentes) y controles. Emplazamiento: Unidad de atención primaria en Cancún, Quintana Roo, México. Participantes: Mujeres mayores de 18 años con vida en pareja en los últimos 12 meses. Mediciones principales: Mediante escala para identificación de violencia validada para población mexicana, se evaluó: violencia de pareja total, violencia física, psicológica y sexual. Antecedente de violencia y variables sociodemográficas. Se determinó chi cuadrado para variables categóricas y odds ratio (OR) para la estimación de riesgo. Resultados: La violencia de pareja total fue del 15,05%, y la violencia psicológica, del 37,3%. En violencia total se observaron diferencias en edad, nivel socioeconómico, estado civil, antecedente de violencia y consumo de alcohol en la pareja (p

Introducción: el desarrollo psicomotor es la progresiva adquisición de habilidades funcionales del niño a medida que este crece, es un proceso gradual en el cual es posible identificar etapas o estadios de creciente nivel de complejidad, determinado por aspectos biológicos, la interacción social y las experiencias propias del aprendizaje. Objetivo: analizar las distintas escalas de evaluación del desarrollo infantil en América, para identificar y fundamentar los instrumentos más completos y versátiles que se pueden adaptar a nuestro país con base a la literatura científica. Metodología: se realizó una búsqueda en las bases de datos PubMed, Scielo, PEDRO y Cochrane, utilizando los términos de búsqueda: “child development” y “neurodevelopment”, asociando con los términos: “tests for measuring” y “scales of assessment”. Se excluyeron trabajos mayores a 10 años o aquellos basados en patologías específicas, revisiones sistemáticas, guías de evaluación u opiniones personales. Los artículos compilados son de lengua española, inglesa y portuguesa. La selección se llevó a cabo a través de tres filtros. El primero basado en el título, el segundo basado en el abstract y el tercero basado en el contenido del manuscrito. Resultados: se obtuvieron 107 artículos potencialmente relevantes, de los cuales fueron seleccionados 50, que abarcaran la temática con mayor exactitud y relevancia, efectuándose así una descripción y análisis de los instrumentos de evaluación del desarrollo infantil, teniendo en cuenta sus ventajas y desventajas en cuanto a su accesibilidad en costo, características de la aplicación, manejo y sus propiedades psicométricas. Conclusiones: se requiere en nuestro contexto estandarizar instrumentos que permitan una evaluación completa del desarrollo infantil. La escala Bayley se muestra como el instrumento más completo, con alto nivel de sensibilidad y especificidad para medir el desarrollo infantil.

Introducción. Actualmente la infección por virus dengue constituye una de las arbovirosis más importantes y de amplia distribución en las regiones tropicales y subtropicales del planeta. Objetivo. Determinar la evolución del virus dengue circulante en el Ecuador durante el periodo 2000 a 2015. Diseño. Estudio no experimental, transversal, de tipo descriptivo y correlacional; Lugar. Unidades de salud del Ecuador. Participantes. Muestras tomadas a sospechosos de dengue con menos de 5 días de iniciada su enfermedad. Resultados. En el año 2000 se tuvo la presencia de los 4 serotipos, con predominio del DEN3 durante 2001 al 2006, coincidentes con los incrementos de casos del 2000, 2001 y 2005; en el año 2004 reapareció el virus DEN1 y los años siguientes su presencia predominó entre 2007 y 2012, coincidiendo con el incremento de casos en el 2010. Del año 2011 al 2015 se presentaron 3 virus circulantes a la vez (DEN1, DEN2 y DEN4), en 2014 y 2015 hubo la presencia del virus DEN3, con predominio del virus DEN2 en 2013 y 2014 y virus DEN1 en 2015; y ha sido la provincia del Guayas la de mayor relación con los virus. Conclusiones. La presencia de varios serotipos de virus dengue circulando a la vez y su permanencia se debería a otros factores que están influenciando en el comportamiento del virus, con una variabilidad de los cuatro serotipos. Se debe fortalecer la vigilancia molecular de la circulación de serotipos, genotipos y linajes del virus dengue.

