[Initial assessment of immigrant patients in primary care]. / Atención inicial al paciente inmigrante en atención primaria.

The clinical interview of immigrant patients requires cultural competence to ensure good understanding and correct communication, in addition to collecting specific information that differs from that of native patients, such as origin and migratory route or cultural identity. Screening for latent tuberculosis infection is recommended in certain cases and screening for other infections, both cosmopolitan with a higher prevalence in migrants (HIV, syphilis, hepatitis B and C) and imported (Chagas, intestinal parasites, strongyloidiasis, schistosomiasis), depending on origin. It is essential to check the vaccination status and complete the vaccination schedule, adapting it to the current calendar, prioritizing vaccines such as measles, rubella and poliomyelitis. We propose preventive activities to be carried out when traveling to countries of origin, due to their special characteristics and risks: general advice, exploring the risk of malaria, assessing specific vaccinations, advice regarding sexually transmitted infections and special considerations if they have chronic diseases; and addressing, if appropriate, the risks of female genital mutilation.

Histamine and Tyramine in Chihuahua Cheeses during Shelf Life: Association with the Presence of tdc and hdc Genes.

Cheese is a product of animal origin with a high nutritional value, and it is one of the most consumed dairy foods in Mexico. In addition, Chihuahua cheese is the most consumed matured cheese in Mexico. In the production process of Chihuahua cheese, maturation is carried out by adding acid lactic microorganisms, mainly of the Lactococcus genus and, in some cases, also the Streptococcus and Lactobacillus genus. As part of the metabolism of fermenting microorganisms, biogenic amines can develop in matured foods, which result from the activity of amino decarboxylase enzymes. In cheeses, histamine and tyramine are the main amines that are formed, and the consumption of these represents a great risk to the health of consumers. In this work, the presence of biogenic amines (histamine and tyramine) was determined by HPLC at different times of the shelf life of Chihuahua cheeses. In addition, the presence of genes hdc and tdc that code for the enzymes responsible for the synthesis of these compounds (histidine and tyrosine decarboxylase, or HDC and TDC) was determined by molecular techniques. A significant correlation was observed between the presence of both histamine and tyramine at the end of shelf life with the presence of genes that code for the enzymes responsible for their synthesis.

Assessing the suitability of recovering shrub biowaste involved in wildland fires in the South of Europe through torrefaction mobile units.

Several types of shrubs and oak inducing high wildland fire risk in the South of Europe were evaluated for their potential valorization through torrefaction. Biomasses were firstly characterized in terms of macromolecular and elemental composition. Lab-scale TGA-GC/MS torrefaction experiments allowed the in-depth study of the solid mass transformation and the production profile of 23 volatile species (200 to 300 °C at 3 °C·min-1 and 300 °C for 30 min). The proportion of the torrefied products (solid, CO, CO2, water and volatile species) was evaluated through mass balance in a lab-scale furnace under typical torrefaction conditions (300 °C, 40 min). The results show a similar characterization and behavior in torrefaction for oak and shrublands, and slightly different characteristics for fern. However, fern may grow separately from shrublands and is considered to present a low fire risk. This suggests that the in-situ direct valorization of these biomasses through torrefaction mobile units seems promising. However, other properties, such as density, flowability and grindability need to be studied to confirm the feasibility of the process. Regarding torrefaction products, a higher carbon content and an interesting increase in heating value were measured for the torrefied solid, which makes it suitable for energetic valorization, among other uses. The composition of permanent gases was evaluated and found in agreement with previous studies. Finally, the volatile species released were studied in function of the torrefaction temperature, in view of their possible valorization as green chemicals.

