Potential healthcare resource use and associated costs of every 2 month injectable cabotegravir plus rilpivirine long-acting regimen implementation in the Spanish National Healthcare System compared to daily oral HIV treatments.

INTRODUCTION: HIV treatment currently consists of daily oral antiretroviral therapy (ART). Cabotegravir + rilpivirine long-acting (CAB + RPV LA) is the first ART available in Spain administered every 2 months through intramuscular injection by a healthcare professional (HCP). The objective of this analysis was to assess potential healthcare resource use (HRU) and cost impact of implementing CAB + RPV LA vs. daily oral ART at National Health System (NHS) hospitals. METHODS: Online quantitative interviews and cost analysis were performed. Infectious disease specialists (IDS), hospital pharmacists (HP) and nurses were asked about their perception of potential differences in HRU between CAB + RPV LA vs. daily oral ART, among other concepts of interest. Spanish official tariffs were applied as unit costs to the HRU estimates (€2022). RESULTS: 120 responders (n = 40 IDS, n = 40 HP, n = 40 nurses) estimated an average number of annual visits per patient by speciality (IDS, HP, and nurse, respectively) of 3.3 vs. 3.7; 4.4 vs. 6.2; 6.1 vs. 3.9, for CAB + RPV LA vs. daily oral ART, and 3.0 vs. 3.2; 4.8 vs. 5.8; 6.9 vs. 4.9, respectively when adjusting by corresponding specialist responses. Estimation by the total sample led to an annual total cost per patient of €2,076 vs. €2,473, being €2,032 vs. €2,237 after adjusting by corresponding HCP, for CAB + RPV LA vs. daily oral ART. CONCLUSIONS: These results suggest that the implementation of CAB + RPV LA in NHS hospitals would not incur in increased HRU-related costs compared to current daily oral ARTs, being potentially neutral or even cost-saving.

Prediction of some physicochemical properties in Colombian crude oils upgraded by catalytic aquathermolysis using UV-VIS spectroscopy associated with chemometric methods.

The simulated distillation curve (ASTM/D-7169) is a quantitative method to determine fractions of crude oils by boiling point temperature ranges (36-720 °C). In this work, 45 samples of typical Colombian crudes were selected, and the samples were produced under conventional process. Also 8 upgraded crude oils under catalytic aquathermolysis conditions at laboratory scale were added. The tests were developed at 270 °C and 800psi (@25 °C) during 66 h of reaction. In addition, 30 samples were selected for density tests, according to the pycnometer method. Subsequently, the crude oil samples under study were diluted in chloroform and analyzed by UV-VIS Spectroscopy. The UV-VIS spectra were correlated with selected properties by using PCA-MLR and PLS models. The distillation curves of the crude oils were modelled using the Riazi probability function. The prediction models of parameters To, A, and B from the Riazi probability function exhibited R2 correlation coefficients, higher than 0.94. The correlation model for the crude oil density showed a much better coefficient, higher than 0.99 and Root-Mean-Squared-Error (RMSE) close to 0.004. Additionally, even more important is the contribution of the use of UV-VIS spectroscopy as a useful tool to quickly evaluate the quality of crude oil.

Comparative Analysis of the Impact of Training through Simulation Using the Crisis Resource Management Tool for Primary Care Professionals.

This was a prospective observational study based on clinical simulation courses taught in 2017 at the IDEhA Simulation Center of Alcorcón Foundation University Hospital. Two courses in metabolic emergencies (MEs) and respiratory emergencies (REs) were offered to primary care physicians all over Spain. The main objective was to teach nontechnical skills (crisis resource management). Using a modified five-level Kirkpatrick-Phillips education evaluation model, level I (reaction, K1), level II (learning, K2) and level III (behavioral change, K3) changes were evaluated through surveys at the end of the courses and one year later. Thirty courses were held (15 ME courses and 15 RE courses) with 283 primary care physicians. The overall satisfaction (K1) was high: ME courses, 9.5/10; RE courses, 9.6/10. More than 80% of the participants rated the organization, resources, content, debriefing and scenarios as excellent, with no significant differences between the two courses. After one year (156 responses), the respondents for both courses reported that they would repeat the training annually (K2), encourage debriefing with colleagues (K3) and have modified some aspects of their workplace (K3), citing improvements in procedures and in the organization of the health team as the most important. After the ME course, few participants, i.e., 5 (6%), reported providing improved care to patients; after the RE course, 15 (19%) participants reported providing improved care; the difference between groups was significant (p < 0.05). Compared with the ME course, the RE course imparted greater knowledge about patient safety (K2) (38 (49%) vs. 24 (31%) (p < 0.05)) and more useful tools for daily clinical practice (K3) (67% vs. 56.4%) and resulted in participants paying more attention to personal performance and to colleagues when working as a team (K2) (64% vs. 50%). Clinical simulation courses are highly valued and potentially effective for training primary care physicians in patient safety and CRM tools. Future studies with objective measures of long-term impact, behavior in the workplace (K3) and benefits to patients (K4) are needed. Based on the results of our study, the areas that are important are those aimed at improving procedures and the organization of health teams.

