Generation of densely labeled oligonucleotides for the detection of small genomic elements.

The genome contains numerous regulatory elements that may undergo complex interactions and contribute to the establishment, maintenance, and change of cellular identity. Three-dimensional genome organization can be explored with fluorescence in situ hybridization (FISH) at the single-cell level, but the detection of small genomic loci remains challenging. Here, we provide a rapid and simple protocol for the generation of bright FISH probes suited for the detection of small genomic elements. We systematically optimized probe design and synthesis, screened polymerases for their ability to incorporate dye-labeled nucleotides, and streamlined purification conditions to yield nanoscopy-compatible oligonucleotides with dyes in variable arrays (NOVA probes). With these probes, we detect genomic loci ranging from genome-wide repetitive regions down to non-repetitive loci below the kilobase scale. In conclusion, we introduce a simple workflow to generate densely labeled oligonucleotide pools that facilitate detection and nanoscopic measurements of small genomic elements in single cells.

Interdisciplinary Delphi study by PROSEC North America: Recommendations on single indirect restorations made from ceramic and nonmetallic biomaterials for posterior teeth.

OBJECTIVE: This article puts forward consensus recommendations from PROSEC North America regarding single indirect restorations made from ceramic and nonmetallic biomaterials in posterior teeth. OVERVIEW: The consensus process involved a multidisciplinary panel and three consensus workshops. A systematic literature review was conducted across five databases to gather evidence. The recommendations, informed by findings from systematic reviews and formulated based on a two-phase e-Delphi survey, emphasize a comprehensive treatment strategy that includes noninvasive measures alongside restorative interventions for managing dental caries and tooth wear. The recommendations advocate for selecting between direct and indirect restorations on a case-by-case basis, favoring inlays and onlays over crowns to align with minimally invasive dentistry principles. The recommendations highlight the critical role of selecting restorative biomaterials based on clinical performance, esthetic properties, and adherence to manufacturer guidelines. They emphasize the importance of precision in restorative procedures, including tooth preparation, impression taking, contamination control, and luting. Regular follow-up and maintenance tailored to individual patient needs are crucial for the longevity of ceramic and nonmetallic restorations. CONCLUSIONS: These PROSEC recommendations provide a framework for dental practitioners to deliver high-quality restorative care, advocating for personalized treatment planning and minimally invasive approaches to optimize oral health outcomes. CLINICAL SIGNIFICANCE: The PROSEC North America recommendations highlight the importance of minimally invasive techniques in posterior tooth restorations using ceramic and non-metallic biomaterials. These principles prioritize tooth structure conservation and personalized treatment planning, essential for enhancing clinical outcomes and long-term oral health.

Effect of cervical contralateral lateral flexion on the median nerve and fascia at the wrist - Cadaveric study.

BACKGROUND: Neurodynamic tests are an essential aspect of the physical examination of the patient when suspicion of neural involvement exists. A manoeuvre that is hypothesised to move nerves differentially relative to other structures (structural differentiation) has been proposed as a necessary part of neurodynamic testing for differential diagnosis. However, although the specificity of structural differentiation for peripheral nerve over muscle has been demonstrated in some body regions, no study has tested specificity of nerve movement relative to fascia. OBJECTIVES: The aim of this study was to measure the effect of the cervical contralateral lateral flexion (CCLF) as an structural differentiation manoeuvre for the median nerve compared to fascia (superficial and deep) at the wrist during the upper limb neurodynamic test 1 (ULNT1). DESIGN: A cross-sectional study was performed in 5 fresh frozen cadavers. METHODS: Excursion and strain in the fascia (superficial and deep) and the median nerve were measured at the wrist with structural differentiation during the ULNT1. KINOVEA software was used to measure kinematic parameters. RESULTS: CCLF resulted in significant proximal excursion in the median nerve (p < 0.001*) but not in the strain. CCLF neither produced changes in strain nor excursion in the superficial and deep fascia (p > 0.05). CONCLUSION: This study showed that CCLF produced significant differential excursion in the median nerve at the wrist compared to the local superficial and deep fascia during the ULNT1. The data support CCLF in mechanical differentiation between nerve and fascia in this area in diagnosis of local sources of wrist pain.

Assessment of the shock index in septic shock: A systematic review.

OBJECTIVE: To identify published research on the Shock Index (SI) in patients with septic shock or severe sepsis and to describe its main findings and conclusions. DESIGN: Systematic review of the literature following the recommendations of the PRISMA protocol (Preferred Reporting Items for Systematic Reviews and Meta-Analyses). SETTINGS: The following databases were consulted: Pubmed, Embase, Library Cochrane and Lilacs. PATIENTS: Patients older than 14 years with septic shock. Pregnant women and population with COVID-19 were excluded. INTERVENTIONS: Studies reporting measurement of the shock index or its modified variants. MAIN VARIABLES OF INTEREST: Absolute frequencies and relative frequencies were assessed with measures of central tendency and dispersion. Effect estimators (OR, RR and HR) were extracted according to the context of each study. RESULTS: Seventeen articles were included, of which 11 investigated the SI as a predictor of mortality. Seven of them found significant differences in the SI when comparing survivors to non-survivors and observed a relationship between the SI evolution and clinical outcomes. Additional research evidenced a relation between the Modified Shock Index and myocardial depression, as well as mortality. Furthermore, they identified a relationship between the Diastolic Shock Index, the dose of administered dobutamine, and mortality. CONCLUSIONS: The results suggest that both the SI and its modified versions, particularly in serial assessments, can be considered for evaluating patient prognosis. The SI can also aid in determining fluid management for patients.

