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Abstract Rehabilitation technologies offer promising opportunities for interventions for patients with motor disabilities. However, their use in routine care remains limited due to their high cost and persistent doubts about their cost-effectiveness. Providing solid evidence of the economic efficiency of rehabilitation technologies would help dispel these doubts in order to better take advantage of these technologies. In this context, this systematic review aimed to examine the cost-effectiveness of rehabilitation interventions based on the use of digital technologies. In total, 660 articles published between 2011 and 2021 were identified, of which eleven studies met all the inclusion criteria. Of these eleven studies, seven proved to be cost-effective, while four were not. Four studies used cost-utility analyses (CUAs) and seven used cost-minimization analyses (CMAs). The majority (ten studies) focused on the rehabilitation of the upper and/or lower limbs after a stroke, while only one study examined the rehabilitation of the lower limbs after knee arthroplasty. Regarding the evaluated devices, seven studies analyzed the cost-effectiveness of robotic rehabilitation and four analyzed rehabilitation with virtual reality.The assessment of the quality of the included studies using the CHEERS (Consolidated Health Economic Evaluation Reporting Standards) suggested that the quality was related to the economic analysis method: all studies that adopted a cost-utility analysis obtained a high quality score (above 80%), while the quality scores of the cost-minimization analyses were average, with the highest score obtained by a CMA being 72%. The average quality score of all the articles was 75%, ranging between 52 and 100. Of the four studies with a considering score, two concluded that there was equivalence between the intervention and conventional care in terms of cost-effectiveness, one concluded that the intervention dominated, while the last one concluded that usual care dominated. This suggests that even considering the quality of the included studies, rehabilitation interventions based on digital technologies remain cost-effective, they improved health outcomes and quality of life for patients with motor disorders while also allowing cost savings.

Objetives. Bacterial resistance to antibiotics is a public health problem, however, few studies are performed in natural water ecosystems in middle-low-income countries. The objective of this study was to evaluate the presence and sensitivity to antimicrobials of Escherichia coli strains isolated from 24 irrigation water samples from the Rimac River in eastern Lima. Materials and methods. E.coli were identified by PCR. Antibiotic susceptibility was determined by disk diffusion method. The extended-spectrum beta-lactamase (ESBL), quinolones and virulence involved genes were determined by PCR. Results. All samples exceeded the permissible limits established in the Environmental Quality Standards for vegetable irrigation. Of the 94 strains, 72.3% showed resistance to at least one antibiotic, 24.5% were multidrug-resistant (MDR), and 2.1% were extremely drug resistant. The highest percentages of resistance were observed against nalidixic acid (50%), trimethoprim-sulfamethoxazole (35.5%) and ciprofloxacin (20.4%). Among the isolates, 3.2% presented ESBL phenotype related to blaCTX-M-15 gene. The transferable mechanisms of resistance to quinolones, qnrB were more frequent (20.4%), and 2.04% had the qnrS. It was determined that 5.3% were diarrheagenic E. coli and of these, 60% were enterotoxigenic E. coli, 20% were enteropathogenic E. coli and 20% were enteroaggregative E. coli. Conclusions. Our results show the existence diarrheagenic pathotypes in water used to irrigate fresh produce and highlights the presence of ESBL-producers and MDR E. coli, demonstrating the role that irrigation water plays in disseminating resistance genes in Peru.

Abstract Background Severe trauma is associated with systemic inflammation and organ dysfunction. Preclinical rodent trauma models are the mainstay of postinjury research but have been criticized for not fully replicating severe human trauma. The aim of this study was to create a rat model of multicompartmental injury which recreates profound traumatic injury. Methods Male Sprague–Dawley rats were subjected to unilateral lung contusion and hemorrhagic shock (LCHS), multicompartmental polytrauma (PT) (unilateral lung contusion, hemorrhagic shock, cecectomy, bifemoral pseudofracture), or naïve controls. Weight, plasma toll‐like receptor 4 (TLR4), hemoglobin, spleen to body weight ratio, bone marrow (BM) erythroid progenitor (CFU‐GEMM, BFU‐E, and CFU‐E) growth, plasma granulocyte colony‐stimulating factor (G‐CSF) and right lung histologic injury were assessed on day 7, with significance defined as p values

Abstract Background: Some experts have made suggestions on how to use simulation during the pandemic, and simulation activities were carried out observing COVID-19 restrictions to improve technical and non-technical skills in health professionals. A number of papers have been published detailing the use of simulation during this period, but it is not clear for this reason, through a retrospective literature review, we analyzed studies published during the pandemic period to assess how simulation was used during this historical period. Methods: Retrospective literature review. Results: The search generated 11,375 records. After removing duplicates, 5431 studies were screened. Of the 643 eligible full-texts, 221 were excluded. A total of 422 articles met the inclusion criteria. Half of the 422 included studies were carried out specifically for COVID-19 (211), while 152 (36%) were performed during the pandemic but for other reasons. Analysis showed that simulation was used during the pandemic, with clear educational and research objectives. Most of the included studies dealt with COVID-19, focusing on high-acuity and critical scenarios but also including technical and non-technical skills. Conclusion: The experience gained with both “COVID-related” and “During COVID” studies could be applied to other settings in case of urgent training needed in case of disasters and to tailor simulation courses to retain technical skills.

Background: Oral squamous cell carcinoma (OSCC) treatment mainly relies on surgery. The status of surgical margin is a major prognostic factor for patients as positive margins are associated with lower survival. However, the anatomical particularities of this area complicate margin establishment. Fluorescence guided surgery (FGS) could be employed as an intraoperative technique to improve tumor resection and margin investigation. Quantum dots (QDs) serve as ideal contrast agents in this technique due to their brightness and stability. Since αVβ6 integrin is overexpressed in OSCC, coupling QDs with A20FMDV2 peptide (QDs-A20) targeting the αVβ6 integrin constitute a real opportunity. This study investigates the accumulation of QDs-A20 in 2D and 3D tongue cancer models, as well as QDs coupled to a scrambled version of this peptide (QDs-Scr) or without peptide (QDs-SPP), for imaging purposes. Methods: CdSeCdS/ZnS quantum dots were coated with sulfobetaine polymers (QDs-SPP) and conjugated to A20FMDV2 peptide (QDs-A20) or its scrambled version (QDs-Scr). Two-dimensional (2D) and three-dimensional (3D) tongue cancer cells HSC-3 were employed to test the effectiveness of intracellular accumulation of all types of QDs. Targeting ability of each QDs was assessed by flow cytometry, while the depth of penetration into cancerous spheroids was assessed by fluorescence microscopy. Results: QDs coating with sulfobetaines polymers (QDs-SPP) completely prevented their internalization by HSC-3 cells in 2D and 3D models, making QDs stealthy and preventing their non-specific accumulation. Conversely, peptides conjugated QDs (QDs-A20 & QDs-Scr) labeled HSC-3 monolayers and managed to label spheroid periphery up to 23 µm deep. However, no difference in accumulation was found between these two QDs whereas only A20 peptide could potentially target αVβ6 integrin. It appears that peptide conjugation increased QDs zeta potential, promoting their adsorption and subsequent endocytosis by cells, independently from αVβ6 integrin. Conclusions: The present study highlighted the impact of peptide conjugation on QDs internalization in 2D and 3D tongue cancer cell models. QDs-SPP were stealthy and did not accumulate in cells. Peptides conjugated QDs could be used as contrast agents, but in a passive targeting approach. Modifications to surface chemistry are required to target αVβ6 integrin through active targeting. This study also highlights the need for controls such as scrambled peptides, the absence of which can lead to misinterpretation of results.

Introduction Despite the progress in reducing child mortality, the rate remains high, particularly in sub-Saharan African countries. Limited data exist on child survival and other birth outcomes by sex. This study compared survival rates and birth outcomes by sex among neonates and children under 2 in Ethiopia.Methods Women who gave birth after 28 weeks of gestation and their newborns were included in the analysis. Survival probabilities were estimated for males and females in the neonatal period as well as the 2-year period following birth using Kaplan-Meier curves. HRs and 95% CIs were compared between males and females under 2. Descriptive statistics and χ2 tests were used to determine the sex-disaggregated variation in the birth outcomes of preterm birth, low birth weight (LBW), stillbirth, small for gestational age (SGA) and large for gestational age (LGA).Results The study included a total of 3904 women and child pairs. The neonatal mortality rate for males (3.4%, 95% CI 2.6% to 4.2%) was higher compared with females (1.7%, 95% CI 1.1% to 2.3%). The hazard of death during the first 28 days of life was approximately two times higher for males compared with females (HR 1.99, 95% CI 1.30 to 3.06) but was not significantly different after this period. While there was a non-significant difference between males and females in the proportion of preterm, LBW and LGA births, we found a significantly higher proportion of stillbirth (2.7% vs 1.3%, p=0.003) and SGA (20.5% vs 15.6%, p

Summary: The human transcriptome predominantly consists of noncoding RNAs (ncRNAs), transcripts that do not encode proteins. The noncoding transcriptome governs a multitude of pathophysiological processes, offering a rich source of next-generation biomarkers. Toward achieving a holistic view of disease, the integration of these transcripts with clinical records and additional data from omic technologies (“multiomic” strategies) has motivated the adoption of artificial intelligence (AI) approaches. Given their intricate biological complexity, machine learning (ML) techniques are becoming a key component of ncRNA-based research. This article presents an overview of the potential and challenges associated with employing AI/ML-driven approaches to identify clinically relevant ncRNA biomarkers and to decipher ncRNA-associated pathogenetic mechanisms. Methodological and conceptual constraints are discussed, along with an exploration of ethical considerations inherent to AI applications for healthcare and research. The ultimate goal is to provide a comprehensive examination of the multifaceted landscape of this innovative field and its clinical implications.

