Search

Montserrat Masip,1,2,* Neus Pagès-Puigdemont,1,2,* Anna López-Ferrer,2,3,* Héctor David de Paz,4,* Esther Serra-Baldrich,2,3,* Lluís Puig,2,3,* Pau Riera1,2,* 1Pharmacy Service, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain; 2Institut de Recerca Sant Pau (IR SANT PAU), Barcelona, Spain; 3Dermatology Department, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain; 4Outcomes’ 10 (a ProductLife Group Company), Castellón de la Plana, Spain*These authors contributed equally to this workCorrespondence: Neus Pagès-Puigdemont, Pharmacy Service, Hospital de la Santa Creu i Sant Pau, Sant Quintí 81, Barcelona, 08041, Spain, Email NPages@santpau.catPurpose: This study aims to map the clinical pathway for psoriasis and atopic dermatitis (AD) in a tertiary hospital to better understand patient needs and experiences, thereby suggesting improvements in patient-centered care.Methods: A mixed-method approach was utilised involving a literature review, a questionnaire for healthcare professionals (HCPs), and two focus groups (one with HCPs and the other with patients with psoriasis or AD). Ethical approvals were obtained, and informed consent was acquired from all participants.Results: Patients and HCPs identified significant delays in the pre-diagnosis phase, extending up to five years for psoriasis and three years for AD, adversely affecting the timely initiation of effective treatment. In addition, there were reported difficulties in obtaining appointments during flares, a lack of dermatologic emergencies, a need to increase human resources and physical space, and a need for telematic consultations for urgent cases. Discrepancies between HCPs’ perceptions and patients’ experiences highlighted unmet needs, particularly in primary care settings and emergency departments. Several strengths were also identified, including satisfactory experience in dermatology, the hospital’s high level of specialisation in the management of complex patients, optimal communication between services, consideration of patient preferences, and proper advice on hospital pharmacy care and administration support of treatment and adherence monitoring.Conclusion: The findings underscore the necessity for interventions to reduce wait times and improve treatment immediacy and effectiveness post-diagnosis. The insights from this study can direct enhancements in patient management and satisfaction for individuals with psoriasis and AD.Plain Language Summary: This study looked into how patients with psoriasis and atopic dermatitis (AD) are treated in a tertiary hospital. It focused on understanding the time it takes for patients to receive help and their satisfaction with the care received. By talking to doctors and patients, the researchers learned about the challenges in the early stages of these diseases and the delays in starting treatment or in the treatment process, among others. They discovered that these patients often wait too long before seeing a dermatologist, leading to a delay in treatment access. The study suggests that quicker diagnosis and treatment could improve how these conditions are managed and increase patient satisfaction.Keywords: psoriasis, atopic dermatitis, care pathway, patient centered care

Within patients with sepsis, there exists significant heterogeneity, and while all patients should receive conventional therapy, there are subgroups of patients who may benefit from specific therapies, often referred to as rescue therapies. Therefore, the identification of these specific patient subgroups is crucial and lays the groundwork for the application of precision medicine based on the development of targeted interventions. Over the years, efforts have been made to categorize sepsis into different subtypes based on clinical characteristics, biomarkers, or underlying mechanisms. For example, sepsis can be stratified into different phenotypes based on the predominant dysregulated host response. These phenotypes can range from hyperinflammatory states to immunosuppressive states and even mixed phenotypes. Each phenotype may require different therapeutic approaches to improve patient outcomes. Rescue strategies for septic shock may encompass various interventions, such as immunomodulatory therapies, extracorporeal support (e.g., ECMO), or therapies targeted at specific molecular or cellular pathways involved in the pathophysiology of sepsis. In recent years, there has been growing interest in precision medicine approaches to sepsis and phenotype identification. Precision medicine aims to tailor treatments to each individual patient based on their unique characteristics and disease mechanisms.

Resumen: Objetivos: Evaluar el efecto de una intervención de terapia ocupacional en usuarios diagnosticados recientemente de síndrome del declive, con una disminución en el índice de Barthel y/o Lawton en el último mes y susceptible de mejora según criterio clínico. Diseño: Estudio cuasiexperimental longitudinal no controlado. Intervención pre-post. Emplazamiento: Centro de salud Sant Hipòlit de Voltregà. Osona, Barcelona. Participantes: Pacientes remitidos por el profesional de enfermería, trabajo social o medicina de familia del centro con diagnóstico reciente de síndrome del declive que pueda beneficiarse de una intervención con terapia ocupacional. Intervenciones: Tras la visita inicial de valoración se llevaron a cabo cuatro sesiones de capacitación para mejorar la independencia funcional, la movilidad y adaptación del entorno doméstico, ofreciendo formación a los cuidadores principales. Mediciones principales: Se valoró la autonomía del paciente a través de la escala de Barthel y Lawton, la calidad de vida a través del cuestionario EuroQol (EQ-5D) y la adecuación del hogar a través del cuestionario de valoración de adecuación del hogar. Resultados: Se observaron mejoras en la autonomía en las actividades de la vida diaria (p = 0,003), la movilidad (p = 0,001) y la adaptación de la vivienda (p

Resumen: Antecedentes y objetivo: la educación interprofesional permite mejorar la comunicación y adquirir las competencias interprofesionales para un mejor cuidado del paciente. El objetivo del presente estudio fue analizar dichos cambios en el grupo clase, y antes-después de participar en una asignatura de grado basada en la simulación interprofesional (SIP). Metodología: estudio descriptivo transversal en estudiantes de primer curso del grado de Enfermería y segundo del grado de Medicina antes de participar en la asignatura optativa de SIP en el curso académico posterior. Se realizó un estudio prospectivo antes y después con 12 estudiantes del grado de Enfermería y 12 de Medicina que recibieron dicha formación. Se usó la Escala de Socialización Interprofesional y Valores para valorar actitudes y creencias hacia la educación colaborativa y la socialización en el grupo profesional. Se analizaron diferencias entre grados con el Test U de Mann-Whitney y entre las 2 fases con la prueba de Friedman parar datos apareados. Resultados: globalmente, el alumnado de Enfermería mostraba, previo a la simulación, un mejor conocimiento del rol, que el alumnado de Medicina. En el corte presimulación, los alumnos de la asignatura de Simulación Interprofesional, puntuaron bajo en los ítems de la escala ISVS relacionados con el uso de un lenguaje común, conocimiento del rol y toma de decisiones compartidas. En el corte postsimulación puntuaron de forma significativamente más alta en todos los ítems de la escala (p < 0,001). Conclusiones: La educación basada en SIP es óptima para desarrollar la socialización interprofesional entre estudiantes de Enfermería y Medicina en el contexto de una asignatura optativa con estudiantes de ambos grados. Posibilita el entrenamiento del propio rol y el conocimiento del rol de los otros miembros, mejorando la comunicación y el trabajo en equipo. Abstract: Background and objective: Interprofessional education allows improving communication and acquiring interprofessional competencies for better patient care. The aim of the present study was to analyze such changes in the class group, and before-after participating in an undergraduate subject based on interprofessional simulation. Methodology: Descriptive cross-sectional study in first year students of the nursing degree and second year students of the medical degree before participating in the interprofessional simulation elective subject in the subsequent academic year. A prospective before and after study was conducted with 12 students of the nursing degree and 12 medical students who received such training. The Interprofessional Socialization and Values Scale was used to assess attitudes and beliefs toward collaborative education and socialization in the professional group. Differences between grades were analyzed with the Mann-Whitney U test and between the two phases with the Friedman test for paired data. Results: Overall, nursing students showed better pre-simulation role knowledge than medical students. In the pre-simulation cut-off, interprofessional simulation students scored low on the ISVS scale items related to the use of common language, role knowledge and shared decision making. In the post-simulation cut-off they scored significantly higher on all items of the scale (p < 0.001). Conclusions: Interprofessional simulation-based education is optimal for developing interprofessional socialization between nursing and medical students in the context of an elective subject with students from both grades. It enables training of one's own role and knowledge of the role of the other members, improving communication and teamwork.