La Reserva de la Biosfera Maya (RBM) es un área protegida de relevancia nacional, regional y mundial por la diversidad biológica asociada y los beneficios que se obtienen de esta. En su plan maestro se plantea el conjunto de elementos de conservación a partir de los cuales se orientan estrategias y se evalúa la efectividad de manejo de dicha reserva, entre los cuales se incluye a Tapirella bairdii (tapir), por lo que es importante contar con un monitoreo de esta especie como una herramienta para la administración de esta reserva. En el 2015 se inició el desarrollo de un protocolo de monitoreo basado en la estimación de la probabilidad de ocupación y el presente estudio constituye la continuación de esta iniciativa a través de la implementación de las temporadas de muestreo en 2017 y 2018. Se registró la presencia del tapir en cinco zonas núcleo de la RBM empleando trampas cámara y se estimó la probabilidad de ocupación. Los valores estimados sugieren una relación de la ocupación con la integridad ecológica, en la cual hay una mayor ocupación en áreas con menor perturbación. Se generaron modelos con cinco covariables relacionadas con amenazas potenciales, sin embargo fue el modelo nulo el que se seleccionó de acuerdo al criterio definido. Los resultados sugieren que la integridad ecológica en las áreas de estudio está siendo afectada como consecuencia de las presiones antrópicas por lo que es necesario el fortalecimiento de aquellas con menores valores de ocupación.

Abstract Mutations in multiple genes of the growth hormone/IGF‐I axis have been identified in syndromes marked by growth failure. However, no pathogenic human mutations have been reported in the six high‐affinity IGF‐binding proteins (IGFBPs) or their regulators, such as the metalloproteinase pregnancy‐associated plasma protein A2 (PAPP‐A2) that is hypothesized to increase IGF‐I bioactivity by specific proteolytic cleavage of IGFBP‐3 and ‐5. Multiple members of two unrelated families presented with progressive growth failure, moderate microcephaly, thin long bones, mildly decreased bone density and elevated circulating total IGF‐I, IGFBP‐3, and ‐5, acid labile subunit, and IGF‐II concentrations. Two different homozygous mutations in PAPPA2, p.D643fs25* and p.Ala1033Val, were associated with this novel syndrome of growth failure. In vitro analysis of IGFBP cleavage demonstrated that both mutations cause a complete absence of PAPP‐A2 proteolytic activity. Size‐exclusion chromatography showed a significant increase in IGF‐I bound in its ternary complex. Free IGF‐I concentrations were decreased. These patients provide important insights into the regulation of longitudinal growth in humans, documenting the critical role of PAPP‐A2 in releasing IGF‐I from its BPs.

Abstract The molecular basis of a significant number of cases of isolated growth hormone deficiency remains unknown. We describe three sisters affected with severe isolated growth hormone deficiency and pituitary hypoplasia caused by biallelic mutations in the RNPC3 gene, which codes for a minor spliceosome protein required for U11/U12 small nuclear ribonucleoprotein (snRNP) formation and splicing of U12‐type introns. We found anomalies in U11/U12 di‐snRNP formation and in splicing of multiple U12‐type introns in patient cells. Defective transcripts include preprohormone convertases SPCS2 and SPCS3 and actin‐related ARPC5L genes, which are candidates for the somatotroph‐restricted dysfunction. The reported novel mechanism for familial growth hormone deficiency demonstrates that general mRNA processing defects of the minor spliceosome can lead to very narrow tissue‐specific consequences.

Background: Nursing professionals face a variety of stressful situations daily, where the patients’ own stresses and the demands of their family members are the most important sources of such stress. Methods: The main objectives pursued were to describe the relationships of self-efficacy and emotional intelligence with perceived stress in a sample of nursing professionals. We also developed predictive models for each of the components of perceived stress based on the dimensions of emotional intelligence and self-efficacy, for the total sample, as well as samples differentiated by sex. This study sample consisted of 1777 nurses and was conducted using multiple scales: the perceived stress questionnaire, general self-efficacy scale, and the brief emotional intelligence survey for senior citizens. Results: The variables stress management, mood, adaptability, intrapersonal skills, and self-efficacy explained 22.7% of the variance in the harassment−social component, while these same variables explained 28.9% of the variance in the irritability−tension−fatigue dimension. The variables mood, stress management, self-efficacy, intrapersonal, and interpersonal explained 38.6% of the variance in the energy−joy component, of which the last variable offers the most explanatory capacity. Finally, the variables stress management, mood, interpersonal, self-efficacy and intrapersonal skills explained 27.2% of the variance in the fear−anxiety dimension. Conclusion: The results of this study suggest that one way to reduce stress in professionals would be to help them improve their emotional intelligence in programs (tailored to consider particularities of either sex) within the framework of nursing, enabling them to develop and acquire more effective stress coping strategies, which would alleviate distress and increase the wellbeing of health professionals.

