CD19-Directed CAR T-Cells in a Patient With Refractory MOGAD: Clinical and Immunologic Follow-Up for 1 Year.

OBJECTIVES: In MOG antibody-associated disease (MOGAD), relapse prevention and the treatment approach to refractory symptoms are unknown. We report a patient with refractory MOGAD treated with CD19-directed CAR T-cells. METHODS: CD19-directed CAR T-cells (ARI-0001) were produced in-house by lentiviral transduction of autologous fresh leukapheresis and infused after a conventional lymphodepleting regimen. RESULTS: A 18-year-old man developed 2 episodes of myelitis associated with serum MOG-IgG, which were followed by 6 episodes of left optic neuritis (ON) and sustained the presence of MOG-IgG over 6 years despite multiple immunotherapies. After the sixth episode of ON, accompanied by severe residual visual deficits, CAR T-cell treatment was provided without complications. Follow-up of cell counts showed complete depletion of CD19+ B cells at day +7; reconstituted B cells at day +141 showing a naïve B-cell phenotype, and low or absent memory B cells and plasmablasts for 1 year. MOG-IgG titers have remained undetectable since CAR T-cell infusion. The patient had an early episode of left ON at day +29, when MOG-IgG was already negative, and since then he has remained free of relapses without immunotherapy for 1 year. DISCUSSION: This clinical case shows that CD19-directed CAR T-cell therapy is well-tolerated and is a potential treatment for patients with refractory MOGAD. CLASSIFICATION OF EVIDENCE: This provides Class IV evidence. It is a single observational study without controls.

Preferences for neuromyelitis optica spectrum disorder treatments: A conjoint analysis with neurologists in Spain.

BACKGROUND: The treatment landscape for neuromyelitis optica spectrum disorder (NMOSD) has changed in recent years with the approval of therapies with different efficacy, safety and administration profiles. OBJECTIVE: The aim of this study was to assess neurologists' preferences for different NMOSD treatment attributes using conjoint analysis (CA). METHODS: We conducted an online, non-interventional, cross-sectional study in collaboration with the Spanish Society of Neurology. Our CA assessed five drugs' attributes: prevention of relapse, prevention of disability accumulation, safety risk, management during pregnancy, and route and frequency of administration. Participants were presented with eight hypothetical treatment scenarios to rank based on their preferences from the most preferred to the least. An ordinary least squares method was selected to estimate weighted preferences. RESULTS: A total of 104 neurologists were included. Mean age (standard deviation-SD) was 37.7 (10.3) years, 52.9 % were male, and median time (interquartile range) of experience managing NMOSD was 5.0 (2.9, 10.8) years. Neurologists placed the greatest importance on efficacy attributes, time to relapse (44.1 %) being the most important, followed by preventing disability accumulation (36.8 %). In contrast, route and frequency of administration (4.6 %) was the least important characteristic. Participants who prioritised efficacy attributes felt more comfortable in decision-making, had fewer past experiences of care-related regret and a lower attitude to risk taking than their counterparts. CONCLUSION: Neurologists' treatment preferences in NMOSD were mainly driven by efficacy attributes. These results may be useful to design policy decisions and treatment guidelines for this condition.

Grey Matter Atrophy and its Relationship with White Matter Lesions in Patients with Myelin Oligodendrocyte Glycoprotein Antibody-associated Disease, Aquaporin-4 Antibody-Positive Neuromyelitis Optica Spectrum Disorder, and Multiple Sclerosis.

