Clinical and Epidemiological Characteristics of Patients Being Treated for Scabies in Spain: Opportunities for Improvement - A Multicenter Cross-Sectional CLINI-AEDV Study. / Características clínicas y epidemiológicas de pacientes diagnosticados de escabiosis en España: oportunidades de mejora. Estudio transversal multicéntrico CLINI-AEDV.

BACKGROUND: Several studies support the hypothesis that scabies is on the rise in Spain. There are also concerns about the possible development of resistance to treatment and an increase in atypical presentations. The aims of this study were to describe the demographic and clinical characteristics of patients with scabies seen by dermatologists in Spain, to identify the possible emergence of atypical forms of scabies, and to explore the frequency of treatment failures and associated risk factors. METHODS: We conducted an observational, cross-sectional, multicenter study of data collected prospectively in April and May 2023 using the CLINI-AEDVp platform created by the Spanish Academy of Dermatology and Venereology (AEDV). RESULTS: Participating dermatologists from 31 hospitals in 15 of Spain's autonomous communities recorded 186 cases of active scabies (51% in women) during the study period. A diagnostic certainty level of A, B or C as per the International Alliance for the Control of Scabies Consensus Criteria was required for diagnosis. Overall, 92% of patients had typical scabies and 66% had already been treated with a scabicide for the current episode. Of the treated patients, only 36% had received and completed adequate treatment (including the simultaneous treatment of all household members) and 50% had not received clear written recommendations. CONCLUSIONS: In a high proportion of the cases of scabies studied, the patient had already received treatment. In those cases, we observed several remediable shortcomings that could explain why some of these treatments had failed. Remedying these deficiencies should lead to better control of scabies and an improved assessment of the actual effectiveness of currently available scabicides.

[Translated article] Clinical and Epidemiological Characteristics of Patients Being Treated for Scabies in Spain: Opportunities for Improvement - A Multicenter Cross-Sectional CLINI-AEDV Study.

BACKGROUND: Several studies support the hypothesis that scabies is on the rise in Spain. There are also concerns about the possible development of resistance to treatment and an increase in atypical presentations. The aims of this study were to describe the demographic and clinical characteristics of patients with scabies seen by dermatologists in Spain, to identify the possible emergence of atypical forms of scabies, and to explore the frequency of treatment failures and associated risk factors. METHODS: We conducted an observational, cross-sectional, multicenter study of data collected prospectively in April and May 2023 using the CLINI-AEDVp platform created by the Spanish Academy of Dermatology and Venereology (AEDV). RESULTS: Participating dermatologists from 31 hospitals in 15 of Spain's autonomous communities recorded 186 cases of active scabies (51% in women) during the study period. A diagnostic certainty level of A, B or C as per the International Alliance for the Control of Scabies Consensus Criteria was required for diagnosis. Overall, 92% of patients had clinical features of classic scabies and 66% had already been treated with a scabicide for the current episode. Of the treated patients, only 36% had received and completed adequate treatment (including the simultaneous treatment of all household members) and 50% had not received clear written recommendations. CONCLUSIONS: In a high proportion of scabies cases, the patient has already received treatment. In those cases, we observe several remediable shortcomings that could explain why some of these treatments fail. Remedying these deficiencies should lead to better control of scabies and an improved assessment of the actual effectiveness of currently available scabicides.

Peer-based intervention for acute stress reaction: adaptations by five militaries.

Military service members need to be able to operate under conditions of extreme stress to ensure the success of their team's mission; however, an acute stress reaction (ASR) can compromise team safety and effectiveness by rendering an individual unable to function. Building on an intervention originally developed by the Israel Defense Forces, several countries have developed, tested, and disseminated a peer-based intervention to help service members manage acute stress in others. This paper reviews how five countries (Canada, Germany, Norway, the UK and the USA) adjusted the protocol to fit their organisational culture while retaining essential elements of the original procedure, suggesting there can be interoperability and mutual intelligibility in the management of ASR by military allies. Future research should examine the parameters of effectiveness for this intervention, the impact of intervention on long-term trajectories, and individual differences in managing ASR.