La narratividad descolonizada como alternativa pedagógica práctica y espacio de emergencia identitaria desde un enfoque de género / Decolonized narrativity as a practical pedagogical alternative and identity emergency space from a gender perspective / A narratividade descolonizada como uma alternativa pedagógica prática e um espaço de emergência de identidade a partir de uma abordagem de gênero

Resumen Introducción: La pedagogía narrativa se presenta como una visión dinámica para alcanzar reconocimiento e identificación producidos por la aparición de la trasgresión, la crítica, la mutación y los efectos políticos. La narración se torna obra al ser apropiada por los sujetos activándose así su sentido y su valor. Objetivo: Proponer un marco teórico desde la filosofía educativa denominado la pedagogía del "nosotros" como espacio de construcción/deconstrucción/reconstrucción/disolución. Así pues, Una epistemología descolonizada con enfoque de género. Materiales y métodos: Se trata de una investigación de carácter documental, analítica y explicativa, basada en el feminismo posestructuralista y la teoría crítica. Se hace uso de fuentes secundarias. Resultados: La conceptualización de la categoría de identidad como narración profundiza la idea de incorporación del sentido del ser, introduciendo claramente la agencia. Conclusión: La pedagogía del "nosotros" como espacio de construcción / deconstrucción / reconstrucción / disolución de nuestras identidades, sin pretender alcanzar una verdad o una visión totalizadora, clarifica divergencias y acuerdos para edificar posibles puntos de encuentro basados en el cuidado y la igualdad; intenta desarrollar una opción gnoseológica basada en la narrativa como estrategia pedagógica, porque aparte de ser una forma de conocimiento que reúne todas las pedagogías, es una forma en la que educadores/as y educandos/as pueden interpretar sus experiencias desde diversas perspectivas, incluyendo la convencional, la crítica, la feminista, la posmoderna y la fenomenológica.

Abstract Introduction: Narrative pedagogy is presented as a dynamic vision to achieve recognition and identification produced by the appearance of transgression, criticism, mutation and political effects. The narrative becomes work to be appropriate for the subjects thus activating their meaning and value. Objective: To propose a theoretical framework from the educational philosophy called the pedagogy of "we" as a space of construction / deconstruction / reconstruction / dissolution. A decolonized epistemology with a gender approach. Materials and methods: This is a research with documental, analytical and explanatory characteristics, based on post-structuralist feminism and critical theory. It makes use of secondary sources. Results: The conceptualization of the category of identity as a narrative deepens the idea of incorporating the sense of being, clearly introducing the agency. Conclusion: The pedagogy of "we" as a space of construction / deconstruction / reconstruction / dissolution of our identities, without pretending to achieve a truth or a totalizing vision, clarifies divergences and agreements to build possible points of convergence based on care and equality. Likewise, it tries to develop a gnoseological option based on the narrative as a pedagogical strategy because, apart from being a form of knowledge that brings together all the pedagogies, it is a way in which educators and learners can interpret their experiences from different perspectives, including the conventional, critical, feminist, postmodern and phenomenological.

Resumo Introdução: A pedagogia narrativa apresenta-se como uma visão dinâmica para atingir reconhecimento e identificação produzidos pela participação da transgressão, a crítica, a mutação dos efeitos políticos. A narração torna-se obra ao ser apropriada pelos sujeitos se ativando assim seu sentido e seu valor. Objetivo: Propor um quadro teórico a partir da filosofia educativa denominada a pedagogia de "nós" como o espaço de construção / desconstrução / reconstrução / dissolução. Deste modo, uma epistemologia descolonizada com abordagem de gênero. Materiais e métodos: Trata-se de uma pesquisa de carácter documentário, analítica e explicativa, baseada no feminismo pós-estruturalista e a teoria crítica. Utiliza-se fontes secundárias. Resultados: A conceptualização da categoria de identidade como narração aprofunda a ideia de incorporação do sentido do ser, introduzindo claramente a agência. Conclusão: A pedagogia do "nós" como espaço de construção / desconstrução / reconstrução / dissolução da nossas identidades, sem pretender alcançar uma verdade ou uma visão totalizadora, que clarifica divergências e acordos para edificar possíveis pontos de encontro baseados no cuidado e na igualdade; intenta desenvolver uma opção gnoseológica baseada na narrativa como estratégia pedagógica, porque além e ser uma forma de conhecimento que junta todas as pedagogias, é uma forma em que educadores/as e estudantes podem interpretar suas experiências a partir de diversas perspetivas, incluindo a convencional, a crítica, a feminista, a pós-moderna e a fenomenológica.

Adaptation of oral medication in people institutionalized in nursing homes for whom medication is crushed: The ADECUA Study.

