Impacts of PI3K/protein kinase B pathway activation in reactive astrocytes: from detrimental effects to protective functions.

Astrocytes are the most abundant type of glial cell in the central nervous system. Upon injury and inflammation, astrocytes become reactive and undergo morphological and functional changes. Depending on their phenotypic classification as A1 or A2, reactive astrocytes contribute to both neurotoxic and neuroprotective responses, respectively. However, this binary classification does not fully capture the diversity of astrocyte responses observed across different diseases and injuries. Transcriptomic analysis has revealed that reactive astrocytes have a complex landscape of gene expression profiles, which emphasizes the heterogeneous nature of their reactivity. Astrocytes actively participate in regulating central nervous system inflammation by interacting with microglia and other cell types, releasing cytokines, and influencing the immune response. The phosphoinositide 3-kinase (PI3K)/protein kinase B (AKT) signaling pathway is a central player in astrocyte reactivity and impacts various aspects of astrocyte behavior, as evidenced by in silico , in vitro , and in vivo results. In astrocytes, inflammatory cues trigger a cascade of molecular events, where nuclear factor-κB serves as a central mediator of the pro-inflammatory responses. Here, we review the heterogeneity of reactive astrocytes and the molecular mechanisms underlying their activation. We highlight the involvement of various signaling pathways that regulate astrocyte reactivity, including the PI3K/AKT/mammalian target of rapamycin (mTOR), α v ß 3 integrin/PI3K/AKT/connexin 43, and Notch/PI3K/AKT pathways. While targeting the inactivation of the PI3K/AKT cellular signaling pathway to control reactive astrocytes and prevent central nervous system damage, evidence suggests that activating this pathway could also yield beneficial outcomes. This dual function of the PI3K/AKT pathway underscores its complexity in astrocyte reactivity and brain function modulation. The review emphasizes the importance of employing astrocyte-exclusive models to understand their functions accurately and these models are essential for clarifying astrocyte behavior. The findings should then be validated using in vivo models to ensure real-life relevance. The review also highlights the significance of PI3K/AKT pathway modulation in preventing central nervous system damage, although further studies are required to fully comprehend its role due to varying factors such as different cell types, astrocyte responses to inflammation, and disease contexts. Specific strategies are clearly necessary to address these variables effectively.

A Pro-Inflammatory Stimulus versus Extensive Passaging of DITNC1 Astrocyte Cultures as Models to Study Astrogliosis.

Astrogliosis is a process by which astrocytes, when exposed to inflammation, exhibit hypertrophy, motility, and elevated expression of reactivity markers such as Glial Fibrillar Acidic Protein, Vimentin, and Connexin43. Since 1999, our laboratory in Chile has been studying molecular signaling pathways associated with "gliosis" and has reported that reactive astrocytes upregulate Syndecan 4 and αVß3 Integrin, which are receptors for the neuronal glycoprotein Thy-1. Thy-1 engagement stimulates adhesion and migration of reactive astrocytes and induces neurons to retract neurites, thus hindering neuronal network repair. Reportedly, we have used DITNC1 astrocytes and neuron-like CAD cells to study signaling mechanisms activated by the Syndecan 4-αVß3 Integrin/Thy-1 interaction. Importantly, the sole overexpression of ß3 Integrin in non-reactive astrocytes turns them into reactive cells. In vitro, extensive passaging is a simile for "aging", and aged fibroblasts have shown ß3 Integrin upregulation. However, it is not known if astrocytes upregulate ß3 Integrin after successive cell passages. Here, we hypothesized that astrocytes undergoing long-term passaging increase ß3 Integrin expression levels and behave as reactive astrocytes without needing pro-inflammatory stimuli. We used DITNC1 cells with different passage numbers to study reactivity markers using immunoblots, immunofluorescence, and astrocyte adhesion/migration assays. We also evaluated ß3 Integrin levels by immunoblot and flow cytometry, as well as the neurotoxic effects of reactive astrocytes. Serial cell passaging mimicked the effects of inflammatory stimuli, inducing astrocyte reactivity. Indeed, in response to Thy-1, ß3 Integrin levels, as well as cell adhesion and migration, gradually increased with multiple passages. Importantly, these long-lived astrocytes expressed and secreted factors that inhibited neurite outgrowth and caused neuronal death, just like reactive astrocytes in culture. Therefore, we describe two DITNC1 cell types: a non-reactive type that can be activated with Tumor Necrosis Factor (TNF) and another one that exhibits reactive astrocyte features even in the absence of TNF treatment. Our results emphasize the importance of passage numbers in cell behavior. Likewise, we compare the pro-inflammatory stimulus versus long-term in-plate passaging of cell cultures and introduce them as astrocyte models to study the reactivity process.