Prevention and treatment of delirium in intensive care: Hermeneutics of experiences of the nursing team.

OBJECTIVE: To understand the experiences in nursing care in the prevention and treatment of delirium in people hospitalized in intensive care units. METHODOLOGY: Hermeneutic phenomenological qualitative study. The selection of participants was by intentional sampling: seven nursing assistants and eight nurses. Theoretical saturation was achieved. The phenomenological interview was applied to collect data from a central question and the analysis was carried out following the approaches of Heidegger's hermeneutical circle. RESULTS: Four significant themes emerged from the analysis: (1) delirium prevention, (2) pharmacological treatment, (3) non-pharmacological treatment, and (4) barriers to non-pharmacological treatment. These themes were accompanied by 35 interrelated units of meaning: in the first theme, the most repetitive units were communication, orientation, and family bonding; in the second was the use of pharmacological treatment only in the acute phase; in the third was the modification of the environment according to the patient's preference (where the family is a priority and strategies that provide cognitive and social stimulation can be reinforced), and in the fourth was the work overload for the nursing team. CONCLUSIONS: The experiences of the nursing team in the prevention and treatment of delirium in critically ill patients highlight that communication allows an approach to the patient as a human being immersed in a reality, with a personal history, needs and preferences. Therefore, family members must be involved in these scenarios, as they can complement and support nursing care.

Prevention and treatment of delirium in intensive care: Hermeneutics of experiences of the nursing team. / Prevenir y tratar delirium en cuidados intensivos: hermenéutica de las vivencias del equipo de enfermería.

OBJECTIVE: To understand the experiences in nursing care in the prevention and treatment of delirium in people hospitalized in intensive care units. METHODOLOGY: Hermeneutic phenomenological qualitative study. The selection of participants was by intentional sampling: seven nursing assistants and eight nurses. Theoretical saturation was achieved. The phenomenological interview was applied to collect data from a central question and the analysis was carried out following the approaches of Heidegger's hermeneutical circle. RESULTS: Four significant themes emerged from the analysis: 1) Delirium prevention, 2) Pharmacological treatment, 3) Non-pharmacological treatment, and 4) Barriers to non-pharmacological treatment. These themes were accompanied by 35 interrelated units of meaning: in the first theme, the most repetitive units were communication, orientation, and family bonding; in the second was the use of pharmacological treatment only in the acute phase; in the third was the modification of the environment according to the patient's preference (where the family is a priority and strategies that provide cognitive and social stimulation can be reinforced), and in the fourth was the work overload for the nursing team. CONCLUSIONS: The experiences of the nursing team in the prevention and treatment of delirium in critically ill patients highlight that communication allows an approach to the patient as a human being immersed in a reality, with a personal history, needs and preferences. Therefore, family members must be involved in these scenarios, as they can complement and support nursing care.

[Influence of the covid-19 pandemic period of alert on perceived quality of hospital emergencies]. / Influencia del periodo de alarma por la pandemia covid-19 en la calidad percibida de la atención en urgencias hospitalarias.