Improving quality and patient safety in surgical care through standardisation and harmonisation of perioperative care (SAFEST project): A research protocol for a mixed methods study.

INTRODUCTION: Adverse events in health care affect 8% to 12% of patients admitted to hospitals in the European Union (EU), with surgical adverse events being the most common types reported. AIM: SAFEST project aims to enhance perioperative care quality and patient safety by establishing and implementing widely supported evidence-based perioperative patient safety practices to reduce surgical adverse events. METHODS: We will conduct a mixed-methods hybrid type III implementation study supporting the development and adoption of evidence-based practices through a Quality Improvement Learning Collaborative (QILC) in co-creation with stakeholders. The project will be conducted in 10 hospitals and related healthcare facilities of 5 European countries. We will assess the level of adherence to the standardised practices, as well as surgical complications incidence, patient-reported outcomes, contextual factors influencing the implementation of the patient safety practices, and sustainability. The project will consist of six components: 1) Development of patient safety standardised practices in perioperative care; 2) Guided self-evaluation of the standardised practices; 3) Identification of priorities and actions plans; 4) Implementation of a QILC strategy; 5) Evaluation of the strategy effectiveness; 6) Patient empowerment for patient safety. Sustainability of the project will be ensured by systematic assessment of sustainability factors and business plans. Towards the end of the project, a call for participation will be launched to allow other hospitals to conduct the self-evaluation of the standardized practices. DISCUSSION: The SAFEST project will promote patient safety standardized practices in the continuum of care for adult patients undergoing surgery. This project will result in a broad implementation of evidence-based practices for perioperative care, spanning from the care provided before hospital admission to post-operative recovery at home or outpatient facilities. Different implementation challenges will be faced in the application of the evidence-based practices, which will be mitigated by developing context-specific implementation strategies. Results will be disseminated in peer-reviewed publications and will be available in an online platform.

Efecto antioxidante de la miel de abeja sobre la carne de conejo almacenada en refrigeración / Antioxidant effect of bee honey on rabbit meat stored under refrigeration

Resumen La oxidación de lípidos deteriora los alimentos, por lo que se usan antioxidantes sintéticos para disminuirla, sin embargo, estos compuestos en exceso poseen efectos carcinogénicos. Algunas plantas como el orégano, así como la miel de abeja, contienen antioxidantes naturales que no dañan la salud. Hasta el momento no se han encontrado registros del uso de la miel de abeja para disminuir la oxidación lipídica en carne de conejos. El objetivo de este estudio fue evaluar el efecto de la miel de abeja como antioxidante en la carne cruda de lomo de conejo almacenada en refrigeración a 4 °C. Se evaluó la actividad antioxidante (AA) de tres tipos de miel: oscura, ámbar y clara, para mezclarla con la carne de conejo. Se seleccionó la miel oscura por su mayor efecto antioxidante. Se prepararon 64 muestras de 100 g de carne cruda, 32 se mezclaron con 2 g de miel oscura y las otras 32 se dejaron sin miel (control). Las muestras se almacenaron a 4°C y se evaluó la AA y la concentración de malondialdehído (MDA) a los 0 d, 3 d, 6 d y 9 d de almacenamiento. La AA disminuyó y la concentración de MDA aumentó (P < 0.05) con el tiempo de refrigeración (cambios que indican deterioro de la carne). A los 3 d y 6 d, las muestras de carne cruda con miel exhibieron mayor AA (P < 0.05), y a los 6 d, menores valores de MDA (P < 0.05) comparadas con las muestras control (indicando que no hubo deterioro de la carne). La miel oscura de abeja contiene altas concentraciones de antioxidantes naturales que protegen a la carne cruda molida de lomo de conejo contra el daño oxidativo que puede presentarse durante la refrigeración, por lo que se recomienda su uso para este fin.