OBJECTIVE: To evaluate: (1) the distribution of gray matter (GM) atrophy in myelin oligodendrocyte glycoprotein antibody-associated disease (MOGAD), aquaporin-4 antibody-positive neuromyelitis optica spectrum disorder (AQP4+NMOSD), and relapsing-remitting multiple sclerosis (RRMS); and (2) the relationship between GM volumes and white matter lesions in various brain regions within each disease. METHODS: A retrospective, multicenter analysis of magnetic resonance imaging data included patients with MOGAD/AQP4+NMOSD/RRMS in non-acute disease stage. Voxel-wise analyses and general linear models were used to evaluate the relevance of regional GM atrophy. For significant results (p < 0.05), volumes of atrophic areas are reported. RESULTS: We studied 135 MOGAD patients, 135 AQP4+NMOSD, 175 RRMS, and 144 healthy controls (HC). Compared with HC, MOGAD showed lower GM volumes in the temporal lobes, deep GM, insula, and cingulate cortex (75.79 cm3); AQP4+NMOSD in the occipital cortex (32.83 cm3); and RRMS diffusely in the GM (260.61 cm3). MOGAD showed more pronounced temporal cortex atrophy than RRMS (6.71 cm3), whereas AQP4+NMOSD displayed greater occipital cortex atrophy than RRMS (19.82 cm3). RRMS demonstrated more pronounced deep GM atrophy in comparison with MOGAD (27.90 cm3) and AQP4+NMOSD (47.04 cm3). In MOGAD, higher periventricular and cortical/juxtacortical lesions were linked to reduced temporal cortex, deep GM, and insula volumes. In RRMS, the diffuse GM atrophy was associated with lesions in all locations. AQP4+NMOSD showed no lesion/GM volume correlation. INTERPRETATION: GM atrophy is more widespread in RRMS compared with the other two conditions. MOGAD primarily affects the temporal cortex, whereas AQP4+NMOSD mainly involves the occipital cortex. In MOGAD and RRMS, lesion-related tract degeneration is associated with atrophy, but this link is absent in AQP4+NMOSD. ANN NEUROL 2024;96:276-288.

Does salinity mediate the toxicity of perfluorooctanesulfonic acid (PFOS) in an estuarine fish?

Perfluorooctanesulfonic acid (PFOS) is detected in estuarine environments, where salinity levels fluctuate regularly. We investigated the effects of salinity on the toxicity of PFOS in embryos and larvae of Cyprinodon variegatus. We crossed six PFOS treatments (0, 1-10,000 µg/L) with two salinities (10, 30 ppt). Larvae exposed to the highest concentration of PFOS under high salinity accumulated over twice the amount of PFOS compared to larvae maintained under low salinity. Embryonic survival was unaffected by PFOS, salinity, or their interaction. PFOS delayed time to hatch and increased salinity reduced time to hatch regardless of PFOS treatment; however, no salinity by PFOS interactions were observed. Conversely, PFOS and salinity interacted in the larval stage, with decreased survival at 30 ppt salinity. This is one of the first studies evaluating interactive effects of PFOS and high salinity and highlights the importance of assessing PFAS toxicity across life stages.

Assessing the Combined Effects of Host and Parasite Exposure to Forever Chemicals in an Amphibian-Echinostome System.

Per- and polyfluoroalkyl substances (PFAS) are environmental contaminants of growing concern due to their potential negative effects on wildlife and human health. Per- and polyfluoroalkyl substances have been shown to alter immune function in various taxa, which could influence the outcomes of host-parasite interactions. To date, studies have focused on the effects of PFAS on host susceptibility to parasites, but no studies have addressed the effects of PFAS on parasites. To address this knowledge gap, we independently manipulated exposure of larval northern leopard frogs (Rana pipiens) and parasites (flatworms) via their snail intermediate host to environmentally relevant PFAS concentrations and then conducted trials to assess host susceptibility to infection, parasite infectivity, and parasite longevity after emergence from the host. We found that PFAS exposure to only the host led to no significant change in parasite load, whereas exposure of parasites to a 10-µg/L mixture of PFAS led to a significant reduction in parasite load in hosts that were not exposed to PFAS. We found that when both host and parasite were exposed to PFAS there was no difference in parasite load. In addition, we found significant differences in parasite longevity post emergence following exposure to PFAS. Although some PFAS-exposed parasites had greater longevity, this did not necessarily translate into increased infection success, possibly because of impaired movement of the parasite. Our results indicate that exposure to PFAS can potentially impact host-parasite interactions. Environ Toxicol Chem 2024;43:1537-1546. © 2024 SETAC.

