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We present the design of an on-chip integrated photon pair source based on Spontaneous Four Wave Mixing (SFWM), implemented on a ring resonator in the 4H Silicon Carbide On Insulator (4H-SiCOI) platform, compatible with a solid state quantum memory in the telecommunications band. Through careful engineering of the waveguide dispersion and micro-ring resonator dimensions, we found solutions where the signal photons are emitted at 1536.48 nm with a bandwidth of â¼ 150 MHz, enabling the interaction with the hyperfine structure of Er 3 + ions. Simultaneously, the idler photons are generated at 1563.86 nm, matching the central wavelength of a specific channel in a commercial dense wavelength division multiplexing system. The proposed device fulfill all the spectral requirements in a simple ring-bus coupled waveguide configuration with design parameters within the range of reported values for similar resonators, making feasible its manufacturing with current fabrication capabilities.
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We report the design of an integrated photon pair source based on spontaneous four-wave mixing (SFWM), implemented in an integrated micro-ring resonator in the silicon nitride platform (Si3N4). The signal photon is generated with emission at 606 nm and bandwidth of 3.98 MHz, matching the spectral properties of praseodymium ions (Pr), while the idler photon is generated at 1430.5 nm matching the wavelength of a CWDM channel in the E-band. This novel, to the best of our knowledge, device is designed to interact with a quantum memory based on a Y2SiO5 crystal doped with Pr3+ ions, in which we used cavity-enhanced SFWM along with dispersion engineering to reach the required wavelength and the few megahertz signal photon spectral bandwidth.
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Benzocaine is a widely employed local anaesthetic; however, there is a notable dearth of preclinical and clinical evidence regarding its safety in ophthalmological products. To address this, a comprehensive strategy incorporating in silico and in vitro methodologies was proposed for assessing benzocaine's ocular toxicity without animal testing. To collect the in silico evidence, the QSAR Toolbox (v4.5) was used. A single exposure to two benzocaine concentrations (2% and 20%) was evaluated by in vitro methods. Hen's Egg Chorioallantoic Membrane Test (HET-CAM) was performed to evaluate the effects on the conjunctiva. To study corneal integrity, Short Time Exposure test (STE) and Bovine Corneal Opacity and Permeability (BCOP) assay, followed by histopathological analysis, were carried out. Results from both in silico and in vitro methodologies categorize benzocaine as non-irritating. The histopathological analysis further affirms the safety of using benzocaine in eye drops, as no alterations were observed in evaluated corneal strata. This research proposes a useful combined strategy to provide evidence on the safety of local anaesthetics and particularly show that 2% and 20% benzocaine solutions do not induce eye irritation or corneal damage, supporting the potential use of benzocaine in the development of ophthalmic anesthetic products.
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Lesões da Córnea , Opacidade da Córnea , Animais , Bovinos , Feminino , Benzocaína/toxicidade , Galinhas , Córnea , Irritantes/toxicidade , Alternativas aos Testes com AnimaisRESUMO
The European Society of Gynaecological Oncology, the European Society for Medical Oncology (ESMO) and the European Society of Pathology held a consensus conference (CC) on ovarian cancer on 15-16 June 2022 in Valencia, Spain. The CC panel included 44 experts in the management of ovarian cancer and pathology, an ESMO scientific advisor and a methodologist. The aim was to discuss new or contentious topics and develop recommendations to improve and harmonise the management of patients with ovarian cancer. Eighteen questions were identified for discussion under four main topics: (i) pathology and molecular biology, (ii) early-stage disease and pelvic mass in pregnancy, (iii) advanced stage (including older/frail patients) and (iv) recurrent disease. The panel was divided into four working groups (WGs) to each address questions relating to one of the four topics outlined above, based on their expertise. Relevant scientific literature was reviewed in advance. Recommendations were developed by the WGs and then presented to the entire panel for further discussion and amendment before voting. This manuscript focuses on the recommendation statements that reached a consensus, their voting results and a summary of evidence supporting each recommendation.