PURPOSE: To evaluate the effect of pharmacist interventions in the adaptation of pharmaceutical forms in elders institutionalized in nursing homes whose medicines are crushed, which may have a clinical relevance. METHODS: Quasi-experimental, multicenter, transversal and prospective study carried out in 10 nursing homes. Subjects for whom drugs were being crushed were identified. Their treatments were reviewed in order to identify drugs that should not be crushed. In these cases, we proposed an alternative to the physician and we evaluated the degree of acceptance, its association to other variables and the pre-post adaptation index (tablets that can be crushed and capsules that can be opened/ total number of tablets and capsules before and after the intervention). Moreover, health professionals received a training course. RESULTS: Medication was being crushed for 33% (618/1875) of residents (mean: 5 drugs susceptible of crushing). 220 pharmaceutical interventions were performed, mostly in extended release or gastro-resistant drugs (48% were accepted). Switch was the type of intervention more frequent (79%), mainly to Purpose: To evaluate the effect of pharmacist interventions in the adaptation of pharmaceutical forms in elders institutionalized in nursing homes whose medicines are crushed, which may have a clinical relevance. METHODS: Quasi-experimental, multicenter, transversal and prospective study carried out in 10 nursing homes. Subjects for whom drugs were being crushed were identified. Their treatments were reviewed in order to identify drugs that should not be crushed. In these cases, we proposed an alternative to the physician and we evaluated the degree of acceptance, its association to other variables and the pre-post adaptation index (tablets that can be crushed and capsules that can be opened/ total number of tablets and capsules before and after the intervention). Moreover, health professionals received a training course. RESULTS: Medication was being crushed for 33% (618/1875) of residents (mean: 5 drugs susceptible of crushing). 220 pharmaceutical interventions were performed, mostly in extended release or gastro-resistant drugs (48% were accepted). Switch was the type of intervention more frequent (79%), mainly to.

Objetivo: Evaluar el efecto de la intervención del farmacéutico en la adecuación de formas farmacéuticas en ancianos institucionalizados en residencias de mayores a los que se les tritura la medicación y cuya alteración pueda tener relevancia clínica. Método: Estudio cuasiexperimental, multicéntrico, transversal y prospectivo de diseño antes-después en 10 residencias de mayores. Se identificaron los residentes a los que se les trituraba la medicación y se revisó su tratamiento para identificar los medicamentos que no se pueden triturar. Se comunicó al médico responsable la alternativa disponible y se evaluó el grado de aceptación, su asociación con otras variables medidas y el índice de adecuación pre-post, (comprimidos/cápsulas triturables respecto al total de comprimidos/cápsulas antes y después de la intervención). Se impartió además un curso formativo dirigido a los profesionales sanitarios. Resultados: Se trituraba la medicación al 33% (618/1.875) de los pacientes institucionalizados (media: 5 fármacos susceptibles de trituración). Se realizaron 220 intervenciones, mayoritariamente por tratarse de fármacos de liberación prolongada o gastrorresistentes, de las que se aceptaron el 48%. El tipo de intervención más frecuente fue el cambio (79%), mayoritariamente a formas de liberación inmediata o a otro principio activo. El índice de adecuación pasó del 93% al 95% (p < 0,001). La satisfacción de los profesionales con el curso fue elevada. Conclusiones: La intervención del farmacéutico ha mejorado la correcta administración de los medicamentos, aumentando con ello su seguridad y eficacia.

[Analysis of the use of liposomal amphotericin B]. / Análisis de la utilización de anfotericina B liposomal.

