Search

Objetivo. Establecer la incidencia de flebitis en el Hospital Regional de la Orinoquía durante el período 2015-2021. Métodos. Estudio descriptivo transversal. La muestra, a conveniencia, constituida por los registros de casos de flebitis reportados al Sistema de Información de Eventos Adversos (SIEVA), previa depuración según criterios de elegibilidad. Variables: sexo, edad, tipo de seguridad social; servicio hospitalario, sitio anatómico afectado, signos/síntomas, momento de ocurrencia, catéter, tipo de medicamento, tipo de flebitis y clasificación del evento. Análisis por subgrupos con Epi-Info™ 7.2.4.0 mediante estadística descriptiva, medidas de frecuencia, tendencia/dispersión. Resultados. El 91,3% (840/920) de registros fueron objeto de análisis; 2015(11;1,3%), 2016(137;16,3%), 2017(109;12,9%), 2018 (95;11,3%), 2019(172;20,5%), 2020(140;16,7%) y 2021(176;20,9%); 467(55,60%) hombres; por régimen de afiliación, 557(66,3%) subsidiado, 199(23,7%) contributivo; edad promedio 53,1±23,6 años, 714(85,0%) tenían 27 o más años. Servicio hospitalario: 434(51,1%) hospitalización, 192(22,9%) observación, ocurrencia en promedio a las 12,7±6,9 horas. Sitio afectado: 521(62,0%) brazo; Signos/síntomas: 472(56,2%) rubor, 421(50,1%) calor, 271(32,3%) edema, 215(25,6%) dolor; eventos por cambio de sitio de venopunción, 832(99,0%); tipo de medicamento, 57(6,8%) antibiótico, 56(15,6%) flebitis química, clasificación: 755(89,9%) sin riesgo, 66(7,9%) riesgo medio y 9(1,1%) riesgo alto. Conclusiones. La incidencia de flebitis más alta se presenta en 2021, siendo los hombres los más afectados; en el proceso de internación/urgencias. Anatómicamente, el brazo es el sitio más afectado, y la acción de mayor frecuencia es el cambio de sitio, en su mayoría sin riego. En promedio el evento se presenta cercano al proceso de cambio de turno. Se recomienda generar acciones de educación y vigilancia durante la atención hospitalaria.

Background and Objective: The dorsal osteophyte on the distal phalanx of the first toe (hallux) is a reactive bony protrusion that may be associated with pathologies such as onychocryptosis or pincer nail. This study aims to describe and analyze the correlation between three novel measurements—dorsal osteophyte height (HDO), distal phalangeal hyperextension (DPHA), and distal phalangeal curvature (DCDP)—and to evaluate the impact of minimally invasive surgery on the dorsal osteophyte using fluoroscopic data. Materials and Methods: A total of 125 fluoroscopic images were analyzed. Baseline measurements for the variables were compared between groups. The key variables included distal phalanx curvature, distal phalanx hyperextension, and dorsal osteophyte height. Results: The analysis revealed statistically significant differences in the main group effect for distal phalanx curvature (F [2, 122] = 7.54, p < 0.001), distal phalanx hyperextension (F [2, 122] = 28.90, p < 0.001), and dorsal osteophyte height (F [2, 122] = 13.64, p < 0.001). Significant correlations were found between distal phalanx curvature and distal phalanx hyperextension, as well as between distal phalanx hyperextension and dorsal osteophyte height. However, no significant correlation was observed between distal phalanx curvature and dorsal osteophyte height. Conclusions: The findings suggest that minimally invasive dorsal osteophyte surgery effectively restores the distal phalanx to normal conditions, as indicated by the variables studied.

Background and Objectives: Peritoneal dialysis (PD) is a renal replacement therapy modality in which the dialysis dose can be individually adapted according to the patients’ residual kidney function (RKF). RKF is a crucial factor for technique and patient survival. Pharmacological strategies aimed at slowing the loss of RKF in patients on PD are limited. Therefore, we aimed to assess the potential effects and safety of sodium–glucose cotransporter 2 (SGLT-2) inhibitors on the preservation of RKF in patients with and without type 2 diabetes mellitus (T2DM) on PD during an average follow-up of 6 months. Materials and Methods: In this retrospective observational, single-center study on real-world data, we included patients from the Peritoneal Dialysis Unit of the Hospital General Universitario de Ciudad Real, who started treatment with SGLT-2 inhibitors during the period from December 2022 to December 2023. Data on analytical and clinical parameters, RKF, and peritoneal membrane transport function were retrospectively collected at months 0, 3, and 6. Results: Out of 31 patients in our unit, 16 prevalent patients initiated treatment with SGLT-2 inhibitors (13 empagliflozin and 3 dapagliflozin). A total of 62.5% were male and the mean age was 67.3 years. The baseline peritoneal ultrafiltration was higher in the non-diabetic patient (NDMP) group than in the diabetic patient (DMP) group. However, the residual diuresis volume, 24 h residual renal clearance rate of urea in urine, and 24 h proteinuria were higher in the DMP group than in the NDMP group. At the sixth month, patients in both groups preserved RKF and diuresis, with a trend towards a non-significant reduction in proteinuria and blood pressure. Only two patients of the DMP group presented adverse effects. Conclusions: The use of SGLT-2 inhibitors in our sample of patients with and without T2DM on PD appears to be safe and effective to preserve RKF.

Introducción: Alcanzar las metas de lactancia materna exclusiva ha sido un desafío. Objetivo: Evaluar la efectividad de una estrategia para promover y lograr la lactancia materna exclusiva durante los primeros seis meses de vida. Materiales y métodos: Estudio cuasiexperimental aleatorizado no enmascarado. Se incluyeron primigestantes adultas con edad gestacional entre 12 y 27 semanas, en Cali, Colombia, entre 2014 y 2017. El grupo control recibió atención estándar; el grupo de intervención, además, se sometió a una estrategia prenatal y posnatal que incorporó las tecnologías de la información y comunicación. El seguimiento se realizó hasta los 6 meses posparto. Resultados: Se analizó a 141 participantes distribuidas en dos grupos: control (73) e intervención (68). La duración media de la adherencia a la lactancia materna exclusiva fue mayor en el grupo de intervención (1,1 ± 0,65, p

Introducción: la COVID-19 es causada por el virus SARS-CoV-2. La presentación clínica varía desde pacientes asintomáticos hasta manifestaciones severas. Durante la pandemia se han realizado autopsias que han permitido reconocer los cambios en diferentes órganos, siendo el pulmón el más afectado. El objetivo del presente estudio es informar nuestra experiencia en cuanto a los hallazgos histopatológicos pulmonares, mediante el sistema de autopsia mínimamente invasiva. Metodología: se tomaron muestras a 8 pacientes fallecidos por COVID-19 en la unidad de cuidado intensivo (UCI) confirmado por PCR en el Hospital de San José, Bogotá, Colombia, en la primera hora después de la muerte. Los tejidos fueron analizados por dos patólogos en forma independiente. Resultados: se observó en todos daño alveolar difuso (DAD) en fases exudativa, proliferativa o ambas, además de bronconeumonía y neumonitis intersticial. Discusión: el pulmón es el principal órgano afectado por el SARS-CoV-2 y el hallazgo histopatológico más frecuente es el DAD en fases exudativa y mixta. También se han descrito alteraciones en diferentes sistemas. Conclusiones: el hallazgo histopatológico pulmonar más frecuente es el DAD en diferentes estadios. Se considera que la autopsia mínimamente invasiva es de gran utilidad en escenarios donde la convencional se encuentra limitada, pues no presenta grandes restricciones y permite obtener tejidos viables.

Introducción: los grupos sanguíneos ABO han sido utilizados como marcadores de desenlace en diferentes enfermedades, otorgando al grupo O un factor protector y al A uno de riesgo. Durante el brote de SARS CoV-1 se planteó la posible relación entre riesgo de infección y tipo sanguíneo; se presume que en la pandemia por COVID-19 exista una relación entre determinados desenlaces y los grupos ABO. Objetivo: determinar la asociación entre los diferentes grupos sanguíneos y los desenlaces de mortalidad, ingreso a cuidados intensivos y requerimiento de intubación orotraqueal (IOT) en población con infección por COVID-19. Materiales y métodos: revisión sistemática y metanálisis entre enero 2020 y marzo 2021 en las bases de datos MEDLINE, EMBASE, SCOPUS, Latindex y LILACS, identificando los desenlaces mencionados en pacientes con COVID-19. Resultados: se incluyeron 16 estudios, la mayoría retrospectivos multicéntricos. Se evidenció que pacientes con grupo sanguíneo A tienen mayor riesgo de mortalidad (OR 1.08 ;1.01-0.17), frente al ingreso a UCI no hubo diferencia estadística significativa entre los grupos sanguíneos. Se encontró que el AB representa un factor de riesgo para intubación orotraqueal (OR 1.42 IC95% 1.02-1.96), en tanto que el A demostró proteger contra este desenlace (OR 0.84 IC95%0.73-0.97). Conclusiones: hay evidencia sobre la relación entre el grupo sanguíneo y los desenlaces, asociada con la infección por SARS-CoV-2. Se requieren estudios prospectivos que evalúen grupo sanguíneo, RH y desenlaces específicos.