Lymphedema presents significant challenges to patients’ quality of life, prompting the exploration of innovative treatments, such as collagen scaffolds, aimed at treating and reducing the risk of lymphedema. We aimed to evaluate the preventive and therapeutic efficacy and the lymphangiogenic potential of implanted aligned nanofibrillar collagen scaffolds (BioBridgeTM) following the induction of secondary lymphedema in a rabbit model. Thirty rabbits were divided into treatment (G1), prevention (G2), and control (G3) groups. Secondary lymphedema was induced in all groups. BioBridgeTM implantation was performed in G2 and G1 on days 0 and 60, respectively. Follow-ups included hindlimb circumference measurements and indocyanine green lymphography at 0, 60, and 90 days. None of the study rabbits exhibited dermal backflow on day 0 before surgery. At 60 days, the incidence rates of dermal backflow in G1, G2, and G3 were 100%, 44.4%, and 90%, respectively. Furthermore, at 90 days, the incidence rates were 22.2%, 44.4%, and 90%, respectively. New linear lymphatic observation was seen in rabbits with resolved dermal backflow. The findings of this study demonstrated the capacity of BioBridgeTM scaffolds to induce new lymphatic vessel formation and reduce dermal backflow in secondary lymphedema in a rabbit model.

Summary: Background: Diagnosing Cushing’s syndrome (CS) is highly complex. As the diagnostic potential of urinary steroid metabolome analysis by gas chromatography-mass spectrometry (GC-MS) in combination with systems biology has not yet been fully exploited, we studied a large cohort of patients with CS. Methods: We quantified daily urinary excretion rates of 36 steroid hormone metabolites. Applying cluster analysis, we investigated a control group and 168 patients: 44 with Cushing’s disease (CD) (70% female), 18 with unilateral cortisol-producing adrenal adenoma (83% female), 13 with primary bilateral macronodular adrenal hyperplasia (PBMAH) (77% female), and 93 ruled-out CS (73% female). Findings: Cluster-Analysis delineated five urinary steroid metabotypes in CS. Metabotypes 1, 2 and 3 revealing average levels of cortisol and adrenal androgen metabolites included patients with exclusion of CS or and healthy controls. Metabotype 4 reflecting moderately elevated cortisol metabolites but decreased DHEA metabolites characterized the patients with unilateral adrenal CS and PBMAH. Metabotype 5 showing strong increases both in cortisol and DHEA metabolites, as well as overloaded enzymes of cortisol inactivation, was characteristic of CD patients. 11-oxygenated androgens were elevated in all patients with CS. The biomarkers THS, F, THF/THE, and (An + Et)/(11β-OH-An + 11β-OH-Et) correctly classified 97% of patients with CS and 95% of those without CS. An inverse relationship between 11-deoxygenated and 11-oxygenated androgens was typical for the ACTH independent (adrenal) forms of CS with an accuracy of 95%. Interpretation: GC-MS based urinary steroid metabotyping allows excellent identification of patients with endogenous CS and differentiation of its subtypes. Funding: The study was funded by the Else Kröner-Fresenius-Stiftung and the Eva-Luise-und-Horst-Köhler-Stiftung.

Con el objetivo de describir las características clínicas y epidemiológicas de los pacientes fallecidos por dengue durante el 2017 en Piura, se realizó un estudio retrospectivo de revisión de 24 historias clínicas. El 67% de los casos fueron mujeres y tres (12,5%) estaban embarazadas. La diabetes (12,5%) y la hipertensión (16,7%) fueron las comorbilidades más frecuentes. Sólo en el 12,5% se reportó dengue previo. El tiempo transcurrido desde asistencia sanitaria hasta la muerte fue de 4,10 (DE: 5,34) días. Se hicieron transfusiones de glóbulos rojos en el 45,8% de los casos, plasma en el 25%, plaquetas en el 16,8% y crioprecipitado en el 16,8%. También fueron frecuentes la terapia con ristaloides (91,7%) y el tratamiento con fármacos vasoactivos (70,8%). En conclusión, la mortalidad del dengue grave fue mayoritaria en las mujeres adultas y el tiempo de atención desde el primer establecimiento de salud hasta una unidad especializada fue prolongada.

Introduction: The evaluation of integrated care programmes for high-need high-cost older people is a challenge. We aim to share the early implementation results of the ProPCC programme in the North-Barcelona metropolitan area, in Catalonia, Spain. Methods: We analysed the intervention with retrospective data from May 2018 to December 2021 by describing the cohort complexity and by showing its 6-months pre-post impact on time spent at home and resources used: primary care visits, emergency department visits, hospital admissions and hospital stay. Findings: 264 cases were included (91% at home; 9% in nursing homes). 6-month pre vs. 6-months post results were (mean, p-value): primary care visits 8.2 vs. 11.5 (p < 0.05); emergency department visits 1.4 vs. 0.9 (p < 0.05); hospital admissions 0.7 vs. 0.5 (p < 0.05); hospital stay 12.8 vs. 7.9 days (p < 0.05). Time spent at home was 169.2 vs.174.2 days (p < 0.05). Conclusion: Early implementation of the ProPCC programme results in an increase in time spent at home (up to 3%) and significant reductions in emergency department attendance (–37.2%) and hospital stays (–38.3%). The increased use of primary care resources is compensated by the hospital resources savings, with a result in the average total cost of –46.3%.

Introduction: Non-communicable diseases have emerged as the main causes of death in the world, representing in 2019, 73.6 % of all deaths from all causes. In Cuba, 81.5 % of the total deaths from all causes were caused by these diseases. Premature mortality from cardiovascular diseases turned out to be 34.7 % of the total number of premature deaths globally. Objective: To describe mortality from ischemic heart, cerebrovascular and hypertensive diseases in Cuba, in the 2011- 2020 decade. Material and Methods: A descriptive longitudinal ecological study of annual mortality from ischemic heart, cerebrovascular and hypertensive diseases in Cuba was carried out in the 2011-2020 decade. Crude mortality rates for these diseases were taken into account. The statistical yearbooks published by the Directorate of Medical Records and Health Statistics of the Ministry of Public Health for those years were the source of information. Results: The annual mortality rates from ischemic heart, cerebrovascular and hypertensive diseases in Cuba showed overall increasing trends in the 2011- 2020 decade, more pronounced in the case of hypertensive diseases. An increase in premature mortality rates from these diseases was observed. Conclusions: Arterial hypertension constitutes a severe health problem in Cuba, both as a cause of death and as a risk factor attributable to mortality from ischemic heart and cerebrovascular diseases.

Résumé Contexte Bien que largement utilisée, la congélation lente modifie considérablement les fonctions des spermatozoïdes humains. La cryoconservation induit des altérations nucléaires du sperme et une cryocapacitation, réduisant les chances de grossesse. L’hypotaurine est. naturellement présente dans les voies génitales masculines et féminines et possède des propriétés capacitantes, osmotiques et anti-oxydantes. Les mesures ont été réalisées sur le reliquat de sperme d’hommes avec des paramètres spermatiques normaux (n = 19) ou anormaux (n = 14). Les spermatozoïdes ont été sélectionnés par centrifugation sur gradient de densité (test de migration survie) avant congélation lente. Pour chaque prélèvement, ces étapes ont été réalisées en parallèle avec des milieux supplémentés en hypotaurine (bras « H+ ») ou sans hypotaurine (bras « H- »). Après décongélation, nous avons mesuré la mobilité totale et progressive, la vitalité, l’intégrité de l’acrosome, des marqueurs de la voie de signalisation de la capacitation et la qualité nucléaire. Pour cette dernière, nous nous sommes concentrés sur la condensation de la chromatine, la fragmentation de l’ADN et la présence de vacuoles dans le noyau du sperme. Résultats Post-décongélation, les spermatozoïdes sélectionnés et congelés en présence d’hypotaurine avaient une vitalité plus élevée (+ 16,7%, p

Se presenta la evolución histórica de la certificación de especialistas en medicina familiar en México, a 35 años de su fundación. Asimismo, se abordan brevemente los procesos de evaluación de los sustentantes y la importancia de mantener la «vigencia de la certificación». Se realiza el benchmarking de la certificación en otros países con procesos de certificación bien definidos y consolidados. Al final, se presentan los retos más inmediatos de la certificación en México para esta especialidad.