MOG Antibodies Restricted to CSF in Children With Inflammatory CNS Disorders.

OBJECTIVES: To assess the clinical significance of myelin oligodendrocyte glycoprotein antibodies (MOG-abs) restricted to CSF in children with inflammatory CNS disorders. METHODS: Patients included 760 children (younger than 18 years) from 3 multicenter prospective cohort studies: (A) acquired demyelinating syndromes, including acute disseminated encephalomyelitis (ADEM); (B) non-ADEM encephalitis; and (C) noninflammatory neurologic disorders. For all cases, paired serum/CSF samples were systematically examined using brain immunohistochemistry and live cell-based assays. RESULTS: A total of 109 patients (14%) had MOG-abs in serum or CSF: 79 from cohort A, 30 from B, and none from C. Of these, 63 (58%) had antibodies in both samples, 37 (34%) only in serum, and 9 (8%) only in CSF. Children with MOG-abs only in CSF were older than those with MOG-abs only in serum or in both samples (median 12 vs 6 vs 5 years, p = 0.0002) and were more likely to have CSF oligoclonal bands (86% vs 12% vs 7%, p = 0.0001) and be diagnosed with multiple sclerosis (6/9 [67%] vs 0/37 [0%] vs 1/63 [2%], p < 0.0001). DISCUSSION: Detection of MOG-abs in serum or CSF is associated with CNS inflammatory disorders. Children with MOG-abs restricted to CSF are more likely to have CSF oligoclonal bands and multiple sclerosis than those with MOG-abs detectable in serum.

Therapeutic inertia in the management of neuromyelitis optica spectrum disorder.

Introduction and objective: Limited information is available on how neurologists make therapeutic decisions in neuromyelitis optica spectrum disorder (NMOSD), especially when new treatments with different mechanisms of action, administration, and safety profile are being approved. Decision-making can be complex under this uncertainty and may lead to therapeutic inertia (TI), which refers to lack of treatment initiation or intensification when therapeutic goals are not met. The study aim was to assess neurologists' TI in NMOSD. Methods: An online, cross-sectional study was conducted in collaboration with the Spanish Society of Neurology. Neurologists answered a survey composed of demographic characteristics, professional background, and behavioral traits. TI was defined as the lack of initiation or intensification with high-efficacy treatments when there is evidence of disease activity and was assessed through five NMOSD aquaporin-4 positive (AQP4+) simulated case scenarios. A multivariate logistic regression analysis was used to determine the association between neurologists' characteristics and TI. Results: A total of 78 neurologists were included (median interquartile range [IQR] age: 36.0 [29.0-46.0] years, 55.1% male, median [IQR] experience managing demyelinating conditions was 5.2 [3.0-11.1] years). The majority of participants were general neurologists (59.0%) attending a median (IQR) of 5.0 NMOSD patients (3.0-12.0) annually. Thirty participants (38.5%) were classified as having TI. Working in a low complexity hospital and giving high importance to patient's tolerability/safety when choosing a treatment were predictors of TI. Conclusion: TI is a common phenomenon among neurologists managing NMOSD AQP4+. Identifying TI and implementing specific intervention strategies may be critical to improving therapeutic decisions and patient care.

The Society of Thoracic Surgeons Database Analysis: Comparing Sublobar Techniques in Stage IA Lung Cancer.