Comparative evaluation of dissolution profiles of the generic drug lamivudine 150 mg tablet marketed in Peru vs. the innovative Epivir. / Evaluación comparativa de perfiles de disolución del medicamento genérico lamivudina tableta 150 mg comercializado en Perú frente al innovador Epivir.

Lamivudine is one of the most prescribed drugs in the world, and is used to treat human immunodeficiency and hepatitis B. This study aimed to evaluate the quality attributes and compare the dissolution profiles of two batches (A and B) of generic lamivudine 150 mg tablets with the innovator drug Epivir 150 mg tablets. We conducted an analytical, experimental, cross-sectional study, and used a spectrophotometric method at a wavelength of maximum absorption (λ) corresponding to 270 nm, to measure the percentage of dissolved drug. The study evaluated identification, content, dissolution and mass uniformity. Apparatus 2 USP (Paddle) 75 rpm, 900 mL of dissolution medium (37 ± 0.5 °C) was used in three dissolution media: pH 1.2; 4.5 and 6.8. Samples of 5 mL were obtained at 5, 10, 15, 20 and 30 min. Both batches of generic lamivudine (A and B) were found to have the same dissolution kinetic profile as the innovator drug. Both formulations met the criteria of very fast dissolving (85% dissolved in 15 min), and fast dissolving (85% dissolved in 30 min) drugs. Therefore, it was not necessary to calculate the similarity factor. We concluded that generic drugs A and B are in vitro equivalents to the innovator drug Epivir. Motivation for the study. To evaluate the quality of antiretroviral drugs used in the treatment of HIV dispensed in the HAART Program of the Ministry of Health of Peru. Main findings. Two batches of generic lamivudine drugs were found to achieve a dissolution rate greater than 85% at 15 min, being equivalent in vitro to the reference product Epivir. Implications. There is a need to apply the current regulations regarding equivalence between drugs by the regulatory authority prior to their authorization and to include dissolution profile tests as a requirement in public drug purchases, especially in national strategies (HIV, TB, etc.), in order to ensure quality products for the population.

La lamivudina es uno de los medicamentos más prescritos en el mundo, se utiliza para tratar la inmunodeficiencia humana y la hepatitis B. El objetivo del estudio fue evaluar los atributos de calidad y comparar los perfiles de disolución de dos lotes (A y B) del medicamento genérico lamivudina 150 mg tabletas con el medicamento innovador Epivir 150 mg tabletas. Se realizó un estudio analítico, experimental y de corte transversal, se usó un método espectrofotométrico a una longitud de onda de máxima absorción (λ) correspondiente a 270 nm, para medir el porcentaje de fármaco disuelto. El estudio evaluó identificación, contenido, disolución y uniformidad de masas. Se usó el aparato 2 USP (Paleta) 75 rpm, 900 mL de medio de disolución (37 ± 0,5 °C) a en tres medios de disolución: pH 1,2; 4,5 y 6,8. Se retiraron muestras de 5 mL a los 5, 10, 15, 20 y 30 min. Se encontró que ambos lotes de lamivudina genérico (A y B) presentan el mismo perfil cinético de disolución que el medicamento innovador. Ambas formulaciones cumplen con el criterio de medicamentos de disolución muy rápida (85% disuelto en 15 min), y de disolución rápida (85% disuelto en 30 min). Por lo tanto, no fue necesario calcular el factor de similitud. Se concluye que los medicamentos genéricos A y B son equivalentes in vitro con el medicamento innovador Epivir. Motivación para realizar el estudio. Evaluar la calidad de los medicamentos antirretrovirales usados en el tratamiento del VIH dispensados en el Programa TARGA del Ministerio de Salud de Perú. Principales hallazgos. Se encontró que dos lotes de medicamentos genéricos de lamivudina alcanzaron un porcentaje de disolución mayor del 85% a los 15 min, siendo equivalentes in vitro al producto de referencia Epivir. Implicancias. Existe la necesidad de aplicar la normatividad vigente respecto a equivalencia entre fármacos por parte de la autoridad regulatoria previo a su autorización e incluir ensayos de perfil de disolución como requisito en las compras públicas de medicamentos, especialmente en las estrategias nacionales (VIH, TBC, etc.), con la finalidad de asegurar productos de calidad para la población.