Abstract Background The use of remote consultation modalities has exponentially grown in the past few years, particularly since the onset of the COVID-19 pandemic. Although a huge body of the literature has described the use of phone (tele) and video consultations, very few of the studies correspond to randomized controlled trials, and none of them has assessed the safety of these consultation modalities as the primary objective. The primary objective of this trial was to assess the safety of remote consultations (both video and teleconsultation) in the follow-up of patients in the hospital setting. Methods Multicenter, randomized controlled trial being conducted in four centers of an administrative healthcare area in Catalonia (North-East Spain). Participants will be screened from all individuals, irrespective of age and sex, who require follow-up in outpatient consultations of any of the departments involved in the study. Eligibility criteria have been established based on the local guidelines for screening patients for remote consultation. Participants will be randomly allocated into one of the two study arms: conventional face-to-face consultation (control) and remote consultation, either teleconsultation or video consultation (intervention). Routine follow-up visits will be scheduled at a frequency determined by the physician based on the diagnostic and therapy of the baseline disease (the one triggering enrollment). The primary outcome will be the number of adverse reactions and complications related to the baseline disease. Secondary outcomes will include non-scheduled visits and hospitalizations, as well as usability features of remote consultations. All data will either be recorded in an electronic clinical report form or retrieved from local electronic health records. Based on the complications and adverse reaction rates reported in the literature, we established a target sample size of 1068 participants per arm. Recruitment started in May 2022 and is expected to end in May 2024. Discussion The scarcity of precedents on the assessment of remote consultation modalities using randomized controlled designs challenges making design decisions, including recruitment, selection criteria, and outcome definition, which are discussed in the manuscript. Trial registration NCT05094180. The items of the WHO checklist for trial registration are available in Additional file 1. Registered on 24 November 2021.

Abstract Background Inflammatory memory or trained immunity is a recently described process in immune and non-immune tissue resident cells, whereby previous exposure to inflammation mediators leads to a faster and stronger responses upon secondary challenge. Whether previous muscle injury is associated with altered responses to subsequent injury by satellite cells (SCs), the muscle stem cells, is not known. Methods We used a mouse model of repeated muscle injury, in which intramuscular cardiotoxin (CTX) injections were administered 50 days apart in order to allow for full recovery of the injured muscle before the second injury. The effect of prior injury on the phenotype, proliferation and regenerative potential of satellite cells following a second injury was examined in vitro and in vivo by immunohistochemistry, RT-qPCR and histological analysis. Results We show that SCs isolated from muscle at 50 days post-injury (injury-experienced SCs (ieSCs)) enter the cell cycle faster and form bigger myotubes when cultured in vitro, compared to control SCs isolated from uninjured contralateral muscle. Injury-experienced SCs were characterized by the activation of the mTORC 1 signaling pathway, suggesting they are poised to activate sooner following a second injury. Consequently, upon second injury, SCs accumulate in greater numbers in muscle at 3 and 10 days after injury. These changes in SC phenotype and behavior were associated with accelerated muscle regeneration, as evidenced by an earlier appearance of bigger fibers and increased number of myonuclei per fiber at day 10 after the second injury. Conclusions Overall, we show that skeletal muscle injury has a lasting effect on SC function priming them to respond faster to a subsequent injury. The ieSCs have long-term enhanced regenerative properties that contribute to accelerated regeneration following a secondary challenge.

Background. Patterns of SARS‐CoV‐2 spread have varied by geolocation, with differences in seroprevalence between urban and rural areas, and between waves. Household spread of SARS‐CoV‐2 is a known source of new COVID‐19 infections, with rural areas in sub‐Saharan Africa being more prone than urban areas to COVID‐19 transmission because of limited access to water in some areas, delayed health‐ seeking behaviour and poor access to care. Objectives. To explore SARS‐CoV‐2 infection incidence and transmission in rural households in South Africa (SA). Methods. We conducted a prospective household cluster investigation between 13 April and 21 July 2021 in the Matjhabeng subdistrict, a rural area in Free State Province, SA. Adults with SARS‐CoV‐2 confirmed by polymerase chain reaction (PCR) tests (index cases, ICs) and their household contacts (HCs) were enrolled. Household visits conducted at enrolment and on days 7, 14 and 28 included interviewer‐ administered questionnaires and respiratory and blood sample collection for SARS‐CoV‐2 PCR and SARS‐CoV‐2 immunoglobulin G serological testing, respectively. Co‐primary cases were HCs with a positive SARS‐CoV‐2 PCR test at enrolment. The incidence rate (IR), using the Poisson distribution, was HCs with a new positive PCR and/or serological test per 1 000 person‐days. Associations between outcomes and HC characteristics were adjusted for intra‐cluster correlation using robust standard errors. The secondary infection rate (SIR) was the proportion of new COVID‐19 infections among susceptible HCs. Results. Among 23 ICs and 83 HCs enrolled, 10 SARS‐CoV‐2 incident cases were identified, giving an IR of 5.8 per 1 000 person‐days (95% confidence interval (CI) 3.14 ‐ 11.95). Households with a co‐primary case had higher IRs than households without a co‐primary case (crude IR 14.16 v. 1.75, respectively; p=0.054). HIV infection, obesity and the presence of chronic conditions did not materially alter the crude IR. The SIR was 15.9% (95% CI 7.90 ‐ 29.32). Households with a lower household density (fewer household members per bedroom) had a higher IR (IR 9.58; 95% CI 4.67 ‐ 21.71) than households with a higher density (IR 3.06; 95% CI 1.00 ‐ 12.35). Conclusion. We found a high SARS‐CoV‐2 infection rate among HCs in a rural setting, with 48% of households having a co‐primary case at the time of enrolment. Households with co‐primary cases were associated with a higher seroprevalence and incidence of SARS‐CoV‐2. Sociodemographic and health characteristics were not associated with SARS‐CoV‐2 transmission in this study, and we did not identify any transmission risks inherent to a rural setting.