Chronic pain is a serious public health problem that has grown exponentially in recent years, which is why it has received the attention of numerous researchers. Most of the studies in the field of chronic pain have focused on care as a mediating variable on the perception of painful stimuli and emotions. Nevertheless, there are very few studies that have gone in the opposite direction. This study’s aim is therefore to analyse the impact of emotional variables (anxiety and depression), the rating of pain, and age on vigilance processes in a sample of patients with chronic pain. To do so, the attentional performance of a cohort of 52 patients with chronic pain was measured through the use of a modified dot-probe task. Furthermore, all the participants were evaluated using the following self-report measures: Beck’s Depression Inventory-II (BDI-II), the McGill Pain Questionnaire, and the Pain Anxiety Symptoms Scale-20 (PASS-20). Stepwise multiple linear regression analysis revealed a significant negative correlation between the pain rating index and the number of mistakes the participants made during the attention test. There was also a positive and significant correlation with age and another negative and significant correlation with cognitive anxiety regarding the overall performance times during the undertaking of the experimental task. These results point to the importance of a more in-depth understanding of the impact that the emotional variables and other variables such as age have on attentional processes and the rating of pain. Finally, the discussion focuses on the implications these results could have for clinical practice or for future research studies in this field.

Samira Said Lançoni,1,2 Jocilene Pedroso Albuquerque,1,3 Adriane Muller Nakato,2 Gislayne Castro e Souza de Nieto,4 Cláudio Marcelo Tkac,5 Marcos Fabiano Sigwalt,1,3 Percy Nohama,2 Larissa Riskalla Talamini Souto,2 Paulo Afonso Nunes Nassif1,3 1Graduate Program in Principles of Surgery, Faculdade Evangélica Mackenzie do Paraná, Curitiba, Paraná, Brasil; 2Graduate Program on Health Technology, Pontifícia Universidade Católica do Paraná, Curitiba, Paraná, Brazil; 3Hospital Universitário Evangélico Mackenzie, Curitiba, Paraná, Brasil; 4Department of Pediatrics, Universidade Positivo, Curitiba, Paraná, Brazil; 5School of Medicine and Life Sciences, Pontifícia Universidade Católica do Paraná, Curitiba, Paraná, BrazilCorrespondence: Samira Said Lançoni, Graduate Program on Health Technology, Pontifícia Universidade Católica do Paraná Rua Imaculada Conceição 1155, Curitiba, Paraná, CEP 80215-030, Brazil, Tel +55 41 99977-8255, Email samiraslanconi@hotmail.comPurpose: To analyze leptin levels in placental tissue and premature infants undergoing phototherapy and to evaluate the potential for prescribing passive exercise after phototherapy in this population.Patients and Methods: This analytical, longitudinal, prospective cohort study included 108 parturients and their respective premature infants. Variables examined included weight, gestational age, body mass index, sex, serum leptin levels in placental tissue, serum bilirubin levels, and reticulocyte count.Results: When comparing each group to a leptin threshold, statistically significant differences were observed at all evaluated time points for placental leptin levels (p < 0.001). Additionally, reticulocyte count decreased in relation to rebound time (p < 0.004). No correlations were found between leptin/bilirubin levels, leptin/reticulocytes, onset of nutrition, and BMI/leptin levels.Conclusion: The findings regarding leptin levels suggest that prescribing passive exercises to premature infants undergoing phototherapy may be feasible because this intervention did not increase leptin levels.Keywords: neonatal intensive care unit, prematurity, leptin, hyperbilirubinemia, child obesity

Abstract Background Families face a range of barriers in supporting their children’s active play in nature including family circumstances, environmental constraints, and behavioral factors. Evidence-based strategies to address these barriers are needed. We aimed to develop and pilot test a primary care-based family-centered behavioral intervention to promote active outdoor play in 4–10 year-old children. Methods Project Nature, a provider-delivered intervention that provides informational resources and an age-appropriate toy for nature play, was initially developed for children ages 0–3. With stakeholder input, we adapted existing materials for 4–10 year-olds and conducted usability testing at an urban clinic serving families from diverse backgrounds. Subsequently, we conducted a mix-methods pilot study to evaluate intervention feasibility and acceptability. Parents of 4–10 year-olds completed pre- and post-surveys (n = 22), and a purposive subset (n = 10) completed qualitative interviews. Post-intervention, pediatric providers (n = 4) were interviewed about their implementation experiences. Results The majority (82%) of parents liked the information provided and the remaining (18%) were neutral. Qualitatively, parents reported that: the toy provided a tangible element to help children and parents be active, they did not use the website, and they wished the intervention emphasized strategies for physical activity during cold and wet seasons. Providers felt the materials facilitated discussion about behavior change with families. There were no statistically significant changes in PA and outdoor time pre- and post-intervention. Conclusions Project Nature was welcomed by providers and families and may be a practical intervention to promote outdoor active play during well-child visits. Providing an age-appropriate nature toy seemed to be a critical component of the intervention, and may be worth the additional cost, time and storage space required by clinics. Building from these results, Project Nature should be revised to better support active outdoor play during suboptimal weather and evaluated to test its efficacy in a fully-powered trial.

Summary: Background: The clinical relevance of recurrent venous thromboembolism (VTE) after discontinuing anticoagulation in patients with COVID-19-associated VTE remains uncertain. We estimated the incidence rates and mortality of VTE recurrences developing after discontinuing anticoagulation in patients with COVID-19-associated VTE. Methods: A prospective, multicenter, non-interventional study was conducted between March 25, 2020, and July 26, 2023, including patients who had discontinued anticoagulation after at least 3 months of therapy. All patients from the registry were analyzed during the study period to verify inclusion criteria. Patients with superficial vein thrombosis, those who did not receive at least 3 months of anticoagulant therapy, and those who were followed for less than 15 days after discontinuing anticoagulation were excluded. Outcomes were: 1) Incidence rates of symptomatic VTE recurrences, and 2) fatal PE. The rate of VTE recurrences was defined as the number of patients with recurrent VTE divided by the patient-years at risk of recurrent VTE during the period when anticoagulation was discontinued. Findings: Among 1106 patients with COVID-19-associated VTE (age 62.3 ± 14.4 years; 62.9% male) followed-up for 12.5 months (p25-75, 6.3–20.1) after discontinuing anticoagulation, there were 38 VTE recurrences (3.5%, 95% confidence interval [CI]: 2.5–4.7%), with a rate of 3.1 per 100 patient-years (95% CI: 2.2–4.2). No patient died of recurrent PE (0%, 95% CI: 0–7.6%). Subgroup analyses showed that patients with diagnosis in 2021–2022 (vs. 2020) (Hazard ratio [HR] 2.86; 95% CI 1.45–5.68) or those with isolated deep vein thrombosis (vs. pulmonary embolism) (HR 2.31; 95% CI 1.19–4.49) had significantly higher rates of VTE recurrences. Interpretation: In patients with COVID-19-associated VTE who discontinued anticoagulation after at least 3 months of treatment, the incidence rate of recurrent VTE and the case-fatality rate was low. Therefore, it conceivable that long-term anticoagulation may not be required for many patients with COVID-19-associated VTE, although further research is needed to confirm these findings. Funding: Sanofi and Rovi, Sanofi Spain.

El cultivo de maracuyá amarillo es afectado por múltiples problemas fitosanitarios. Entre los principales, están los virus de los géneros Potyvirus (soybean mosaic virus, SMV), Cucumovirus (cucumber mosaic virus, CMV), Tymovirus (passion fruit yellow mosaic virus, PFYMV) y Begomovirus (passionfruit leaf distortion virus, PLDV). Información acerca de la prevalencia e interacción entre estos virus es escasa. El objetivo del presente estudio fue verificar la prevalencia e identificar los tipos de infecciones virales mixtas de potyvirus, cucumovirus, tymovirus y begomovirus en cultivos de maracuyá en Valle del Cauca, Colombia. Muestras foliares de maracuyá con síntomas virales fueron recolectadas y se purificaron sus ácidos nucleicos. La identificación de los virus se realizó por PCR empleando cebadores universales por género viral, y cebadores específicos para los virus SMV, CMV, PFYMV y PLDV. Se analizó la incidencia de cada virus por municipio y se comparó la severidad de los síntomas con el diagnóstico realizado. En total se colectaron 66 muestras en los municipios de Toro, Dagua, Roldanillo, Bolívar, La Unión y El Cerrito. Se estableció que los virus con mayor prevalencia fueron PLDV, seguido por SMV y CMV. No se detectó la presencia de PFYMV en las muestras analizadas. Se identificó por primera vez la presencia de infecciones dobles y triples entre potyvirus, cucumovirus y begomovirus, encontrándose mayor severidad de síntomas a mayor número de virus identificado por muestra. La presente investigación provee resultados clave para el diseño de estrategias de control de enfermedades virales en maracuyá.