What Is New about the Semimembranosus Distal Tendon? Ultrasound, Anatomical, and Histological Study with Clinical and Therapeutic Application.

The semimembranosus muscle inserts into several tendons that are associated with some pathologies. Although ultrasound is useful for studying, diagnosing, and managing these pathologies, the correct interpretation of any images requires a clear knowledge of the related anatomical structures and the inter-related functions. We studied 38 cryopreserved non-paired knees from adult anatomical specimens and 4 non-paired knees from 29 to 38-week-old fetuses. The semimembranosus muscle and its tendons were located, observed, and injected under ultrasound guidance. The macroscopic anatomy was studied using dissection and anatomical cuts and the tendons were analyzed histologically. Measurements of muscle were taken 10 cm from the medial epicondyle and just before the tendon divided. The ultrasound facilitated the identification of the different divisions of the tendon of semimembranosus muscle and the rotation of the muscle and tendon from medial to posterior. An anatomical study confirmed this rotation and revealed an average width, thickness, and diameter of 38.29 mm, 14.36 mm, and 112.64 mm, respectively. Important relationships were observed between the divisions of the main tendons and the medial collateral ligament, the posterior side of the knee and popliteus muscle. This information can help to explain knee pathologies and facilitate rehabilitation after surgery.

Breast Vascularization and Its Implication in Breast Reduction and Mastopexy Surgery: Anatomical Study.

(1) Background: Breast reduction is one of the most frequently performed plastic surgeries in women worldwide. The Wise pattern breast reduction is one of the most frequent skin designs for this surgery. One key point of the surgery is to preserve a well-vascularized NAC by using different surgical pedicles. This study aims to test and update the anatomical knowledge of breast vascularization, the topographic and anatomical basis of the different surgical vascular pedicles, and the differences between the right and left sides. (2) Methods: A descriptive observational anatomical study was carried out on 15 breasts from 10 cryopreserved body donors. A dissection was performed by quadrants to know the affected arteries' origin in the different patterns. (3) Results: The largest and most frequently dissected internal mammary perforator artery was in the second intercostal space. A total of 44.9% of the dissected perforators are located in the upper inner quadrant, compared to 53.5% in the lower quadrants. (4) Conclusions: The upper inner quadrant alone has the most arterial perforators. In contrast, the sum of the two lower quadrants represents the greatest vascularization of the breast, with a small difference between both.

Human shoulder anatomy: new ultrasound, anatomical, and microscopic perspectives.

This study aimed to describe the shoulder anatomy, together with the anatomical relationships in adults and early stages of development. The shoulder muscles were studied from ultrasound, anatomical, and microscopic perspectives in a sample of 34 human shoulders. Thickness measurements were taken of the tendons and fasciae of the subscapularis, long head tendon of the biceps brachii, supraspinatus, infraspinatus, and teres minor. Ultrasound and dissection techniques are strongly correlated. However, the measurements obtained from the dissection technique were superior to those obtained from the ultrasound in all cases, except for the thickness of the long head tendon of the biceps brachii, the teres minor tendon, and the fascia thickness of the infraspinatus. In addition, the study of shoulder anatomy revealed no differences between females and males. Relevant findings from dissection included a clear overlap between the infraspinatus and supraspinatus, which shared tendon fibers, and a similar connection between the transverse ligament of the long head tendon of the biceps brachii and the subscapularis, which created a more interconnected shoulder function. The study of the anatomical measurements shows an underestimation of the shoulder measurements in the ultrasound compared with the dissection technique, but a high correlation between the measurements made by the two techniques. We present reference values for the tendon and fascia thicknesses of the rotator cuff, with no differences observed by gender. The relationships between shoulder structures described in the anatomical study imply as well that, in the event of an injury, adjacent tissues may be affected. This extended information may facilitate future optimal clinical explorations.

Cluster headache: an update on clinical features, epidemiology, pathophysiology, diagnosis, and treatment.

Cluster headache (CH) is one of the worst primary headaches that remain underdiagnosed and inappropriately treated. There are recent advances in the understanding of this disease and available treatments. This paper aims to review CH's recent clinical and pathophysiological findings, diagnosis, and treatment. We performed a narrative literature review on the socio-demographics, clinical presentations, pathophysiological findings, and diagnosis and treatment of CH. CH affects 0.1% of the population with an incidence of 2.07-9.8/100,00 person-years-habitants, a mean prevalence of 53/100,000 inhabitants (3-150/100,000 inhabitants). The male-to-female ratio remains inconclusive, as the ratio of 4.3:1 has recently been modified to 1.3-2.6, possibly due to previous misdiagnosis in women. Episodic presentation is the most frequent (80%). It is a polygenetic and multifactorial entity that involves dysfunction of the trigeminovascular system, the trigeminal autonomic reflex, and the hypothalamic networks. An MRI of the brain is mandatory to exclude secondary etiologies. There are effective and safe pharmacological treatments oxygen, sphenopalatine, and great occipital nerve block, with the heterogeneity of clinical trial designs for patients with CH divided into acute, transitional, or bridge treatment (prednisone) and preventive interventions. In conclusion, CH remains underdiagnosed, mainly due to a lack of awareness within the medical community, frequently causing a long delay in reaching a final diagnosis. Recent advances in understanding the principal risk factors and underlying pathophysiology exist. There are new therapeutic possibilities that are effective for CH. Indeed, a better understanding of this challenging pathology will continue to be a subject of research, study, and discoveries in its diagnostic and therapeutic approach.