Introduction: Scalp is essential for the protection of intracranial contents and contributes to external aesthetic appearance; it is a unique hair-bearing surface. Total or partial lack of scalp directly affects patient’s quality of life. Case presentation: The objective of this paper is to present four cases of complex scalp wounds solved with fasciocutaneous free flaps. Microvascular free tissue transfer is associated with high success rates in scalp reconstruction (90% success rate). Microsurgery was the last step on the reconstructive ladder, nowadays with reconstructive elevator concept; microsurgery can be used as the first step in reconstruction. Conclusion: Microvascular scalp reconstruction is an invaluable part of a reconstructive surgeon since the advantages outweigh the disadvantages.

IntroductionCatheter-related blood stream infection (CRBSI) is one of the most relevant complications associated to the use of intravascular catheters. In this context, chlorhexidine gluconate (CHG) releasing dressings have been developed to reduce the catheter colonization rate and the risk of infection. The aim of this study is to analyze the release rate of CHG and the antimicrobial activity of a novel CHG-releasing dressing, Oper film® protect CHG, and to compare these parameters to those of the dressing Tegaderm™ CHG in healthy volunteers.MethodsThe study was performed in a cohort of 25 healthy volunteers. Two commercially available chlorhexidine-containing dressings were evaluated and compared in this study, Oper film® protect CHG and Tegaderm™ CHG. The release of CHG and the antimicrobial capacity was determined for one week.ResultsHPLC analysis revealed that both dressings have an equivalent CHG release to the skin 2 days (Oper film® protect CHG, 321 μg/cm2; Tegaderm™ CHG, 279 μg/cm2) and 7 days (Oper film® protect CHG, 456 μg/cm2; Tegaderm™ CHG, 381 μg/cm2) after the placement of the products in the non-disinfected back of the subjects. On the other hand, Oper film® protect CHG and Tegaderm™ CHG similarly reduced colony forming units (CFU) in cultures obtained from the skin under the CHG-containing hydrogel compared to control cultures at both 2 days (control, 3.34 log10 cfu/cm2; Oper film® protect CHG, 0.64 log10 cfu/cm2; Tegaderm™ CHG, 0.7 log10 cfu/cm2) and 7 days (control, 3.95 log10 cfu/cm2; Oper film® protect CHG, 0.11 log10 cfu/cm2; Tegaderm™ CHG, 1 log10 cfu/cm2).DiscussionData confirm that the recent commercially available dressing Oper film® protect CHG maintains the release of CHG and the antimicrobial activity during at least 7 days, and possesses equivalent drug release and antimicrobial action to Tegaderm™ CHG.

La sepsis del recién nacido es una condición médica derivada de la invasión y proliferación de organismos patógenos en el torrente sanguíneo como bacterias, hongos o virus que aparece en los primeros 28 días de vida. De acuerdo con el mecanismo de transmisión, la sepsis neonatal se puede dividir en: sepsis de transmisión vertical, causada por gérmenes localizados en el canal genital materno y que contaminan al feto (por vía ascendente o por contacto directo con el feto) con secreciones contaminadas al pasar por el canal del parto, y la sepsis de transmisión nosocomial, producida por microorganismos adquiridos en el medio hospitalario. La etiología de la sepsis en el recién nacido por lo general es bacteriana, le siguen los hongos y los virus en menos del 1%. Se inicia terapéutica con antibióticos de amplio espectro por las complicaciones y la elevada mortalidad que provoca esta entidad. Con el resultado del hemocultivo, se modificará el tratamiento antibiótico según el antibiograma de cada paciente. Unido a la terapéutica con antibióticos, se aplican medidas de soporte: hidratación parenteral, ventilación mecánica o drogas vasoactivas según el caso. El neonato con sepsis es un paciente en estado grave o crítico y su tratamiento es complejo, cada paciente será bien evaluado y tratado enérgicamente desde las primeras horas de vida en aras de disminuir la mortalidad. Palabras clave: sepsis, neonato, bajo peso al nacer

Las bacterias son capaces de desarrollar mecanismos de resistencia a los antimicrobianos, aquellos adquiridos y transmisibles son los más significativos debido al potencial de diseminación. La aparición de Salmonella enterica con resistencia a C3aG, quinolonas y a colistina representa una amenaza progresiva. El objetivo fue determinar la resistencia a los antimicrobianos y la presencia de los mecanismos de resistencia plasmídicos a quinolonas, β-lactámicos y colistina en aislados de Salmonella provenientes de la vigilancia integrada de enteropatógenos. Fueron estudiadas 501 cepas de Salmonella spp. colectadas entre los años 2020 y 2021, por la red de enteropatógenos del Laboratorio Central de Salud Pública. Se investigó la resistencia a las C3aG, quinolonas y colistina, en aislamientos de humanos, alimentos, animales de consumo y ambiente. Las cepas estudiadas exhibieron resistencia a tetraciclina (32,5%), ácido nalidíxico (29%), ampicilina (13,2%), nitrofurantoína (11,6%), C3aG (7,2%), cotrimoxazol (5,8%), ciprofloxacina (2,2%). El 18% (90/501) presentaron resistencia trasferible por plásmidos, fueron detectados 111 genes (71 cepas con un gen, 17 cepas dos genes y 2 cepas tres genes diferentes). Qnr B: 41,1% (37/90), mcr-1: 38,9% (35/90), CMY: 23,3% (21/90), CTX-M: 16,7% (15/90) y Qnr S: 3,3% (3/90). Heidelberg fue el serovar predominante en muestras de pollo y el mayor portador de genes de resistencia de tipo CMY y mcr-1. La detección de genes en alimentos y animales de consumo, que pueden transmitirse fácilmente al ser humano es motivo de alerta y resalta la importancia de continuar fortaleciendo la vigilancia multisectorial y multidisciplinaria.