Introducción: la mayoría de las aplicaciones en patología digital se encuentran relacionadas con la oncológica, aunque se han propuesto algunos modelos recientes que permiten evaluar la utilidad en el diagnóstico histológico de microorganismos. Material y métodos: se realizó la siguiente revisión en la que se incluyeron 10 artículos publicados en inglés, que tienen como eje central el diagnóstico histopatológico de microorganismos y diferentes modelos de inteligencia artificial. Discusión: los diseñados se han probado para el diagnóstico de Helicobacter pylori, Mycobacterium tuberculosis, Aspergillus, Mucorales y microorganismos relacionados con onicomicosis. Conclusiones: se recomienda el uso de la inteligencia artificial en el diagnóstico histopatológico de microorganismos como un campo emergente que refuerza la función del patólogo coordinador de los diferentes modelos, optimizando así su función y mejorando los tiempos de trabajo y los niveles de efectividad.

Luis Miguel Chinchilla-Tábora,1 Javier Ortiz Rodríguez-Parets,1 Álvaro Otero-Rodríguez,2 Laura Ruiz Martín,2 Juan Carlos Paniagua Escudero,3 Luis Miguel Navarro Martín,4 Belén Cigarral García,4 Adelaida Nieto Palacios,5 Idalia González Morais,1 José María Sayagués,1 María Dolores Ludeña de la Cruz1 1Department of Pathology, University Hospital of Salamanca and Institute for Biomedical Research of Salamanca, Salamanca, Spain; 2Department of Neurosurgery, University Hospital of Salamanca and Institute for Biomedical Research of Salamanca, Salamanca, Spain; 3Department of Radiology, University Hospital of Salamanca and Institute for Biomedical Research of Salamanca, Salamanca, Spain; 4Department of Clinical Oncology, University Hospital of Salamanca and Institute for Biomedical Research of Salamanca, Salamanca, Spain; 5Department of Radiation Oncology, University Hospital of Salamanca and Institute for Biomedical Research of Salamanca, Salamanca, SpainCorrespondence: Luis Miguel Chinchilla-Tábora, Department of Pathology, University Hospital of Salamanca and Institute for Biomedical Research of Salamanca, Paseo de San Vicente, 58-182, Salamanca, PC. 37007, Spain, Tel +34 923291100. Extension: 56738, Email lmct@usal.esAbstract: Hemangioblastoma (HB) is a Central Nervous System (CNS) tumor with a generally favorable behavior and prognosis, classified as WHO grade 1. Sporadic HB is not related to any inherited disease, and it usually appears in a single location. Sporadic or VHL-related HBs show variable patterns of growth velocity. Cases of growing HB can cause mild symptoms such as headache, but some cases develop serious complications such as accumulation of cerebrospinal fluid in the brain with secondary neurological damage sometimes being irreversible when early treatment is not started. Our case showed some clinical characteristics more frequently observed in VHL-related HB rather than sporadic HB, and the presence of alterations in MDM2 and EGFR that could be related to the oncogenesis of these tumors. Even when the treatment of choice for HB is surgery, the presence of these genetic alterations could open a new window for research aimed at assessing the possibility of new therapies with TKIs-EGFR and anti-MDM2 inhibitors in those HB cases with multifocal recurrences or cases with an adverse clinical behavior.Keywords: haemangioblastoma, mouse double minute 2, epidermal growth factor receptor, hydrocephalus, immunohistochemistry, fluorescence in situ hybridization

Resumen: Objetivo: Analizar las variables predictoras del uso de métodos anticonceptivos en jóvenes. Diseño: Revisión sistemática. Fuentes de datos: Se consultaron las bases de datos PubMed, CINAHL, Scopus, Cuiden Plus, LILACS e IME. Selección de estudios: Se realizó una evaluación de la calidad de los estudios que fue revisada por dos investigadores en paralelo. Como resultado, se seleccionaron un total de cinco investigaciones primarias. Extracción de datos: Se extrajo información sobre la población seleccionada en el estudio, método anticonceptivo estudiado y las variables predictoras identificadas. Resultados: Se identificaron siete variables predictoras que explican específicamente el uso del preservativo masculino, píldora anticonceptiva o píldora anticonceptiva de emergencia. Las variables más relevantes fueron el nivel de conocimiento y las actitudes hacia el empleo de los métodos anticonceptivos, de manera que un mayor conocimiento y unas actitudes positivas incrementan la probabilidad de uso de métodos anticonceptivos. Otro resultado destacado fue la presencia de un sesgo formativo con un mayor conocimiento de las mujeres sobre las opciones anticonceptivas hormonales y actitudes más positivas. Conclusión: Los futuros programas formativos deben orientarse hacia la evaluación de cambios en el comportamiento, mediante el desarrollo de actitudes positivas hacia el uso de los métodos anticonceptivos a través de la adquisición de un conocimiento de calidad sobre las opciones contraceptivas. Abstract: Objective: To analyse predictor variables of contraceptive method use in young people. Design: Systematic review. Data sources: PubMed, CINAHL, Scopus, Cuiden Plus, LILACS and IME databases were consulted. Study selection: An assessment of the quality of studies was carried out by two researchers in parallel. As a result, a total of 5 primary research studies were selected. Data extraction: Information was extracted on the selected study population, contraceptive method studied and predictor variables identified. Results: Seven predictor variables were identified that specifically explain the use of the male condom, contraceptive pill or emergency contraceptive pill. The most relevant variables were the level of knowledge and attitudes towards contraceptive use, therefore high knowledge and positive attitudes increase the likelihood of contraceptive use. Another notable finding was the presence of a formative bias with women having higher knowledge of hormonal contraceptive options and more positive attitudes. Conclusion: Future training programs should be oriented towards assessing behavioral changes through the development of positive attitudes towards contraceptive use by gaining knowledge of contraceptive options.

Resumen: Introducción: las habilidades científicas son un pilar importante en la profesión médica, por lo que debe ser abordada desde el pregrado en las universidades y programas. Aun cuando es necesario obtener dichos conocimientos, la evidencia sugiere que son escasos en el profesional médico. El objetivo del estudio fue evaluar las características de la percepción de habilidades científicas en estudiantes de Medicina Humana del Perú y sus factores asociados. Métodos: estudio observacional-analítico, de corte transversal. Los datos fueron obtenidos de una base secundaria generada con base en el formulario de inscripción de un curso virtual realizado en el año 2022. La población de estudio fue estudiantes de Medicina Humana de alguna universidad peruana inscritos a dicho curso. Los factores asociados fueron evaluados mediante regresiones de Poisson con variancias robustas. Resultados: de los 750 estudiantes encuestados (edad media de 22,7 ± 3,2 años) el 27,6; 21,6; 25,5 y 20% reportaron una buena percepción de sus habilidades de búsqueda de información, lectura crítica, metodología de la investigación y redacción científica, respectivamente. El tipo de universidad, el pertenecer a una sociedad científica o a un grupo de investigación se asociaron a una prevalencia del 6 al 16% mayor de estas habilidades científicas. Conclusión: existieron niveles bajos de percepción en habilidades científicas, especialmente en redacción y lectura crítica. Además, pertenecer u obtener un ambiente que propicie la investigación, se asoció a una buena percepción en habilidades científicas. Abstract: Introduction: Scientific skills are a crucial foundation in the medical profession and should be addressed during undergraduate studies in universities and programs. Despite the necessity of acquiring such knowledge, evidence suggests its scarcity among medical professionals. This study aimed to evaluate the characteristics of the perception of scientific skills among students of Human Medicine in Peru and their associated factors. Methods: This was an observational-analytical, cross-sectional study. Data were gathered from a secondary database created from the registration form of a virtual course conducted in 2022. The study population comprised students of Human Medicine from Peruvian universities enrolled in the aforementioned course. Associated factors were assessed using Poisson regressions with robust variances. Results: Out of 750 surveyed students (mean age 22.7 ± 3.2 years), 27.6, 21.6, 25.5, and 20% reported a good perception of their skills in information retrieval, critical reading, research methodology, and scientific writing, respectively. The type of university attended and belonging to a scientific society or research group were associated with a 6% to 16% higher prevalence of these scientific skills. Conclusion: There were low levels of perceived scientific skills, especially in writing and critical reading. Furthermore, being part of or having access to an environment that fosters research was associated with a positive perception of scientific skills.