Background: the epidemiological characteristics of acute myocardial infarction have changed in the last decades. Objective: to characterize the patients with acute myocardial infarction admitted to the “Dr. Ernesto Guevara de la Serna” General Teaching Hospital of Las Tunas, from June 2018 through June 2020. Methods: an observational, descriptive and cross-sectional study was carried out at the department of cardiology of the aforementioned hospital and during the period herein stated. The study universe was made up of 754 patients who were admitted with acute coronary syndrome and the study sample consisted of 440 patients with a confirmed diagnosis of acute myocardial infarction. For the data treatment percentage analysis was used for the qualitative variables and arithmetic mean with standard deviation for the quantitative ones. Results: the average age of the patients was 65.9 ± 12.3 years. 64.1% were male and 76.8 % suffered from arterial hypertension. 81.8 % did not have heart failure at admission. 78.4 % presented ST-elevation infarction, thrombolysis was performed on 45.2% and out of them 83.4 % achieved total reperfusion. 31.4% developed left ventricular dysfunction. Hospital mortality was 8.8 %. In more than 90% aspirin, clopidogrel and statins were prescribed at discharge. 20.2% was referred to cardiac rehabilitation. Conclusions: most of the patients were male, with ST-segment elevation myocardial infarction and with a low percentage of reperfusion. Arterial hypertension was the most frequent associated factor. Hospital mortality was low.

We describe the case of a Greek female patient with the Classic form of the ultra- rare and fatal autosomal recessive disorder Mitochondrial neurogastrointestinal encephalomyopathy (MNGIE) and the impact of allogeneic hematopoietic stem cell transplantation on the biochemical and clinical aspects of the disease.The patient presented at the age of 15 years with severe gastrointestinal symptoms, cachexia, peripheral neuropathy and diffuse leukoencephalopathy. The diagnosis of MNGIE disease was established by the increased levels of thymidine and deoxyuridine in plasma and the complete deficiency of thymidine phosphorylase activity. The novel c.[978dup] (p.Ala327Argfs*?) variant and the previously described variant c.[417 + 1G > A] were identified in TYMP. The donor for the allogeneic hematopoietic stem cell transplantation was her fully compatible sister, a carrier of the disease. The patient had a completely uneventful post- transplant period and satisfactory PB chimerism levels. A marked and rapid decrease in thymidine and deoxyuridine plasma levels and an increase of the thymidine phosphorylase activity to the levels measured in her donor sister was observed and is still present sixteen months post-transplant. Disease symptoms stabilized and some improvement was also observed both in her neurological and gastrointestinal symptoms. Follow up studies will be essential for determining the long term impact of allogeneic hematopoietic stem cell transplantation in our patient.

Summary: Background: Visual impairments are a critical medical hurdle to be addressed in modern society. Müller glia (MG) have regenerative potential in the retina in lower vertebrates, but not in mammals. However, in mice, in vivo cell fusion between MG and adult stem cells forms hybrids that can partially regenerate ablated neurons. Methods: We used organotypic cultures of human retina and preparations of dissociated cells to test the hypothesis that cell fusion between human MG and adult stem cells can induce neuronal regeneration in human systems. Moreover, we established a microinjection system for transplanting human retinal organoids to demonstrate hybrid differentiation. Findings: We first found that cell fusion occurs between MG and adult stem cells, in organotypic cultures of human retina as well as in cell cultures. Next, we showed that the resulting hybrids can differentiate and acquire a proto-neural electrophysiology profile when the Wnt/beta-catenin pathway is activated in the adult stem cells prior fusion. Finally, we demonstrated the engraftment and differentiation of these hybrids into human retinal organoids. Interpretation: We show fusion between human MG and adult stem cells, and demonstrate that the resulting hybrid cells can differentiate towards neural fate in human model systems. Our results suggest that cell fusion-mediated therapy is a potential regenerative approach for treating human retinal dystrophies. Funding: This work was supported by La Caixa Health (HR17-00231), Velux Stiftung (976a) and the Ministerio de Ciencia e Innovación, (BFU2017-86760-P) (AEI/FEDER, UE), AGAUR (2017 SGR 689, 2017 SGR 926).

Resume Le SRAS-CoV-2 (nouveau coronavirus ou coronavirus numéro 2 responsable du syndrome respiratoire aigu sévère) a métamorphosé notre pratique médicale. Début juin 2020, plus de 6,400,000 cas de COVID-19 (maladie à coronavirus 2019) ont été diagnostiqués dans le monde et plus de 380,000 décès ont été reliés à cette maladie. De nombreux symptômes médicaux de cette infection virale ont été signalés. Nous nous concentrerons, ici, sur les impacts potentiels de COVID-19 sur la santé andrologique des hommes. Notre société (Société d’andrologie de langue Française, SALF) émet ici quelques recommandations dans la prise en charge andrologique des hommes infectés par le SRAS-CoV-2. Tout d’abord, compte tenu de la fièvre et de la présence potentielle du SRAS-CoV2 dans le sperme, la SALF recommande d’attendre 3 mois (durée d’un cycle de spermatogenèse et transit épididymaire) avant de recommencer les techniques d’assistance médicale à la procréation pour les hommes diagnostiqués COVID-19 positifs. Quelle que soit la nature des relations entre la testostérone et l’infection à SARS-CoV-2, nous recommandons un examen andrologique, un examen des paramètres du sperme et une évaluation hormonale au moment du diagnostic de l’infection, ainsi qu’à distance (3–6 mois plus tard). De plus, nous sommes préoccupés par la morbidité et la mortalité potentielles de l’infection COVID-19, qui touche principalement les hommes. Ce “biais andrologique”, s’il est. prouvé, doit être réduit par un diagnostic andrologique spécifique et des mesures thérapeutiques et prophylactiques. La recherche dans ce sens doit être étayée et soutenue financièrement au cours des prochains mois (années).

Abstract Background We aimed to describe primary care management at the time of a suicide attempt (SA) and after the SA. Methods An observational (cross-sectional) study was conducted among 166 sentinel GPs within France (a non-gatekeeping country) between 2013 and 2017 for all GP’s patients who attempted suicide. Measurements: frequency of patients 1) managed by the GP at the time of the SA, 2) addressed to an emergency department (ED), 3) without care at the time of the SA, and 4) managed by the GP after the SA and factors associated with GP management at the time of and after the SA. Results Three hundred twenty-one SAs were reported, of which N = 95 (29.6%) were managed by the GP at the time of the SA, N = (70.5%) were referred to an ED, and N = (27.4%) remained at home. Forty-eight (14.9%) patients did not receive any care at the time of the SA and 178 (55.4%) were managed directly by an ED. GPs were more likely to be involved in management of the patient at the time of the SA if they were younger (39.2% for patients

El Consejo Mexicano de Certificación en Medicina Familiar (CMCMF)1 es un organismo técnico, normativo y autónomo que evalúa las competencias para ejercer la especialidad, en concordancia con los lineamientos del Comité Normativo Nacional de Consejos de Especialidades Médicas (CONACEM)2.