Summary: Background: While a low CD4/CD8 ratio during HIV treatment correlates with immunosenescence, its value in identifying patients at an increased risk for clinical events remains unclear. Methods: We analyzed data from the CoRIS cohort to determine whether CD4 count, CD8 count, and CD4/CD8 ratio at year two of antiretroviral therapy (ART) could predict the risk of serious non-AIDS events (SNAEs) during the next five years. These included major adverse cardiovascular events, non-AIDS-defining malignancies, and non-accidental deaths. We used pooled logistic regression with inverse probability weighting to estimate the survival curves and cumulative risk of clinical events. Findings: The study included 4625 participants, 83% male, of whom 200 (4.3%) experienced an SNAE during the follow-up period. A CD4/CD8 ratio

La diabetes mellitus neonatal es una enfermedad infrecuente que se diagnostica en recién nacidos y lactantes menores de 6 meses de edad. La incidencia es de 1 de cada 90 000 nacidos vivos. Este tipo de diabetes de aparición temprana es originado por una serie de mutaciones genéticas dadas por anomalías del locus 6q24 y los genes ABCC8 o KCNJ11 que codifican el canal de potasio en la célula β del páncreas; en otros casos aparece por malformación del páncreas con alteración del desarrollo de las células secretoras de insulina o función anormal de las células β pancreáticas existentes. El diagnóstico se obtiene mediante pruebas genéticas. El tratamiento de esta enfermedad es complejo, representa un reto para neonatólogos e intensivistas por la complejidad que representa la atención del recién nacido. Se debe prestar especial atención al control metabólico de la hiperglicemia persistente, que se logra con la administración de insulina e hipoglicemiantes orales para evitar complicaciones y lograr un crecimiento y desarrollo adecuado. La remisión de la enfermedad en algunos casos se logra, pero puede reaparecer en la pubertad, de ahí la importancia en el seguimiento y manejo por un equipo médico especializado hasta terminar la edad pediátrica. Este trabajo tiene como objetivo actualizar el diagnóstico y manejo terapéutico de la diabetes neonatal. Palabras clave: diabetes neonatal, morbimortalidad en el recién nacido, enfermedades metabólicas en neonatos, enfermedades genéticas en recién nacidos

Introduction: The Covid-19 pandemic soon became an international health emergency raising concern about its impact not only on physical health but also on quality of life and mental health. Rare diseases are chronically debilitating conditions with challenging patient care needs. We aimed to assess the quality of life and mental health of patients with rare diseases in Spain, with a special focus on inherited metabolic disorders (IMD). Methods: A prospective case-control study was designed, comparing 459 patients suffering from a rare disease (including 53 patients with IMD) and 446 healthy controls. Quality of life (QoL) and mental health were assessed using validated scales according to age: KINDL-R and the Pediatric Symptom Checklist (PSC) for children and the WhoQoL-Bref questionnaire, GAD and PHQ-9 in adults. Results: First, children and adults (but not adolescents) with IMD showed greater psychological effects than controls (p = 0.022, p = 0.026 respectively). Second, when comparing QoL, only adult patients with IMD showed worse score than controls (66/100 vs 74,6/100 respectively, p = 0.017). Finally, IMD had better quality of life than other rare neurological and genetic diseases (p = 0.008) or other rare diseases (p

BackgroundChronic bleeding due to gastrointestinal (GI) involvement in patients with hemorrhagic hereditary telangiectasia (HHT) can provoke severe anemia with high red blood cells (RBC) transfusion requirements. However, the evidence about how to deal with these patients is scarce. We aimed to assess the long-term efficacy and safety of somatostatin analogs (SA) for anemia management in HHT patients with GI involvement.MethodsThis is a prospective observational study including patients with HHT and GI involvement attended at a referral center. SA were considered for those patients with chronic anemia. Anemia-related variables were compared in patients receiving SA before and during treatment. Patients receiving SA were divided into responders (patients with minimal hemoglobin levels improvement >10 g/L and maintaining hemoglobin levels ≥80 g/L during treatment), and non-responders. Adverse effects during follow-up were collected.ResultsAmong 119 HHT patients with GI involvement, 67 (56.3%) received SA. These patients showed lower minimal hemoglobin levels (73 [60–87] vs. 99 [70.2–122.5], p

In patients with head and neck cancer, functional oropharyngeal dysphagia and tracheobronchial aspiration are potential aftereffects of radiotherapy (RT). Likewise, recurrent aspiration is a known cause of bronchiectasis and aspiration pneumonia. However, the signs and symptoms of dysphagia or aspiration may not be clinically obvious, and a high index of suspicion must be born in mind and elicited from the clinical data. Here we present a male with unnoticed recurrent aspiration as an aftereffect of neck RT, discuss our clinical management, and comment on the related literature. Resumen: En los pacientes con cáncer de cabeza y cuello, la disfagia orofaríngea funcional y la aspiración traqueobronquial son posibles secuelas de la radioterapia (RT). Asimismo, la aspiración recurrente es una causa conocida de bronquiectasias y neumonía por aspiración. Sin embargo, los signos y síntomas de disfagia o aspiración pueden no ser clínicamente evidentes, por lo que hay que tener presente un alto índice de sospecha y obtenerlo a partir de los datos clínicos. Aquí presentamos a un varón con aspiración recurrente inadvertida como secuela de una RT de cuello, discutimos nuestro tratamiento clínico y comentamos la literatura relacionada.

Birut&edot; Tumien&edot;,1,2 Mireia del Toro Riera,3 Jurgita Grikiniene,4 R&umacr;ta Samaitiene-Aleknien&edot;,4 R&umacr;ta Praninskien&edot;,4 Ahmad Ardeshir Monavari,5,6 Jolanta Sykut-Cegielska7 1Institute of Biomedical Sciences, Faculty of Medicine, Vilnius University, Vilnius, Lithuania; 2Vilnius University Hospital Santaros klinikos, Vilnius, Lithuania; 3Pediatric Neurology Department, Unit of Hereditary Metabolic Disorders, Hospital Universitari Vall d’Hebron, Barcelona, Spain; 4Clinic of Children’s Diseases, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, Vilnius, Lithuania; 5National Centre for Inherited Metabolic Disorders, Children’s Health Ireland at Temple Street Dublin, Dublin, Ireland; 6University College Dublin, Dublin, Ireland; 7Department of Inborn Errors of Metabolism and Paediatrics, the Institute of Mother and Child, Warsaw, PolandCorrespondence: Birut&edot; Tumien&edot;, Institute of Biomedical Sciences, Faculty of Medicine, Vilnius University, Santariskiu str. 2, Vilnius, LT-06681, Lithuania, Tel +370 614 45026, Email birute.tumiene@santa.ltAbstract: More than 650 inherited metabolic diseases may present with epilepsy or seizures. These diseases are often multisystem, life-long and induce complex needs of patients and families. Multidisciplinary care involves all stages of disease management: diagnostics, specific or symptomatic, acute and chronic treatments, and integrated care that takes into account not only medical, but also manifold psychosocial, educational, vocational and other needs of patients and their caregivers. Care coordination is indispensable to ensure smooth transitions of care across life and disease stages, including management of emergencies, transition from pediatric to adult services and palliative care. Care pathways are highly diverse and have to find the right balance between highly specialized and locally provided services. While multidisciplinary teams consist of many professionals, a named supervising physician in a highly specialized healthcare setting and a care coordinator are highly important. As the greatest burden of care always falls onto the shoulders of patients and/or families, patient empowerment should be a part of every care pathway and include provision of required information, involvement into common decision-making, patient’s and family’s education, support for self-management, liaison with peer support groups and emotional/ psychological support. Due to the rarity and complexity of these diseases, sufficient expertise may not be available in a national healthcare system and cross-border services (virtual or physical) in the recently developed European Reference Networks should be ensured through the proper organization of referral systems in each EU and EEA country. Finally, digital technologies are particularly important in the provision of services for patients with rare diseases and can significantly increase the availability of highly specialized services and expertise.Keywords: integrated care, transition, care pathways, care coordination, patient empowerment, management of emergencies