BACKGROUND: The increase in immunosuppressed patients and in the use of cytotoxic and immunosuppressive agents in the last few years has led to a rise in the incidence of invasive fungal infections. AIMS: The objective of this study is to evaluate the use of liposomal amphotericin B according to its indication, dosage, effectiveness and nephrotoxicity. METHODS: This is a retrospective study over a 8 year-period. Indications and dosage described in the Summary of Product Characteristics were taken as reference. Effectiveness was measured in terms of resolution of infection, no recurrence or emergence, survival at 7th day, no discontinuation and no addition of another antifungal. Effectiveness was also analysed in relation to indication, dosage, treatment duration, cumulative dose and comorbidity. Nephrotoxicity was defined as a doubled serum creatinine when compared with basal values. RESULTS: A total of 47 episodes were analysed, with 91.5% of treatments being adequate for the indications. Effectiveness was achieved in 44.7% of cases: 33% in neutropenic patients, 50% of aspergillosis, 60% of candidiasis, and 100% of the leishmaniasis. Response rates in patients treated for 15 days or less and those for more than 15 days were 25 and 56.5% (P=.039), respectively. The main causes of failure were death (23%) and lack of effectiveness (17%), with 9% of patients suffering from nephrotoxicity. CONCLUSIONS: The effectiveness and nephrotoxicity data agree with those obtained in other studies. Liposomal amphotericin B is a safe drug with a moderate effectiveness that is associated with the duration of the treatment.

[Are intravenous immunoglobulins useful in severe episodes of autoimmune hemolytic anemia?: Comparative results in 21 episodes from a single centre]. / Inmunoglobulinas intravenosas en los episodios graves de anemia hemolítica autoinmune: resultados comparativos en 21 episodios de un único centro.

BACKGROUND AND OBJECTIVE: To analyze haemolytic episodes in patients with warm antibody autoimmune haemolytic anemia (AIHA) and compare corticosteroids treatment with intravenous immunoglobulins (IVIG) (group A) or without IVIG (group B). PATIENTS AND METHODS: Observational study that includes 21 haemolytic episodes occurred in 17 patients (9 males and 12 females), with a median age of 59 years (26-82). In group A, 8 episodes received IGIV + corticosteroids and in group B, 12 episodes received only corticosteroids and one rituximab. RESULTS: Hemoglobin (Hb) value at diagnosis was 1.8 g/dl lower (95% confidence interval: 0.6 to 3.1; P = .007) in group A, with a median Hb of 6.3g/dl in this group vs 7.9 g/dl in group B. There were non-significant differences in red blood cells transfusion (50 vs 23%; P > .20) and global increase of Hb values (7.3 vs 5.6; P > .20). Overall hematological responses were similar: 88 vs 92% (P > .20). CONCLUSIONS: Hematological response achieved in more severe episodes with the use of IVIG was similar to non-severe episodes treated without IVIG.

Clinical comparison of two Mexican coccidioidins.

Coccidioidin, an extract from the saprophytic mycelial form of Coccidioides spp., has been a very useful antigen preparation both for skin and serological tests for coccidioidomycosis. Unfortunately, coccidioidin is not currently available for skin testing in the United States. Coccidioidin has been produced commercially in Mexico by a vaccine and reagents laboratory of the Mexican Federal Government. It also has been produced at the Microbiology Laboratory of the Faculty of Medicine, Universidad Nacional Autónoma de México exclusively as an antigen for research projects. The objective of the study was to compare both coccidioidins in their reactivity and safety when applied in humans. One hundred and eighty-four volunteers were tested; median age was 33 (range 14-82). When the cutoff point is set in 5 mm, 88 subjects (47.8%) had a positive test for the commercial coccidioidin and 76 (41.3%; CI(95%) 0.50, 1.15; P = 0.20) were positive with the research antigen. Seventy-five subjects were positive for both antigens and 96 were negative for both. Fifty-nine subjects (31.3%) reported an adverse reaction after the application of the antigen; they were mostly very mild local reactions. Mexican research coccidioidin is a safe and reliable antigen that can be used for the detection of coccidioidomycosis infection in mammals.

Eficiencia y efectividad del servicio de catalogo colectivo de publicaciones seriadas / Eficience and effective of the colective catalog of serial publications

Se realiza un estudio de la eficiencia y efectividad del servicio de catálogo colectivo de publicaciones seriadas del Sistema Nacional de Información de Ciencias Médicas en Cuba, en el que se consideran los indicadores costo-tiempo-productividad para medir la eficacia. La efectividad se evalúa mediante el análisis de la necesidad. Los resultados obtenidos muestran valores positivos en cuanto a la eficiencia, aunque en relación con la efectividad no son tan satisfactorios. Se ofrecen los resultados en forma de números absolutos y en valores porcentuales, que se representan en gráficos estadísticos y tablas