BACKGROUND: This study compares sublobar resections-wedge resection and segmentectomy-in clinical stage IA lung cancers. It tests the hypothesis that overall survival after wedge resection is similar to segmentectomy. METHODS: Adults undergoing wedge resection or segmentectomy for clinical stage IA lung cancer were identified from The Society of Thoracic Surgeons General Thoracic Surgery Database. Eligible patients were linked to the Centers for Medicare and Medicaid Services database using a matching algorithm. The primary outcome was long-term overall survival. Propensity scores overlap weighting (PSOW) adjustment of wedge resection using validated covariates was used for group difference mitigation. Kaplan-Meier and Cox regression models analyzed survival. All-cause first readmission, and morbidity and mortality were examined using PSOW regression models. RESULTS: Of 9756 patients, 6141 met inclusion criteria, comprising 2154 segmentectomies and 3987 wedge resections. PSOW reduced differences between the groups. Unadjusted perioperative mortality was comparable, but wedge resection showed lower major morbidity rates. Weighted regression analysis indicated reduced mortality and major morbidity risks in wedge resection. Kaplan-Meier analysis revealed no mortality difference between groups, which was confirmed by PSOW Cox regression models. The cumulative risk of readmission was also comparable for both groups, with Cox Fine-Gray models showing no difference in rehospitalization risks. CONCLUSIONS: In clinical stage IA lung cancer, relative to segmentectomy, wedge resection has comparable overall survival and lower perioperative morbidity, suggesting it is an equally effective option for the broader population of patients with clinical stage IA lung cancer, not only those at highest risk of complications.

Limited impact of weathered residues from the Deepwater Horizon oil spill on the gut-microbiome and foraging behavior of sheepshead minnows (Cyprinodon variegatus).

The Deepwater Horizon disaster of April 2010 was the largest oil spill in U.S. history and exerted catastrophic effects on several ecologically important fish species in the Gulf of Mexico (GoM). Within fish, the microbiome plays a key symbiotic role in maintaining host health and aids in acquiring nutrients, supporting immune function, and modulating behavior. The aim of this study was to examine if exposure to weathered oil might produce significant shifts in fish gut-associated microbial communities as determined from taxa and genes known for hydrocarbon degradation, and whether foraging behavior was affected. The gut microbiome (16S rRNA and shotgun metagenomics) of sheepshead minnow (Cyprinodon variegatus) was characterized after fish were exposed to oil in High Energy Water Accommodated Fractions (HEWAF; tPAH = 81.1 ± 12.4 µg/L) for 7 days. A foraging behavioral assay was used to determine feeding efficiency before and after oil exposure. The fish gut microbiome was not significantly altered in alpha or beta diversity. None of the most abundant taxa produced any significant shifts as a result of oil exposure, with only rare taxa showing significant shifts in abundance between treatments. However, several bioindicator taxa known for hydrocarbon degradation were detected in the oil treatment, primarily Sphingomonas and Acinetobacter. Notably, the genus Stenotrophomonas was detected in high abundance in 16S data, which previously was not described as a core member of fish gut microbiomes. Data also demonstrated that behavior was not significantly affected by oil exposure. Potential low bioavailability of the oil may have been a factor in our observation of minor shifts in taxa and no behavioral effects. This study lays a foundation for understanding the microbiome of captive sheepshead minnows and indicates the need for further research to elucidate the responses of the fish gut-microbiome under oil spill conditions.

La pandemia de COVID-19 y el cumplimiento de las guías alimentarias en una comunidad universitaria de Chile / COVID-19 pandemic and adherence to food- based dietary guidelines in a Chilean university community

Introducción. La pandemia de SARS-CoV-2/COVID-19 y las restricciones sanitarias afectaron la disponibilidad, acceso y consumo de alimentos, impactando la alimentación y el estado nutricional. Objetivo. Determinar el efecto de la pandemia SARS-CoV-2/COVID-19 sobre el cumplimiento de las Guías Alimentarias Basadas en Alimentos de Chile, en una comunidad universitaria, antes y durante la pandemia. Materiales y métodos. Estudio de cohorte retrospectiva con 427 participantes. Se aplicó una encuesta online con preguntas basadas en los mensajes de las GABA. La encuesta se validó por juicio de expertos y análisis psicométrico, evaluando la concordancia con el estadístico de Kappa (K=89,95) y la confiabilidad con el coeficiente Alfa de Cronbach (=0,97). Se fijó como período antes de la pandemia al tiempo anterior a marzo del año 2020, y durante la pandemia, entre marzo del 2020 y octubre del 2021. Para medir los cambios antes y durante la pandemia se aplicó el test de simetría considerando un p <0,05 con un intervalo de confianza del 95%, mediante el software estadístico STATA versión 16. Resultados. Se observaron cambios estadísticamente significativos antes y durante la pandemia en los mensajes relacionados con el estado nutricional (p=0,000), consumo semanal de: productos de pastelería (p=0,0040), cecinas y embutidos (p=0,0034), frituras (p=0,0070), legumbres (p=0,0000), aguas (p=0,0000) y lectura e información nutricional de los productos (p=0,0000). Conclusiones. La pandemia de SARS-CoV-2/COVID-19 generó cambios en la alimentación y estado nutricional respecto a los mensajes de las guías. Se precisan políticas alimentarias y estrategias educativas en alimentación y en nutrición para emergencias sanitarias(AU)