Hydrogenolysis of Glycerol over NiCeZr Catalyst Modified with Mg, Cu, and Sn at the Surface Level.

Biomass valorization is an essential strategy for converting organic resources into valuable energy and chemicals, contributing to the circular economy, and reducing carbon footprints. Glycerol, a byproduct of biodiesel production, can be used as a feedstock for a variety of high-value products and can contribute to reducing the carbon footprint. This study examines the impact of surface-level modifications of Mg, Cu, and Sn on Ni-Ce-Zr catalysts for the hydrogenolysis of glycerol, with in situ generated hydrogen. The aim of this approach is to enhance the efficiency and sustainability of the biomass valorization process. However, the surface modification resulted in a decrease in the global conversion of glycerol due to the reduced availability of metal sites. The study found that valuable products, such as H2 and CH4 in the gas phase, and 1,2-PG in the liquid phase, were obtained. The majority of the liquid fraction was observed, particularly for Cu- and Sn-doped catalysts, which was attributed to their increased acidity. The primary selectivity was towards the cleavage of the C-O bond. Post-reaction characterizations revealed that the primary causes of deactivation was leaching, which was reduced by the inclusion of Cu and Sn. These findings demonstrate the potential of Cu- and Sn-modified Ni-Ce-Zr catalysts to provide a sustainable pathway for converting glycerol into value-added chemicals.

[Advance care planning in nursing homes: scoping review]. / Planificación anticipada de cuidados en residencias de mayores: revisión narrativa.

Advance care planning is a deliberative process that aims to help patients define goals and preferences for future care and treatment at a times when they have limited decision-making capacity. This study aims to analyze models of advance care planning in elderly individuals living in nursing homes. We reviewed papers published in Cochrane, PubMed and Embase. A total of 26 studies were selected, including a total of 44,131 people over 65 years of age. We analyzed the types of intervention (interviews, videos, workshops, documentation, etc.) and their results derived from the application. We conclude that no study implements a standardized intervention model. These interventions include decision-making (transfers to hospital, resucitation orders) and the adequacy of therapeutic effort (antibiotherapy, nutrition, serotherapy, etc.). Other outcomes are implementation barriers (time and training).

Adaptation of SARS-CoV-2 to ACE2H353K mice reveals new spike residues that drive mouse infection.

The Coronavirus Disease 2019 (COVID-19) pandemic continues to cause extraordinary loss of life and economic damage. Animal models of severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2) infection are needed to better understand disease pathogenesis and evaluate preventive measures and therapies. While mice are widely used to model human disease, mouse angiotensin converting enzyme 2 (ACE2) does not bind the ancestral SARS-CoV-2 spike protein to mediate viral entry. To overcome this limitation, we "humanized" mouse Ace2 using CRISPR gene editing to introduce a single amino acid substitution, H353K, predicted to facilitate S protein binding. While H353K knockin Ace2 (mACE2H353K) mice supported SARS-CoV-2 infection and replication, they exhibited minimal disease manifestations. Following 30 serial passages of ancestral SARS-CoV-2 in mACE2H353K mice, we generated and cloned a more virulent virus. A single isolate (SARS2MA-H353K) was prepared for detailed studies. In 7-11-month-old mACE2H353K mice, a 104 PFU inocula resulted in diffuse alveolar disease manifested as edema, hyaline membrane formation, and interstitial cellular infiltration/thickening. Unexpectedly, the mouse-adapted virus also infected standard BALB/c and C57BL/6 mice and caused severe disease. The mouse-adapted virus acquired five new missense mutations including two in spike (K417E, Q493K), one each in nsp4, nsp9, and M and a single nucleotide change in the 5' untranslated region. The Q493K spike mutation arose early in serial passage and is predicted to provide affinity-enhancing molecular interactions with mACE2 and further increase the stability and affinity to the receptor. This new model and mouse-adapted virus will be useful to evaluate COVID-19 disease and prophylactic and therapeutic interventions.IMPORTANCEWe developed a new mouse model with a humanized angiotensin converting enzyme 2 (ACE2) locus that preserves native regulatory elements. A single point mutation in mouse ACE2 (H353K) was sufficient to confer in vivo infection with ancestral severe acute respiratory syndrome-coronavirus-2 virus. Through in vivo serial passage, a virulent mouse-adapted strain was obtained. In aged mACE2H353K mice, the mouse-adapted strain caused diffuse alveolar disease. The mouse-adapted virus also infected standard BALB/c and C57BL/6 mice, causing severe disease. The mouse-adapted virus acquired five new missense mutations including two in spike (K417E, Q493K), one each in nsp4, nsp9, and M and a single nucleotide change in the 5' untranslated region. The Q493K spike mutation arose early in serial passage and is predicted to provide affinity-enhancing molecular interactions with mACE2 and further increase the stability and affinity to the receptor. This new model and mouse-adapted virus will be useful to evaluate COVID-19 disease and prophylactic and therapeutic interventions.