The case report of a 4 years child is described assisted initially in the Pediatrics Service of the Social Security Ecuadorian Institute Hospital of Ibarra in Ecuador Republic and then in the Vascular Surgery Service, where she was diagnosed Parkes Weber syndrome.

Background: Ageing is associated with sleep pattern changes and body composition changes, which are related to several diseases. Purpose: This study aimed to analyse the association between sleep quality and an extensive set of body composition parameters (waist-hip ratio, body mass index, bone mineral content, bone mineral density, lean mass, lean mass index, fat mass, fat mass percentage, fat mass index, visceral adipose tissue) and sleep quality in sedentary middle-aged adults. We also aimed to evaluate whether the possible associations accord between subjective and objective measurements of sleep quality. Methods: 74 (39 women) middle-aged sedentary adults (40⁻65 years old) participated in the present study. The sleep quality was assessed using the Pittsburgh sleep quality index (PSQI) scale and accelerometers. A PSQI global score more than 5 indicates poor sleep quality. Weight, height, waist and hip circumferences were measured, and body mass index and waist-hip ratio were also calculated. Body composition was assessed with a dual-energy X-ray absorptiometry scanner. Results: The PSQI global score was negatively associated with bone mineral content, bone mineral density, lean mass, lean mass index and positively associated with fat mass percentage. No association was found between accelerometer parameters and body composition variables. Conclusion: We showed that a subjective poor sleep quality was negatively associated with bone mineral content (BMC), bone mineral density (BMD), lean mass and lean mass index (LMI) whereas was positively associated with fat mass percentage in middle-aged adults. We also observed that these associations did not accord with objective sleep quality measurements.

INTRODUCCIÓN Y OBJETIVOS El presente estudio analizó los pacientes con fibrosis quística (FQ) atendidos en un programa multidisciplinario en el Hospital Infantil Universitario San José de Bogotá, desde marzo del 2010. El objetivo de este trabajo fue caracterizar y analizar los principales aspectos de la condición clínica y funcional de estos pacientes. MATERIALES Y MÉTODOS En el programa del HIUSJ, los pacientes con FQ tienen un seguimiento multidisciplinario regular trimestral, y son sometidos a evaluaciones paraclínicas periódicas que permiten monitorizar las principales variables clínicas, las cuales se analizaron en el presente estudio. RESULTADOS Se atendieron en el programa un promedio de 58 pacientes por año, con igual distribución en cuanto a sexo. Cuarenta y un pacientes (87,5%) completaron 4 años de seguimiento. La mayoría de los pacientes (49/58; 84%) pertenecían a los estratos socioeconómicos 2 y 3. El mayor número se ubicó en el rango de edad de 15 a 20 años, con aumento progresivo de la proporción de adultos, de 15/56 (25,8%) a 32/56 (57%). El germen cultivado con mayor frecuencia en las exacerbaciones fue Pseudomonas aeruginosa (31,2%), seguido por Staphylococcus aureus (20,7%) y hubo un promedio de 5,1 hospitalizaciones por mes durante el 2013. En cuanto a la función pulmonar (VEF1) se clasificaron en severos (menos de 40%) 16,6%; moderados (40%-69%) 30,3%; leves (70%-79%) 7,8% y normales (más del 80%) 44%. El porcentaje de pacientes adultos con Índice de Masa Corporal (IMC) mayor de 18,5% aumentó de 60% a 73%. También se observó mejoría en los IMC en los niños. Durante este seguimiento fallecieron seis pacientes, tres de ellos por causas pulmonares. Se hicieron dos encuestas de satisfacción por año y se obtuvieron los siguientes promedios, según el año: 2010: 90,5%; 2011: 96%; 2013: 94,5%; 2012: 96%; 2013: 94,5%. CONCLUSIONES Se resalta la importancia del seguimiento periódico por un grupo multidisciplinario de los pacientes con FQ para poder analizar a lo largo del tiempo las principales variables clínicas; por ser una enfermedad crónica y progresiva, el seguimiento a largo plazo de las cohortes más jóvenes pueden evidenciar diferencias significativas.