OBJECTIVE: To assess changes in perceived quality in patients who required A&E hospital care before and during the COVID-19 period of alert. METHODS: Retrospective descriptive observational study using the «Net Promoter Score¼ (NPS), which classifies patients as promoters or detractors. Three perceived quality dimensions (accessibility, professionals, and information) were measured in 160 patients discharged home before alert, and in a further 160 in the first 2 months during alert. A standard of ≥90% promoters and ≤10% detractors was verified by lot acceptance (LQAS) in different access routes and times. Factors related to the probability that a patient was a promoter, or a detractor were analysed using logistic regression. RESULTS: The mean score was lower in accessibility than in the other dimensions (8.6 vs. 9.1 and 9.0, P<.0001). During alert, accessibility obtained better results (NPS 70 vs. 32, P<.001). Per access route, Paediatrics and Ophthalmology improved and Maternity did not experience changes. LQAS showed more lots accepted during alert (85 vs. 72%). The likelihood for a patient to be a promoter was higher during alert (OR 1.85, P<.0001), especially in accessibility (OR 3.08, P<0.0001). The likelihood to be a detractor was reduced (OR .54, P<.05), and also greater in accessibility (OR .39, P<.05). CONCLUSIONS: Perceived quality improved during the period of alert, its declaration being the most influential factor. This improvement is evident in paediatric and ophthalmological patients, but imperceptible in Maternity or Traumatology, perhaps because the pandemic acted as an adequacy corrector.

[Prevention of thromboembolic disease in elderly patients admitted to medical wards]. / Adecuación de la profilaxis tromboembólica en pacientes de edad avanzada hospitalizados en servicios médicos de un hospital de tercer nivel.

OBJECTIVES: To determine the suitability of the prevention of thromboembolic disease in elderly patients admitted to medical departments, as well as some associated factors, such as the measures required in order to improve quality and safety. PATIENTS AND METHODS: A retrospective study in a tertiary level hospital that included elderly patients that were admitted to medical departments. A simple, non-proportional, randomised sample was used, stratified by department. The risk was measured using the Padua prediction model and the risk assessment model of the International Medical Prevention Registry on Venous Thromboembolism (IMPROVE) adjusting depending on the number of discharges. A Lot Quality Assurance Sampling (LQAS) plan was used with three levels, good, (standard 95%, threshold 70%), acceptable (standard 95%, threshold 50%), and not acceptable. RESULTS: A total of 72 cases from 8 departments were evaluated. Just over half (51.4%) of patients had a high risk of thromboembolic disease (Padua≥4), and 23.6% of bleeding (IMPROVE≥7). Besides the advanced age, the adjusted scores were particularly due to cancer (22%) and reduced mobility (19%) for Padua, and male gender (13%) and renal failure (12%) for IMPROVE. The adjusted overall suitability was 57.5% (95%CI: ±19.0%). The OR for suitable conduct on not starting medication, 1.56 (95%CI: 1.07-2.26). The suitability by department was not uniform: all the lots were acceptable, in 3 with level "good" and in 5 with "acceptable". CONCLUSIONS: The suitability of thromboembolic prophylaxis in the study hospital maintains acceptable levels, although not homogeneous. There is an opportunity for improvement that must be taken. The data obtained may help in deciding interventions, with LQAS being useful to optimise the evaluation effort.

Measurement of the interaction between mucin and oenological tannins by Surface Plasmon Resonance (SPR); relationship with astringency.

The interaction between stomach porcine mucin and 3 oenological tannins (extract of ellagitannins from oak, extract of gallotannins from gall nuts and extract of proanthocyanidins from grape seeds) was measured by Surface Plasmon Resonance (SPR). These tannins were analysed and their astringency was determined using the Astringency Index method and by tasting. The interaction constants were determined using a Biacore SPR device (1:1 Langmuir binding model). The results indicate that the ellagitannins are more astringent than gallotannins and those, in turn, are more astringent than seed proanthocyanidins if the richness of the commercial extracts is considered. The astringency index of these tannins had high correlation and regression coefficients with their kinetic and thermodynamic dissociation constants. This data support a hypothesis that astringency depends not only on the thermodynamic tendency to form the complex between tannins and salivary proteins but also probably on the time required to dissociate the complex.

Quantum control of surface acoustic-wave phonons.