Evaluación comparativa de perfiles de disolución del medicamento genérico lamivudina tableta 150 mg comercializado en Perú frente al innovador Epivir / Comparative evaluation of dissolution profiles of the generic drug lamivudine 150 mg tablet marketed in Peru vs. the innovative Epivir

RESUMEN La lamivudina es uno de los medicamentos más prescritos en el mundo, se utiliza para tratar la inmunodeficiencia humana y la hepatitis B. El objetivo del estudio fue evaluar los atributos de calidad y comparar los perfiles de disolución de dos lotes (A y B) del medicamento genérico lamivudina 150 mg tabletas con el medicamento innovador Epivir 150 mg tabletas. Se realizó un estudio analítico, experimental y de corte transversal, se usó un método espectrofotométrico a una longitud de onda de máxima absorción (λ) correspondiente a 270 nm, para medir el porcentaje de fármaco disuelto. El estudio evaluó identificación, contenido, disolución y uniformidad de masas. Se usó el aparato 2 USP (Paleta) 75 rpm, 900 mL de medio de disolución (37 ± 0,5 °C) a en tres medios de disolución: pH 1,2; 4,5 y 6,8. Se retiraron muestras de 5 mL a los 5, 10, 15, 20 y 30 min. Se encontró que ambos lotes de lamivudina genérico (A y B) presentan el mismo perfil cinético de disolución que el medicamento innovador. Ambas formulaciones cumplen con el criterio de medicamentos de disolución muy rápida (85% disuelto en 15 min), y de disolución rápida (85% disuelto en 30 min). Por lo tanto, no fue necesario calcular el factor de similitud. Se concluye que los medicamentos genéricos A y B son equivalentes in vitro con el medicamento innovador Epivir.

ABSTRACT Lamivudine is one of the most prescribed drugs in the world, and is used to treat human immunodeficiency and hepatitis B. This study aimed to evaluate the quality attributes and compare the dissolution profiles of two batches (A and B) of generic lamivudine 150 mg tablets with the innovator drug Epivir 150 mg tablets. We conducted an analytical, experimental, cross-sectional study, and used a spectrophotometric method at a wavelength of maximum absorption (λ) corresponding to 270 nm, to measure the percentage of dissolved drug. The study evaluated identification, content, dissolution and mass uniformity. Apparatus 2 USP (Paddle) 75 rpm, 900 mL of dissolution medium (37 ± 0.5 °C) was used in three dissolution media: pH 1.2; 4.5 and 6.8. Samples of 5 mL were obtained at 5, 10, 15, 20 and 30 min. Both batches of generic lamivudine (A and B) were found to have the same dissolution kinetic profile as the innovator drug. Both formulations met the criteria of very fast dissolving (85% dissolved in 15 min), and fast dissolving (85% dissolved in 30 min) drugs. Therefore, it was not necessary to calculate the similarity factor. We concluded that generic drugs A and B are in vitro equivalents to the innovator drug Epivir.

Análisis del nivel de satisfacción de la atención de pacientes en el área de hospitalización clínica de un hospital oncológico de Guayaquil / Analysis of the level of satisfaction with patient care in the clinical hospitalization area of a Guayaquil cancer hospital

Introducción: La calidad asistencial es la relación entre los servicios prestados y la obtención de los resultados deseados, enfocándose en las necesidades de los pacientes y optimización de recursos, siendo oportuno conocer el nivel de satisfacción de los usuarios que consiste en el resultado de la evaluación de la atención recibida. EL objetivo de este trabajo fue describir el nivel de satisfacción obtenido en el área de Hospitalización Clínica de un hospital oncológico de Guayaquil. Métodos: El presente estudio observacional se realizó en el Hospital de SOLCA Guayaquil-Ecuador de marzo del 2021 a marzo 2022. Se incluyeron pacientes o familiares en el área de hospitalización clínica. Las variables fueron sexo, tipo de cuidador, nivel de satisfacción (variable dependiente a escala Likert). La muestra fue probabilística. Se presenta un análisis de la calidad del cuestionario con el coeficiente alfa (α) de Cronbach y la Prueba U de Mann-Whitney. Se utiliza un análisis de asociación entre las preguntas del cuestionario para observar la correlación. Resultados: Participaron 345 encuestados, 19 pacientes, 326 familiares. Mayores a 56 años en familiares (29.1%) y pacientes (78.9%). La calidad del cuestionario fue alta , alfa de Cronbach =1. La satisfacción global fue de 4.85 ± 0.41(sobre 5). La calificación mas baja fue para el tiempo de espera de cama con instancia intrahospitalaria 4.67 ± 0.65. Hubo asociación estadística entre el tiempo de espera para signación de cama y de habitación R=0.80, P<0.001. Conclusiones: La atención a los usuarios puede verse afectada por la presencia de nudos críticos los cuales son situaciones que afectan el correcto funcionamiento de procedimientos técnicos, operativos o gerenciales de una organización como el tiempo de espera para hospitalización y el tiempo de espera dentro de la institución para la asignación de cama.