Evaluation of Rheological Properties of Asphalt Binder Modified with Biochar from Oat Hulls.

In this study, the effect of biochar from oat hulls (BO) on the rheological properties of a PG 64-22 asphalt binder was evaluated using a full factorial design, which included the following factors: pyrolysis temperature (PT) (300 °C and 500 °C), BO particle size (<20 µm and <75 µm), and the amount of BO (2.5%, 5%, and 7.5%). First, the morphological and physicochemical properties of BO were analyzed by comparing it with graphite powder (CFG) and commercial activated carbon (CAC). The physicochemical properties of the modified asphalt binder were then evaluated using confocal laser microscopy, scanning electron microscopy (SEM-EDX), and Fourier-transform infrared spectroscopy (FTIR). Its storage stability was also evaluated. Subsequently, the rutting parameter G*/sin(δ) and the Fraass breaking point were analyzed to select asphalt binders that extended their viscoelastic range. The asphalt binders selected were those with 2.5%, 5%, and 7.5% BO, produced at a PT of 300 °C with a particle size <20 µm (BO300S). Next, the rheological properties of the selected samples were evaluated by testing for rotational viscosity, rutting parameter G*/sin(δ), multiple stress creep recovery (MSCR), fatigue parameter G*·sin(δ), and creep stiffness by bending beam rheometry (BBR). The rheological aging index according to rutting parameter G*/sin(δ) (RAI) was also evaluated. These tests were conducted in different states of the asphalt binder: original, short-term aged, and long-term aged. According to the results, the application of BO300S significantly increased the resistance of the asphalt binder to rutting and rotational viscosity, proportional to the amount added to the asphalt binder. Moreover, low modifier percentages improved fatigue resistance, outperforming CFG and CAC. In addition, it performs well at low service temperatures, registering better resistance than the control asphalt binders.

Adjusted versus Targeted Fortification in Extremely Low Birth Weight Preterm Infants: Fortin Study-A Randomized Clinical Trial.

Fortified human milk is the first choice for preterm infants. Although individualized fortification is recommended, the optimal method for this population remains uncertain. We conducted a comparative study assessing the growth effects of adjusted (AF) and targeted fortification (TF) in extremely low birth weight (ELBW) infants. This single-center, randomized, controlled clinical trial was conducted at a tertiary neonatal unit in Spain. Eligible participants were premature infants with a birthweight of <1000 g exclusively fed with human milk. A total of 38 patients were enrolled, 15 of them randomized to AF group and 23 to TF group. AF was based on blood urea nitrogen (BUN) concentration and TF on human milk analysis. The primary outcome was weight gain velocity (g/kg/day). No significant differences were found in weight gain velocity at 28 days, at 36 weeks of postmenstrual age, at discharge, nor during the intervention. Protein intake was significantly higher in the AF group (5.02 g/kg/day vs. 4.48 g/kg/day, p = 0.001). No differences were found in the lipid, carbohydrate, and energy intake; in the weight z score change between the different time points; nor in the length and head circumference growth. Both AF and TF are comparable methods of fortification and provide the appropriate growth rate in ELBW infants.

[Dietary patterns associated with obesity and its comorbidities]. / Patrones dietéticos asociados a la obesidad y a sus comorbilidades.