One of the hallmarks of quantum physics is the generation of non-classical quantum states and superpositions, which has been demonstrated in several quantum systems, including ions, solid-state qubits and photons. However, only indirect demonstrations of non-classical states have been achieved in mechanical systems, despite the scientific appeal and technical utility of such a capability1,2, including in quantum sensing, computation and communication applications. This is due in part to the highly linear response of most mechanical systems, which makes quantum operations difficult, as well as their characteristically low frequencies, which hinder access to the quantum ground state3-7. Here we demonstrate full quantum control of the mechanical state of a macroscale mechanical resonator. We strongly couple a surface acoustic-wave8 resonator to a superconducting qubit, using the qubit to control and measure quantum states in the mechanical resonator. We generate a non-classical superposition of the zero- and one-phonon Fock states and map this and other states using Wigner tomography9-14. Such precise, programmable quantum control is essential to a range of applications of surface acoustic waves in the quantum limit, including the coupling of disparate quantum systems15,16.

Integración de Un Sistema Robótico de Terapia Ocupacional para Extremidades Superiores con Estimulación Visual/Táctil de Los Pacientes / Integration of an Occupational-Therapy Robotic System for Upper Limbs with Visual/tactile Stimulation of Patients

Resumen: Los ejercicios tradicionales de rehabilitación de extremidades superiores tienen como objetivo principal recuperar la fuerza o rango de movimiento del área lesionada de los pacientes. Una opción alternativa que se ha presentado en los últimos años es el uso de interfaces hápticas, las cuales han mostrado ser herramientas potenciales en el apoyo de las terapias de rehabilitación. En este artículo se presenta un sistema de rehabilitación háptico de movimientos finos en extremidades superiores, cuya característica principal es que los usuarios del sistema pueden interactuar de forma visual y táctil con objetos virtuales mezclados con escenarios reales logrando con ello un ambiente de realidad aumentada. El sistema fue probado en dos etapas, ambas con sujetos que presentaban un grado de discapacidad en extremidades superiores. Los datos recopilados fueron trayectorias seguidas, errores de seguimiento y la actividad muscular obtenida por medio de electromiografía; esta información recolectada permitió analizar de forma cuantitativa el grado de avance de los pacientes. Además, se consideraron las valoraciones hechas por fisioterapeutas, concluyendo que el sistema propuesto puede ser utilizado como una herramienta viable que complementa a las terapias de rehabilitación convencionales.

Abstract: Traditional upper limb rehabilitation exercises are primarily aimed at regaining the strength or range of motion of the patients' injured area. An alternative option that has been presented in the last years is the use of haptic interfaces, which have shown their potential as tools that support rehabilitation therapies. This article presents a haptic system of rehabilitation for fine upper limb movements, whose main characteristic is that users of the system can interact in a visual and tactile fashion with virtual objects mixed with real scenarios, thereby achieving an augmented reality environment. The system was tested in two stages, both with subjects who had a degree of disability in upper limbs. The data collected were followed trajectories, follow-up errors and the muscular activity obtained by means of electromyography; the collected information enabled the analysis, in a quantitative way, of the degree of progress of the patients. In addition, the assessments made by physiotherapists were considered, concluding that the proposed system can be used as a viable complementary tool for conventional rehabilitation therapies.

Human intestinal pro-inflammatory CD11chighCCR2+CX3CR1+ macrophages, but not their tolerogenic CD11c-CCR2-CX3CR1- counterparts, are expanded in inflammatory bowel disease.