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Oncologia , Neoplasias Ovarianas , Humanos , Feminino , Sociedades Médicas , Espanha , Neoplasias Ovarianas/genética , Neoplasias Ovarianas/terapia , Biologia MolecularRESUMO
OBJECTIVE: The aim of this investigation was to compare the fracture resistance of chairside computer-aided design and computer-aided manufacturing (CAD/CAM) lithium disilicate-reinforced ceramic occlusal veneers with and without margin and traditional full coverage premolar crowns. METHODS AND MATERIALS: A total of 60 chairside CAD/CAM lithium disilicate-reinforced ceramic (Amber Mill, Hass Bio) restorations were designed and fabricated with a chairside CAD/CAM system (CEREC Dentsply Sirona). The restorations were divided into three groups (n=20): 1) occlusal veneer with 1.0-mm uniform occlusal thickness and with chamfer margin; 2) occlusal veneer with 1.0-mm uniform occlusal thickness and without margin; and 3) full coverage crown with uniform occlusal thickness and gingival margin. Occlusal veneers and crowns were cemented with dual cured resin luting cement (Multilink, Ivoclar Vivadent) to printed resin dies, load cycled (5 million load cycles at 1 Hz with 275 N force), and then loaded until fracture. Load at break (LB) and peak load (PL) until fracture were recorded. Scanning electron microscope images of the tested restorations on the abutments were obtained. RESULTS: Fracture strengths were different depending on the design of the restoration. There was no significant difference in fracture strength between the two types of occlusal veneer (LB: 1132.45 N; PL: 1143.30 N for veneers with margin; LB: 1149.25 N; PL: 1219.05 N for veneers without margin). Full coverage crowns showed the lowest fracture resistance (LB: 936.26 N, PL: 976.42 N), which was significantly lower than both designs of occlusal veneer. CONCLUSIONS: The fracture resistance of the CAD/CAM lithium disilicate-reinforced ceramic restorations was influenced by the design. Occlusal veneers with and without margin displayed higher fracture resistance than traditional crowns.
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Porcelana Dentária , Planejamento de Prótese Dentária , Cerâmica , Coroas , Desenho Assistido por Computador , Teste de Materiais , Análise do Estresse Dentário , Falha de Restauração DentáriaRESUMO
OBJECTIVES: To analyse whether dynapenic abdominal obesity is a risk factor for Metabolic syndrome (MetS) and its components in individuals 50 years of age or older. DESIGN: A longitudinal study was conducted with an eight-year follow-up. SETTING: Representative sample of community-dwelling participants of the English Longitudinal Study of Ageing (ELSA). PARTICIPANTS: 3,952 individuals free of MetS at baseline. MEASUREMENTS: Dynapenic abdominal obesity was defined based on waist circumference (> 102 cm for men and > 88 cm for women) and grip strength (< 26 kg for men and < 16 kg for women). The participants were classified as non-abdominally obese/non-dynapenic (NAO/ND - reference group), abdominally obese/non-dynapenic (AO/ND), non-abdominally obese/dynapenic (NAO/D) and abdominally obese/dynapenic (AO/D). The outcome was the incidence of MetS based on the presence of three or more of the following criteria: hypertriglyceridemia, hyperglycaemia, low HDL cholesterol, arterial hypertension or body mass index ≥ 30 kg/m2 throughout eight-year follow-up. Additionally, the incidence of each component of MetS was also analyzed. Poisson regression models were run and controlled for sociodemographic, behavioural and clinical variables. RESULTS: The mean age of the participants was 65 years and 55% were women. The prevalence of AO/ND, NAO/D and AO/D were 35.3, 4.3 and 2.2%, respectively. At the end of follow-up 558 incident cases of MetS were recorded. The adjusted model demonstrated that although abdominal obesity was a risk factor for MetS (IRR: 2.26; 95% CI: 1.87 - 2.73), the IRR was greater in AO/D individuals (IRR: 3.34; 95% CI: 2.03 - 5.50) compared with ND/NAO group. Furthermore, ND/AO was a risk factor for incidence of hypertriglyceridemia (IRR: 1.27; 95% CI: 1.06 - 1.52), hyperglycaemia (IRR: 1.41; 95% CI: 1.18 - 1.69), low HDL cholesterol (IRR: 1.70; 95% CI: 1.32 - 2.19) and BMI ≥ 30 kg/m2 (IRR: 2.58; 95% CI: 2.04 - 3.26) while D/AO was a risk factor for hyperglycaemia (IRR: 1.78; 95% CI: 1.02 - 3.10), low HDL cholesterol (IRR: 2.36; 95% CI: 1.10 - 5.08), and BMI ≥ 30 kg/m2 (IRR: 2.79; 95% CI: 1.38 - 5.62). CONCLUSIONS: Dynapenic abdominal obesity increases the risk of MetS, with a higher IRR compared to obesity alone. The understanding of this synergic action could guide specific clinical strategies, enabling the prevention of metabolic changes that can lead to cardiovascular disease, disability and death.