Abstract Objectives The primary objectives of the study are: 1. To assess the effect of hydroxychloroquine (HCQ) in reducing SARS-CoV-2 viral shedding by PCR in infected pregnant women with mild symptoms. 2. To assess the efficacy of HCQ to prevent SARS-CoV-2 infection in pregnant women in contact with an infected or suspected case. 3. To evaluate the effect of HCQ in preventing the development of the COVID-19 disease in asymptomatic SARS-CoV-2-infected pregnant women. The secondary objectives are: 1. To determine the effect of HCQ on the clinical course and duration of the COVID-19 disease in SARS-CoV-2-infected pregnant women. 2. To determine the impact of HCQ on the risk of hospitalization and mortality of SARS-CoV-2-infected pregnant women. 3. To assess the safety and tolerability of HCQ in pregnant women. 4. To describe the clinical presentation of SARS-CoV-2 infection during pregnancy. 5. To describe the effects of maternal SARS-CoV-2 infection on pregnancy and perinatal outcomes by treatment group. 6. To determine the risk of vertical transmission (intra-utero and intra-partum) of SARS-CoV-2. Trial design Randomized double-blind placebo-controlled two-arm multicentre clinical trial to evaluate the safety and efficacy of HCQ to prevent and/or minimize SARS-CoV-2 infection during pregnancy. Participants will be randomized to receive a 14-day oral treatment course of HCQ or placebo, ratio 1:1. Participants Study population: pregnant women undergoing routine prenatal follow up or attending emergency units at the participating hospitals who report either symptoms/signs suggestive of COVID-19 disease or close contact with a suspected or confirmed COVID-19 case. Inclusion criteria Women will be invited to participate in the trial and sign an informed consent if they meet the following inclusion criteria. • Presenting with fever (≥37.5°C) and/or one mild symptom suggestive of COVID-19 disease (cough, dyspnoea, chills, odynophagia, diarrhoea, muscle pain, anosmia, dysgeusia, headache) OR being contact* of a SARS-CoV-2 confirmed or suspected case in the past 14 days • More than 12 weeks of gestation (dated by ultrasonography) • Agreement to deliver in the study hospitals Exclusion criteria • Known hypersensitivity to HCQ or other 4-amonoquinoline compounds • History of retinopathy of any aetiology • Concomitant use of digoxin, cyclosporine, cimetidine • Known liver disease • Clinical history of cardiac pathology including known long QT syndrome • Unable to cooperate with the requirements of the study • Participating in other intervention studies • Delivery onset (characterized by painful uterine contractions and variable changes of the cervix, including some degree of effacement and slower progression of dilatation up to 5 cm for first and subsequent labours) The study participants will be stratified by clinical presentation and SARS-CoV-2 PCR results. Assignment of participants to study groups will be as follows: • SARS-CoV-2-PCR confirmed, infected pregnant women: a. symptomatic (n=100) b. asymptomatic (n=100) • SARS-CoV-2 PCR negative pregnant women in contact* with a SARS-CoV-2-infected confirmed or suspected case (n=514). *The ECDC definition of close contact will be followed. The trial will be conducted in five hospitals in Spain: Hospital Clínic of Barcelona, Hospital Sant Joan de Déu and Hospital de la Santa Creu i Sant Pau, in Barcelona, and HM Puerta del Sur and Hospital Universitario de Torrejón, in Madrid. Intervention and comparator Participants will be randomized to HCQ (400 mg/day for three days, followed by 200 mg/day for 11 days) or placebo (2 tablets for three days, followed by one tablet for 11 days). Main outcomes The primary outcome is the number of PCR-confirmed infected pregnant women assessed from collected nasopharyngeal and oropharyngeal swabs at day 21 after treatment start (one week after treatment is completed). Randomisation Allocation of participants to study arms will be done centrally by the trial’s Sponsor (the Barcelona Institute for Global Health, ISGlobal) by block randomization. This method will ensure balanced allocation to both arms. The electronic CRF will automatically assign a study number to each participant, depending on her study group and recruitment site. Each number will be related to a treatment number, which assigns them to one of the study arms. Blinding (masking) Participants, caregivers, investigators and those assessing the outcomes will be blinded to group assignment. Study tablets (HCQ and placebo) will be identically packaged in small opaque bottles. Numbers to be randomised (sample size) This study requires 200 SARS-CoV-2 infected and 514 contact pregnant women, randomised 1:1 with 100 and 227 respectively in each study arm. Trial Status Protocol version 1.0, from May 8th, 2020. Recruitment is ongoing (first patient recruited the 19th May 2020 and recruitment end anticipated by December 2020). Trial registration EudraCT number: 2020-001587-29, registered 2 April 2020. Clinicaltrials.gov identifier: NCT04410562 , retrospectively registered 1 June 2020. Full protocol The full protocol is attached as an additional file, accessible from the Trials website (Additional file 1). In the interest in expediting dissemination of this material, the familiar formatting has been eliminated; this Letter serves as a summary of the key elements of the full protocol.

Abstract Background Older adults suffer from various chronic conditions which make them particularly vulnerable. The proper management of multiple drug use is therefore crucial. The aim of our study was to describe drug prescription and medication patterns in this population. Methods A cross-sectional study in Barcelona (Spain) using electronic health records from 50 primary healthcare centres. Participants were aged 65 to 94 years, presenting multimorbidity (≥2 chronic diseases), and had been prescribed at least 1 drug for 6 months or longer during 2009. We calculated the prevalence of prescribed drugs and identified medication patterns using multiple correspondence analysis and k-means clustering. Analyses were stratified by sex and age (65–79, 80–94 years). Results We studied 164,513 patients (66.8% women) prescribed a median of 4 drugs (interquartile range [IQR] = 3–7) in the 65–79 age-group and 6 drugs (IQR = 4–8) in the 80–94 age-group. A minimum of 45.9% of patients aged 65–79 years, and 61.8% of those aged 80–94 years, were prescribed 5 or more drugs. We identified 6 medication patterns, a non-specific one and 5 encompassing 8 anatomical groups (alimentary tract and metabolism, blood, cardiovascular, dermatological, musculo-skeletal, neurological, respiratory, and sensory organ). Conclusions Drug prescription is widespread among the elderly. Six medication patterns were identified, 5 of which were related to one or more anatomical group, with associations among drugs from different systems. Overall, guidelines do not accurately reflect the situation of the elderly multimorbid, new strategies for managing multiple drug uses are needed to optimize prescribing in these patients.

Summary: Physical exercise stimulates adult hippocampal neurogenesis and is considered a relevant strategy for preventing age-related cognitive decline in humans. The underlying mechanisms remains controversial. Here, we show that exercise increases proliferation of neural precursor cells (NPCs) of the mouse dentate gyrus (DG) via downregulation of microRNA 135a-5p (miR-135a). MiR-135a inhibition stimulates NPC proliferation leading to increased neurogenesis, but not astrogliogenesis, in DG of resting mice, and intriguingly it re-activates NPC proliferation in aged mice. We identify 17 proteins (11 putative targets) modulated by miR-135 in NPCs. Of note, inositol 1,4,5-trisphosphate (IP3) receptor 1 and inositol polyphosphate-4-phosphatase type I are among the modulated proteins, suggesting that IP3 signaling may act downstream miR-135. miR-135 is the first noncoding RNA essential modulator of the brain's response to physical exercise. Prospectively, the miR-135-IP3 axis might represent a novel target of therapeutic intervention to prevent pathological brain aging. : Pons-Espinal, Gasperini, and colleagues report that running induces NPC proliferation and neurogenesis via downregulation of miR-135a-5p in the mouse hippocampus. Remarkably, downregulation of miR-135a stimulates proliferation in the hippocampus of aged mice. ITPR1 and INPP4A, involved in IP3 signaling, are modulated by miR-135 in NPCs. Prospectively, therapeutic exploitation of the miR-135-IP3 axis might represent a novel intervention strategy for successful aging. Keywords: adult neurogenesis, running, aging, miR-135a, inositol 1,4,5-trisphosphate (IP3) pathway, ITPR1, INPP4A

Introducción: Un mortinato, es un evento del embarazo que supone un resultado negativo para padres, familias y personal de salud involucrado. La falta de recursos podría ser el principal obstáculo al acceso de atención prenatal, síntoma de inequidades en salud. El débil conocimiento de causas de mortinatalidad se asocia a la creencia de que son inevitables; sin embargo, muchos factores vinculantes son potencialmente modificables.Objetivo: Describir las causas de mortinatalidad en Chile.Material y métodos: Estudio transversal y analítico. El análisis se precisó desde las 22 semanas gestacionales, según criterio estándar de la Organización Mundial de la Salud. Las causas de mayor frecuencia se utilizaron para determinar asociación mediante test con nivel de significación estadística pResultados: El mayor porcentaje de muertes fetales se registró a las 35 o más semanas (35,63%). Principales macro-causas de mortinatalidad fueron tipo: fetal (47,0%), placentaria (31,4%) y desconocida (10,89%). Principales causas específicas fueron: hipoxia intrauterina (24,4%), causa no especificada (10,87%), y anomalías morfológicas-funcionales placentarias (10,83%). Causa específica hipoxia intrauterina se asocia a edad gestacional, edad materna y nivel educacional materno (pConclusiones: La salud prenatal es reflejo de atención obstétrica, calidad y progreso en atención sanitaria. Existen brechas en detección de causas y calidad de los registros, por lo que las causas desconocidas tiendan al alza en el tiempo. Es recomendable adicionar al registro de muertes fetales componentes temporal, biológico y social maternos.Palabras claves: Mortinatalidad, muerte fetal, inequidades en salud, resultado del embarazo, causas de muerte, factores de riesgo.