Introduction. The SARS-CoV-2/COVID-19 pandemic, as well as health restrictions, impacted food availability, access and consumption, affecting dietary habits and nutritional status. Objective. To determine the effect of the SARS-CoV-2/ COVID-19 pandemic on the adherence to Chilean Food-Based Dietary Guidelines, within a university community, both before and during the pandemic. Materials and methods. A retrospective cohort study involving 427 participants was conducted. An online survey was administered, with questions based on the FBDGs' messages. The survey was validated through expert judgment and psychometric analysis, and agreement was assessed using the Kappa statistic (K = 89.95) while reliability was determined using the Cronbach's Alpha coefficient ( = 0.97). The period before the pandemic was defined as the time prior to March 2020, and the pandemic period was set between March 2020 and October 2021. Changes before and during the pandemic were measured using the symmetry test, considering a p value of <0.05 and a 95% confidence level, using the STATA 16 statistical software. Results. Statistically significant changes were observed before and during the pandemic in messages related to nutritional status (p = 0.000), weekly consumption of bakery products (p = 0.0040), cold meats (p = 0.0034), fried foods (p = 0.0070), legumes (p = 0.0000), water (p = 0.0000), and messages related to reading and nutrition information of products (p = 0.0000). Conclusions. The pandemic led to dietary changes in relation to FBDGs messages. Food policies and food and nutrition education strategies are required to address health emergency contexts(AU)

Consenso de expertos sobre recomendaciones basadas en evidencia para el diagnóstico, tratamiento y seguimiento de enfermedad de Fabry en pediatría / Expert Consensus on Evidence-Based Recommendations for the Diagnosis, Treatment, and Follow-Up of Fabry Disease in Pediatric Patients / Consenso de especialistas colombianos sobre recomendações baseadas em evidências para o diagnóstico, tratamento e acompanhamento da doença de Fabry em pediatria

Antecedentes: la enfermedad de Fabry (Ef) es una enfermedad rara ligada a X secundaria al depósito lisosomal de glicoesfingolípidos, debido a la deficiencia de la enzima alfa galactosidasa A (α-Gal A). A pesar de su baja frecuencia, es una condición que afecta la calidad de vida de los pacientes y disminuye su esperanza de vida. Objetivo: generar recomendaciones informadas para el diagnóstico y tratamiento de pacientes pediátricos (menores de 18 años) con Ef. Material y Métodos: revisión de literatura en bases de datos y literatura gris a partir de 2010, incluyendo guías de práctica clínica, revisiones sistemáticas y estudios primarios. La calidad de evidencia se evaluó de acuerdo con el tipo. Las recomendaciones se sometieron a consenso de expertos a través de metodología Delphi modificada. El acuerdo se definió a partir del 80 %. Resultados: A partir del análisis de la evidencia recolectada se formularon un total de 45 recomendaciones para tamización, diagnóstico y tratamiento de paciente pediátrico con Ef. El panel revisor estuvo conformado por once expertos en el tema. Las recomendaciones fueron aprobadas con puntuaciones entre 82.3 % y 100 %. Conclusiones: las recomendaciones resultantes del consenso de expertos permitirán la toma de decisiones clínicas y estandarización de la práctica en la atención de pacientes pediátricos con Ef en el país y la región. El diagnóstico temprano y oportuno garantiza una disminución del impacto en la calidad de vida de los pacientes y sus familiares