Antecedentes. Se ha presentado una evolución en la relación entre discapacidad y actividades recreativas, que ha influido para favorecer la interacción entre la población con limitaciones y la sociedad, motivadando la generación y puesta en marcha de políticas que apuntan a mejorar su calidad de vida y bienestar. Objetivos. Esta investigación buscó caracterizar, en términos de población participante, metodología y cumplimiento de expectativas, el programa recreativo «Atención a Personas con Limitaciones », que ofrece el Instituto Distrital para la Recreación y el Deporte (IDRD), desde una metodología cualitativa. Material y métodos. Se utilizaron tres técnicas para la recolección de la información: observación panorámica no participativa, entrevista a profundidad y grupos de discusión. Se observó una población con y sin limitación (4460 personas) y 158 personas entre familiares y acompañantes en 41 sesiones, utilizando para su registro un diario de campo. Con las entrevistas a profundidad se obtuvo información de 11 miembros del equipo de trabajo, utilizando un guión de preguntas para su desarrollo. Se conformaron cinco grupos de discusión, que convocaron a 26 personas entre participantes directos, familiares y representantes de instituciones, usando como instrumento un guión de temas. Resultados. La población participante estuvo compuesta en su mayoría por personas menores de 15 años, de genero masculino en quienes predominaba la limitación cognoscitiva. La más alta proporción de estas personas era funcional, pertenecía a instituciones, y no disponía de otros espacios de recreación. La planeación y ejecución de las actividades respondió a pautas establecidas en cada zona. Si bien, se contaba con lineamientos generales sobre el significado de cada actividad, no se plantearon posibles estrategias y métodos que las llevaran a la práctica. Conclusiones. Se hizo evidente que el compo nente práctico no correspondía al teórico, pues no se tenía conocimiento de las características, necesidades, capacidades y expectativas de los usuarios. Las actividades desarrolladas en este programa, por lo general, no partían del conocimiento de sus participantes y ellos comprendían que el programa cumplía sus expectativas en lo mínimo pero no en lo necesario

Undernutrition elicited by a low-protein diet determines a marked reduction of hypophyseal activity and affects the function of the respective target organs. The objective of the present investigation was to study the ultrastructural and quantitative immunohistochemical changes of the different pituitary cell populations in undernourished monkeys that had been previously shown to have significant changes in craniofacial growth. Twenty Saimiri sciureus boliviensis monkeys of both sexes were used. The animals were born in captivity and were separated into two groups at one year of age, i.e., control and undernourished animals. The monkeys were fed ad libitum a 20% (control group) and a 10% (experimental group) protein diet for two years. Pituitaries were processed for light and electron microscopy. The former was immunolabeled with anti-GH, -PRL, -LH, -FSH, -ACTH, and -TSH sera. Volume density and cell density were measured using an image analyzer. Quantitative immunohistochemistry revealed a decrease in these parameters with regard to somatotrophs, lactotrophs, gonadotrophs and thyrotrophs from undernourished animals compared to control ones. In these populations, the ultrastructural study showed changes suggesting compensatory hyperfunction. On the contrary, no significant changes were found in the morphometric parameters or the ultrastructure of the corticotroph population. We conclude that in undernourished monkeys the somatotroph, lactotroph, gonadotroph, and thyrotroph cell populations showed quantitative immunohistochemical changes that can be correlated with ultrastructural findings.

Objectives. Our primary purpose was to establish the prevalence of the diseases which could be associated with thrombocytosis in children. Methods. It is a transversal study in patients less than fifteen years old in children's hospital "Lorencita Villegas de Santos". Clinical files were selected and rewied under convenience criteria: patients with platelet count higher than 450 * 1O/L,if they had in addition a total leucocyte count and an eritrocyte sedimentation rate, and a diagnosis of an illness in which physicians based treatment. Patients with splenectomy were excluded. Descriptive and correlational statistics were applied. Results. Diseases associated with thrombocytosis were, in decreasing order of prevalence: infectious deseases (62.5%), malignant diseases (lO.4 %), most of them lymphoreticular and hematological origins, inflammatory diseases (5%), specifically bronchial asthma and allergic rhinitis. No differences were observed between groups of diseases and platelet count. Older mean age was found in patients with malignant diseases, following by infectious diseases; difference was statistically significant. No correlation was observed between platelet and white cell counts. A weak lineal positive correlation between platelet count and eritrocyte sedimentation rate was statistically significant. Conclusions: In children and infants (between 0 and 13 years of age) thrombocytosis was associated, in decreasing order of prevalence, with: infectious diseases, cancer of Iymphoreticular and hematological origins and inflammatory diseases, specially in those of allergic cause. Mean age of patients seems to be older in patients with malignant diseases compared with other groups studied. No difference was found in platelet count between the groups studied; therefore,reactive thrombocytosis is unable itself to suggest the underlying disease.