Background: The relationship between the gut microbiome and the human host is dynamic and we may expect adjustments in microbiome function if host physiology changes. Metatranscriptomic approaches should be key in unraveling how such adjustments occur. Methods: We employ metatranscriptomic sequencing analyses to study gene expression in the gut microbiota of infants through their first year of life, and of their mothers days before delivery and one year afterwards. Findings: In infants, hallmarks of aerobic metabolism disappear from the microbial metatranscriptome as development proceeds, while the expression of functions related to carbohydrate transport and metabolism increases and diversifies, approaching that observed in non-pregnant women. Butyrate synthesis enzymes are overexpressed at three months of age, even though most butyrate-producing organisms are still rare. In late pregnancy, the microbiota readjusts the expression of carbohydrate-related functions in a manner consistent with a high availability of glucose. Interpretation: Our findings suggest that butyrate production may be ensured in the gut of young infants before the typical butyrate synthesizers of the adult gut become abundant. The late pregnancy gut microbiota may be able to access the high levels of blood glucose characteristic of this period. Moreover, late pregnancy gut bacteria may reach stationary phase, which may affect their likelihood of translocating across the intestinal epithelium. Funds: This work was supported by grants CSD2009-00006 (CONSOLIDER Program) and SAF2009-13032-C02-02 from MICINN (Ministry of Science and Innovation, Spain), and by grant SAF2012-31187 from MINECO (Ministry of Economics and Competitiveness, Spain). Keywords: Metatranscriptomics, Microbiota, Gut, Metabolism, Infant, Pregnancy

Geleophysic dysplasia (GPHYSD1, MIM231050; GPHYSD2, MIM614185; GPHYSD3, MIM617809) is an autosomal disorder characterized by short-limb dwarfism, brachydactyly, cardiac valvular disease, and laryngotracheal stenosis. Mutations in ADAMTSL2, FBN1, and LTBP3 genes are responsible for this condition. We found that three previously described cases of GPHYSD diagnosed clinically were homozygote or compound heterozygotes for five ADAMTSL2 variants, four of which not being previously reported. By electron microscopy, skin fibroblasts available in one case homozygote for an ADAMTSL2 variant showed a defective intracellular localization of mutant ADAMTSL2 protein that did not accumulate within lysosome-like intra-cytoplasmic inclusions. Moreover, this mutant ADAMTSL2 protein was less secreted in medium and resulted in increased SMAD2 phosphorylation in transfected HEK293 cells. Keywords: Geleophysic dysplasia, ADAMTSL2, Connective tissue disorder, TGF-β signaling

Abstract Background The purpose of this study was to ascertain multimorbidity patterns using a non-hierarchical cluster analysis in adult primary patients with multimorbidity attended in primary care centers in Catalonia. Methods Cross-sectional study using electronic health records from 523,656 patients, aged 45–64 years in 274 primary health care teams in 2010 in Catalonia, Spain. Data were provided by the Information System for the Development of Research in Primary Care (SIDIAP), a population database. Diagnoses were extracted using 241 blocks of diseases (International Classification of Diseases, version 10). Multimorbidity patterns were identified using two steps: 1) multiple correspondence analysis and 2) k-means clustering. Analysis was stratified by sex. Results The 408,994 patients who met multimorbidity criteria were included in the analysis (mean age, 54.2 years [Standard deviation, SD: 5.8], 53.3% women). Six multimorbidity patterns were obtained for each sex; the three most prevalent included 68% of the women and 66% of the men, respectively. The top cluster included coincident diseases in both men and women: Metabolic disorders, Hypertensive diseases, Mental and behavioural disorders due to psychoactive substance use, Other dorsopathies, and Other soft tissue disorders. Conclusion Non-hierarchical cluster analysis identified multimorbidity patterns consistent with clinical practice, identifying phenotypic subgroups of patients.

Introduction: Commensal flora of healthy people is becoming an important reservoir of resistant bacteria. Objectives: To evaluate the relationship of previous antibiotic-dispensed and resistance pattern of strains of Staphylococcus aureus in primary care patients. Methods: A cross-sectional study was carried out in seven primary care centres in Catalonia, Spain, from October 2010 to May 2011, as part of the APRES (The appropriateness of prescribing antibiotics in primary care in Europe concerning antibiotic resistance) study. Outpatients aged 4 or more who did not present an infectious disease and had not taken antibiotic or had not been hospitalised in the previous 3 months were invited to participate. Nasal swabs were collected for S. aureus culture, and antimicrobial susceptibility testing was carried out. Antibiotics dispensed boxes in the previous 4 years were extracted from Information System for Research in Primary Care. Results: A total of 4,001 nasal swabs were collected, and 3,969 were tested for identification, 765 S. aureus were tested for resistance. Resistance rates to penicillin, azithromycin and methicillin were 87.1%, 11.6% and 1.3%, respectively, and a total of 10 MRSA strains were isolated (1.3%). Penicillin-resistant staphylococci were statistically significantly associated with the previous number of packages of penicillin dispensed (OR, 1.18; 95% CI, 1.04–1.35). Conclusion: Although no causal inference is possible, an association was observed between previous antibiotic dispensation and isolation of resistant organisms in community-dwelling individuals, mainly between packages of penicillin and penicillin-resistant staphylococci.

Introducción: La información existente sobre la resistencia a los antibióticos se basa habitualmente en muestras de personas hospitalizadas. El objetivo fue evaluar la prevalencia de resistencia antibiótica de cepas de Staphylococcus aureus y Streptococcus pneumoniae de personas portadores nasales atendidas en las consultas de atención primaria según edad y sexo. Diseño: Estudio transversal. Emplazamiento: Siete centros de salud del área de Barcelona. Participantes: Personas portadoras nasales a partir de 4 años de edad, sin signos de enfermedad infecciosa y que no habían tomado antibióticos ni habían estado hospitalizados en los 3 meses anteriores. Mediciones principales: Se recogieron 3.969 frotis nasales válidos para identificación entre 2010 y 2011 y fueron enviados a un laboratorio central de microbiología para el aislamiento de ambos gérmenes. La resistencia a los antibióticos se estableció según los puntos de corte actuales de la guía del European Committee on Antimicrobial Susceptibility Testing. Resultados: La prevalencia de S. aureus resistente a meticilina fue del 1,3% (IC 95%: 0,5-2,1%), con porcentajes de resistencia frente a fenoximetilpenicilina del 87,1% y a azitromicina del 11,6%, sin observar diferencias significativas según edad y sexo. Un 2,4% (IC 95%: 0,1-4,7%) de las cepas de neumococo fueron altamente resistentes a fenoximetilpenicilina y macrólidos, mientras que las mayores resistencias se observaron frente a cefaclor (53,3%), tetraciclina (20%) y cefuroxima (12,1%). Conclusiones: Estos patógenos tienen resistencias más bajas en la comunidad que las que se observan en el medio hospitalario. Es importante que se conozca la resistencia antibiótica actual para poder hacer un uso más prudente de los antibióticos.

Fundamento: las alteraciones del estado de salud bucodental que aparecen durante el embarazo son de interés para muchos investigadores y profesionales. Objetivo: caracterizar la situación de salud bucodental en embarazadas. Métodos: estudio descriptivo realizado en el Área II de Cienfuegos, que incluyó 128 pacientes embarazadas, seleccionadas por muestreo aleatorio simple, atendidas en la Clínica de Especialidades desde septiembre de 2013 a septiembre de 2014. Las variables estudiadas fueron: edad, nivel educacional, nivel socioeconómico, factores de riesgo y salud bucodental. Los datos se obtuvieron a partir de la entrevista personal y análisis de documentos como historia clínica individual y encuestas de salud bucodental. Resultados: las edades de las gestantes estudiadas oscilaron entre 20 y 34 años de edad; las enfermedades bucodentales que prevalecieron fueron la caries dental (60,2 %) y la enfermedad gingival inflamatoria crónica edematosa (11,9 %); los factores de riesgo que más se presentaron fueron antecedentes de caries (95,3 %) e higiene bucal deficiente (60,9 %). Las gestantes con nivel superior o con buen nivel socioeconómico presentaron mejor estado de salud. Conclusiones: se evidenció una asociación directamente proporcional entre los niveles educacionales y socioeconómicos con el estado de salud bucodental en las gestantes, así como deterioro gradual de la salud oral a medida que avanza la edad.

Foundation: periodontic care ranges from patient motivation and conventional treatments to the most sophisticated techniques of tissue engineering, among which guided tissue regeneration is a consolidated procedure in bone formation and preservation. Objective: to determine the clinical results obtained in patients who underwent a guided tissue regeneration procedure for the treatment of bone defects. Methods: a quasi-experimental intervention study of the before and after type, on patients treated at the periodontics office of Dr. Gustavo Aldereguía Lima University Hospital, from May 2014 to May 2016, with chronic adult periodontitis diagnosis and were treated with guided tissue regeneration. The sample consisted of 35 patients in whom the following clinical parameters were assessed: depth to the catheter, level of insertion of the marginal gingiva and bone level. Results: The female sex, in the ages of 35 to 59 years, was the most affected by chronic adult periodontitis and in the right and left upper molars. After treatment, a considerable reduction in depth to drilling and gain in bone level was obtained, independently of the discrete decrease in the marginal gingival insertion level. Conclusions: In patients with chronic adult periodontitis, the technique of guided tissue regeneration for the treatment of bone defects showed effectiveness according to clinical parameters obtained.