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Envelhecimento , Hiperglicemia , Hipertrigliceridemia , Síndrome Metabólica , Obesidade Abdominal , Idoso , Feminino , Humanos , Masculino , HDL-Colesterol , Hiperglicemia/complicações , Hiperglicemia/epidemiologia , Hipertrigliceridemia/complicações , Hipertrigliceridemia/epidemiologia , Estudos Longitudinais , Síndrome Metabólica/epidemiologia , Síndrome Metabólica/etiologia , Obesidade Abdominal/complicações , Obesidade Abdominal/epidemiologia , Fatores de RiscoRESUMO
Primary aldosteronism (PA) is the most common cause of secondary arterial hypertension. For unilateral cases, surgery offers the possibility of cure, with unilateral adrenalectomy being the treatment of choice, whereas bilateral forms of PA are treated mainly with mineralocorticoid receptor antagonists (MRA). The goals of treatment for PA due to either unilateral or bilateral adrenal disease include reversal of the adverse cardiovascular effects of hyperaldosteronism, normalization of serum potassium in patients with hypokalemia, and normalization of blood pressure. The Primary Aldosteronism Surgery Outcome group (PASO) published a study defining clinical and biochemical outcomes based on blood pressure and correction of hypokalemia and aldosterone to renin ratio (ARR) levels for patients undergoing total unilateral adrenalectomy for unilateral PA. In this review, we provide several practical recommendations for the medical and surgical management and follow-up of patients with PA.
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Hiperaldosteronismo , Hipertensão , Hipopotassemia , Humanos , Aldosterona/uso terapêutico , Hipopotassemia/etiologia , Seguimentos , Hiperaldosteronismo/terapia , Hiperaldosteronismo/complicações , Hipertensão/terapia , Hipertensão/complicações , Adrenalectomia/efeitos adversosRESUMO
Recalcitrant pollutants present in wastewater, without an effective treatment, have several effects on aquatic ecosystems and human health due to their chemical structure and persistence. Therefore, it is crucial the development of efficient technologies to eliminate such pollutants in water. Nano-photocatalysts are considered a promising technology for water remediation; however, one common drawback is the difficulty of recovering it after water processing. One effective strategy to overcome such problem is its immobilization into substrates such as polymeric membranes. In this study, a polymeric membrane with embedded Mg0.975Ni0.025SiO3is proposed to remove model pollutants diclofenac sodium and methylene blue dye by synergetic adsorption and photocatalytic processes. Mg0.975Ni0.025SiO3was synthesized by the combustion method. The matrix polymeric blend consisting of a blend of cellulose acetate, crystalline nanocellulose and polyvinylidene fluoride was obtained by the phase inversion method. The composite membranes were characterized by FTIR, x-ray diffraction, and scanning electron microscopy. With pollutant solutions at pH 7, the pollutant adsorption capacity of the membranes reached up to 30% and 45% removal efficiencies for diclofenac sodium and methylene blue, respectively. Under simulated solar irradiation photocatalytic removal performances of 70% for diclofenac sodium pH 7, and of 97% for methylene blue dye at pH 13, were reached. The membrane photocatalytic activity allows the membrane to avoid pollutant accumulation on its surface, given a self-cleaning property that allows the reuse of at least three cycles under sunlight simulator irradiation. These results suggest the high potential of photocatalytic membranes using suitable and economical materials such as cellulosic compounds and magnesium silicates for water remediation.