Introduction: The quality of care is the relationship between the services provided and obtaining the desired results, focusing on the needs of the patients and optimization of resources, being opportune to know the level of satisfaction of the users that consists of the result of the evaluation. of the care received. This work aimed to describe the level of satisfaction obtained in the Clinical Hospitalization area of a cancer hospital in Guayaquil. Methods: This observational study was conducted at the Hospital de SOLCA Guayaquil-Ecuador from March 2021 to March 2022. Patients or relatives in the clinical hospitalization area were included. The variables were sex, type of caregiver, and level of satisfaction (dependent variable on a Likert scale). The sample was probabilistic. An analysis of the quality of the questionnaire with Cronbach's alpha (α) coefficient and the Mann-Whitney U Test is presented. An association analysis between the questions in the questionnaire is used to observe the correlation. Results: 345 respondents participated, including 19 patients and 326 relatives. Over 56 years in relatives (29.1%) and patients (78.9%). The questionnaire quality was high, with Cronbach's alpha =1. Global satisfaction was 4.85 ± 0.41 (out of 5). The lowest qualification was for the bed waiting time with intrahospital instance 4.67 ± 0.65. There was a statistical association between the waiting time for bed and room assignment R=0.80, P<0.001. Conclusions: The users' attention can be affected by the presence of critical knots, which are situations that affect the correct functioning of technical, operative, or managerial procedures of an organization, such as the waiting time for hospitalization and the waiting time within the institution for bed assignment.

Diabetic foot and COVID-19. Medical consultation and severity of lesions compared to 2019 / Pie diabético y COVID-19. Número de consultas y gravedad de las lesiones comparadas con 2019

Abstract At the end of 2019 a novel coronavirus was identified as a cause of pneumonia in Wuhan, China. This emerging disease has caused an unexpected turn in the economy and in society, which has led to the necessity of social isolation and confinement. Diabetic foot consultation was affected by the ongoing situation. The aim of this study was to compare the number of medical visits and the severity of new lesions at presentation at the Diabetic Foot Unit during June 2020 compared to June 2019. Three hundred and fifty six medical visits were analyzed, resulting in a 29% reduction in the number of visits during 2020. The number of patients presenting with new lesions increased from 6.4% to 10.3% (p = ns) during pandemic. The number of visits from the patients´ relatives was higher during June 2020 (16.3% vs. 1.4%) (p < 0.05). Controls of feet without active lesions (i.e.: closed wound or periodic control) decreased from 16.8% to 4.5% (p < 0.05). Consultation for medical prescription only was higher in 2020 (22.4%) than in 2019 (7.3%) (p < 0.05). In our sample, there were no significant differences in the severity of new lesions at presentation or on the days of evolution of new ones in comparison with the previous year. During 2020, telehealth consults represented a 7% of all medical visits. There were no major amputations during 2019 and 4 during 2020. Given the dynamics of confinement, further studies about this topic are required to make sound and accurate decisions.

Resumen A fines de 2019 se identificó un nuevo coronavirus como causa de neumonía, en Wuhan, China. Esta nueva enfermedad (COVID-19) causó un inesperado vuelco en la economía y en la sociedad. El aislamiento social y el confinamiento provocaron cambios en la dinámica de las consultas médicas. En este estudio se compararon la cantidad de consultas y la gravedad de las lesiones nuevas en la Unidad de Pie Diabético entre junio de 2020 y junio de 2019. Se analizaron en total 356 visitas médicas, hallando un 29% de reducción en el número de visitas en 2020. El número de consultas por lesión nueva aumentó del 6.4% a 10.3% (p = ns) durante la pandemia. Las visitas de familiares por diversos motivos en lugar del paciente aumentaron durante 2020 de 1.4% a 16.3% (p < 0.05). Los controles de pacientes sin lesión (pie de alto riesgo, control post alta), disminuyeron de 16.8% a 4.5% (p < 0.05) y también aumentaron las visitas únicamente para prescripciones médicas (7.3% a 22.4%, p < 0.05). En nuestra muestra, no hubo diferencias significativas en la gravedad de la presentación ni en los días de evolución de las lesiones nuevas en relación al año anterior. Durante 2020 las teleconsultas representaron el 7% del total. En junio de 2019 no se registraron amputaciones mayores y en 2020 se registraron 4. Dada la dinámica del confinamiento, se requiere un continuo seguimiento y nuevos estudios para evaluar las consecuencias que se producirán en los pacientes con esta enfermedad con el fin de tomar decisiones acertadas.