Objective: To evaluate the impact of computerized clinical practice guidelines on the management, diagnosis, treatment, control, and follow-up of the main cardiovascular risk factors: hypertension, hypercholesterolaemia, and type 2 diabetes mellitus. Design: Pre-post controlled study. Setting: Catalonia, autonomous community located in north-eastern Spain. Participants: Individuals aged 35–74 years assigned to general practitioners of the Catalan Health Institute. Intervention: The intervention group consisted of individuals whose general practitioners had accessed the computerized clinical practice guidelines at least twice a day, while the control group consisted of individuals whose general practitioner had never accessed the computerized clinical practice guidelines platform. Main outcomes: The Chi-squared test was used to detect significant differences in the follow-up, control, and treatment variables for all three disorders (hypertension, hypercholesterolaemia, and type 2 diabetes mellitus) between individuals assigned to users and non-users of the computerized clinical practice guidelines, respectively. Results: A total of 189,067 patients were included in this study, with a mean age of 56 years (standard deviation 12), and 55.5% of whom were women. Significant differences were observed in hypertension management, treatment and control; type 2 diabetes mellitus management, treatment and diagnoses, and the management and control of hypercholesterolaemia in both sexes. Conclusions: Computerized clinical practice guidelines are an effective tool for the control and follow-up of patients diagnosed with hypertension, type 2 diabetes mellitus, and hypercholesterolaemia. The usefulness of computerized clinical practice guidelines to diagnose and adequately treat individuals with these disorders remains unclear.

RESUMEN El alcoholismo constituye un flagelo que alcanza en mayor o menor grado a todas las sociedades del mundo. Se realizó un estudio de intervención educativa con el objetivo de implementar una intervención educativa que contribuya a elevar el nivel de conocimiento sobre alcoholismo en adolescentes de riesgo pertenecientes al CMF 9 del Policlínico 1 Dra. Francisca Rivero Arocha en el municipio Manzanillo de enero- julio del 2016. El universo estuvo conformado por 25 adolescentes, comprendidos en el rango de edades de 13- 15 años, se tomó una muestra intencional de 15 adolescentes. El instrumento de recogida de la información lo constituyó una encuesta a partir de la cual se diseña y aplica el programa educativo Adolescentes por la vida. El 86,6 % de la muestra fueron masculinos, con edad de 15 y 19 años, solo 5 adolescentes respondieron correctamente la encuesta inicial; después de aplicada la estrategia educativa se logró mejorar el nivel de conocimiento sobre los riesgos, criterios para identificar el alcoholismo en un sujeto, mitos sobre el abuso de alcohol, consecuencias del alcoholismo y qué hacer para abandonar el consumo en 14 estudiantes (93,3 %). ABSTRACT Alcoholism is a scourge that reaches more or less all societies in the world. An educational intervention study was carried out with the objective of implementing an educational intervention that contributes to raise the level of knowledge about alcoholism among adolescents at risk belonging to CMF 9 of the Polyclinic 1 Dr. Francisca Rivero Arocha from Manzanillo municipality from January-July 2016. The universe consisted of 25 adolescents, included in the age range of 13-15 years; an intentional sample of 15 adolescents was taken. The instrument for collecting information was a survey from which the educational program Adolescents for Life was designed and implemented. 86.6 % of the sample are male, aged 15 and 19 years, only 5 adolescents correctly answered the initial survey; after applying the educational strategy, it was possible to improve the level of knowledge about risks, criteria to identify alcoholism in a subject, myths about alcohol abuse, consequences of alcoholism and what to do to quit consumption in 14 students (93,3 %).

RESUMEN Estudios recientes demuestran la importancia de educar la sexualidad en pacientes con síndrome de Down desde la infancia, con el propósito de darle respuesta a las curiosidades sexuales de la etapa, así como prepararlos para arribar a la adultez. A partir de esta afirmación, la presente investigación tuvo como objetivo general determinar el nivel de conocimientos de los adolescentes con síndromes de Down en relación con la sexualidad y crear un programa de intervención educativa, con el fin de propiciarles una sexualidad sana; para ello se escogieron 6 adolescentes de edades entre 10 y 15 años, pertenecientes a la escuela especial Francisco Vicente Agujera del municipio Manzanillo de la provincia Granma. Los referentes teóricos se apoyaron en una concepción humanista - desarrolladora y en la teoría del reforzamiento positivo. La estrategia estuvo en función del trabajo interrelacionado de los adolescentes con síndrome de Down. Se partió de las necesidades educativas arrojadas en el diagnóstico, se diseñó el programa con sus objetivos, posibilitó que estos adolescentes consoliden su identidad sexual, identificándose de acuerdo con su sexo, se incluyeron los genitales en su esquema corporal denominándolos, fomentaron hábitos de higiene relacionados con el cuidado del cuerpo y estimularon las relaciones afectivas a través de los juegos de roles. Se recomienda ampliar esta investigación, con seguimiento hasta la adultez y llevar a la comunidad una estrategia que sensibilice a sus integrantes con la sexualidad de los síndromes de Down. ABSTRACT Recent studies demonstrate the importance of educating sexuality in patients with Down syndrome since infancy, in order to respond to the sexual curiosities of the stage, as well as prepare them to reach adulthood. Based on this assertion, the present research had as general objective to determine the level of knowledge of the adolescents with Down syndromes in relation to the sexuality and to create a program of educational intervention, in order to propitiate them a healthy sexuality; six teenagers between 10 and 15 years of age, belonging to the Francisco Vicente Aguilera special school in the Manzanillo municipality of the Granma province were chosen. The theoretical references were based on a humanist - developmental conception and on the theory of positive reinforcement. The strategy was based on the interrelated work of adolescents with Down syndrome. It was based on the educational needs of the diagnosis, the program was designed with its objectives, enabled these adolescents to consolidate their sexual identity, identified according to their sex, included the genitals in their body schema, naming them, fostered related hygiene habits With the care of the body and stimulated the affective relations through the role plays. It is recommended to expand this research, with follow-up until adulthood and bring to the community a strategy that sensitizes its members with the sexuality of Down syndrome.

RESUMEN Introducción: como todos los seres vivos, los seres humanos dependen del medio ambiente que los rodea, para satisfacer sus necesidades de salud y supervivencia. Objetivo: implementar un programa de intervención educativo sobre salud ambiental en los estudiantes de 9º grado de la escuela secundaria básica Pedro Véliz Hernández, de Yara correspondiente al curso escolar 2013-2014. Método: estudio experimental de intervención educativa, para modificar conocimientos sobre salud ambiental, en 203 estudiantes de 9º grado de la ESBU Pedro Véliz Hernández, del área de salud del policlínico Luis E. de la Paz, Yara, curso escolar 2013-2014. Se aplicó un cuestionario inicial, que permitió la detección de necesidades de aprendizaje, se diseñó un programa educativo, que estuvo compuesto por cinco encuentros por cada grupo, con tres frecuencias semanales y duración de una hora, se emplearon técnicas participativas que hicieron más entendibles los temas impartidos y se efectuó la evaluación final con el mismo instrumento inicial. Resultados: se alcanzó menos del 80 % de conocimientos correctos en los alumnos, situación que se modificó después de la capacitación, pues se obtuvo más del 90 % de conocimientos acertados en todas las variables evaluadas. Se recomienda la extensión de estos tipos de estudios a otros centros escolares para contribuir a la formación de una cultura ambientalista, en aras de lograr la participación de los estudiantes en los problemas locales y de la comunidad. Conclusiones: el programa educativo resultó efectivo pues logró modificar los conocimientos que sobre la salud ambiental tenían los estudiantes de 9º grado. ABSTRACT Introduction: as all living things, human beings depend on environment surrounds, in order to fulfill his needs of health and survival. Objective: implementing an intervention educational program on environmental health for 9 th graders from Pedro Véliz Hernandez high school, Yara municipality corresponding to the school year 2013-2014. Method: experimental study of educational intervention, to modify knowledge on environmental health, in 203 9 th graders from Pedro Véliz Hernandez high school, from health area, Luis E. de la Paz polyclinic, Yara, school period 2013-2014. It was applied an initial questionnaire, for the detection of learning needs, it was designed an educational program, composed by five meetings for each group with three weekly frequencies, an hour duration, there were used communicative techniques that did understandable the given topics, and a final evaluation employing the same initial instrument took effect . Results: less than 80% of correct knowledge in students was achieved, situation that was modified after receiving the training, it was obtained more than 90 % of knowledge guessed in all evaluated variables. It is recommended the extension of these types of studies to other school centers to contribute to the formation of an environmental culture, to achieve student’s participation in local and community problems. Conclusions: it proved the effectiveness because we could modify knowledge on environmental health 9 th graders had.