Introduction: it is vital to promote a conception and strategies of social prevention in Cuban universities appropriate to social problems and contradictions that their actors experience as socioethical subjects in various spheres of life to establish themselves as agents of change from a humanist and emancipatory praxis in accordance with the social project Cuban. Objective: to analyze critically and purposefully, from a sociological perspective, the role of social prevention as a tool for ethical-professional training in Cuban universities. Methods: systematic bibliographic review for critical reflection of documents, (diploma works, master's theses and doctorate 2008-2021), original and review articles (2010-2021) located in SciELO, Google academic and in the digital library of the Center of Community Studies (UCLV). It focused on approaches and discourses produced from the social sciences and politics on the problem. Development: the Cuban university must promote personal and social leadership in solving the problems of daily life (result or manifestation of the contradictions in society) in the exercise of different social roles and that from an ethical-critical position it acts in social prevention. Conclusions: sociological knowledge is a tool for self-reflection and institutional reflection to promote alternatives to traditional formalized preventive practices, critically articulating with ethical training. Prevention is an educational process and social intervention with the purpose of transforming behaviors and attitudes of vulnerability of professionals in training, detached from formalism and bureaucratization.

Herein, we present the first described hereditary hemorrhagic telangiectasia (HHT) patient treated with aflibercept for severe GI involvement after tachyphylaxis to bevacizumab, with promising results. HHT is a rare genetic disease characterized by systemic vascular malformations. Gastrointestinal telangiectasia is one of the major involvements that can produce chronic severe iron-deficiency anemia. Nowadays, support treatment with iron replacement therapy, red blood cell transfusions, and antiangiogenic drugs—mainly bevacizumab, a monoclonal antibody against vascular endothelial growth factor (VEGF)—are the main therapeutic options for this complication. The evidence of alternative drugs in patients with failure to this approach, such as tachyphylaxis to bevacizumab, is scarce. Aflibercept is a VEGF inhibitor with antiangiogenic properties approved for the treatment of different types of cancer and ocular neovascularization diseases.

The long-term clinical management and evolution of a cohort of critical COVID-19 survivors have not been described in detail. We report a prospective observational study of COVID-19 patients admitted to the ICU between March and August 2020. The follow-up in a post-COVID consultation comprised symptoms, pulmonary function tests, the 6-minute walking test (6MWT), and chest computed tomography (CT). Additionally, questionnaires to evaluate the prevalence of post-COVID-19 syndrome were administered at 1 year. A total of 181 patients were admitted to the ICU during the study period. They were middle-aged (median [IQR] of 61 [52;67]) and male (66.9%), with a median ICU stay of 9 (5–24.2) days. 20% died in the hospital, and 39 were not able to be included. A cohort of 105 patients initiated the follow-up. At 1 year, 32.2% persisted with respiratory alterations and needed to continue the follow-up. Ten percent still had moderate/severe lung diffusion (DLCO) involvement (

Salmonella enterica es un patógeno transmitido por alimentos y agente etiológico de brotes alimentarios de gran impacto en la salud humana. El aumento de la resistencia bacteriana constituye una amenaza a la salud pública, la aparición de cepas de Salmonella con resistencia a múltiples antimicrobianos (MDR) fue descrita en humanos, alimentos y animales para consumo; por ello se considera muy importante conocer la situación epidemiológica local. El objetivo de este trabajo fue generar información sobre los serotipos circulantes, resistencia a los antibióticos y presencia de resistencia simultánea a múltiples fármacos en Salmonella provenientes de muestras clínicas humanas y muestras de alimentos en el periodo desde 2017 a 2019. Fueron analizadas un total de 668 cepas de Salmonella aisladas en los años 2017, 2018 y 2019 a partir de muestras clínicas humanas y de alimentos, en el Laboratorio Central de Salud Pública y/o remitidas por Laboratorios de la Red de Enteropatógenos. Se observaron serotipos muy diversos con prevalencia del serovar Heidelberg en alimentos y Typhimurium en muestras de humanos. Se encontró que el 45,4% de las cepas fueron sensibles a todos los antibióticos (ATB), el 35,6% fueron resistentes de 1 a 6 ATB y el 19% con sensibilidad intermedia; observándose mayor resistencia a Tetraciclina, Ác. Nalidíxico, Ampicilina y Nitrofurantoína, en menor grado se evidenció resistencia a cefalosporinas (C3ªG) y a ciprofloxacina. El 16.9% de las cepas presentaron resistencia múltiple (3 o más antibióticos) con 37 fenotipos distintos. Las serovariedades que presentaron mayor resistencia a los antimicrobianos fueron Heidelberg, Schwarzengrund y Typhimurium.

BackgroundA better understanding of COVID-19 immunopathology is needed to identify the most vulnerable patients and improve treatment options.ObjectiveWe aimed to identify immune system cell populations, cytokines, and inflammatory markers related to severity in COVID-19.Methods139 hospitalized patients with COVID-19−58 mild/moderate and 81 severe/critical—and 74 recovered patients were included in a prospective longitudinal study. Clinical data and blood samples were obtained on admission for laboratory markers, cytokines, and lymphocyte subsets study. In the recovered patients, lymphocyte subsets were analyzed 8–12 weeks after discharge.ResultsA National Early Warning Score 2 >2 (OR:41.4; CI:10.38–167.0), ferritin >583 pg/mL (OR:16.3; CI: 3.88–69.9), neutrophil/lymphocyte ratio >3 (OR: 3.5; CI: 1.08–12.0), sIL-2rα (sCD25) >512 pg/mL (OR: 3.3; CI: 1.48–7.9), IL-1Ra >94 pg/mL (OR: 3.2; IC: 1.4–7.3), and IL-18 >125 pg/mL (OR: 2.4; CI: 1.1–5.0) were associated with severe/critical COVID-19 in the multivariate models used. Lower absolute values of CD3, CD4, CD8, and CD19 lymphocytes together with higher frequencies of NK cells, a CD4 and CD8 activated (CD38+HLA-DR+) memory T cell and effector memory CD45RA+ (EMRA) phenotype, and lower T regulatory cell frequencies were found in severe/critical patients relative to mild/moderate and recovered COVID-19 patients. A significant reduction in Th1, Tfh1, and Tc1 with higher Th2, Tfh2, Tc2, and plasma cell frequencies was found in the most severe cases.ConclusionA characteristic hyperinflammatory state with significantly elevated neutrophil/lymphocyte ratio and ferritin, IL-1Ra, sIL-2rα, and IL-18 levels together with a “low T1 lymphocyte signature” was found in severe/critical COVID-19 patients.