Abstract Lipid oxidation deteriorates foods; therefore, synthetic antioxidants are used to decrease it. However, excess synthetic antioxidants have carcinogenic effects. Some plants such as oregano, as well as bee honey, contain natural antioxidants which are not harmful to health. No reports were found on the use of bee honey to decrease lipid oxidation in rabbit meat. The objective of this study was to assess the effect of bee honey as antioxidant on raw rabbit loin, refrigerated at 4 °C. The antioxidant activity (AA)of three types of honey was evaluated: dark, amber and clear, to be mixed with rabbit meat. Dark honey was selected for its higher antioxidant effect. 64 samples of 100 g of raw meat were prepared, 32 samples were mixed with 2 g dark honey and the other 32 were left without honey (control). The samples were stored at 4 °C and AA as well as malondialdehyde (MDA) concentrations were evaluated at 0 d, 3 d, 6 d and 9 d of storage. The AA decreased, and the MDA concentration increased (P < 0.05) with refrigeration time (changes that indicate meat spoilage). After 3 d and 6 d, the raw meat samples with honey showed higher AA (P < 0.05) and after 6 d, they showed lower MDA values (P < 0.05) compared to the control samples (these changes indicate no spoilage of meat). Dark bee honey contains high concentrations of natural antioxidants that protect ground raw rabbit loin against oxidative damage that can occur during refrigeration, therefore, its use is recommended for this purpose.

Expression, purification and thermal stability evaluation of an engineered amaranth protein expressed in Escherichia coli

Background: The acidic subunit of amarantin (AAC)-the predominant amaranth seed storage protein-has functional potential and its third variable region (VR) has been modified with antihypertensive peptides to improve this potential. Here, we modified the C-terminal in the fourth VR of AAC by inserting four VY antihypertensive peptides. This modified protein (AACM.4) was expressed in Escherichia coli. In addition, we also recombinantly expressed other derivatives of the amarantin protein. These include: unmodified amarantin acidic subunit (AAC); amarantin acidic subunit modified at the third VR with four VY peptides (AACM.3); and amarantin acidic subunit doubly modified, in the third VR with four VY peptides and in the fourth VR with the RIPP peptide (AACM.3.4). Results: E. coli BL21-CodonPlus (DE3)-RIL was the most favorable strain for the expression of proteins. After 6 h of induction, it showed the best recombinant protein titer. The AAC and AACM.4 were obtained at higher titers (0.56 g/L) while proteins modified in the third VR showed lower titers: 0.44 g/L and 0.33 g/L for AACM.3 and AACM.3.4, respectively. As these AAC variants were mostly expressed in an insoluble form, we applied a refolding protocol. This made it possible to obtain all proteins in soluble form. Modification of the VR 4 improves the thermal stability of amarantin acidic subunit; AAC manifested melting temperature (Tm) at 34°C and AACM.4 at 37.2°C. The AACM.3 and AACM.3.4 did not show transition curves. Conclusions: Modifications to the third VR affect the thermal stability of amarantin acidic subunit.

Divertículo de Meckel complicado: análisis sobre 11 casos / Complicated Meckel's diverticulum: analysis of 11 cases

Antecedentes: El divertículo de Meckel es una de las alteraciones congénitas más frecuentes del tracto gastrointestinal. Objetivo: Analizar en forma retrospectiva: presentación clínica, morbimortalidaad y opciones terapéuticas más apropiadas. Lugar de aplicación: Servicio de cirugía general del HIGA San Martín. Práctica privada. Diseño: Estudio clínico observacional retrospectivo. Población: Grupo de 11 pacientes intervenidos quirúrgicamente por presentar divertículo de Meckel complicado en el período comprendido entre Enero de 1995 a Septiembre de 2001. Método: Se analizan la frecuencia de complicaciones, la morbimortalidad, el tiempo de internación y las variantes en cuanto al tratamiento quirúrgico. Resultados: El mayor número de complicaciones estuvo representado por la diverticulitis con un 54,4 por ciento. La técnica quirúrgica más empleada fue la resección segmentaria del intestino delgado. El promedio de días de internación fue de 8,5, con uma morbilidad de 18,1 por ciento y una mortalidad del 9,0 por ciento...

Hemorragias digestivas del intestino delgado de origen tumoral / Digestive hemorrages of small bowel from tumoral origin

Antecedentes: la literatura reporta que el leiomiosarcoma y el melanoma son dos de los tumores (primario y secundario respectivamente) que causan síndrome anémico por hemorragia digestiva oculta de intestino delgado. Objetivo: establecer pautas diagnósticas y tratamiento. Lugar de aplicación: Servicio de Cirugía General, Hospital Interzonal de Agudos General San Martín de La Plata, Hospital Español de La Plata. Material y métodos: dos pacientes, una de sexo femenino de 56 años de edad; paciente de sexo masculino de 69 años. Resultados: se describen el modo diagnóstico, hallazgo quirúrgico, anatomía patológica y tratamiento. Conclusiones: son patologías de habitual tardío y dificultoso diagnóstico dada la inespecificidad signosintomatológica. Existe un retraso diagnóstico de las mismas aproximadamente 6-8 meses. Es importante la ecografía como método diagnóstico de localización. La cirugía es el método de elección para su tratamiento