Abstract Background The COVID-19 pandemic generated or accelerated healthcare changes, some of which persist thereafter (e.g., healthcare reorganisation, remote consultation). Such changes entail novel risks for patient safety. Methods Aim To compare the characteristics of patient safety incidents with harm (PSIH) in primary care before the pandemic and at present. Design and setting Cross-sectional, comparative, observational study conducted within the entire Primary Care Service of the Madrid region with observations at two time points (2018 and 2021/2022). Participants Patients > 18 years of age with at least one consultation in the previous year. The necessary sample size was established at N1 = 2,000 for the first time point and N2 = 2,700 for the second. Sampling was performed by simple randomisation for the first group and by clusters followed by simple randomisation for the second. Main measurements Age, gender, presence of PSIH in the medical record, and characteristics of the PSIH, specifically avoidability, severity, place of occurrence, nature, and contributory factors. Triggers validated in primary care were employed to screen the patients’ medical records and those containing any trigger were reviewed by three nurse-physician teams who underwent previous training. Analysis Comparative analysis using Fisher’s exact test. Results A total of 63 PSIHs and 25 PSIHs were found for the first and second samples, respectively. The comparison of the characteristics of PSIH before the pandemic and currently was: avoidable 62% vs. 52% (p = 0.47), mild 51% vs. 48% (p = 0.57), in the primary care setting 73% vs. 64% (p = 0.47), respectively. Although no statistically significant differences were observed globally in the nature of the incidents (p = 0.13), statistically significant differences were found for diagnostic errors, with pre-pandemic rates of 6% vs. 20% at present (p

Combined Kelly syndrome, also known as anterior hyperfunction syndrome, is a complex pathological condition of the stomatognathic system, originally established by five characteristics but primarily triggered by edentulism, specifically, the absence of the upper and posterior mandibular teeth. This condition is characterized by a series of clinical features, such as bone loss, tuberosity growth, enamel wear, periodontal damage, muscle fatigue, pain, and temporomandibular joint issues. However, these features are not unique and rather reflect an oral hyperfunction state. There is a lack of consensus on the best way to assess and diagnose this condition, which is proposed to be understood as an “oral hyperfunction state” rather than a syndrome. This study aims to conduct a literature review to analyze the available information on anterior hyperfunction syndrome in dentistry, with the goal of proposing a conceptual model of the etiological risk factors that contribute to early diagnosis and the prevention of complications. This approach has important clinical implications, as it would allow for the early identification and management of risk factors, thus improving the quality of life of patients and preventing malpractice that could compromise their oral health.

Introducción El desarrollo de la relación molar permanente está determinado por el tipo de plano terminal presente en el niño y con ello ejecutar el tratamiento ortodóntico interceptivo preventivo. Objetivo: Identificar el plano terminal más frecuente en pacientes de3 a 5 años de la clínica de Odontopediatría de la Facultad de Odontología de la Universidad de Guayaquil durante el primer semestre del 2024 Método: Estudio de tipo descriptivo, observacional y transversal, la muestra estuvo conformada de 148 historias clínicas que cumplieron con los criterios de inclusión, las variables estudiadas fueron prevalencia de planos terminales, edad y sexo. Resultados: Al evaluar los planos terminales se reporta la mayor frecuencia del plano terminal recto con 53 % en ambos lados, seguido del escalón mesial con 39% y finalmente el escalón distal con 8%. Con relación a la edad se observó que el plano terminal recto fue la relación molar predominante en ambos lados derecho e izquierdo a la edad de 4 años con una prevalencia del 27.02% y 25.67% respectivamente, El escalón mesial derecho a los 5 años con un 17,56%, mientras que el escalón mesial izquierdo predominó a los 4 años con igual porcentaje 17,56%. Por otro lado, el escalón distal presentó una mayor prevalencia a los 5 años en ambos lados con 5,4%. Según el sexo el plano más prevalente fue el recto en el masculino. Conclusiones: Dada las características de la relación molar temporal, esto permite predecir la vía de erupción y la relación molar permanente.