Mónica Antón,1 Nieves Cabañes,2 Salvador Fernández-Meléndez,3 Mar Fernández-Nieto,4 Gloria Jiménez-Ferrera,5 Antonio Letrán,6 Paula Méndez-Brea,7 Javier Montoro,8,9 Francisco Moreno,6 Pilar Mur-Gimeno,10 Virginia Rodríguez-Vázquez,7 Ana Rosado,11 Inmaculada Sánchez-Guerrero,12 Jose Mª Vega-Chicote,3 Carmen Vidal7,13 1Allergy Department, Hospital Universitario San Juan de Alicante, Alicante, Spain; 2Allergy Department, Hospital Universitario de Toledo, Toledo, Spain; 3Allergy Department, Hospital Civil de Málaga, Malaga, Spain; 4Allergy Department, Hospital Universitario Fundación Jiménez Díaz, Madrid, Spain; 5Allergy Department, Hospital Universitario de Badajoz, Badajoz, Spain; 6Allergy Unit, Centro médico Asisa Doctor Lobatón, Cádiz, Spain; 7Allergy Department, Complejo Hospitalario Clínico Universitario de Santiago, Santiago de Compostela, Spain; 8Allergy Department, Hospital de Llíria, Valencia, Spain; 9Department of Medicine, Universidad Católica de Valencia San Vicente Mártir, Valencia, Spain; 10Allergy Department, Hospital de Santa Bárbara, Puertollano, Ciudad Real, Spain; 11Allergy Department, Hospital Universitario Fundación Alcorcón, Alcorcón, Madrid, Spain; 12Allergy Department, Hospital Clínico Universitario Virgen de la Arrixaca, Murcia, Spain; 13Department of Medicine, Universidad de Santiago de Compostela, Santiago de Compostela, SpainCorrespondence: Carmen Vidal, Allergy Department, Complejo Hospitalario Universitario de Santiago, Santiago de Compostela, 15706, Spain, Tel +34 981 951752, Email carmen.vidal.pan@sergas.esPurpose: The objective of this study was to develop and validate a questionnaire, through a Delphi consensus, to be used by allergists in their routine clinical practice to assess the preferences of patients starting allergen immunotherapy (AIT) treatment using an objective approach.Patients and Methods: A Delphi consensus-driven process was used. The scientific committee, composed of 15 allergists, led the study and participated in the preparation of the questionnaire. Two-hundred panelists from different Spanish regions were invited to complete a 16-item questionnaire on a nine-point Likert scale covering six topic blocks. Consensus was achieved if ≥ 66.6% of panelists reached agreement or disagreement.Results: Of the 200 experts invited to participate in the Delphi process, a total of 195 (97.5%) answered the questionnaire. The panel experts reached a consensus on “agreement” on a total of 12 of the 16 (75.0%) items, covering a total of six categories: (a) patient knowledge (2 questions), (b) barriers to patient adherence (3 questions), (c) patient behavior (4 questions), (d) future actions (3 questions), (e) treatment costs (2 questions), and (f) final patient preferences (2 questions).Conclusion: This Delphi consensus study validated a set of twelve recommended questions for patients objectively assessing their preferences and suitability for the most common AIT options available. The questionnaire intends to assist allergists in making an objective, unconditioned decision regarding the best AIT option for each patient, after informing them about the different routes.Keywords: allergen immunotherapy, Delphi consensus, shared decision-making, questionnaire

Introduction: In the assessment of the second specialty training programs, the opinion of residents and graduates is essential to know the degree of satisfaction with the training received. The aimed was to assess the perceptions of Peruvian nephrology residents and graduates regarding their training. Material: A descriptive, cross-sectional study included all final-year residents and graduates of the nephrology program in 2022. An anonymous virtual survey assessed sociodemographic aspects, nephrology tutoring, clinical training, external rotations, research, the impact of the COVID-19 pandemic, and overall perception of their training. Results: With a response rate of 79.68%, 51 participants were evaluated. 76.48% of the participants rated their overall training during the residency as good. 58% agreed or strongly agreed that their tutor's performance was good. 66.6% agreed or strongly agreed that their theoretical training was good, with less certainty in genetic kidney diseases. 90% agreed or strongly agreed that their practical training was good, with less certainty in training in slow therapies, renal biopsies, acute peritoneal dialysis, and peritoneal dialysis catheter placement. 80.4% agreed or strongly agreed that the pandemic affected their training. The general perception had a positive correlation with the tutor's performance as good (r=0.50; P

La bioética estudia la conducta humana en los campos de las ciencias biológicas y de la atención de la salud. Es imprescindible que el contenido programático de las facultades de ciencias de la salud divulgue su significado e importancia. Todo aquel que pretenda una práctica profesional en la cual interaccione directamente con la vida, debe adquirir competencias desde el campo de la bioética con fundamentos arraigados en los principios éticos de no maleficencia, beneficencia, autonomía y justicia. De tal forma que desarrollen capacidad de reflexión crítica sobre los conflictos éticos provocados por los avances de la ciencia de la vida y la medicina. Cada día se propone más el uso de herramientas audiovisuales en la docencia, para facilitar el abordaje de dilemas éticos, crear espacios de análisis, discusión, que ayudan a la comprensión, memoria e interpretación de este tema entre los estudiantes. En este artículo se pretende divulgar la experiencia a través de una estrategia pedagógica que involucra el cineforo como medio de aprendizaje en bioética en un grupo de estudiantes posgrado en salud.

Fundamento: En Cuba, durante la pandemia de COVID-19, se puso a prueba la importancia de las escalas clínicas para el tratamiento de pacientes adultos con amigdalitis aguda por no contar con pruebas de detección rápida de antígenos, sin embargo, su uso sigue siendo controversial. Objetivo: Describir los resultados de la aplicación de la escala Centor en la atención a pacientes con amigdalitis aguda durante la COVID-19. Metodología: Se realizó un estudio de serie de casos y se incluyeron los pacientes con amigdalitis aguda diagnosticados en un período de dos años en la consulta externa de Otorrinolaringología del Hospital General Provincial Camilo Cienfuegos, Sancti Spíritus, Cuba. A todos se les aplicó la escala Centor. Resultados: Se incluyeron 114 pacientes. La media de edad fue de 28.9 + 18.7 años, más de la mitad de los pacientes tenían antecedentes de amigdalitis crónica y adenoiditis crónica y eran fumadores activos. Aproximadamente 2 de cada 5 pacientes tuvieron puntuaciones

Summary: Background: The intestine of children with severe malnutrition (SM) shows structural and functional changes that are linked to increased infection and mortality. SM dysregulates the tryptophan-kynurenine pathway, which may impact processes such as SIRT1- and mTORC1-mediated autophagy and mitochondrial homeostasis. Using a mouse and organoid model of SM, we studied the repercussions of these dysregulations on malnutrition enteropathy and the protective capacity of maintaining autophagy activity and mitochondrial health. Methods: SM was induced through feeding male weanling C57BL/6 mice a low protein diet (LPD) for 14-days. Mice were either treated with the NAD+-precursor, nicotinamide; an mTORC1-inhibitor, rapamycin; a SIRT1-activator, resveratrol; or SIRT1-inhibitor, EX-527. Malnutrition enteropathy was induced in enteric organoids through amino-acid deprivation. Features of and pathways to malnutrition enteropathy were examined, including paracellular permeability, nutrient absorption, and autophagic, mitochondrial, and reactive-oxygen-species (ROS) abnormalities. Findings: LPD-feeding and ensuing low-tryptophan availability led to villus atrophy, nutrient malabsorption, and intestinal barrier dysfunction. In LPD-fed mice, nicotinamide-supplementation was linked to SIRT1-mediated activation of mitophagy, which reduced damaged mitochondria, and improved intestinal barrier function. Inhibition of mTORC1 reduced intestinal barrier dysfunction and nutrient malabsorption. Findings were validated and extended using an organoid model, demonstrating that resolution of mitochondrial ROS resolved barrier dysfunction. Interpretation: Malnutrition enteropathy arises from a dysregulation of the SIRT1 and mTORC1 pathways, leading to disrupted autophagy, mitochondrial homeostasis, and ROS. Whether nicotinamide-supplementation in children with SM could ameliorate malnutrition enteropathy should be explored in clinical trials. Funding: This work was supported by the Bill and Melinda Gates Foundation, the Sickkids Research Institute, the Canadian Institutes of Health Research, and the University Medical Center Groningen.

Introducción: La enseñanza en enfermería debe transitar desde una perspectiva tradicionalista, centrada en el docente, a un enfoque que esté centrado al estudiante. Esto último promueve el aprendizaje autónomo, donde el docente actúa como mediador, no como fuente de conocimiento. Objetivo: Identificar la necesidad de usar guías y videos de simulación clínica para el aprendizaje autónomo de estudiantes de enfermería de la Universidad de Cundinamarca. Materiales y Métodos: Investigación bajo el paradigma positivista, de diseño descriptivo, con enfoque cuantitativo, de corte transversal, durante el primer trimestre de 2020. Población 376. Se realizó un muestreo intencional no probabilístico, conformado por 95 estudiantes de enfermería. Los datos se obtuvieron mediante una encuesta autoadministrada y anónima. Se realizó una evaluación descriptiva de los datos. Resultados: El 75 % de los estudiantes demostró un nivel alto de necesidad de usar guías y videos para su aprendizaje autónomo, consideran un mayor grado de seguridad y claridad al realizar procedimientos en las prácticas simuladas, 62 % aseguró que es una herramienta pertinente para el aprendizaje de enfermería. Conclusiones: Se demostró alta necesidad de guías y videos de simulación clínica para el aprendizaje autónomo en estudiantes de enfermería. Estos recursos fomentan la motivación, seguridad y habilidades para el cuidado, reduciendo riesgos en prácticas clínicas. La actualización periódica es crucial para garantizar su utilidad e innovación.