Therapeutic hypothermia and/or cooling therapy are suggested to have benefits in patients with acute traumatic brain injury, and several systematic reviews (SRs) have been performed to synthesize the evidence from randomized clinical trials (RCTs). The objective of this critical appraisal study was to assess the methodological quality of SRs that evaluated the use of therapeutic hypothermia and/or cooling therapy in patients with acute traumatic brain injury. A broad and sensitive search of the literature was performed in March 2019. Four major electronic databases (MEDLINE, EMBASE, LILACS and Cochrane Library) were considered. The study selection, data extraction and the appraisal of the methodological quality was carried out by two independent reviewers. The methodological quality of the included SRs was assessed using the AMSTAR-2 (A MeaSurement Tool to Assess systematic Reviews) tool. The search strategy retrieved 149 articles, and 16 SRs were included after the selection process. They were published between 2003 and 2018, and the number of included clinical trials varied from 0 to 37. The overall confidence in the results from included SRs was graded as critically low in 53.3%, low in 13.3%, moderate in 20%, high in 13.3%. In Conclusion, most of the included SRs had poor methodological quality and only two systematic reviews were judged as having high overall confidence in the results in accordance to AMSTAR-2. Decision makers should consider the overall quality of the synthesis when using or recommending hypothermia and/or cooling therapy for practice.

Background: chronic media otitis is an important cause of morbidity, hearing impairment and hospital admissions due to recurrences and complications, with modified radical mastoidectomy being the appropriate technique to achieve anatomical and functional results. Objective: to describe the results of the modified radical mastoidectomy in patients with suppurative chronic media otitis. Methods: a retrospective, longitudinal descriptive study in 54 patients with chronic media otitis, who underwent modified radical mastoidectomy. The variables under study were of clinical and epidemiological characterization and the results were evaluated as excellent, good, fair and bad. The data were processed using descriptive statistics for distribution of absolute and relative frequencies, and were reflected in tables. Results: the largest number of patients was male, between the third and fourth decade of life; hearing loss, otorrhea and tympanic perforation were the most frequent manifestations. The tumor image and conductive hearing loss and Pseudomonas aeruginosa were found more frequently. The mastoidectomy with tympanoplasty type III by lysis of the ossicles, clean, wide cavities, low walls and intact graft, allowed the majority of patients to have good anatomical and functional results, and complications were scarce. Conclusions: the technique used was modified radical mastoidectomy, associated with tympanoplasty type III and excellent, good and regular results prevailed in the operated patients. DeCS: MASTOIDECTOMY/methods; TYMPANOPLASTY/methods; CHOLESTEATOMA/surgery; OTITIS MEDIA, SUPPURATIVE/surgery; OTITIS MEDIA, SUPPURATIVE/complications.

Mauro José de Deus Morais,1–3 Luiz Carlos de Abreu,2–4 Fabiano Santana de Oliveira,1–3 Italla Maria Pinheiro Bezerra,2,3,5 Rodrigo Daminello Raimundo,3 Romeu Paulo Martins Silva,1 Vitor Engracia Valenti,6 Andrés Ricardo Pérez-Riera2,31Centro de Saúde e Desporto, Universidade Federal do Acre, Rio Branco, Acre, Brazil; 2Laboratório de Delineamento em Pesquisas e Escrita Científica, Centro Universitário Saúde ABC Santo André, São Paulo, Brazil; 3Laboratório de Delineamento em Pesquisas e Escrita Científica, Escola Superior de Ciências da Santa Casa de Misericórdia de Vitória, Vitória, Espirito Santo, Brazil; 4Graduate Entry Medical School, University of Limerick, Limerick V94 T9PX, Ireland; 5Escola Superior de Ciências da Santa Casa de Misericórdia, EMESCAM, Vitória, Brazil; 6Centro de Estudos do Sistema Nervoso Autônomo, State University of São Paulo, Marília, São Paulo, BrazilCorrespondence: Mauro José de Deus MoraisCentro de Saúde e Desporto, Universidade Federal do Acre, Rua Gumercindo, nº 292, Bairro: Universitário, Rio Branco 69.917.698, Acre, BrazilTel +55 6 899 971 6122Email maurodedeus@outlook.comItalla Maria Pinheiro BezerraEscola Superior de Ciências da Santa Casa de Misericórdia, EMESCAM, Bolsista Capes Brasil, Vitória, Rio Branco 69.915-900, BrazilTel +55 2 799 253 4941Email italla.bezerra@emescam.brIntroduction: Physical exercises help in the rehabilitation and recovery of various diseases. Cardiovascular and hypertension problems are the main causes of people being affected by kidney problems, which as a consequence, affects the heart rate variability (HRV) of the individual. Physical activity developed in a well-planned and thorough way can be a component in the treatment of this problem.Objective: We aimed to evaluate the effects of aerobic exercise intervention during hemodialysis on autonomic heart rate regulation in individuals with chronic kidney disease (CKD).Methods: This was a longitudinal trial conducted in 19 CKD patients. The patients underwent three weekly sessions of aerobic exercise during hemodialysis for 30 mins for 12 weeks (three months).Results: HRV was analyzed before and after the protocol training. Linear indices of HRV were not different between before and after the protocol training. Nonlinear HRV analysis indicated reduced values of determinism (p=0008, Cohen’s d=0.82) and entropy (p=003, Cohen’s d=0.84) after the training protocol.Conclusion: In conclusion, aerobic exercise training during hemodialysis did not improve autonomic control of heart rate in CKD patients.Keywords: autonomic nervous system, cardiovascular system, exercise, kidney diseases, renal dialysis

CONTEXT: Based on the results of preliminary studies, the off-label use of hydroxychloroquine for COVID-19 infection has been observed in practice. OBJECTIVES: To identify, systematically assess and summarize the best available evidence on the efficacy and safety of the use of hydroxychloroquine and chloroquine for COVID-19 infection. METHODS: Rapid systematic review. RESULTS: After the selection process, 30 studies were included: one open-label randomized trial, one open-label non-randomized trial and 28 ongoing studies. The outcome 'detection of viral load in oral swab' (surrogate outcome) was evaluated by both studies, involving a total of 72 participants. The findings of the studies were discordant: one study observed a higher frequency of negative viral load associated with hydroxychloroquine on day-7, while the other study did not observe any difference between hydroxychloroquine and the control group (standard treatment) on day-6. Both studies have methodological limitations when evaluated by specific tools according to study design (Cochrane Bias Risk Table and ROBINS-I). CONCLUSION: This rapid systematic review identified two clinical studies (with available data), with limited methodological quality, that evaluated the effects of hydroxychloroquine for COVID-19 infection. Based on the findings of these two studies, the efficacy and safety of hydroxychloroquine and chloroquine in patients with COVID-19 is still uncertain (very low evidence certainty) and its routine use for this situation should not be recommended until the results of ongoing studies could provide a proper assessment of their effects.