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PURPOSE: To evaluate the prevalence, risk factors and evolution of diabetes mellitus (DM) after targeted treatment in patients with primary aldosteronism (PA). METHODS: A retrospective multicenter study of PA patients in follow-up at 27 Spanish tertiary hospitals (SPAIN-ALDO Register). RESULTS: Overall, 646 patients with PA were included. At diagnosis, 21.2% (n = 137) had DM and 67% of them had HbA1c levels < 7%. In multivariate analysis, family history of DM (OR 4.00 [1.68-9.53]), the coexistence of dyslipidemia (OR 3.57 [1.51-8.43]) and advanced age (OR 1.04 per year of increase [1.00-1.09]) were identified as independent predictive factors of DM. Diabetic patients were on beta blockers (46.7% (n = 64) vs. 27.5% (n = 140), P < 0.001) and diuretics (51.1% (n = 70) vs. 33.2% (n = 169), p < 0.001) more frequently than non-diabetics. After a median follow-up of 22 months [IQR 7.5-63.0], 6.9% of patients developed DM, with no difference between those undergoing adrenalectomy and those treated medically (HR 1.07 [0.49-2.36], p = 0.866). There was also no significant difference in the evolution of glycemic control between DM patients who underwent surgery and those medically treated (p > 0.05). CONCLUSION: DM affects about one quarter of patients with PA and the risk factors for its development are common to those of the general population. Medical and surgical treatment provides similar benefit in glycemic control in patients with PA and DM.
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Diabetes Mellitus , Hiperaldosteronismo , Humanos , Prevalência , Espanha/epidemiologia , Diabetes Mellitus/epidemiologia , Diabetes Mellitus/etiologia , Fatores de Risco , Hiperaldosteronismo/complicações , Hiperaldosteronismo/epidemiologia , Hiperaldosteronismo/terapia , Sistema de RegistrosRESUMO
BACKGROUND: Despite evidence supporting its use, many Enhanced Recovery After Surgery (ERAS) recommendations remain poorly adhered to and barriers to ERAS implementation persist. In this second updated ERAS® Society guideline, a consensus for optimal perioperative care in gynecologic oncology surgery is presented, with a specific emphasis on implementation challenges. METHODS: Based on the gaps identified by clinician stakeholder groups, nine implementation challenge topics were prioritized for review. A database search of publications using Embase and PubMed was performed (2018-2023). Studies on each topic were selected with emphasis on meta-analyses, randomized controlled trials, and large prospective cohort studies. These studies were then reviewed and graded by an international panel according to the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) system. RESULTS: All recommendations on ERAS implementation challenge topics are based on best available evidence. The level of evidence for each item is presented accordingly. CONCLUSIONS: The updated evidence base and recommendations for stakeholder derived ERAS implementation challenges in gynecologic oncology are presented by the ERAS® Society in this consensus review.
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Recuperação Pós-Cirúrgica Melhorada , Neoplasias dos Genitais Femininos , Feminino , Humanos , Neoplasias dos Genitais Femininos/cirurgia , Estudos Prospectivos , Assistência Perioperatória , Procedimentos Cirúrgicos em GinecologiaRESUMO
OBJECTIVE: Abnormal endotoxin activity in critically ill patients has been described in the absence of Gram-negative bacterial (GNB) infection. As disease severity seems to be crucial in the detection of this phenomenon, we decided to assess and compare endotoxin exposure in those patients representing the critical situation: septic shock and cardiogenic shock. DESIGN: Prospective, observational non intervention study. SETTING: Critical Care Department of a University tertiary hospital. PATIENTS: Cardiogenic shock (CS) and septic shock (SS) patients. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Follow-up was performed for the first three days. Inflammatory biomarkers (C-reactive protein, procalcitonin and interleuquin-6) and IgM antiendotoxin-core antibodies titter (IgM EndoCAb) were daily analyzed. Sixty-two patients were included; twenty-five patients with SS and thirty-seven with CS. Microbial etiology was established in 23 SS patients (92%) and GNB were present in 13 cases (52%). Although infection was suspected and even treated in 30 CS patients (81%), any episode could be finally confirmed. EndoCAb consumption was more intense in SS patients, although twenty-two CS patients (59.5%) had IgM anti-endotoxin value below 10th percentile range for healthy people. No statistically significant difference in endotoxin exposure was detected between Gram-positive and Gram-negative infections in the SS group. Endotoxin exposure ability to distinguish between SS and CS was moderate (AUC 0.7892, 95% IC: 0.6564-0.9218). CONCLUSIONS: In the severely ill patient some mechanisms take place allowing endotoxin incursion and therefore blurring the limits of diseases pathophysiology. Our work representatively shows how exposure to endotoxin was not fully capable of distinguishing between CS and SS.