Abstract Introduction Antibody‐drug conjugates (ADCs) are a family of therapeutic agents that have demonstrated clinical activity in several indications. Material and methods In this article, we performed a deep analysis of their clinical landscape matched with public genomic human datasets from tumour antigen targets (TATs), to identify empty areas for clinical development. Results We observed that TATs used in haematological malignancies were more specific than the ones developed in solid cancers. Those included CD19, CD22, CD30, CD33 and CD79b. In solid tumours, we identified TATs, with approved ADCs, widely expressed in non‐explored niche indications like Enfortumab vedotin (anti‐Nectin4) in lung or cervical cancer; Tisotumab vedotin (anti‐TF) in glioblastoma or pancreatic cancer; and Sacituzumab govitecan (anti‐TROP2) in pancreatic, gastric, thyroid or endometrial cancer, among others. Similarly, niche indications for ADCs in clinical development included targets for CD71, PSMA, PTK7 or CD74, in tumours like breast, lung, stomach or colon. Some of these TATs were essential for the survival of tumour cells like CD71, PSMA and PTK7. Conclusions In summary, our study opens the door for further evaluation of ADCs in several indications not explored before.

Summary: Background: COVID-19 in paediatric ages could result in hospitalizations and death. In addition, excluding children from vaccination could turn them into reservoirs of the SARS-COV-2. Safe and effective COVID-19 vaccines are urgently needed for large-scale paediatric vaccination. ISMAELILLO study aimed to evaluate safety and immunogenicity of two strengths of a new recombinant receptor-binding domain (RBD) protein vaccine (Abdala) in paediatric population. Methods: A double-blinded, multicentre, randomised, phase 1/2 clinical trial was conducted in nine polyclinics in the province of Camagüey, Cuba. Healthy children and adolescents were stratified according to age (3–11 years old, or 12–18 years old) and they were randomly assigned (1:1; block size four) in two dosage level groups of vaccine to receive three intramuscular doses of 25 μg or 50 μg of RBD, 14 days apart. Main safety endpoint was analyzed as the percentage of serious adverse reactions during vaccination up to 28 days after the third dose (Day 56) in participants who received at least one dose vaccination. The primary immunogenicity endpoint assessed was seroconversion rate of anti-RBD IgG antibody at day 56. The immunogenicity outcomes were assessed in the per-protocol population. This trial is registered with Cuban Public Registry of Clinical Trials, RPCEC00000381. Findings: Between July 15, 2021, and August 16, 2021, 644 paediatric subjects were screened, of whom 592 were enrolled after verifying that they met the selection criteria: firstly 88 were included in Phase 1 of the study and 504 who completed Phase 2. The vaccine was well tolerated. Injection site pain was the most frequently reported local event (143 [8·4%] of 1707 total doses applied), taking place in 66/851 (7·8%) in the 25 μg group and in 77/856 (9·0%) in the 50 μg. The most common systemic adverse event (AE) was headache: 23/851 (2·7%) in the 25 μg group and 19/856 (2·2%) in the 50 μg. Reactogenicity was mild or moderate in severity, represented in 75% of cases by local symptoms, completely resolved in the first 24–48 h. Twenty-eight days after the third dose, seroconversion anti-RBD IgG were observed in 98·2% of the children and adolescents (231/234) for the 50 μg group and 98·7% (224/228) for the 25 μg group without differences between both strength. The specific IgG antibody geometric mean titres (GMT) showed higher titres between participants who received Abdala 50 μg (231·3; 95% CI 222·6–240·4) compared to those who received 25 μg (126·7; 95% CI 121·9–131·7). The mean ACE2 inhibition %, were 59·4% for 25 μg, and for 50 μg, 72·9% (p

Introduction: Mechanical ventilation is a common practice in intensive care units and anesthesiology with both therapeutic and potentially harmful implications for the respiratory system and distant organs, that is why it is of utmost importance to continually monitor ventilation parameters. Objective: To describe the equation of motion of the respiratory system and its clinical applications in the patient under invasive mechanical ventilation. Main: The equation of motion of the respiratory system integrates the dynamic forces generated by the ventilator with the intrinsic properties of the lung and chest wall. It expresses the pressure in the respiratory system in relation to volume, elastance, resistance, air flow and pressures generated by the ventilator and the patient. Elevated pressures in the respiratory system during mechanical ventilation are associated with greater mortality, that is why the identification of the components responsible for elevation of pressures through the equation of motion of the respiratory system allows to modify ventilator programmed parameters to maintain a protective ventilation. Conclusion: Decision-making based on the equation of motion of the respiratory system allows to modify ventilatory parameters according to the characteristics and diseases of the patient under mechanical ventilation.

(1) Background: Somatic mutations may be connected to the exposome, potentially playing a role in breast cancer’s development and clinical outcomes. There needs to be information regarding Latin American women specifically, as they are underrepresented in clinical trials and have limited access to somatic analysis in their countries. This study aims to systematically investigate somatic mutations in breast cancer patients from Latin America to gain a better understanding of tumor biology in the region. (2) Methods: We realize a systematic review of studies on breast cancer in 21 Latin American countries using various databases such as PubMed, Google Scholar, Web of Science, RedAlyc, Dianlet, and Biblioteca Virtual en Salud. Of 392 articles that fit the criteria, 10 studies have clinical data which can be used to create a database containing clinical and genetic information. We compared mutation frequencies across different breast cancer subtypes using statistical analyses and meta-analyses of proportions. Furthermore, we identified overexpressed biological processes and canonical pathways through functional enrichment analysis. (3) Results: 342 mutations were found in six Latin American countries, with the TP53 and PIK3CA genes being the most studied mutations. The most common PIK3CA mutation was H1047R. Functional analysis provided insights into tumor biology and potential therapies. (4) Conclusion: evaluating specific somatic mutations in the Latin American population is crucial for understanding tumor biology and determining appropriate treatment options. Combining targeted therapies may improve clinical outcomes in breast cancer. Moreover, implementing healthy lifestyle strategies in Latin America could enhance therapy effectiveness and clinical outcomes.

Background: Kidney transplantation is the treatment of choice for end-stage renal disease. An adequate post-transplant follow-up improves the graft and patient's long-term survival. Objective: The aim of this study was to compare the outcomes of kidney transplant patients who live in the Medellin metropolitan area with those who live outside this area, to propose a model for follow-up care through telemedicine. Methods: Descriptive, retrospective and one-center study. Kaplan-Meier method was used to determine the survival rate. Results: Between 2005 and 2015, 742 patients were transplanted, 42% of whom lived outside the metropolitan area. The survival rates after 1, 3 and 5 years of treatment in patients in the metropolitan area of Medellín compared to those outsides were 96.8%, 93.7% y 91.8% and 94.4%, 90.3% y 85.2% respectively, with statistically significant differences (Log-rank test p=0.048, Hazard ratio 1.68, IC 95% 0.99-2.84, p=0.052). Conclusion: The survival rate was lower in kidney transplant patients living outside the urban area. These findings motivate the development of a telemedicine project to facilitate the follow-up of these patients after a kidney transplantation.

The coronavirus disease 2019 has been demonstrated to be a trigger for multiple immune-mediated diseases, such as antineutrophil cytoplasmic antibody-associated vasculitis. Associated vasculitis consists of rare autoimmune disorders that predominantly affect small vessels, leading to endothelial injury and tissue damage. We present a case of a newly diagnosed microscopic polyangiitis temporally associated with coronavirus disease 2019 infection in a previously healthy woman and a literature review. A 66-year-old female presented to the Emergency Room with fever, edema on her legs, productive cough, dyspnea, and hemoptysis. A chest computerized tomography scan revealed bilateral diffuse alveolar opacities with the appearance of diffuse alveolar hemorrhage. Blood analysis revealed a moderate normocytic, normochromic anemia with a hemoglobin of 6.6 g/dL, platelet count of 347 k/dL, leucocytes of 12,000/dL, a creatinine of 3.91 mg/dL (basal Cr: 0.9 mg/dL), and a Blood Urine Nnitrogen of 78 mg/dL. A urine sediment demonstrated glomerular hematuria, with mixed shapes of red blood cells. She was admitted to the intensive care unit and a bedside bronchoscopy revealed progressive bleeding with a bronchioalveolar lavage positive for diffuse alveolar hemorrhage. Given the critical involvement of the lungs and kidney function, the diagnostic approach revealed a positive p-anti-neutrophil cytoplasmic antibody on immunofluorescence and an anti-MPO (myeloperoxidase) level of 124.6 IU/mL. A renal biopsy demonstrated pauciimmune focal and segmental glomerulosclerosis. A diagnosis of microscopic polyangiitis triggered by severe acute respiratory syndrome coronavirus 2 infection was made, and immediate treatment with pulse-dose steroids and cyclophosphamide was initiated. The patient needed renal replacement therapy and was discharged for follow-up with nephrology and rheumatology services. The diagnostic approach of associated vasculitis can be more challenging in the coronavirus disease era. Atypical features in the pulmonary imaging and a rapid deterioration of the renal function should arise the clinical suspicion of the presence of an added condition to the coronavirus disease infection. Autoimmune conditions such as associated vasculitis should be evaluated even in the absence of previous autoimmune history. Prompt diagnosis and treatments must be prioritized to avoid end-organ definite damage. Further, larger and more collaborative studies are needed to confirm the potential role of coronavirus disease 2019 as a trigger of associated vasculitis.