Obesity is a major public health challenge, in Spain the prevalence of excess of weight and obesity and is 56 % and 19 %, respectively, and it is linked to numerous preventable chronic diseases. Nutritional epidemiology focused on nutrients has evolved towards the study of dietary patterns that consider synergistic interactions between foods and nutrients. This study aims to investigate the relationship between obesity and its treatment by healthy dietary patterns. The Mediterranean diet and Dietary Approaches to Stop Hypertension (DASH), based on plant products, whole grains and low levels of salt, sugars and red meat, have been shown to promote weight loss and reduce comorbidities associated with obesity. Although vegetarian and vegan diets are adequate options for disease management and prevention, they require planning to avoid nutritional deficiencies. In conclusion, healthy dietary patterns such as the Mediterranean diet, DASH and vegetarian options are effective in both the prevention and treatment of obesity, highlighting the importance of considering the synergy between foods and nutrients in the management of this health condition.

[Role of diet in the prevention and development of Crohn's Disease]. / Papel de la dieta en la prevención y el desarrollo de la enfermedad de Crohn.

Crohn's disease (CD) is a chronic recurrent inflammatory bowel disease (IBD) with frequent ileocolic location, although it can affect the entire gastrointestinal tract. It is characterized by the development of skipped lesions and transmural inflammation and its incidence is increasing. The etiology and pathogenesis are related to genetic susceptibility, intestinal microbiota, dysbiosis, immunological abnormalities and environmental factors (tobacco use, NSAIDs, oral contraceptives and diet). Diet may play a key role in the development and prevention of CD. Dietary patterns with high inflammatory potential (high intake of saturated fat, sugars, proteins, salt, as well as low consumption of fruits and vegetables) are associated with a higher risk of CD, while the consumption of a healthy diet, together with the practice of Exercise is a protective factor against relapses in IBD and reduces the risk of CD. Regarding dietary components, the consumption of fiber, as well as dietary polyphenols, has been related to the maintenance of the intestinal barrier by preventing erosion of the mucosal layer. ω-3 fatty acids, in addition to their anti-inflammatory activity, promote the balance of the intestinal microbiota and their supplementation reduces postoperative complications and accelerates recovery in patients with CD. Vitamin D also plays an important role in the integrity of the intestinal barrier by reducing permeability, in addition to having an immunomodulatory and anti-inflammatory effect, being a useful tool in the improvement of patients with CD. Prebiotics and probiotics may be useful in the treatment of IBD patients by stimulating mucus production, reducing inflammation and dysbiosis, and maintaining the integrity of the intestinal barrier.

[Evolution of critical nutrients (salt, sugars and saturated fats) in Spanish foods and beverages in the last 25 years]. / Evolución de nutrientes críticos (sal, azúcares y grasas saturadas) en alimentos y bebidas españoles en los últimos 25 años.

Non-communicable diseases (cardiovascular diseases, cancer, chronic respiratory diseases, diabetes, etc.) are the leading cause of death worldwide, accounting for 71 % of global deaths. The risk factors for all of them are closely linked to lifestyle and in particular to diet. For this reason, public health policies in European Union countries, in line with World Health Organization (WHO) recommendations, include in their priority measures actions aimed at promoting healthier food environments. One of these measures are policies for the reformulation of processed foods to reduce critical nutrients: salt, saturated fats, trans fats and added sugars. In Spain, as part of the NAOS Strategy, food reformulation measures have been implemented since 2008. Of all of them, the Plan de Colaboración para la Mejora de la Composición de Alimentos y Bebidas y otras Medidas 2020 stands out, which has led to a reduction in the content of salt, sugar, saturated and total fat in foods belonging to 57 subcategories marketed by the main food manufacturing and marketing companies from 2016 to 2021. Despite this, to date no population-based study has been conducted to test the impact of the measure on the diet of the Spanish population. The present article, by way of example, shows results of the theoretical estimation of total sugar intake in the pre-reformulation period (2016) and post-reformulation period (2024) based on the consumption of beverages in Spain. Data highlight that reformulation policies could have positive effects that need to be evaluated in representative studies of the Spanish population assessing the overall diet, in order to solidly confirm their positive effects on the population's diet.

[Egg components involved in cognitive function]. / Componentes del huevo implicados en la función cognitiva.