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Choque Séptico , Humanos , Choque Cardiogênico , Estudos Prospectivos , Endotoxinas , Imunoglobulina MRESUMO
Antimicrobial stewardship programs (ASPs) have been shown to be effective and safe, contributing to reducing and adjusting antimicrobial use in clinical practice. Such programs not only reduce antibiotic selection pressure and therefore the selection of multidrug-resistant strains, but also reduce the potential deleterious effects for individual patients and even improve the prognosis by adjusting the choice of drug and dosage, and lessening the risk of adverse effects and interactions. Gram-negative bacilli (GNB), particularly multidrug-resistant strains (MDR-GNB), represent the main infectious problem in the Intensive Care Unit (ICU), and are therefore a target for ASPs. The present review provides an update on the relationship between ASPs and MDR-GNB.
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Gestão de Antimicrobianos , Infecções por Bactérias Gram-Negativas , Humanos , Infecções por Bactérias Gram-Negativas/tratamento farmacológico , Farmacorresistência Bacteriana Múltipla , Bactérias Gram-Negativas , Unidades de Terapia IntensivaRESUMO
Primary hyperaldosteronism (PAH) is the most frequent cause of secondary arterial hypertension. Most PAHs occur sporadically, but 5% of cases have a hereditary origin (familial PAH). Four forms of familial PAH have been described. Type I familial PAH is produced by a fusion of the CYP11B2 and CYP11B1 genes, in this way the synthesis of aldosterone becomes to be regulated by ACTH instead of by angiotensin II. In type II, III and IV familial PAH there is an increase in the transcription and expression of CYP11B2 responsible for aldosterone synthesis due to a germinal mutation in CLCN2, KCNJ5 and CACNA1H, respectively. On the other hand, somatic mutations have been identified in 50% of sporadic PAHs, with gain-of-function mutations at the level of KCNJ5, ATP1A1, ATP2B3 and CACNA1D being the most common. This review provides a detailed description of the different forms of familial PAH and the molecular profile of patients with sporadic PAH.
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Aldosterona , Hiperaldosteronismo , Humanos , Aldosterona/metabolismo , Esteroide 11-beta-Hidroxilase/metabolismo , Citocromo P-450 CYP11B2/metabolismo , Angiotensina II/metabolismo , ATPase Trocadora de Sódio-Potássio/genética , ATPase Trocadora de Sódio-Potássio/metabolismo , Hiperaldosteronismo/genética , Hormônio Adrenocorticotrópico/metabolismo , Canais de Potássio Corretores do Fluxo de Internalização Acoplados a Proteínas G/genética , Canais de Potássio Corretores do Fluxo de Internalização Acoplados a Proteínas G/metabolismoRESUMO
We evaluated feathers as a non-destructive biomonitoring tool documenting organochlorine pesticides (OCP) in liver and checked possible trends in pesticide use in two areas based on OCP concentrations in barn owls (Tyto alba). We measured the concentrations of 16 OCP in 15 primary feathers and 15 livers from barn owl carcasses collected on roadsides in Tagus Valley and Évora regions, south Portugal. Total OCP mean concentration was 8 120 ng g-1 in feathers and 178 ng g-1 in livers. All compounds were detected in feathers while in livers δ-HCH, endosulfan sulphate, p,p'-DDT and p,p'-DDD were not detected. The high ß-HCH and heptachlor concentrations in feathers most likely derived from external endogenous contamination. P,p'-DDE was the OCP with the highest hepatic concentration. Both matrices indicated an exposure to recently released heptachlor. The differing OCP concentrations between Tagus Valley and Évora seem to reflect differences in land-use and pesticide use histories of the two locations, and/or faster degradation of OCP in the Tagus area.