Key Clinical Massage Preeclampsia is defined as elevation of blood pressure and any of the following severity criteria: proteinuria, thrombocytopenia, elevation of creatinine in the absence of another renal pathology, elevation of transaminases, pulmonary edema, or neurological symptoms. However, after 20 weeks of gestation in a previously normotensive patient, cases of preeclampsia associated with molar pregnancy have been described in patients at less than 20 weeks of gestation. A 26‐year‐old woman, at 14.1 weeks of gestation was admitted to the lower extremities with facial edema, holocranial headache, nausea, epigastralgia, phosphenes, and photophobia, with a double‐length uterine fundus for gestational age and ultrasonography. Obstetricians who showed images of snowflakes without fetuses and annexes had multiple thecal‐lutein cysts. Atypical preeclampsia was identified using the severity data for complete hydatidiform moles. Given the possibility of serious complications that may endanger the life of the maternal–fetal binomial, atypical forms of preeclampsia should be suspected.

Pulmonary embolism is a common and potentially fatal disease, with a significant burden on health and survival. Right ventricular dysfunction and hemodynamic instability are considered two key determinants of mortality in pulmonary embolism, which can reach up to 65% in severe cases. Therefore, timely diagnosis and management are of paramount importance to ensure the best quality of care. However, hemodynamic and respiratory support, both major constituents of management in pulmonary embolism, associated with cardiogenic shock or cardiac arrest, have been given little attention in recent years, in favor of other novel advances such as systemic thrombolysis or direct oral anticoagulants. Moreover, it has been implied that current recommendations regarding this supportive care lack enough robustness, further complicating the problem. In this review, we critically discuss and summarize the current literature concerning the hemodynamic and respiratory support in pulmonary embolism, including fluid therapy, diuretics, pharmacological support with vasopressors, inotropes and vasodilators, oxygen therapy and ventilation, and mechanical circulatory support with veno-arterial extracorporeal membrane oxygenation and right ventricular assist devices, while also providing some insights into contemporary research gaps.

Background and Objective: Dehydration and hyperhydration impact athletes’ performance. Exploring the fluid balance concerning body composition might help estimate individual hydration requirements. This area of research, particularly regarding sodium losses, has been relatively understudied. We evaluated the sweat rate (SR), sweat sodium losses, and their relationship with body composition in professional soccer players in Cali, Colombia. Materials and Methods: Thirty-two male players, aged 24.3 (±5.2) years, from the Colombian main soccer league, underwent high-intensity training at 32 °C (with a relative humidity of 79%). The outcome variables included SR, calculated using weight loss and fluid intake; forearm sweat sodium concentration (FSCC), measured through the direct ion-selective electrode method; and estimated the predicted whole sweat sodium loss (PWSSL) in mmol. Predictor variables (body mass, fat, and muscle masses) were estimated using the Deborah Kerr anthropometry method. The association between predictors and outcomes was assessed using linear regression. Results: The mean FSCC, PWSSL, and SR were 26.7 ± 11.3 mmol/L, 43 ± 15.9 mmol/L, and 1.7 ± 0.5 L/h, respectively. Body mass positively predicted FSCC in unadjusted and age/fat-mass-adjusted models [Beta 1.28, 95% confidence interval (CI) 0.39–2.18, p = 0.006], and continued related to FSCC after adjustment for muscle mass with marginal significance [Beta 0.85, 95% CI −0.02 to 1.73, p = 0.056]. Muscle mass was associated with the PWSSL in unadjusted and age/fat-mass-adjusted models [Beta 2.42, 95% CI 0.58–4.26, p = 0.012] and sustained an association with marginal statistical significance after adjustment for body mass [Beta 1.86, 95% CI −0.35 to 4.09, p = 0.097]. Conclusions: Under hot tropical weather conditions, FSCC was relatively low among the players. Body mass was better associated with the FSSC, and muscle mass better related to the PWSSL. Body and muscle masses could be regarded as potential factors to be explored in the estimation of individual sodium needs. However, further studies are required to validate and contrast our findings.

Summary: Background: Anti-COVID-19 hyperimmune immunoglobulin (hIG) can provide standardized and controlled antibody content. Data from controlled clinical trials using hIG for the prevention or treatment of COVID-19 outpatients have not been reported. We assessed the safety and efficacy of subcutaneous anti-COVID-19 hyperimmune immunoglobulin 20% (C19-IG20%) compared to placebo in preventing development of symptomatic COVID-19 in asymptomatic individuals with SARS-CoV-2 infection. Methods: We did a multicentre, randomized, double-blind, placebo-controlled trial, in asymptomatic unvaccinated adults (≥18 years of age) with confirmed SARS-CoV-2 infection within 5 days between April 28 and December 27, 2021. Participants were randomly assigned (1:1:1) to receive a blinded subcutaneous infusion of 10 mL with 1 g or 2 g of C19-IG20%, or an equivalent volume of saline as placebo. The primary endpoint was the proportion of participants who remained asymptomatic through day 14 after infusion. Secondary endpoints included the proportion of individuals who required oxygen supplementation, any medically attended visit, hospitalisation, or ICU, and viral load reduction and viral clearance in nasopharyngeal swabs. Safety was assessed as the proportion of patients with adverse events. The trial was terminated early due to a lack of potential benefit in the target population in a planned interim analysis conducted in December 2021. ClinicalTrials.gov registry: NCT04847141. Findings: 461 individuals (mean age 39.6 years [SD 12.8]) were randomized and received the intervention within a mean of 3.1 (SD 1.27) days from a positive SARS-CoV-2 test. In the prespecified modified intention-to-treat analysis that included only participants who received a subcutaneous infusion, the primary outcome occurred in 59.9% (91/152) of participants receiving 1 g C19-IG20%, 64.7% (99/153) receiving 2 g, and 63.5% (99/156) receiving placebo (difference in proportions 1 g C19-IG20% vs. placebo, −3.6%; 95% CI -14.6% to 7.3%, p = 0.53; 2 g C19-IG20% vs placebo, 1.1%; −9.6% to 11.9%, p = 0.85). None of the secondary clinical efficacy endpoints or virological endpoints were significantly different between study groups. Adverse event rate was similar between groups, and no severe or life-threatening adverse events related to investigational product infusion were reported. Interpretation: Our findings suggested that administration of subcutaneous human hyperimmune immunoglobulin C19-IG20% to asymptomatic individuals with SARS-CoV-2 infection was safe but did not prevent development of symptomatic COVID-19. Funding: Grifols.

La espectroscopía de reflectancia en el infrarrojo cercano (NIRS) es una tecnología rápida, multiparamétrica, amigable con el ambiente, de bajo costo y gran exactitud, para el análisis de diversos componentes en alimentos, en suelo y en agricultura. El objetivo del presente estudio fue construir modelos de calibración NIRS, para la predicción de nutrientes en tejido vegetal de caña de azúcar, para producción de panela, cultivada en la región de la Hoya del río Suárez. Un total de 416 muestras de tejido fueron escaneadas en el segmento espectral Vis-NIR. El análisis quimiométrico, se realizó con el software WinISI V4.10, aplicando la regresión de mínimos cuadrados parciales modificados, junto a una validación cruzada. Se evaluaron cuatro modelos con diferentes tratamientos matemáticos y el rendimiento de las calibraciones, se hizo por medio de la validación externa, analizando las medidas de bondad de ajuste, como el coeficiente de determinación de la predicción, el error estándar de la predicción ajustado por el sesgo y la desviación predictiva residual. Los resultados muestran que el modelo de calibración para N presentó el mayor poder predictivo. Para macronutrientes, las calibraciones, con mayor poder predictivo, fueron P y K y para micronutrientes, el modelo para B, mientras que para Cu presentó el más bajo poder predictivo. Se encontraron modelos adecuados para la predicción de los contenidos de N, Ca y P; para los demás nutrientes, se recomienda ampliar el conjunto de calibración.

ObjectivesTo assess performance of interstitial pneumonia (IP) with autoimmune features (IPAF) criteria in clinical practice and describe the utility of additional workup in identifying patients with underlying connective tissue diseases (CTD).MethodsWe set a retrospective study of our patients with autoimmune IP, who were allocated to CTD-IP, IPAF or undifferentiated autoimmune IP (uAIP) subgroups according to the updated classification criteria. Presence of the process-related variables comprising IPAF defining domains was scrutinized in all patients, and, when available, the results of nailfold videocapillaroscopy (NVC) were recorded.ResultsThirty nine out of 118 patients, accounting for 71% of former undifferentiated cases, fulfilled IPAF criteria. Arthritis and Raynaud’s phenomenon were prevalent in this subgroup. While systemic sclerosis-specific autoantibodies were restricted to CTD-IP patients, anti-tRNA synthetase antibodies were also present in IPAF. In contrast, rheumatoid factor, anti-Ro antibodies and ANA nucleolar patterns could be found in all subgroups. Usual interstitial pneumonia (UIP) / possible UIP were the most frequently observed radiographic patterns Therefore, the presence of thoracic multicompartimental findings as also performance of open lung biopsies were useful in characterizing as IPAF those UIP cases lacking a clinical domain. Interestingly, we could observe NVC abnormalities in 54% of IPAF and 36% of uAIP tested patients, even though many of them did not report Raynaud’s phenomenon.ConclusionBesides application of IPAF criteria, distribution of IPAF defining variables along with NVC exams help identify more homogeneous phenotypic subgroups of autoimmune IP of potential relevance beyond clinical diagnosis.