Asociación entre la resistencia a la insulina y acantosis nigricans en niños con obesidad en un hospital de tercer nivel en Lima, 2018 - 2019 / Association between insulin resistance and acanthosis nigricans in obese children in a tertiary care hospital in Lima, 2018 - 2019

RESUMEN Objetivo: explorar la asociación entre la frecuencia de resistencia a la insulina y la presencia y distribución de acantosis nigricans en niños con obesidad. Materiales y métodos: estudio transversal en el que participaron 42 niños con obesidad entre 5 y 10 años. Se caracterizó la presencia de acantosis nigricans (número de zonas y distribución) y otras variables como la edad, sexo e IMC. Se formó cuatro grupos y se determinó la frecuencia de resistencia a la insulina para explorar la asociación entre las demás variables. Resultados: la media de edad fue 8,6 años, con una frecuencia de sexo masculino del 54,8%. El 64,3% presentó acantosis nigricans, de los cuales un 78% presentó resistencia a la insulina. Las variables que resultaron con significancia estadística fueron edad (p=0,009), índice de masa corporal (p=0,025) y presencia de acantosis nigricans en cuello (p=0,007). Conclusiones: existe asociación entre la presencia de resistencia a la insulina y la presencia de acantosis nigricans en cuello en niños con obesidad.

ABSTRACT Objective : to explore whether there is an association between the frequency of insulin resistance and the presence and distribution of acanthosis nigricans in obese children. Materials and methods : this is a cross-sectional study in which 42 obese children between 5 and 10 years of age participated. The presence of acanthosis nigricans was characterized (number and distribution of affected areas) as well as other variables, such as age, sex, and Body Mass Index. Four groups were formed, and the frequency of insulin resistance was determined, aiming to explore its association with the other variables. Results : mean participants' age was 8.6 years, and male subjects accounted for 54.8%. Nearly two-thirds of participants (64.3%) had acanthosis nigricans, and 78% of them had insulin resistance. Associated variables with statistical significance were age (p= 0.009), BMI (p= 0.025), and the presence of acanthosis nigricans affecting the neck region. Conclusions : there is an association between insulin resistance and the presence of acanthosis nigricans affecting the neck of obese children.

Equivalencia terapéutica evaluada mediante estudios in vitro de medicamentos multifuentes: estudio de casos de amoxicilina, doxiciclina y fluconazol en Lima, Perú / Therapeutic equivalence evaluated by in vitro studies of multisource pharmaceutical products: case studies of amoxicillin, doxycycline and fluconazole in Lima, Peru

RESUMEN El objetivo del estudio fue determinar la equivalencia terapéutica evaluada mediante estudios in vitro de cuatro marcas de medicamentos conteniendo amoxicilina, doxiciclina y fluconazol adquiridos en establecimientos farmacéuticos de Lima Metropolitana y establecer su intercambiabilidad con un producto de referencia (PR). Se empleó un método validado de espectrofotometría ultravioleta visible para determinar el perfil de disolución. El factor de similitud (f2) se utilizó para establecer la equivalencia terapéutica, considerándose equivalentes si los valores de f2 se encontraban entre 50 y 100. Para doxiciclina los cuatro medicamentos fueron equivalentes in vitro al PR, para amoxicilina sólo dos medicamentos fueron equivalentes in vitro al PR y para fluconazol ninguno fue equivalente in vitro al PR. Se concluye que algunos medicamentos de amoxicilina y fluconazol que circulan en el mercado nacional no cumplen con la equivalencia terapéutica evaluada mediante estudios in vitro; es decir, no son intercambiables.

ABSTRACT The objective of the study was to determine the therapeutic equivalence evaluated through in vitro studies of four brands of drugs containing amoxicillin, doxycycline, and fluconazole purchased at pharmaceutical facilities in Metropolitan Lima, and to establish their interchangeability with a reference product (RP). A validated method of visible ultraviolet spectrophotometry was used to determine the dissolution profile. The similarity factor (f2) was used to establish the therapeutic equivalence, being considered equivalent if the values of f2 were between 50 and 100. For doxycycline, the four drugs were equivalent in vitro to the RP; for amoxicillin, only two drugs were equivalent in vitro to the RP; and for fluconazole, none was equivalent in vitro to the RP. It is concluded that some amoxicillin and fluconazole drugs circulating in the national market do not meet the therapeutic equivalence assessed by in vitro studies; in other words, they are not interchangeable.