RESUMEN Introducción: la infección urinaria es un proceso inflamatorio determinado por la invasión y multiplicación de cualquier microorganismo, desde la uretra hasta el riñón. Objetivo: conocer el diagnóstico microbiológico por urocultivo de la infección urinaria, y determinar las causas por bacterias coliformes en el municipio de Yara. Métodos: estudio descriptivo- retrospectivo, sobre las infecciones urinarias causadas por bacterias coliformes, así como de la inadecuada indicación en un gran número de muestras analizadas. Resultados: se obtuvo un 24,2 % de positividad; 98,7 % de las muestras fue positiva a gramnegativas con predominio de la E. coli (64, 2 %), el antibiótico más sensible fue el ácido nalidíxico (53,3 %) y el grupo más afectado fue el de 25 a 54 años (43,9 %) en féminas (16,8 %). Conclusiones: la cantidad de muestras positivas resultó baja, la Escherichia coli resultó el germen causal más frecuente de infecciones urinarias, el antibiótico con mayor efectividad fue el ácido nalidíxico y de las muestras positivas, el mayor número se obtuvo en pacientes de 25 a 54 años con predominio del sexo femenino. ABSTRACT Introduction: urinary infection is an inflammatory process determined by invasion and spreading of any microorganism from urethra to the kidney. Objective: to know the microbiology diagnosis in urinalysis in urinary infections, so as to determine the main causes of coliform bacteria in Yara municipality. Methods: a descriptive- retrospective study on urinary infections caused by coliform bacteria, so as inadequate indication of a great amount of sample analyzed. Results: it was obtained 24,2 % of positivity; 98,7 % of the samples were positive to gram-negative bacteria with prevalence of E. coli (64, 2 %), the more sensible antibiotic was nalidixic acid (53,3 %), the most affected group was from 25 to 54 años (43,9 %) in females (16,8 %). Conclusion: the amount of positive samples was low, E. coli was the bacterium more frequently found in urinary infections, the antibiotic with greater effect was nalidixic acid; from positive samples, the greater amount was in patients from 25 to 54 años in females.

Introducción: Los accidentes con escorpiones datan de tiempos inmemoriales, sin embargo, recién a principios del año 2000, comenzaron a ser registrados a causa de la nueva normativa impulsada por el Ministerio de Salud de la Nación1 . El escorpionismo o alacranismo en la ciudad de Córdoba, tiene un impacto importante en la salud pública, generando cada año numerosos accidentes por picaduras2, 3, 4. Los escorpiones o alacranes de importancia médica en Argentina pertenecen al género Tityus y T. trivittatus es la especie más frecuente en Argentina;1 Tucumán y Córdoba son las provincias con mayor cantidad de casos notificados2 . Los accidentes por escorpiones para el período comprendido entre los años 2000 y 2011, fueron de 69.156 casos para el total del territorio nacional. La tasa de morbilidad cada 100.000 habitantes fue de 2,7 y la de letalidad fue de 0,05%, con 31 casos mortales1. Objetivos: El propósito fue informar a los alumnos y docentes de 2 escuelas periféricas de esta ciudad sobre la problemática del escorpionismo y proveer de las herramientas intelectuales para el reconocimiento de los arácnidos, el desarrollo de acciones preventivas y las conductas apropiadas una vez sucedido un accidente.Materiales y métodos: Se desarrolló la modalidad Taller 10 para la exposición e intercambio de contenidos entre tutores universitarios, docentes de las escuelas y alumnos;se afectaron a 354 alumnos. El programa de estudio abordó la temática sobre escorpionismo y herramientas de promoción de la salud, prácticas preventivas y de erradicación de los escorpiones. Apoyados en los recientes aportes de las neurociencias para favorecer el aprendizaje y concitar el interés, la atención y la emoción de los niños-elementos centrales para lograr aprendizajes duraderos-8 , se asocióuna técnica creativa, la xilografía para representar los escorpiones en grabados sobre madera. Evaluación: se pudo valorar un alto compromiso de los educadores afectados y gran disposición de los niños durante todo el proceso, siendo capaces de representar las características morfológicas de los escorpiones como corolario del recorrido educativo, dando grandes muestras de satisfacción por la ejecución del trabajo creativo, todo lo cual se aprecia en las expresiones corporales de la documentación fotográfica (Fotos 1,2,3,4). El momento final de esta experiencia tuvo lugar con exposición de las estampas xilográficas en el Pabellón Argentina y Brujas de la Facultad de Artes Visuales de la UNC. Conclusiones: La presente experiencia demuestra que otro modo de enseñanza es posible con la sinergia entre el arte y la ciencia; se dimensiona un nuevo rol de la Universidad en la gestión del conocimiento hacia la generación de conductastransformadoras de la realidad en prácticas sanitarias valiosas. Por otra parte, supone un enfoque en que cada participante del proceso educativo -profesores, maestros y alumnos-, se constituye en vehículo eficiente de transmisión de la información para el cuidado dela salud y agente con vocación de cambio y transformación de la realidad.

Aim Our purpose was to evaluate by cardiovascular magnetic resonance (CMR) the presence of diffuse as well as focal MF in a series of high-performance veteran endurance athletes.Methods Thirty-four veteran healthy male endurance athletes, still being in regular training, with more than 10 years of training underwent a CMR. A cardiopulmonary exercise test was also performed to assess their maximal physical performance. The control group consisted in 12 non-trained normal individuals.Results We found an increase in both, right and left ventricular (LV) volumes in the athlete’s group when compared with controls. There was no increase in indexed LV myocardial mass despite of a significantly increased maximal myocardial wall thickness in comparison to controls. Native T1 values and extracellular volume (ECV) were normal in all cases. We did not find differences in native T1 values and ECV between both groups. In three athletes (9%), non-ischaemic late gadolinium enhancement (LGE) was observed. We did not find a correlation between total training volume and presence of LGE or with the ECV value.Conclusions Our results show that the majority of veteran endurance athletes present with myocardial remodelling without MF as a physiological adaptive phenomenon. In the only three athletes with focal MF, the LGE pattern observed suggests an intercurrent event not related with the remodelling phenomenon.

Introducción: las evaluaciones son vitales para el éxito de cualquier programa al medir y analizar el cumplimiento de los objetivos trazados. La más utilizada se basa en la evaluación de los tres componentes: estructura, proceso y resultados. Objetivo: evaluar el programa nacional de control de la tuberculosis en instituciones cerradas de Pinar del Río. Material y método: se realizó una investigación evaluativa, con un diseño de estudio descriptivo retrospectivo. Se definieron criterios y variables, escala de clasificación, descripción operacional con indicadores y estándares en los tres componentes del programa. La información se obtuvo de registros estadísticos, historias y cuadro epidemiológico. Se realizó la evaluación de los indicadores, comparando el resultado obtenido con los estándares establecidos en el programa nacional de control de la tuberculosis del Ministerio de Salud Pública de Cuba y otros fijados por las instituciones cerradas de salud, otorgándoles las categorías de bien, regular o mal. Resultados: se identificó la adecuada cobertura, capacitación de recursos humanos, materiales y el control de calidad en el componente de estructura, interrupciones en el tratamiento de quimioprofilaxis de los contactos, diagnósticos tardíos y realizados en la atención secundaria de salud en el componente de proceso, media de edad de 36 años, incremento en la incidencia y predominio en la institución cerrada provincial como los principales del componente de resultados. Conclusiones: el programa se evaluó de regular. La investigación permitió identificar brechas existentes en las acciones de prevención y control realizadas, aportando evidencias objetivas y científicas del funcionamiento del mismo, útiles en la toma de decisiones.

Introducción: la enfermedad diarreica aguda es un problema de salud común en la población, sobre todo en países en vías de desarrollo. Es una enfermedad autolimitada que obedece a múltiples etiologías. Objetivo: identificar los factores de riesgo de enfermedad diarreica aguda en menores de cinco años. Métodos: se realizó un estudio de casos y controles, en el área de salud “Edgar Ramón Uzcátegui”, municipio Maracaibo, estado Zulia, Venezuela, durante 6 meses, en el 2007. El grupo de casos estuvo representado por 45 niños que enfermaron de diarrea aguda y el grupo control, por la misma cantidad de niños que no presentaron ninguna enfermedad en este periodo, de la misma área, la misma edad y del mismo sexo. A ambos grupos se les aplicó una encuesta cuyos datos obtenidos se procesaron automatizadamente. Resultados: predominó la enfermedad diarreica aguda en menores de 1 año, el tipo de lactancia fue el factor que predominó en el grupo de casos. El tipo de lactancia, la higiene doméstica y el destete precoz se comportaron como riesgo fuerte para la aparición de la diarrea aguda y al modificarlos o eliminarlos se reduciría el riesgo considerablemente. La mayor proporción de prevalencia en expuestos se encontró en el factor tipo de lactancia y pudimos inferir que existía relación directa de los factores de riesgo con el evento. Conclusiones: los factores de riesgos asociados a las enfermedades diarreicas agudas en menores de 5 años fueron el tipo de lactancia utilizada, la higiene doméstica, el destete precoz, y edad menor de 1 año.