Interest in the relationship between diet and cognitive function has increased in recent years. In this sense, eggs contain many essential nutrients that are also beneficial for cognitive function. Several studies have shown that moderate egg consumption not only does not increase cardiovascular risk but is positively associated with better cognitive performance and a lower risk of dementia. Egg protein is particularly rich in tryptophan, which is a precursor to serotonin, the neurotransmitter involved in mood, and melatonin, the hormone that regulates the sleep-wake cycle. Consumption of tryptophan-rich egg hydrolysates has been associated with improved attention and reduced feelings of sadness or depression. Egg choline is needed for the synthesis of acetylcholine, the neurotransmitter involved in memory and learning, and also for the synthesis of phosphatidylcholine, the intake of which has been linked to better mental function and a lower risk of dementia in adults. Choline intake during pregnancy reduces the risk of neural tube defects and is associated with better offspring development. And lutein and zeaxanthin, which are particularly concentrated in the nervous system, are associated with better visual function and cognitive development in the offspring and also in the elderly. All this evidence confirms the importance of including eggs in a balanced diet to prevent cognitive decline and improve cognitive health throughout life.

[Dietary strategies for cardiovascular disease prevention]. / Estrategias dietéticas para la prevención de la enfermedad cardiovascular.

The present review aims to provide specific dietary guidelines based on scientific evidence to prevent the onset of cardiovascular disease (CVD). In general, a high daily consumption of foods of plant origin (whole grains, vegetables, fruits, legumes, and nuts) is recommended compared to foods of animal origin, especially red and processed meats, moderate use of extra virgin olive oil as a culinary fat compared to other types of fats and oils, and low salt intake, especially from processed foods. Despite the scientific evidence and the nutritional education carried out in primary care, CVD continues to be the leading cause of death worldwide, which highlights the need to develop attractive and motivating approaches that enable the population to adhere definitively to healthy habits.

Unlocking the in vitro neuroprotection of sloe residues phenolic extracts by bioanalytical and chemometric strategies.

Wild fruits, particularly the underutilized sloe (Prunus spinosa), are gaining interest as natural antioxidants, with residues from liqueur production being a source of bioactive compounds. This study proposes a sustainable approach for valorizing sloe residues, seeds and skins, by employing an innovative green extraction method. HPLC-ESI-QTOF and spectrophotometric techniques were used to explore the phenolic profile, highlighting the predominance of quercetin, 2,3-dihydroxybenzoic and ferulic acids (9.7-57 µg·g-1). In addition, the presence of Cu, Zn and Ca was confirmed by atomic absorption spectroscopy. Simultaneously, their neuroprotective potential against Alzheimer's disease (AD) was studied by exploring the inhibition of beta-amyloid aggregation and oxidative stress cytoprotection in SH-SY5Y cell line, standing out 1 µg·g-1 and 10 µg·g-1 extracts of sloe skin. Phenolic composition was correlated with bioactivities by means of multivariate analysis. These results contributed to highlight the potential of this bio-residue as a neuroprotective agent against AD in pharmaceutical and nutraceutical industries.

[Cardiac arrhythmias in adults with congenital heart disease]. / Herzrhythmusstörungen bei Erwachsenen mit angeborenen Herzfehlern.

In patients with congenital heart disease, cardiac arrhythmias are complex and require a thorough understanding of the anatomy, past surgical and interventional procedures, and the specific electric processes. Supraventricular tachycardias commonly present as emergency situations and should be treated immediately, particularly when there is an underlying complex malformation. Establishing sinus rhythm is usually superior to pure frequency control for hemodynamic reasons. Catheter ablation should be preferred over medical treatment, even though several procedures are often necessary. In addition, bradycardia is seen more frequently in congenital heart defects; this could be aggravated by antiarrhythmic drugs. There are significant differences between the indications and techniques used for pacemaker implantation in patients with congenital heart defects and those without. Patients with complex congenital heart diseases have an increased risk of thromboembolism; therefore, an individual and early indication for low-threshold oral anticoagulation is necessary; direct oral anticoagulants can also be used for this purpose. In risk stratification for sudden cardiac death, the principles of general guidelines are often not applicable, and individualized decisions are required. Recently, a new general risk score for congenital heart disease has been developed. The treatment of cardiac arrhythmias in patients with congenital heart disease should always be performed in close cooperation with specialized centers.