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Hidrocarbonetos Clorados , Praguicidas , Estrigiformes , Animais , DDT , Diclorodifenil Dicloroetileno , Monitoramento Ambiental , Plumas/química , Heptacloro , Hidrocarbonetos Clorados/análise , Fígado/metabolismo , Praguicidas/análise , Portugal , Estrigiformes/metabolismoRESUMO
The appearance and spread of new mechanisms of bacterial resistance to antibiotics is a serious health problem. One of the most difficult resistance mechanisms to treat is the production of carbapenemases. Carbapenemase KPC is one of those mechanisms with few therapeutic options. Meropenem-vaborbactam has shown great efficacy against this type of microorganism, both from a clinical and microbiological point of view. Its good pharmacokinetics, including in the lung, and its safety profile make meropenem-vaborbactam an excellent therapeutic option. Finally, the absence of resistance genesis during treatment seems to indicate that its efficacy will be long-lasting.
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Antibacterianos , Pneumonia , Antibacterianos/efeitos adversos , Antibacterianos/farmacocinética , Ácidos Borônicos , Humanos , Meropeném/uso terapêutico , Pneumonia/tratamento farmacológicoRESUMO
PURPOSE: Patients with hereditary hypophosphatemic rickets are short and disproportionate and very little information is available on segmental growth, but the body disproportion at adulthood leads us to think that the growth velocity of legs is slower. METHODS: A total of 96 children were included and molecular testing was carried out in 42. Children who reached adult height were classified into two groups according to their compliance to conventional treatment (phosphate supplement and calcitriol). Individual growth records of height and sitting height/height were plotted using Argentine reference data in 96 children and growth curves were estimated by fitting Preece-Baines Model 1 in 19 of the children. RESULTS: Molecular testing revealed sequence deleterious alterations or large deletions in 36/42 patients. During childhood, 76% of children grew below - 1.88 standard deviation score (SDS) and 97% had body disproportion. During adolescence, the mean peak height velocity for the good and poor compliance to treatment groups was 7.8 (0.6) and 5.4 (0.4) cm/year in boys and 7.0 (0.7) and 5.2 (0.8) cm/year in girls, respectively. At adulthood, the median sitting height/height ratio was 2.32 and 6.21 SDS for the good and poor compliance to treatment groups, respectively. The mean pubertal growth spurt of the trunk was -0.8 (1.4) SDS, with a short pubertal growth spurt of - 1.8 (0.4) SDS for limbs in the good compliance group. Median adult height in 13/29 males and 30/67 females was -4.56 and -3.16 SDS, respectively. CONCLUSION: For all patients the growth spurt was slower, secondary to a short growth spurt of limbs, reaching a short adult height with body disproportion that was more prominent in the poor compliance group.
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Raquitismo Hipofosfatêmico Familiar , Adolescente , Adulto , Estatura , Calcitriol , Criança , Raquitismo Hipofosfatêmico Familiar/genética , Feminino , Humanos , Masculino , Fosfatos , Puberdade , Estudos RetrospectivosRESUMO
Parasites cause losses in animal production. Parasite infection in ruminants has been estimated to be a major problem causing more than 3 billion USD per year, from which 60% corresponds to the sheep industry. Treatment is based on the use of synthetic anthelmintics; however, repeated application or under dosage have resulted in the selection of nematodes resistant to anthelmintics. The objective of the present work was to perform a diagnosis of gastrointestinal parasites in sheep kept under different zootechnical management. Ninety female sheep were used, most of them pregnant. Sampling was performed monthly from December 2015 to June 2016 (flock 5 until April). Fecal samples were collected from the rectum; the McMaster technique was performed, morphological characteristics were observed, oocysts and eggs were counted per gram of feces (opg and epg), frequency and intensity were obtained. Faecal culture was performed for feces that had a positive result, infective larvae were obtained and taxonomically identified. At the end of the study, a dewormer (fenbendazole) was administered and its effect was measured. The frequency of gastrointestinal parasites was 100%. The highest opg was 3,600 (flock 3, March, 2016), the epg for cestodes was 2800 (flock 1, January, 2016) and for gastrointestinal nematodes (GIN) was 25,000 (flock 1, May, 2016); the intensity was variable and it was increased by peripartum. Protists (Eimeria spp), cestodes (Moniezia) and nematodes (Haemonchus, Trichostrongylus, Cooperia, Chabertia ovina. Teladorsagia, Oesophagostomum, Nematodirus and Trichuris ovis) were identified. No previous diagnosis is performed in flocks, and sometimes dewormers are administered, even though resistance to ivermectin and benzimidazole is suspected. Flock management, its feeding system and its conditions were determinant for the observed results; therefore, it is necessary to count with a diagnosis that provides information about the parasitic population and its dynamic, in order to carry out a selective and comprehensive control that has an impact on the animal, human and environmental health.