IntroductionThere is a pressing need to develop novel drugs for treating patients with chronic hepatitis B (CHB), as commercially available antiviral drugs are endowed with safety and efficacy concerns.MethodsA phase III clinical trial was conducted with a therapeutic vaccine containing two antigens of the hepatitis B virus (HBV; named NASVAC) in 78 patients with CHB expressing both HBV DNA and elevated levels of alanine aminotransferase (ALT) in the blood. Five years after the end of treatment (EOT), 60 NASVAC-recipient patients were enrolled in this long-term follow-up study to evaluate the safety, antiviral potential, and liver-protective capacity of NASVAC.ResultsNASVAC exhibited an excellent safety profile 5 years after EOT. The levels of HBV DNA in the sera were reduced in 55 of the 60 patients, and 45 of them were negative for HBV DNA in the sera. ALT levels were also normalized in 40 of the 60 patients 5 years after EOT. None of the patients receiving NASVAC developed liver cirrhosis or cancer.DiscussionThe present study is the first to exhibit long-term follow-up data of a finite immune therapy for CHB that is safe and endowed with potent antiviral and liver-protecting capacities.

Kidney transplantation is the recommended treatment for end-stage chronic kidney disease, improving patients’ quality of life and survival compared to dialysis. Nevertheless, to keep a functional graft and avoid rejection, strong immunosuppression is required during the graft’s lifetime, which can lead to complications such as increased susceptibility to infections, development of cancer, metabolic changes and cardiovascular problems. Patients infected with the human immunodeficiency virus are at high risk of developing endstag renal disease. Previous this century, kidney transplantation was considered contraindicated for these patients group. However nowa-days, kidney transplantation is a therapeutic option for well-selected patients and with well-established treatment protocols. Several studies reported a three-year graft survival rate of 88,2% and patient survival of 82,6%. In this article, we present an overview of the worldwide experience with the treatment of kidney transplant patients with HIV infection.

Chronic kidney disease (CKD) is defined as an abnormality of the kid-ney structure or function for ≥ 3 months. This disease affects 10% to 15% of the world’s population, with diabetes, arterial hypertension, primary glomerulopathies and genetic disorders being the most common etiologies associated with this disease worldwide. Nevertheless, in lowincome countries, other diseases causing CKD are also reported; among them, Mesoamerican nephropathy, which is a common cause of CKD in Mesoamerica, especially in the young male population, leading to loss of productive working capacity. In Colombia, the prevalence of CKD with unknown etiology is high and there are few studies on chronic kidney disease in agricultural communities, given that the agricultural population in Colombia is exposed to harmful climatic and occupational agents similar to those in Mesoamerica, it is possible that this nephropathy is also a cause of CKD in our population. This article provides an overview of CKD in agricultural communities to sensitize health workers to the importance of screening for this disease in vulnerable populations, which could have a positive impact on the health of farmers.

Introduction: Is a risk factor for morbidity, mortality and disability in older adults, so its management is a priority in geriatrics. The aim of this article is to characterize a population of older adults from two geriatric homes and to establish the prevalence of sarcopenia and the degree of dependence. Methods: Cross-sectional study developed in the city of Pereira-Colombia. A population of 72 adults from 65 to 98 years of age was included, using probability sampling. Sarcopenia was determined by means of the Criteria of the European Consensus on Definition and Diagnosis of Sarcopenia, evaluating grip strength, skeletal muscle mass index, in case of sarcopenia, the severity of sarcopenia together with walking speed, and the degree of dependence according to the Barthel scale. Results: 57 people participated. A total of 68.4% (n=39) were women. The median age was 83 years. Two percent had no sarcopenia, 9% had suspected sarcopenia, 28% had confirmed sarcopenia and 61% had severe sarcopenia. According to the Barthel scale, 31.5% were independent, 45.6% had mild, 15.8% moderate, 5.3% severe and 1.8% total dependence. Conclusions: The prevalence of sarcopenia in nursing homes in Pereira is higher compared to that reported in the literature. Similarly, being in a private nursing home does not guarantee a better physical condition and/or quality of life

Abstract Background A shift towards parenchymal-sparing liver resections in open and laparoscopic surgery emerged in the last few years. Laparoscopic liver resection is technically feasible and safe, and consensus guidelines acknowledge the laparoscopic approach in the posterosuperior segments. Lesions situated in these segments are considered the most challenging for the laparoscopic approach. The aim of this trial is to compare the postoperative time to functional recovery, complications, oncological safety, quality of life, survival and costs after laparoscopic versus open parenchymal-sparing liver resections in the posterosuperior liver segments within an enhanced recovery setting. Methods The ORANGE Segments trial is an international multicentre randomised controlled superiority trial conducted in centres experienced in laparoscopic liver resection. Eligible patients for minor resections in the posterosuperior segments will be randomised in a 1:1 ratio to undergo laparoscopic or open resections in an enhanced recovery setting. Patients and ward personnel are blinded to the treatment allocation until postoperative day 4 using a large abdominal dressing. The primary endpoint is time to functional recovery. Secondary endpoints include intraoperative outcomes, length of stay, resection margin, postoperative complications, 90-day mortality, time to adjuvant chemotherapy initiation, quality of life and overall survival. Laparoscopic liver surgery of the posterosuperior segments is hypothesised to reduce time to functional recovery by 2 days in comparison with open surgery. With a power of 80% and alpha of 0.04 to adjust for interim analysis halfway the trial, a total of 250 patients are required to be randomised. Discussion The ORANGE Segments trial is the first multicentre international randomised controlled study to compare short- and long-term surgical and oncological outcomes of laparoscopic and open resections in the posterosuperior segments within an enhanced recovery programme. Trial registration ClinicalTrials.gov NCT03270917 . Registered on September 1, 2017. Before start of inclusion. Protocol version: version 12, May 9, 2017

Background and Objectives: Metabolic-dysfunction-associated steatotic liver disease or MASLD is the main cause of chronic liver diseases in children, and it is estimated to affect 35% of children living with obesity. This study aimed to identify metabolic phenotypes associated with two advanced stages of MASLD (hepatic steatosis and hepatic steatosis plus fibrosis) in Mexican children with obesity. Materials and Methods: This is a cross-sectional analysis derived from a randomized clinical trial conducted in children and adolescents with obesity aged 8 to 16 years. Anthropometric and biochemical data were measured, and targeted metabolomic analyses were carried out using mass spectrometry. Liver steatosis and fibrosis were estimated using transient elastography (Fibroscan® Echosens, Paris, France). Three groups were studied: a non-MASLD group, an MASLD group, and a group for MASLD + fibrosis. A partial least squares discriminant analysis (PLS-DA) was performed to identify the discrimination between the study groups and to visualize the differences between their heatmaps; also, Variable Importance Projection (VIP) plots were graphed. A VIP score of >1.5 was considered to establish the importance of metabolites and biochemical parameters that characterized each group. Logistic regression models were constructed considering VIP scores of >1.5, and the receiver operating characteristic (ROC) curves were estimated to evaluate different combinations of variables. Results: The metabolic MASLD phenotype was associated with increased concentrations of ALT and decreased arginine, glycine, and acylcarnitine (AC) AC5:1, while MASLD + fibrosis, an advanced stage of MASLD, was associated with a phenotype characterized by increased concentrations of ALT, proline, and alanine and a decreased Matsuda Index. Conclusions: The metabolic MASLD phenotype changes as this metabolic dysfunction progresses. Understanding metabolic disturbances in MASLD would allow for early identification and the development of intervention strategies focused on limiting the progression of liver damage in children and adolescents.

Objective. This retrospective study aimed to analyze the clinical evolution of newborns who presented acute vomiting without abdominal distension and who presented lactacidemia in the rooming-in area or transitional nursery in a tertiary care hospital. Material and methods. An observational, comparative, retrospective, and cross-sectional study was performed from January 1, 2021, to December 22, 2021. Records of newborns with acute vomiting were reviewed, and two groups, Group A with elevated lactate and Group B with normal lactate, were formed. Results. The sample consisted of 62 neonates, of which 41 (66%) had elevated serum lactate (Group A). Logistic regression was performed, finding that time to resolution in hours had a statistical significance of 0.003 and an odds ratio of 1.278 in Group A (18 ± 10) to restart the oral route (p < 0.05). In contrast, Group B had a higher platelet count (p < 0.001). Conclusions. We found elevated serum lactate in 66% of the neonates studied with acute vomiting without abdominal distension in the rooming-in area or transitional nursery, a finding not reported to date in the literature.