Thermosensitive chitosan-based hydrogel: a vehicle for overcoming the limitations of nose-to-brain cell therapy.

Cell therapy is a promising strategy for treating neurological pathologies but requires invasive methods to bypass the blood-brain barrier restrictions. The nose-to-brain route has been presented as a direct and less invasive alternative to access the brain. The primary limitations of this route are low retention in the olfactory epithelium and poor cell survival in the harsh conditions of the nasal cavity. Thus, using chitosan-based hydrogel as a vehicle is proposed in this work to overcome the limitations of nose-to-brain cell administration. The hydrogel's design was driven to achieve gelification in response to body temperature and a mucosa-interacting chemical structure biocompatible with cells. The hydrogel showed a <30 min gelation time at 37°C and >95% biocompatibility with 2D and 3D cultures of mesenchymal stromal cells. Additionally, the viability, stability, and migration capacity of oligodendrocyte precursor cells (OPCs) within the hydrogel were maintained in vitro for up to 72 hours. After the intranasal administration of the OPCs-containing hydrogel, histological analysis showed the presence of viable cells in the nasal cavity for up to 72 hours post-administration in healthy athymic mice. These results demonstrate the hydrogel's capacity to increase the residence time in the nasal cavity while providing the cells with a favorable environment for their viability. This study presents for the first time the use of thermosensitive hydrogels in nose-to-brain cell therapy, opening the possibility of increasing the delivery efficiency in future approaches in translational medicine. STATEMENT OF SIGNIFICANCE: : This work highlights the potential of biomaterials, specifically hydrogels, in improving the effectiveness of cell therapy administered through the nose. The nose-to-brain route has been suggested as a non-invasive way to directly access the brain. However, delivering stem cells through this route poses a challenge since their viability must be preserved and cells can be swept away by nasal mucus. Earlier attempts at intranasal cell therapy have shown low efficiency, but still hold promise to the future. The hydrogels designed for this study can provide stem cells with a biocompatible environment and adhesion to the nasal atrium, easing the successful migration of viable cells to the brain.

ECMO in severe hypoxemia post liver transplant for hepatopulmonary syndrome.

Hepatopulmonary syndrome (HPS) poses a significant challenge in liver transplant patients, affecting between 10% and 30% of candidates. Historically, HPS was considered a contraindication for liver transplantation due to its association with high mortality rates. However, recent studies have shown improvements in pulmonary function post-transplant, leading to the inclusion of these patients as candidates. Despite this progress, approximately one-fifth of liver transplant recipients develop severe postoperative hypoxia, further complicating their clinical course and contributing to increased mortality. The management of post-transplant HPS involves various strategies, including extracorporeal membrane oxygenation (ECMO), although its use remains infrequently reported. Theoretical models suggest that oxygenation typically improves within 10 days post-transplant, while resolution of HPS may take 6-12 months, making ECMO an attractive possibility as a bridge to recovery in this population. We present a case were ECMO was used in this context.

Validation of the delirium diagnostic tool-provisional (DDT-Pro) in geriatric medical inpatients with diagnostic permutations of the 3Ds with and without delirium.

OBJECTIVE: Validations of brief delirium tools have not included analysis of psychiatric disorders comorbidities or control groups. We validated the Delirium Diagnostic Tool-Provisional (DDT-Pro) in 422 geriatric inpatients with high incidence of depression and/or dementia. METHODS: Cross-sectional study using two delirium reference standards, DSM-5-TR and Delirium Rating Scale-Revised-98 (DRS-R98). We assessed concurrent and construct DDT-Pro validity too. RESULTS: There were 117 (27.7%) delirium cases using DDT-Pro, 104 (24.6%) per DSM-5-TR and 93 (22.0%) per DRS-R98; 133 patients (31.5%) had depression and 105 (24.9%) dementia, some comorbid with delirium. DDT-Pro accuracy (AUC under ROC curve) ranges were 88.3-95.9% vs DSM-5-TR and 92.7-95.0% vs DRS-R98 for whole sample and four diagnostic groups, without statistical differences. DDT-Pro ≤6 had the most balanced sensitivity-specificity for delirium diagnosis against both DSM-5-TR and DRS-R98 with similar specificity but higher sensitivity for DRS-R98 than DSM-5-TR delirium, with the highest values in patients with depression and dementia (≥92% sensitivity, ≥81% specificity). Positive and negative likelihood ratios support diagnostic strength. Concurrent validity was high reflected by significant correlations (p < 0.001) of DDT-Pro total and item scores with DRS-R98 and Delirium Frontal Index scores, highest in groups with comorbid depression and/or dementia. The DDT-Pro represented a single construct for delirium demonstrated by one factor with high item loadings and high internal consistency reliability of its items. CONCLUSIONS: The DDT-Pro demonstrated strong performance metrics in general hospital elderly inpatients with preexisting depression and/or dementia, which is unique among brief delirium tools. Its optimized cutoff score was the same as in other populations.