Está bastante difundida la idea de que los valores y las actitudes forman parte de los contenidos de enseñanza-aprendizaje. A tales efectos se exponen algunos aspectos relacionados con el proceso de formación de valores, donde se revela la importancia del valor responsabilidad en la integración de la Farmacología con el proceso de atención de enfermería en la formación curricular, en beneficio de la calidad y la excelencia en los servicios de salud

Se realizó un estudio descriptivo y transversal de 188 gerontes, ingresados en la Sala de Cuidados Intensivos del Hospital General Docente "Dr. Juan Bruno Zayas Alfonso" de Santiago de Cuba, durante el 2012, a fin de caracterizarles según variables de interés. En la casuística primaron el sexo femenino, el grupo etario de 60-74 años y las enfermedades quirúrgicas. Requirieron de ventilaron mecánica invasiva 47 ancianos (35,0 %), de los cuales fallecieron 33 (70,0 %). La corta estadía en la unidad estuvo relacionada con el mayor número de pacientes vivos

Se realizó un estudio descriptivo, transversal y retrospectivo de 175 pacientes, que requirieron de ventilación mecánica invasiva, ingresados en la Unidad de Cuidados Intensivos del Hospital General Docente "Dr. Juan Bruno Zayas Alfonso" de Santiago de Cuba, durante el año 2012, a fin de caracterizar los aspectos relacionados con la morbilidad y mortalidad en estos afectados. Se evidenció que el riesgo de fallecer para estos pacientes estuvo asociado a factores, tales como: edad avanzada, profundas alteraciones fisiológicas en relación con sus antecedentes personales, tiempo de ventilación mecánica y prolongada estadía en la unidad. Predominó la neumonía asociada a la ventilación mecánica como la principal causa de muerte relacionada directamente con gérmenes gramnegativos altamente invasivos y el mayor número de fallecidos correspondió a los pacientes operados

OBJECTIVES: To assess the quality of systematic reviews and clinical trials on women's health recently published in a Brazilian evidence-based health journal. METHOD: All systematic reviews and clinical trials on women's health published in the last five years in the Brazilian Journal of Evidence-based Health were retrieved. Two independent reviewers critically assessed the methodological quality of reviews and trials using AMSTAR and the Cochrane Risk of Bias Table, respectively. RESULTS: Systematic reviews and clinical trials accounted for less than 10% of the 61 original studies on women's health published in the São Paulo Medical Journal over the last five years. All five reviews were considered to be of moderate quality; the worst domains were publication bias and the appropriate use of study quality in formulating conclusions. All three clinical trials were judged to have a high risk of bias. The participant blinding, personnel and outcome assessors and allocation concealment domains had the worst scores. CONCLUSIONS: Most of the systematic reviews and clinical trials on women's health recently published in a Brazilian evidence-based journal are of low to moderate quality. The quality of these types of studies needs improvement.

Fundamento: la salud y el trabajo están estrechamente relacionados, este último es una actividad que el individuo desarrolla para satisfacer sus necesidades y tener una vida digna, además, es un medio en el cual se desarrollan capacidades tanto físicas como psicológicas. Las enfermedades cardíacas, y en particular el infarto agudo miocárdico, son las que con más frecuencia apartan al individuo del quehacer laboral. Objetivo: describir el comportamiento de la reincorporación laboral en los pacientes con infarto agudo de miocardio. Método: se realizó un estudio observacional longitudinal descriptivo, con un universo constituido por 106 pacientes de las áreas de salud correspondientes al Policlínico Comunitario Docente Dr. Carlos J. Finlay y Joaquín de Agüero de la provincia Camagüey, que sufrieron infarto agudo miocárdico de julio a diciembre del año 2010. La muestra no probabilística quedó integrada por 81 pacientes. Resultados: la mayor parte de los pacientes reincorporados estaban entre los 48 y 53 años. El 69,2 % de los pacientes reincorporados lograron adecuar su trabajo. Un 75 % de los pacientes reinsertados laboralmente, recibieron rehabilitación cardiovascular después del episodio de infarto cardiaco. Conclusiones: los pacientes del grupo de edad entre 48 y 53 años, presentaron una buena satisfacción laboral, los que tuvieron posibilidades de adecuar su actividad laboral luego del infarto, así como los que recibieron rehabilitación cardiovascular integral y que con mayor número se reinsertaron laboralmente.

Fundamento: la elevación de la cultura sanitaria de los pacientes, la creación de programas encaminados a mejorar el estado de salud de la población y la introducción de la cirugía de mínimo acceso ha elevado la frecuencia de la cirugía ambulatoria. Objetivo: evaluar el trabajo realizado por los médicos y las enfermeras de la familia con los pacientes quirúrgicos ambulatorios de tres áreas de salud del municipio Camagüey, durante el año 2010. Método: se realizó un estudio observacional, descriptivo y transversal, con un universo de 4 170 pacientes y una muestra de 196. Los datos se obtuvieron de las encuestas, las historias cínicas y los informes operatorios. Se utilizó estadística descriptiva. Resultado s: los médicos de familia realizaron el 50,5 % de los diagnósticos, coordinaron el 24,5 % de las operaciones, identificaron el 52,2 % de las complicaciones posoperatorias y trataron el 30,4 % de ellas. El equipo básico de salud curó el 66,8 % de los pacientes y retiraron el 64,8 % de las suturas. El 17,3 % de los casos se ingresaron y el 68,9 % de los pacientes tuvieron una opinión buena respecto al trabajo. Conclusion es: el trabajo desempeñado por el equipo básico de salud a los pacientes quirúrgicos ambulatorios fue evaluado de regular.