Complicaciones de la canalización venosa central con técnica ecoguiada y convencional en el servicio de urgencias del Hospital de San José, Bogotá, Colombia / Complications of the central venous catheter with ecoguide and conventional technique in emergency department of Hospital de San Jose, Bogota, Colombia

Introducción: la utilización de la ultrasonografía como técnica de elección para la colocación de catéteres venosos centrales durante situaciones de emergencia aumenta la seguridad del paciente al presentar baja frecuencia de complicaciones, menor exposición a irradiación e incremento de la calidad de atención. Objetivo: comparar las complicaciones mecánicas de la colocación de catéter venoso central por la técnica guiada por ultrasonografía y la convencional; realizada por residentesde la especialización en Medicina de Urgencias del Hospital de San José (Bogotá,Colombia). Materiales y métodos: estudio descriptivo de dos cohortes en pacientes mayores de 15 años que ingresaron al servicio de urgencias del Hospital de San José, con indicación de colocación de catéter venoso central por técnica convencional entre 2012 y 2013 (cohorte no expuesta) y técnica ecoguiada en 2014 (cohorte expuesta). Como desenlace se observó la presencia de complicacionesen cualquiera de los dos grupos. Resultados: se incluyeron 73 casos, 38 (52,1%) con colocación del catéter venoso central por la técnica ecoguiada. Se presentaron nueve (12,3%) complicaciones, ocho (88,9%) de ellas con la técnica convencional. La mediante del tiempo del procedimiento fue 20 minutos (rango intercuatílico: 15-20 minutos) con la técnica convencional y 10 minutos (rango intercuatílico: 7-10 minutos) con la técnica ecoguiada; esta última con colocación del catéter en un único intento en el 78,9% de los casos. Conclusión: se observó un menor número de complicaciones de tipo mecánico cuando con la técnica ecoguiadarespecto a la técnica convencional en los pacientes críticos con indicación de canulación venosa central.

Introduction: the use of ultrasound as a technique of choice for central venous catheter placement during emergencies increases patient safety due to low frequencyof complications, reduction of exposure to radiation, and increasing quality of care. Objective: To compare the mechanical complications of central venous catheterplacement under ultrasound guided and conventional technique by residents of emergency medicine specialty at the Hospital de San Jose (Bogota, Colombia). Material and methods: Descriptive study of two cohorts, which include patients over 15 years old, admitted to the emergency department of Hospital de San Jose with indication of central venous catheter placement by conventional technique between2012 and 2013 (unexposed cohort) and ultrasound-guided technique in 2014 (exposed cohort). As outcome was observed the presence of complications in both groups. Results: A total of 73 cases were included, 38 (52.1%) of them with central venous catheter placement by ultrasound-guided technique. A total of nine complications(12.3%) were presented, eight (88.9%) of them with the conventional technique.The median of time procedure was of 20 minutes (interquartile range: 15-20 minute) with the conventional technique and 10 minutes (interquartile range: 7-10 minutes) with ecoguide technique. In the ultrasound-guided technique, the catheter placement was achieved in an only attempt in 78.9% of cases. Conclusion: Fewer mechanical complications were observed with ultrasound guided technique respect conventional technique in critically ill patients who have indication of central venous cannulation.

Validación de un método de cromatografía líquida para la determinación de rifampicina en plasma humano / Validation of a liquid chromatography method for rifampicin determination in human plasma

Objetivos: Validar un método de cromatografía líquida de alta resolución (HPLC) para la determinación de rifampicina (RFP) en plasma humano. Materiales y métodos. Se desarrolló un método HPLC para la determinación de RFP en plasma. La separación fue realizada por cromatografía de fase reversa con una columna C18 y una fase móvil compuesta por una mezcla de acetonitrilo y solución amortiguadora de fosfato de potasio monobásico 0,05 M (38:62 v/v) a 335 nm. En el cual se empleó como estándar interno rifampicina quinona (RFP-QN). Resultados. Los tiempos de retención de RFP y RFP-QN fueron 7,81 y 12,26 minutos, respectivamente. El ensayo fue lineal de 0,5 a 250 ug/mL Los parámetros evaluados de precisión, exactitud, selectividad, linealidad, recuperación cumplieron con lo establecido en las guías internacionales de validación de métodos bioanalíticos. Conclusiones. El método HPLC desarrollado es simple, específico, sensible, selectivo y lineal para un amplio rango de concentraciones de RFP en plasma.

Objectives: To validate the high-performance liquid chromatography method (HPLC) for rifampicin (RFP) determination in human plasma. Materials and methods. A HPLC method for RFP determination in plasma was developed. The separation was performed by reversed-phase chromatography with C18 column and a mobile phase composed of a mixture of acetonitrile and monobasic potassium phosphate buffer solution 0.05 M (38:62 v/v) at 335 nm in which standard rifampicin quinone (RFP-QN) was used. Results. The retention times of RFP and RFP-QN were 7.81 and 12.26 minutes, respectively. The trial was linear from 0.5 to 250 ug/mL. The evaluated parameters of precision, accuracy, selectivity, linearity, and recovery complied with the established international standards for validation of bioanalytical methods. Conclusions. The developed HPLC method is simple, specific, sensitive, selective and linear for a wide range of RFP concentrations in plasma.