Although macrophages (Mϕ) maintain intestinal immune homoeostasis, there is not much available information about their subset composition, phenotype and function in the human setting. Human intestinal Mϕ (CD45+HLA-DR+CD14+CD64+) can be divided into subsets based on the expression of CD11c, CCR2 and CX3CR1. Monocyte-like cells can be identified as CD11chighCCR2+CX3CR1+ cells, a phenotype also shared by circulating CD14+ monocytes. On the contrary, their Mϕ-like tissue-resident counterparts display a CD11c-CCR2-CX3CR1- phenotype. CD11chigh monocyte-like cells produced IL-1ß, both in resting conditions and after LPS stimulation, while CD11c- Mϕ-like cells produced IL-10. CD11chigh pro-inflammatory monocyte-like cells, but not the others, were increased in the inflamed colon from patients with inflammatory bowel disease (IBD), including Crohn's disease and ulcerative colitis. Tolerogenic IL-10-producing CD11c- Mϕ-like cells were generated from monocytes following mucosal conditioning. Finally, the colonic mucosa recruited circulating CD14+ monocytes in a CCR2-dependent manner, being such capacity expanded in IBD. Mϕ subsets represent, therefore, transition stages from newly arrived pro-inflammatory monocyte-like cells (CD11chighCCR2+CX3CR1+) into tolerogenic tissue-resident (CD11c-CCR2-CX3CR1-) Mϕ-like cells as reflected by the mucosal capacity to recruit circulating monocytes and induce CD11c- Mϕ. The process is nevertheless dysregulated in IBD, where there is an increased migration and accumulation of pro-inflammatory CD11chigh monocyte-like cells.

Deficiencia de vitamina D en el paciente quemado / Deficiency of vitamin D in the burn patient

Resumen: Las quemaduras son un escenario especial de trauma grave que condiciona osteopenia, alteraciones del metabolismo del calcio, miopatía e inmunosupresión, entre otras. Los pacientes quemados tienen elevado riesgo de hipovitaminosis D debido a que condicionan incremento en la pérdida de calcio, disminución de su captación en hueso e importantes alteraciones en la síntesis de vitamina D. En este contexto la suplementación con vitamina D en el paciente con quemaduras pudiera compensar su deficiencia y los efectos nocivos secundarios. El objetivo de este trabajo es revisar los conceptos actuales relacionados con el metabolismo de la vitamina D y el efecto de su deficiencia en los enfermos con quemaduras.

Abstract: Severe burn injury represents a special trauma leading to major systemic dysfunctions such a bone loss, mineral disruptions, myopathy and immunosuppression. Burn patients are at high risk of hypovitaminosis D. Burn injury gives rise to calcium wasting, failure of bone to take up calcium, and vitamin D insufficiency. In this context vitamin D supplementation could help counteract post-burn sequelae. The aim of this paper is to review the current concepts on vitamin D metabolism with special focus in burn patients.

Mesoscopic model for DNA G-quadruplex unfolding.

Genomes contain rare guanine-rich sequences capable of assembling into four-stranded helical structures, termed G-quadruplexes, with potential roles in gene regulation and chromosome stability. Their mechanical unfolding has only been reported to date by all-atom simulations, which cannot dissect the major physical interactions responsible for their cohesion. Here, we propose a mesoscopic model to describe both the mechanical and thermal stability of DNA G-quadruplexes, where each nucleotide of the structure, as well as each central cation located at the inner channel, is mapped onto a single bead. In this framework we are able to simulate loading rates similar to the experimental ones, which are not reachable in simulations with atomistic resolution. In this regard, we present single-molecule force-induced unfolding experiments by a high-resolution optical tweezers on a DNA telomeric sequence capable of adopting a G-quadruplex conformation. Fitting the parameters of the model to the experiments we find a correct prediction of the rupture-force kinetics and a good agreement with previous near equilibrium measurements. Since G-quadruplex unfolding dynamics is halfway in complexity between secondary nucleic acids and tertiary protein structures, our model entails a nanoscale paradigm for non-equilibrium processes in the cell.

Terahertz imaging for early screening of diabetic foot syndrome: A proof of concept.

Most people with diabetes suffer some deterioration of the feet. Diabetic foot syndrome causes ulceration in about 15% of cases and such deterioration leads to amputation in about 2.5% of diabetic patients, diminishing their quality of life and generating extraordinary costs for patients and public health systems. Currently, there is no objective method for the detection of diabetic foot syndrome in its early stages. We propose terahertz imaging as a method for the evaluation of such deterioration. This screening method could aid the prevention and medical treatment of this condition in the future.