[Dengue encephalitis in Argentina]. / Encefalitis por dengue en Argentina.

Dengue virus is an endemic virus in Argentina that, although it was initially considered to be non-neurotropic, it is currently recognized to be neuroinvasive; thus conditioning a prevalence of neurological manifestations of up to 15% among patients. Even being considered severe symptoms, there is underdiagnoses of dengue encephalitis due to its varied clinical presentation. Neurological manifestations of dengue encephalitis can range from fever and headache to altered levels of consciousness and seizures. Although the cerebrospinal fluid may be normal in up to a third of cases, it usually presents increased protein concentration and pleocytosis. Regarding neuroimaging methods, the findings are usually varied and nonspecific, and can even be normal in up to 40-50% of cases. We present three cases of dengue encephalitis diagnosed in a university hospital in Buenos Aires, Argentina, where the clinical presentation varied from temporal-spatial disorientation to refractory convulsive status with different presentations in the cerebrospinal fluid but all with positive PCR for dengue in it and with normal neuroimaging.

El virus dengue es un virus endémico en Argentina que, si bien inicialmente se consideró que no era neurotrópico, actualmente se reconoce que tiene neuroinvasión, condicionando así una prevalencia de manifestaciones neurológicas de hasta el 15% entre los enfermos. Aun siendo considerados síntomas de gravedad, existe subdiagnóstico de encefalitis por dengue debido a su variada forma de presentación clínica. Las manifestaciones neurológicas de la encefalitis por dengue pueden abarcar desde fiebre y cefalea hasta alteraciones del nivel de conciencia y convulsiones. Si bien el líquido cefalorraquídeo (LCR) puede hallarse normal en hasta un tercio de los casos, lo habitual es que presente aumento de concentración de proteínas y pleocitosis. En cuanto a los métodos de neuroimagen, los hallazgos suelen ser variados e inespecíficos, e incluso pueden ser normales hasta en 40-50% de los casos. Se presentan 3 casos de encefalitis por dengue diagnosticados en un hospital universitario de Buenos Aires, Argentina, en donde la presentación clínica varió desde desorientación témporo-espacial hasta estatus convulsivo refractario con diferentes presentaciones en el LCR pero todos con PCR positivo para dengue y con neuroimágenes sin alteraciones.

Circulating tumour DNA dynamics predict recurrence in stage III melanoma patients receiving neoadjuvant immunotherapy.

BACKGROUND: Neoadjuvant therapy improves recurrence-free survival (RFS) in resectable stage III cutaneous melanoma. However, accurately predicting individual recurrence risk remains a significant challenge. We investigated circulating tumour DNA (ctDNA) as a biomarker for recurrence in measurable stage IIIB/C melanoma patients undergoing neoadjuvant immunotherapy. METHODS: Plasma samples were collected pre-neoadjuvant treatment, pre-surgery and/or six weeks post-surgery from 40 patients enrolled in the OpACIN-neo and PRADO clinical trials. Patients received two cycles of ipilimumab (anti-CTLA-4) and nivolumab (anti-PD-1) before surgery. Cell free DNA (cfDNA) underwent unbiased pre-amplification followed by tumour-informed mutation detection using droplet digital polymerase chain reaction (ddPCR) with the Bio-Rad QX600 PCR system. RESULTS: Pre-treatment ctDNA was detectable in 19/40 (48%) patients. Among these, 17/19 (89%) zero-converted within six weeks of surgery and none recurred. Positive ctDNA post-surgery (N = 4), irrespective of pre-treatment ctDNA status, was 100% predictive of recurrence (sensitivity 44%, specificity 100%). Furthermore, ctDNA cleared prior to surgery in 7/9 (78%) patients who did not recur, warranting further investigation into ctDNA-guided surgical management. CONCLUSION: Post-surgery ctDNA positivity and zero-conversion are highly predictive of recurrence, offering a window for personalised modification of adjuvant therapy.