Objetivo: identificar como es el conocimiento sobre el VIH y los tipos de respuesta que tiene un grupo de hombres homosexuales, ante su situación de diagnóstico. Método: estudio cualitativo y descriptivo. Los participantes fueron seleccionados mediante muestreo bola de nieve, la recolección fue a través de entrevistas semiestructuradas, aplicadas en un consultorio particular, durante febrero y mayo de 2021 en la ciudad de Puebla, México, las cuales fueron grabadas y transcritas en su totalidad. El análisis fue a través del programa MAXQDA y las seis fases propuestas por Braun y Clarke. Apegándose a los principios de bioética y a los criterios de calidad establecidos para este tipo de investigaciones. Resultados: se realizaron cinco entrevistas a HSH auto identificados como homosexuales con un promedio de edad de 27.4 años. Como resultado del análisis de contenido se encontraron cinco categorías periféricas: conocimiento acerca del VIH, proceso adaptativo, comportamiento sexual, redes de apoyo y discriminación percibida, alrededor de una categoría central denominada el HSH con VIH. Conclusión: se observa conductas sexuales de riesgo, falta de apego al tratamiento, así como conocimientos y creencias erróneas acerca del VIH. Además de implementar intervenciones dirigidas a los profesionales de la salud.

Objetivo: comparar la sensibilidad ética de estudiantes de una universidad privada del estado de Puebla versus profesionales de enfermería adscritos a instituciones de salud. Método: comparativo, prospectivo y de corte transversal, en 217participantes divididos en 109 para estudiantes y 108 para profesionales. Se aplicó el instrumento de sensibilidad ética. Se aplico estadística descriptiva y ANOVA de un factor. Resultados: la sensibilidad etica de las enfermeras y enfermeros en general es alta (= 73.14 ±15.38); Sin embargo, en relación al grado académico el promedio de la sensibilidad ética fue más alto en la licenciatura en enfermería (= 74.41 ±14.47) y posgrado en enfermería (= 73.77 ±11.57) en comparación el postécnico en enfermería (= 69.78 ±18.22). Al realizar el análisis de varianza de la ANOVA de un factor,se muestra que no existe diferencia entre el grado académico y la sensibilidad ética (F= 1.865, p = .167). Conclusión: la sensibilidad ética en estudiantes como profesionales de enfermería es alta y no cambia a pesar de que estén en ámbitos hospitalarios o universitarios, por lo que en la profesión de enfermería existen valores consistentes en sus diferentes ámbitos.

Introducción: El efecto deletéreo de material particulado fino exterior sobre la salud respiratoria de la población de niños y de adultos mayores, es de interés en salud pública. Objetivo: Establecer el efecto de la contaminación por Material Particulado de menos de 2,5 μm de diámetro (PM2,5), sobre la Enfermedad Respiratoria Aguda (ERA) en los menores de 5 y personas de mínimo 65 años, ajustado por variables meteorológicas y climáticas, en los municipios del Área Metropolitana del Valle de Aburrá (Colombia), 2008 a 2015. Materiales y métodos: Estudio ecológico con información de la red de vigilancia de calidad del aire y de registros de prestación de servicios de salud. Se construyeron Modelos Aditivos Generalizados con función de enlace Poisson y suavización spline. Para cada rezago distribuido se calculó la medida de la asociación e intervalo de confianza. Resultados: Los casos de ERA aumentaron significativamente en los menores de 5 años en Envigado y Caldas (43,3% vs 29,6%) y en los de 65 y más años, en Medellín (13,2%) por cada incremento de 10 µg/m3 en PM2.5 al día quince a partir de la exposición. Conclusiones: Los eventos diarios respiratorios tuvieron especial frecuencia en Medellín y en municipios de la zona sur.

Resumen: Los «Objetivos para el desarrollo sostenible 2030» marcan la necesidad de una educación para el desarrollo sostenible que logre mantener la salud planetaria. Así, las instituciones de educación superior que forman a profesionales sanitarios deberían considerar la integración de competencias para promover la salud planetaria. Las competencias para lograr la salud planetaria incluyen los desplazamientos debidos al cambio climático, las poblaciones vulnerables como niños, ancianos o los más pobres, la seguridad del agua y alimentaria, la carga de enfermedades infecciosas, las catástrofes como inundaciones o temperaturas extremas, los contaminantes aéreos, o los efectos en la salud mental. De esta forma, la educación para el desarrollo sostenible pretende dotar y capacitar al alumnado con los conocimientos, las habilidades y las actitudes para que pueda ser eficaz en la resolución de los retos de la salud planetaria, como son la interdependencia de los ecosistemas y la salud humana, incluyendo los efectos del cambio ambiental en la salud, así como el impacto del sector sanitario y su dependencia del medio ambiente. Algunas universidades europeas ya han empezado a sostenibilizar la formación de profesionales sanitarios, siendo ejemplos de los pasos necesarios a seguir. Abstract: The “2030 Sustainable Development Goals” outline the need for education for sustainable development to sustain planetary health. Thus, higher education institutions that train health professionals should consider embedding competencies to promote planetary health. Competencies for achieving planetary health include displacement due to climate change, vulnerable populations such as children, the elderly or the poorest, water and food security, the burden of infectious diseases, catastrophes such as floods or extreme temperatures, air pollutants, or mental health effects. Therefore, education for sustainable development aims to provide students with the knowledge, skills and attitudes to be effective in addressing global health challenges, such as the interdependence of ecosystems and human health, including the effects of environmental change on health, as well as the impact of the health sector and its dependence on the environment. Some European universities have already started to make the training of health professionals more sustainable and are examples of the steps that need to be taken.

Cerebral nocardia infections is a rare entity, which has been mainly reported in immunosuppressed patients. Currently, there are no clinical guidelines for first-line treatment. Our case refers to an older immunocompetent adult, with encephalopathy and left hemiparesis, associated with lesions compatible with multiple brain abscess and suggestive of infectious etiology. He initially received treatment for tuberculosis, bacterial abscess, and toxoplasmosis, without a favorable clinical response. An empirical treatment for nocardiosis started, by using meropenem and trimethoprim / sulfamethoxazole, and clinical and imaging improvement was achieved. The occurrence of adverse events forces the temporary use of alternative medications. We highlight some criteria for including nocardiosis in the differential diagnosis in cases of multiple brain abscess and mention laboratory diagnostic methods and drugs to initiate empirical treatment.

Rubén Cuesta-Barriuso,1,2 Ana Torres-Ortuño,3 Joaquín Nieto-Munuera,3 José Antonio López-Pina4 1Department of Physiotherapy, University of Murcia, Murcia, Spain; 2Royal Victoria Eugenia Foundation, Madrid, Spain; 3Department of Psychiatry and Social Psychology, University of Murcia, Murcia, Spain; 4Department of Basic Psychology and Methodology, University of Murcia, Murcia, SpainCorrespondence: Rubén Cuesta-BarriusoDepartment of Physiotherapy, University of Murcia, Campus Espinardo, Murcia, 30200, SpainTel +34 868 887 286Email ruben.cuestab@gmail.comBackground: Hemophilia is characterized by the development of joint bleeds that cause long-term joint damage (hemophilic arthropathy). Joint damage leads to disability and affects psychosocial aspects in patients with hemophilia.Objective: To compare the clinical situation, perception of disease and quality of life, and coping strategies in adult patients with hemophilia in El Salvador and Spain.Methods: In this comparative clinical study, 43 patients with hemophilia aged between 18 and 50 years old from Spain and El Salvador participated. After obtaining the patients’ consent, they completed the Illness Perception Questionnaire-Revised (IPQ-R), Hemophilia-QoL and Inventory of Coping strategies questionnaires. Joint status was assessed using the Hemophilia Joint Health Score and based on a record of clinical and treatment data.Results: Hemophilia patients from Spain showed an improved perception of quality of life (p < 0.05), although there were only differences in the self-criticism variable (p = 0.04) for coping strategies. Joint damage and age correlated (p < 0.05) negatively with perception of disease, perceived quality of life and coping strategies in both populations. There were differences (p < 0.05) between the two populations based on HIV and HCV coinfections in perception of disease and perceived quality of life.Conclusion: Patients with hemophilia in El Salvador exhibit a poorer perception of disease and quality of life. Despite differences in access to treatment from one country to the other, there is no difference in coping with the disease. Older patients are better able to adapt to the disease.Keywords: hemophilia, joint disease, quality of life, illness perception, coping strategies

Introduction: Subjects with asymptomatic infections are not generally admitted to health care facilities, however, they may benefit from antiviral therapy. Objective: To evaluate the contribution to treatment with combined therapy based on recombinant human interferon alpha 2b + Lopinavir/Ritonavir + Chloroquine versus Lopinavir/Ritonavir + Chloroquine in asymptomatic and symptomatic patients. Material and Methods: An observational study was carried out in patients with a positive diagnosis of COVID-19 from April 1st to July 30th, 2020. From a total of 308 patients treated with interferon + Lopinavir/Ritonavir + Chloroquine, we selected a statistically representative sample of 40 patients using a simple randomization process. As a control group, 27 patients who only received treatment with Lopinavir/Ritonavir + Chloroquine were selected. These patients underwent determinations of anti-SARS-CoV-2 antibodies, determinations of inflammatory markers, and follow-up by RT-PCR to evaluate the time length of negativization. Results: The group treated with interferon had a significantly shorter time to negativization. Patients treated with interferon showed a significant decrease in inflammatory markers at the time of hospital discharge and they had an increase in antibody titers at two and four months after hospital discharge, compared to the group of patients who did not receive interferon. Conclusions: The treatment with exogenous interferon in patients with COVID-19 had a significant contribution to the regulation of the immune response of the patients.