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Anti-Helmínticos , Enteropatias Parasitárias , Nematoides , Infecções por Nematoides , Parasitos , Doenças dos Ovinos , Animais , Anti-Helmínticos/uso terapêutico , Fezes/parasitologia , Feminino , Enteropatias Parasitárias/epidemiologia , Enteropatias Parasitárias/parasitologia , Enteropatias Parasitárias/veterinária , México/epidemiologia , Infecções por Nematoides/diagnóstico , Infecções por Nematoides/tratamento farmacológico , Infecções por Nematoides/veterinária , Contagem de Ovos de Parasitas/veterinária , Gravidez , Ovinos , Doenças dos Ovinos/diagnóstico , Doenças dos Ovinos/tratamento farmacológicoRESUMO
Osteoarthrosis of the knee is one of the most important causes of disability around the world, being total knee arthroplasty (TKA) a cost-effective surgical procedure for treating its severe stage when all knee compartments are compromised. Despite the good functional results and good survival of the implants and of the patients, still, 15 to 20% of the patients are dissatisfied after surgery. One of the causes of dissatisfaction is persistent pain located in the anterior part of the knee, which leads to controversy over whether to perform the patellar replacement. Advantages and complications are described in both scenarios, and neither is superior to the other in pain and implant survival. In the case of TKA without patellar replacement, the position of the femoral component plays a crucial role in achieving normal patellar tracking. The current challenge is to determine those clinical and radiological variables that allow us to predict the absence of long-term anterior pain in patients who require TKA and who do not undergo patellar replacement. (AU)
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Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Idoso , Dor Pós-Operatória/complicações , Artroplastia do Joelho/efeitos adversos , Osteoartrite do Joelho/cirurgia , Complicações Pós-Operatórias , Artroplastia do Joelho/métodosRESUMO
OBJECTIVES: 1. To determine the satisfaction of tutors and residents with a specific methodology used to implement CoBaTrICE. 2. To determine the reliability and validity of the global rating scales designed ad hoc to assess the performance of the residents for training purposes. DESIGN: Prospective cohort study. PARTICIPANTS: All the residents and tutors of the ICU Department of the Hospital Universitario y Politécnico la Fe de Valencia. INTERVENTION: CoBaTrICE implementation started in March 2016, it was based on: (1) Training the tutors in feedback techniques; (2) Performing multiple objective and structured work based assessments to achieve the competences of the program; and (3) The use of an electronic portfolio to promote learning reflection and to collect the evidence that learning was taking place. METHODS: The acceptance of CoBaTrICE was explored through a satisfaction survey conducted after 9 months of implementation of the training program. The 15 residents and 5 tutors of the ICU Department were asked about the methodology of the formative assessments, the quality of the feedback, self-learning regulation and the electronic portfolio usefulness. The validity of the global rating scales was assessed through the tests alfa de Cronbach, reliability and generalizability indexes, and intraclass correlation coefficient. RESULTS: The implementation of CoBaTrICE was satisfactory in all the dimensions studied. The global rating scales used for formative purposes showed reliability and validity. CONCLUSIONS: The methodology used to implement CoBaTrICE was highly valued by tutors and residents. The global rating scales used for formative purposes showed reliability and validity.
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Educação Médica , Cuidados Críticos , Humanos , Estudos Prospectivos , Encaminhamento e Consulta , Reprodutibilidade dos TestesRESUMO
Infections have become one of the main complications of patients with severe SARS-CoV-2 pneumonia admitted in ICU. Poor immune status, frequent development of organic failure requiring invasive supportive treatments, and prolonged ICU length of stay in saturated structural areas of patients are risk factors for infection development. The Working Group on Infectious Diseases and Sepsis GTEIS of the Spanish Society of Intensive Medicine and Coronary Units SEMICYUC emphasizes the importance of infection prevention measures related to health care, the detection and early treatment of major infections in the patient with SARS-CoV-2 infections. Bacterial co-infection, respiratory infections related to mechanical ventilation, catheter-related bacteremia, device-associated urinary tract infection and opportunistic infections are review in the document.