Occupational Stress in Healthcare Professionals in Spain: A Multicenter Study.

Introduction: Occupational stress significantly impacts healthcare professionals in the Spanish public hospital system. This study, conducted from April to June 2022, focuses on analyzing stress levels using the Nursing Stress Scale through an online survey. Methods: A cross-sectional study was carried out using an online survey from April to June 2022 in four hospitals. The Nursing Stress Scale was used to comprehensively assess stress levels among healthcare professionals. Results: The findings revealed a substantial contrast in stress outcomes based on personal circumstances. Healthcare professionals in stable partnerships and with children exhibited lower stress levels, acting as protective factors during the pandemic. Conversely, those engaged in rotating shifts, especially those working over 60 h per week, showed a sevenfold increase in high-stress probability (p < 0.05). Temporary contract holders and those with heightened exposure to COVID-19 reported elevated stress levels, highlighting the complex dynamics impacting the mental well-being of healthcare workers. Conclusions: Findings emphasize the necessity for targeted interventions to safeguard healthcare professionals' well-being, focusing on the psychological consequences of factors like rotating shifts and extended working hours. Protective elements such as stable partnerships and parenthood could serve as a foundation for initiatives supporting work-life balance, potentially involving government policies and hospital management.

COVID-19 and menstrual-related disturbances: a Spanish retrospective observational study in formerly menstruating women.

Introduction: Four years after the start of the pandemic, there is limited evidence on the impact of COVID-19 on the women's health regardless of their reproductive status. Objective: The aim was to analyze the prevalence and associated factors of menstrual-related disturbances in formerly menstruating women following SARS-CoV-2 infection. Study design: A retrospective observational study of adult women in Spain was conducted during the month of December 2021 using an online survey (N = 17,512). The present analysis includes a subpopulation of SARS-CoV-2-infected and formerly menstruating women (n = 72). The collected data included general characteristics, medical history, and specific information on COVID-19. Chi-square and Mann-Whitney U-tests were performed. Bivariate logistic regression analysis was then performed to investigate possible associations between the occurrence of menstrual-related disturbances after SARS-CoV-2 infection. Results: 38.8% of participants experienced menstrual-related disturbances following COVID-19. Among these, unexpected vaginal bleeding (20.8%) was the most common event, followed by spotting (11.1%) ( Table 1). Other reported changes were in the length (shorter = 12.5%) and flow (heavier = 30.3%) of menstrual bleeding in comparison to their previous experience. Regression analysis revealed that being a perimenopausal woman [adjusted odds ratio (AOR) 4.721, CI 95%, 1.022-21.796, p = 0.047] and having a previous diagnosis of menorrhagia (AOR 5.824 CI 95%, 1.521-22.310, p = 0.010) were factors associated with the event. Conclusion: These findings could help health professionals provide their patients with up-to-date scientific information to empower them to actively manage their reproductive health, especially in societies where menstrual health is still taboo.

[Low power laser as an adjuvant to paresthesia. report of two cases]. / Láser de baja potencia como coadyuvante a la parestesia. reporte de dos casos.

Tooth extraction or extraction is a common procedure in dental practice, although it is a common practice, it is not exempt from complications. Paraesthesia is defined as a neuropathy with altered sensations and permanent anesthesia. The case of two patients who attended the Department of Pathology at the Faculty of Dentistry with paresthesia is reported. Both were treated with low-power laser therapy, showing a significant improvement in their clinical condition. The application of low-power laser presents ideal benefits in various areas of the stomatological field. As it is a non-invasive, painless treatment and short sessions, the patient is encouraged to continue with the treatment until they are almost completely rehabilitated.