La autoevaluación se identifica, con mucha frecuencia, con el paso previo para la realización del proceso de acreditación universitaria, lo que reduce su verdadero significado para el mejoramiento de la calidad de una institución de educación superior. Se desarrolla el presente trabajo con el objetivo de contribuir a la actualización de los profesores, estudiantes y directivos de la Universidad de Ciencias Médicas de Cienfuegos en los preceptos teóricos de la evaluación institucional, así como destacar la importancia de la autoevaluación como herramienta indispensable en la calidad de los procesos universitarios. Se hace referencia a la importancia y necesidad que en la actualidad se le confiere a la autoevaluación en las universidades para el mejoramiento de su quehacer institucional. Se presenta una síntesis de las tendencias y enfoques que abordan la autoevaluación, con énfasis en las diferentes modalidades evaluativas. Se concluye que es necesario involucrar responsablemente a toda la comunidad universitaria en el desarrollo de la autoevaluación creando una verdadera cultura de calidad en nuestras instituciones, que permita no solo estar listos para una evaluación externa sino para cumplir con calidad nuestro encargo social.

Se realizó un estudio descriptivo y transversal de 53 pacientes con diagnóstico clínico y por resonancia magnética de afección meniscal, atendidos en el Hospital General Docente "Dr. Juan Bruno Zayas Alfonso" de Santiago de Cuba, desde enero de 2011 hasta diciembre de 2012. En la serie prevalecieron las lesiones meniscales en los más jóvenes, con edad media de 43 años y similar para ambos sexos, así como el antecedente de trauma (58,5%), con manifestaciones de dolor, dificultad para la marcha y aumento de volumen en el total de integrantes; asimismo, las lesiones se localizaron fundamentalmente en la rodilla derecha, en el menisco externo y en los cuernos posteriores de ambos meniscos. Los tipos de lesiones más diagnosticadas resultaron ser las roturas incompletas, las completas y los cambios degenerativos, asociadas fundamentalmente a sinovitis. Existió excelente relación diagnóstica entre la resonancia magnética y la artroscopia

Need—National legislative health and safety (H&S) frameworks impose requirements but grant self-management to organisations. Consequently variability arises in management systems, and some organisations struggle to achieve successful implementation. The risk assessment process is key to the H&S management system, and could benefit from greater consistency and better external alignment with the legislative framework of the jurisdiction. Approach—The harm categories in the New Zealand (NZ) Act were adapted into a consequence scale. A non-linear scale was developed for the consequence axis to represent the disproportional nature of catastrophic harm outcomes compared to minor injuries. A hazard assessment process was devised based on systems engineering methods. Organisational decision-criteria were derived from the communications requirement in the Act, and these thresholds linked to expected treatments. Originality—A method is providing for aligning risk assessments with a national legislative framework, and integrating the technical aspects of risk assessment with the management processes. The approach also more explicitly includes recovery actions in contrast to existing methods where prevention dominates. Regarding the management aspects, it shows how thresholds may be defined relative to the legislation, to give clear expectations regarding treatment and internal communication, thereby assisting executives (‘officers’ in terms of the NZ Act) meet their duties.

Se describen 3 casos clínicos de pacientes ingresados en el Hospital General Docente "Dr. Juan Bruno Zayas Alfonso" de Santiago de Cuba por sospecharse la presencia de aneurismas cerebrales, teniendo en cuenta las manifestaciones neurológicas que presentaban. Mediante los estudios de resonancia magnética y angiorresonancia realizados, se observaron las imágenes de la lesión vascular, las cuales fueron confirmadas por angiografía carotídea.Three clinical cases of patients admitted in "Dr. Juan Bruno Zayas Alfonso" Teaching General Hospital in Santiago de Cuba due to the suspicious presence of cerebral aneurysms are described, keeping in mind the neurological manifestations they presented. By means of the studies of magnetic resonance and angiographic resonance carried out, the images of the vascular lesion were observed, which were confirmed by carotid angiography.

Fundamento: el tejido dentinal posee una alta sensibilidad para responder con dolor ante diferentes estímulos, característica que se conoce como hiperestesia dentinaria y está enmarcada dentro de los estados reversibles de la pulpa vital. Objetivo: determinar factores de riesgo para hiperestesia dentinaria en pacientes de entre 20-40 años. Métodos: estudio descriptivo de serie de casos, realizado en el Servicio de Urgencias Estomatológicas del Policlínico Área 6, municipio de Cienfuegos, en el período de mayo de 2008 a junio de 2009, que incluyó a todos los pacientes que acudieron solicitando servicio de urgencias en el período de estudio, con sintomatología de dolor dentinal. Se analizaron las variables: edad, sexo, causas de la consulta y factores de riesgo. Resultados: predominó el sexo femenino (77, 5 %) y las edades entre 36 y 40 años (40 %), entre los últimos fue más frecuente la presencia de hiperestesia. El factor de riesgo que prevaleció fue la recesión gingival (67, 5 %) y también fue más frecuente en el grupo de 36 a 40 años. El tipo de dieta como factor de riesgo se presentó en 60, 8 % de los casos. Predominó el tipo de cepillado vigoroso con 42, 5 %. Conclusiones: la recesión gingival y el tipo de dieta fueron los principales factores de riesgo para la hiperestesia dentinaria.

Se realizó un estudio descriptivo y transversal de 635 pacientes con hernia discal atendidos en el Hospital General Docente "Dr. Juan Bruno Zayas Alfonso" de Santiago de Cuba, desde diciembre del 2009 hasta igual mes del 2010, para determinar las características clínicas e imagenológicas de esta afección mediante resonancia magnética. En la casuística primaron el grupo etario de 30 a 49 años, el sexo masculino, la obesidad como principal factor de riesgo en las mujeres y la carga física excesiva en los hombres, así como el dolor, la localización lumbar y las hernias posteriores centrolaterales y laterales derechas. Se encontró que las protrusiones focales y difusas resultaron ser las más comunes, asociadas a edema óseo en las placas terminales, que la compresión medular y las mielopatías secundarias fueron provocadas por protrusiones focales cervicales y que la estenosis del canal se presentó mayoritariamente en el segmento lumbar.A descriptive and cross-sectional study of 635 patients with discal hernia assisted in "Dr. Juan Bruno Zayas Alfonso" Teaching General Hospital in Santiago de Cuba was carried out from December, 2009 to the same month of 2010, to determine the clinical and imaging characteristics of this disorder by means of magnetic resonance. The age group from 30 to 49 years, male sex, obesity as the main risk factor in the women and the excessive physical load in the men prevailed in the case material, as well as the pain, the lumbar localization and the right posterior centro-lateral and lateral hernias. It was found that the focal and diffuse protrusions turned out to be more common, associated with bony edema in the terminal plates, that the medullary compression and the secondary myelopathies were caused by cervical focal protrusions and the stenosis of the channel was mainly presented in the lumbar segment.

La ecografía bidimensional y Doppler es la primera prueba a realizar en los pacientes con deterioro de la función del injerto renal de causa no aclarada. Ofrece información rápida sobre las características morfológicas relacionadas con el tamaño, grosor y ecogenicidad del parénquima, diferenciación corticomedular, obstrucción del flujo urinario, colecciones perirenales, características del flujo sanguíneo en el interior de las arterias y venas renales que son de especial importancia cuando se sospecha una enfermedad de causa vascular. El índice de resistencia tiene valor predictivo en la función del trasplante renal a largo plazo y en el diagnóstico de la nefropatía crónica del injerto. La ecografía constituye la modalidad imagenológica de elección para el diagnóstico precoz y seguimiento de las complicaciones clínicas y quirúrgicas del riñón trasplantado, lo cual contribuye al tratamiento oportuno de las complicaciones, la preservación del injerto y el mejoramiento de la calidad de vida del enfermo.Doppler scanning and ultrasound B-scan are the first test to perform in patients with impaired renal implant function of unknown cause. It provides rapid information on morphological characteristics related to size, thickness and parenchymal echogenicity, corticomedullary differentiation, urinary outflow obstruction, perirenal collections and blood flow characteristics within the renal arteries and veins that are of particular importance when a disease of vascular cause is suspected. The resistance index has predictive value in long-term renal transplant function and in the diagnosis of the implant chronic kidney disease. Ultrasound constitutes the imaging modality of choice for the early diagnosis and monitoring the clinical and surgical complications of the transplanted kidney, which contributes to the early treatment of complications, implant preservation and improvement of the quality of patient's life.