Use of biologic therapies in the management of pyoderma gangrenosum: a systematic review.

Treatment of pyoderma gangrenosum (PG) is challenging due to the absence of standardized guidelines and the lack of evidence-based, effective treatment options. Here, we performed a systematic review to summarize the use of biologics and their efficacy in the treatment of PG. We searched PubMed/MEDLINE, EMBASE, and Cochrane electronic databases from their inception to September 22nd, 2022, and included 82 peer-reviewed studies with a total of 108 patients. Infliximab, adalimumab, and etanercept were the most utilized biologic therapies in the treatment of PG in 64.8% (70/108), 16.7% (18/108), and 11.1% (12/108) of the cases, respectively. With respect to treatment response, 88.9% (96/108) of the patients achieved complete resolution of PG with biologic therapies. The average number of days to improvement and resolution of PG treated after starting biologic therapies was 30 and 161, respectively. PG recurred in 15.5% (11/71) of those reported the outcome. Our study suggests that biologic therapies may be an attractive therapeutic option for PG with an excellent efficacy.

Assessing sectoral water stress states from the demand-side perspective through water footprint dimensions decomposition.

Due to its essentiality and scarcity, water is subject to stress from the supply and demand side. The SDG and many methods for assessing water stress (WS) are based on water supply, even though the total water supply is uncontrollable by humans in the short term. Conversely, from a water demand perspective, WS arises from the deliberate and manageable use of water to produce goods and services, with few methods proposing to evaluate WS. We propose a method to assess the sectoral demand-side water stress states (DWSS) to fill this gap. The method comprises a quantitative step followed by a qualitative analysis. Quantitatively, an environmentally extended input-output model integrated Brazilian water resource and economic data for 2010 and 2015, including the imported virtual water in the water footprint calculation. Three dimensions of water footprint (DWF) were calculated: consumptive use of water (CUWF), water consumption (CWF), and return to the environment (REWF). The variations in DWFs over time were used as criteria to define five DWSS ranging from weak to strong. Brazilian economy as a whole presented a moderately weak DWSS. Among economic sectors, the most frequent DWSS was moderately weak, with sixteen sectors. The Livestock and Forestry, fishing, and aquaculture sectors had a strong DWSS, while the Slaughter, meat, and dairy and Public administration sectors had weak DWSS. Despite its limitations, the demand-side analysis can complement the usual method from a supply perspective.

New spectrum of the neurologic consequences of Zika.

Zika virus infection represents a new neuropathological agent with association to a wide spectrum of neurological complications: a) Congenital Zika Syndrome by affecting the neural stem cells of the human fetal brain; b) Guillain-Barré Syndrome by an autoimmune response against peripheral myelin and/or axonal components or probable direct inflammatory reaction; c) Encephalitis/meningoencephalitis and myelitis by a direct viral inflammatory process on the central nervous system; d) Sensory neuropathy by infecting directly the peripheral neurons and causing substantial cell death and pathogenic transcriptional dysregulation; e) Acute Disseminated Encephalomyelitis and optic neuropathy; f) Seizures and Epilepsy and g) childhood arterial ischemic stroke by probable inflammatory reaction and endothelial injury.

Calidad de atención y satisfacción del usuario con cita previa en medicina familiar de Guadalajara / Quality of care and level of satisfaction of user with previous appointment in family medicine practice in Guadalajara

OBJETIVO: evaluar la calidad de la atención y satisfacción del usuario con cita previa en unidades de medicina familiar. MÉTODOS: se aplicó un diseño transversal analítico a una muestra probabilística de 983 usuarios, se usaron dos cuestionarios validados para explorar calidad del servicio y satisfacción del usuario, se registraron variables sociodemográficas y cita previa. Se aplicaron las pruebas estadísticas F de Fisher, y chi cuadrado. RESULTADOS: la muestra se caracterizó por tener 67 por ciento de sexo femenino, edad 40,83 ± 21,6 años, 40 por ciento asalariados, 67 por ciento casados, tiempo de espera 55,46 ± 74,03 min, 56 por ciento con cita previa. La calidad de la atención calificó alta en seis de siete dimensiones, el tiempo de espera en dos de las tres unidades alcanzó el 36 por ciento de calidad. La satisfacción del usuario en dimensión médico familiar ³ 79 por ciento (no significativo), unidad de medicina familiar mostró calificación ³59 (p= 0,00), otros servicios calificaron 53 por ciento. Cita previa se asoció con satisfacción en todas las dimensiones (p= 0,00). CONCLUSIONES: la calidad de atención fue alta, excepto en tiempo de espera. La satisfacción del usuario se asoció con la cita previa.

OBJECTIVE: to Evaluate the quality of assistance and level of satisfaction of the user with previous appointment in family medicine centers. METHODS: a cross-sectional analytical design was applied to a probabilistic sample of 983 users; two validated questionnaires were used to track quality of service and level of satisfaction of users; sociodemographic variables and previous appointments were recorded. Fisher´s F and Chi-square tests were performed. RESULTS: the probablistic sample was characterized by having 67 percent of females, age 40.83 ± 21,6 years; 40 percent workers, 67 percent married, waiting time 55.46 ± 74.03 min, 56 percent had previous appointment. The quality of assistance was high in six out of seven dimensions; waiting time had 36 percent of quality in two of the three centers. The level of satisfaction of the users in dimension family physician ³ 79 percent (not significant), and in family medicine centers, the qualification was ³ 59 percent (p= 0,00). Other services rated 53 percent. Previous appointment was associated to satisfaction in all the dimensions (p= 0,00). CONCLUSIONS: the quality of assistance was high except for waiting time. The level of satisfaction of users was related to previous appointment.

Estabilidad de sistemas electricos de potencia

Contenido: Descripcion teorica de los conceptos de estabilidad de un sistema de energia, red general, ecuaciones generales para la corriente, ecuaciones generales de la red para la potencia real, estudio de algunos casos de estabilidad, caracteristicas de angulo de potencia de las maquinas sincronas: barra infinitas, turborotores, rotores con polos salientes, efecto de la saturacion, maquinas de polos salientes conectado a una barra infinita a traves de una resistencia externa, conclusiones sobre el efecto de los polos salientes en el estudio de estabilidad estable 4. Limites de estabilidad: distincion entre el estado estable y la estabilidad transiente 5.Estudio de flujo de potencia de un sistema: el sistema por unidad, datos para los estudios de carga, desarrollo de las ecuaciones para solucion digital, representacion de los transformadores con taps, diagrama de flujo , calculo de flujo de potencia de un sistema 6. Programa de estabilidad estable calculo de admitancias, matriz de admitancias eliminacion de nudos por algebra matricial. 8 La ecuacion de oscilacion y su solucion, desarrollo de las ecuaciones, la constante de inercia, solucion de la ecuacion de oscilacion, construccion paso a paso de la curva de oscilacion, suposiciones hechas normalmente en un estudio de estabilidad 9.Programa de estabilidad transparente: descripcion del programa 10. consideraciones sobre metodos posibles para aumentar los limites de estabilidad 11. Estabilidad del sistema interconectado Sucre-Potosi-Corani Cochabamba, Catavi, Miguilla.