Se realizó un estudio descriptivo y retrospectivo en la Unidad de Cuidados Intensivos del Hospital General Docente "Dr. Juan Bruno Zayas Alfonso" de Santiago de Cuba, desde enero hasta diciembre de 2009, a fin de precisar lo concerniente a la ventilación mecánica asociada a neumonía, para lo cual se analizaron las variables demográficas de interés, así como las afecciones que condicionaron el uso de la ventilación mecánica, los gérmenes aislados, los días con el procedimiento y el estado al egreso. En la casuística predominaron el sexo masculino (73,4 %) y las edades de 56-75 años (73,3 %). La enfermedad cerebrovascular (53,3 %) constituyó la principal causa por la cual los pacientes requirieron ventilación mecánica. Los gérmenes frecuentemente aislados en las secreciones endotraqueales fueron Klebsiella (26,6 %) y Escherichia coli (20,0 %). Del séptimo al décimo días con ventilación mecánica fue el tiempo promedio cuando se presentó con mayor frecuencia la neumonía hospitalaria. Dos terceras partes de los integrantes de la serie fallecieron, para una alta tasa de letalidad en el Servicio. Al igual que en otras casuísticas, quedó por aclarar si el paciente muere por neumonía asociada a la ventilación o con neumonía asociada a esta.A descriptive and retrospective study was carried out at the Intensive Care Unit from "Dr Juan Bruno Zayas Alfonso" Teaching General Hospital in Santiago de Cuba from January to December, 2009 in order to specify the information about mechanical ventilation associated with pneumonia. For this purpose, demographic variables of interest, isolated germens, days during the procedure application, and physical condition when being discharged from the hospital, as well as the affections that suggested using mechanical ventilation, were analyzed. Male sex (73,4 %) and age between 56 and 57 years (73,3 %) were predominant in the case material. Cerebrovascular disease (53,3 %) constituted the primary cause for which patients required mechanical ventilation. Klebsiella (26,6 %) and Escherichia coli (20,0 %) were the germens frequently isolated in the endotraqueal secretions. Average period of time receiving mechanical ventilation included from the seventh to the tenth day, when the highest frequency of hospital pneumonia was observed. Two third parts of the subjects in the series died, showing a high rate of mortality. Just like in other case materials, further research is needed to clarify whether the patient dies due to pneumonia associated with ventilation or suffering from pneumonia associated with ventilation.

OBJECTIVES: To estimate the direct costs of hospital stays for premature newborns in the Interlagos Hospital and Maternity Center in São Paulo, Brazil and to assess the difference between the amount reimbursed to the hospital by the Unified Health System and the real cost of care for each premature newborn. METHODS: A cost-estimate study in which hospital and professional costs were estimated for premature infants born at 22 to 36 weeks gestation during the calendar year of 2004 and surviving beyond one hour of age. Direct costs included hospital services, professional care, diagnoses and therapy, orthotics, prosthetics, special materials, and blood products. Costs were estimated using tables published by the Unified Health System and the Brasindice as well as the list of medical procedures provided by the Brazilian Classification of Medical Procedures. RESULTS: The average direct cost of care for initial hospitalization of a premature newborn in 2004 was $2,386 USD. Total hospital expenses and professional services for all premature infants in this hospital were $227,000 and $69,500 USD, respectively. The costs for diagnostic testing and blood products for all premature infants totaled $22,440 and $1,833 USD. The daily average cost of a premature newborn weighing less than 1,000 g was $115 USD, and the daily average cost of a premature newborn weighing more than 2,500 g was $89 USD. Amounts reimbursed to the hospital by the Unified Health System corresponded to only 27.42% of the real cost of care. CONCLUSIONS: The cost of hospital stays for premature newborns was much greater than the amount reimbursed to the hospital by the Unified Health System. The highest costs corresponded to newborns with lower birth weight. Hospital costs progressively and discretely decreased as the newborns' weight increased.

Introducción. Los programas de visualización permiten profundizar el conocimiento teórico sobre la estructura proteica. Este trabajo tiene por finalidad familiarizar al alumno con el manejo del programa de visualización molecular RasMol v. 2.7.2 para el análisis de proteínas, ya que integra conocimientos previos y persigue otros objetivos generales de la formación universitaria. Materiales y métodos. El trabajo se contextualizó considerando el eje integrador de las materias. Además, se articuló con los contenidos conceptuales y procedimentales de la temática "Niveles estructurales de las proteínas". En primer lugar, se seleccionaron actividades que permitieran evaluar aspectos vinculados con la formación general pretendida para este nivel de la enseñanza formal, como expresión escrita y oral, interpretación de textos científicos en idioma inglés y manejo de base de datos bibliográficos. Resultados y conclusiones. El 70% de los alumnos pudo realizar las actividades de manera satisfactoria. La mayoría de los grupos enfatizó tanto las cuestiones teóricas como las netamente inherentes al manejo del programa. El 30% tuvo problemas de expresión oral y escrita. Se notaron algunas dificultades en la interpretación de los modelos teóricos planteados y en la interpretación del idioma inglés, pero también hubo desconocimiento previo de la temática y falta de iniciativa para la búsqueda de material complementario. Se propone la inclusión de algunas revisiones en idioma nativo, sin perjuicio de los textos en inglés, y ejemplos más sencillos de manera introductoria para los programas de visualización, con una paulatina incorporación de ejemplos más complejos que requieran lectura complementaria.Introduction. Visualizations programs allow to analyze deeply theoretical knowledge of protein structure. The aim of this work was to familiarize the students with the molecular visualization program RasMol v. 2.7.2 for protein analysis, integrating previous concepts and pursuing other general objectives of university formation. Materials and methods. The work was contextualized considering the integrative axis of the subjects, articulating it with conceptual and procedural contents of the topic "Protein Structure Levels". Activities were selected in order to evaluate different aspects of the general formation pretended at this level of teaching, like oral and written expression, interpretation of scientific papers in English, and bibliographic database search. Results and conclusions. 80% of the students were able to do the proposed activities with acceptable quality. Most of the students equally emphasized both the theoretical and practical procedures. 30% of the students have shown problems with oral or written expression. We noticed some difficulties in the interpretation of the proposed theoretical models and interpretation of the scientific papers in English. Additionally students did not show previous knowledge of the topics and did not look up for complementary bibliography. We propose to include some reviews in native language and simpler examples to serve as an introduction to the visualization program, with gradual incorporation of more complex models that require complementary bibliography reading.

OBJECTIVES: There is a direct relationship between the regression of left ventricular hypertrophy (LVH) and a decreased risk of mortality. This investigation aimed to describe the effects of anti-hypertensive drugs on cardiac hypertrophy through a meta-analysis of the literature. METHODS: The Medline (via PubMed), Lilacs and Scielo databases were searched using the subject keywords cardiac hypertrophy, antihypertensive and mortality. We aimed to analyze the effect of anti-hypertensive drugs on ventricle hypertrophy. RESULTS: The main drugs we described were enalapril, verapamil, nifedipine, indapamina, losartan, angiotensin-converting enzyme inhibitors and atenolol. These drugs are usually used in follow up programs, however, the studies we investigated used different protocols. Enalapril (angiotensin-converting enzyme inhibitor) and verapamil (Ca++ channel blocker) caused hypertrophy to regress in LVH rats. The effects of enalapril and nifedipine (Ca++ channel blocker) were similar. Indapamina (diuretic) had a stronger effect than enalapril, and losartan (angiotensin II receptor type 1 (AT1) receptor antagonist) produced better results than atenolol (selective β1 receptor antagonist) with respect to LVH regression. CONCLUSION: The anti-hypertensive drugs induced various degrees of hypertrophic regression.