Objetivo: identificar los factores de riesgo de caries dental en niños preescolares con labio y paladar fisurado. Metodología: estudio de tipo analítico transversal donde participaron 70 niños de 3 a 6 años con FLAP que fueron atendidos por el servicio de odontopediatría de la Organización No Gubernamental Qorito (Lima-Perú), de enero a diciembre del 2022. Las variables analizadas fueron caries dental, higiene oral, dieta, tipo de fisura, sexo, edad. Los análisis aplicados fueron la evaluación de Spearman, la prueba de Chi cuadrado y la regresión logística múltiple. Resultados: la prevalencia de caries dental en niños con FLAP fue del 92,9%. Para esto se empleó un índice que codifica los dientes deciduos como cariados, extraídos y obturados (CEOD) con manchas blancas. Además, se encontró que el tipo de fisura es un factor de riesgo para la caries dental con un (OR) de 3,15. Conclusión: la caries dental tiene una relación significativa con una deficiente higiene oral. A su vez, los niños con labio y paladar fisurado con una buena higiene oral tenían menos probabilidades de desarrollar caries dental que aquellos con una higiene oral deficiente.

The heavy workload and pressure to which nurses are subjected leads to an increase in stress-related problems, such as burnout. Personal resources, such as job crafting, proactive personality, self-efficacy and regulatory focus are fundamental in palliating negative effects in the work environment and reducing quitting by male nurses. The objective of this study was to analyze individual differences, with attention to proactive personality, regulatory approach and general self-efficacy in job crafting, and to determine the predictive power of these variables for burnout in nurses. The sample was made up of 643 nurses. After correlation and descriptive analyses, multiple linear regression models were computed to find out the possible predictor role of the individual variables on burnout. The results showed that job crafting, proactive personality, general self-efficacy and the promotion regulatory focus were associated with a decrease in burnout in nurses. Similarly, the predictive models for each of the factors in burnout in all cases included the increase in structural resources dimension of job crafting as the variable with the most weight. Furthermore, self-efficacy, increase in job crafting social resources and proactive personality were mediators in this relationship for personal impact, social climate and job dissatisfaction factors of burnout. These findings are significant for improving performance of nurses and increasing their retention, which could be especially significant among male nurses.

Summary: Background: There is a subset of individuals with overweight/obesity characterized by a lower risk of cardiometabolic complications, the so-called metabolically healthy overweight/obesity (MHOO) phenotype. Despite the relatively higher levels of subcutaneous adipose tissue and lower visceral adipose tissue observed in individuals with MHOO than individuals with metabolically unhealthy overweight/obesity (MUOO), little is known about the differences in brown adipose tissue (BAT). Methods: This study included 53 young adults (28 women) with a body mass index (BMI) ≥25 kg/m2 which were classified as MHOO (n = 34) or MUOO (n = 19). BAT was assessed through a static 18F-FDG positron emission tomography/computed tomography scan after a 2-h personalized cooling protocol. Energy expenditure, skin temperature, and thermal perception were assessed during a standardized mixed meal test (3.5 h) and a 1-h personalized cold exposure. Body composition was assessed by dual-energy x-ray absorptiometry, energy intake was determined during an ad libitum meal test and dietary recalls, and physical activity levels were determined by a wrist-worn accelerometer. Findings: Participants with MHOO presented higher BAT volume (+124%, P = 0.008), SUVmean (+63%, P = 0.001), and SUVpeak (+133%, P = 0.003) than MUOO, despite having similar BAT mean radiodensity (P = 0.354). In addition, individuals with MHOO exhibited marginally higher meal-induced thermogenesis (P = 0.096) and cold-induced thermogenesis (+158%, P = 0.050). Moreover, MHOO participants showed higher supraclavicular skin temperature than MUOO during the first hour of the postprandial period and during the cold exposure, while no statistically significant differences were observed in other skin temperature parameters. We observed no statistically significant differences between MHOO and MUOO in thermal perception, body composition, outdoor ambient temperature exposure, resting metabolic rate, energy intake, or physical activity levels. Interpretation: Adults with MHOO present higher BAT volume and activity than MUOO. The higher meal- and cold-induced thermogenesis and cold-induced supraclavicular skin temperature are compatible with a higher BAT activity. Overall, these results suggest that BAT presence and activity might be linked to a healthier phenotype in young adults with overweight or obesity. Funding: See acknowledgments section.