Background: Fabry disease (fD) is a rare X-linked disease characterized by the accumulation of glyco- sphingolipids in lysosomes due to the deficiency in the production of alpha-galactosidase A (α-Gal A) enzyme. Despite its low frequency, this disease has a serious impact on the life expectancy and quality. Objective: To make evidence-based recommendations for the diagnosis and treatment of fD in pediatric patients (<18 years of age). Materials and Methods: A study of databases and gray literature was conducted in 2010, including clinical practice guidelines, systematic reviews, and primary research. The type of evidence was used to determine the quality of evidence. The recommendations were submitted to an expert consensus using the modified Delphi process. The agreement was set at 80%. Conclusions: The recommendations emerging from this expert consensus will enable the standardization of care provision for pediatric patients with fD in Colombia and Latin America and clinical decision-making for disease management. Notably, making an early diagnosis ensures a reduction in the impact of this disease on the quality of life of patients and their families

Fundamento: a doença de Fabry (Df) é uma rara doença ligada ao cromossomo X secundária à deposi- ção lisossômica de glicoesfingolipídeos devido à deficiência da enzima alfa galactosidase A (α-Gal A). Apesar de sua baixa frequência, é uma condição que afeta a qualidade de vida dos pacientes e diminui sua expectativa de vida. Objetivo: gerar recomendações baseadas em evidências para o diagnóstico e tratamento de pacientes pediátricos (com menos de 8 anos de idade) com Df. Materais e Métodos: foi realizada uma revisão da literatura em bases de dados e literatura cinza a partir de 2010, incluindo diretrizes de prática clínica, revisões sistemáticas e estudos primários. A qualidade da evidência foi avaliada de acordo com o tipo de evidência. As recomendações foram submetidas ao consenso de especialistas usando a metodologia Delphi modificada. A concordância foi definida a partir de 80%. Resultados: com base na análise das evidências coletadas, foram formuladas um total de 45 recomendações para triagem, diagnóstico e tratamento de pacientes pediátricos com doença de Fabry. O painel de revisão foi composto por onze especialistas no assunto. As recomendações foram aprovadas com pontuações entre 82,3% e 100%. Conclusões: as recomendações resultantes do consenso de especialistas permitirão a tomada de decisão clínica e a padronização da prática no cuidado de pacientes pediátricos com Df em nível nacional e regional; o diagnóstico precoce e oportuno garante a redução do impacto na qualidade de vida dos pacientes e seus familiares.

Perfil académico, percepción de competencias en estudiantes de enfermería y desempeño en el examen de grado basado en simulación de alta fidelidad

Objetivo: Analizar la relación entre perfil académico y la percepción de competencias en estudiantes de enfermería, con su desempeño en el examen de grado basado en simulación de alta fidelidad para la obtención del título de enfermera/o. Material y Método: Estudio cuantitativo, transversal y correlacional que siguió la guía STROBE. Midió variables del perfil académico (número de semestres cursados, asignaturas reprobadas, calificación de internado y al 8vo semestre) y la percepción de competencias en una muestra probabilística de 101 estudiantes de enfermería previo al examen de grado basado en simulación clínica de alta fidelidad. Luego se relacionaron con la calificación obtenida en el examen de grado. Resultados: El 36,6% de los estudiantes tardó 14 o más semestres en completar la carrera, y 52,4% tuvo más de 5 asignaturas reprobadas. En el 8vo semestre, el 58,4% obtuvo calificación suficiente. Durante el internado, el 55,4% tuvo calificación muy buena, el 94% percibió sus competencias como buenas o excelente antes del examen de grado y en el examen de grado, el 67,1% obtuvo calificación muy buena y 6,9% sobresaliente. Se encontraron relaciones significativas entre percepción de competencias del estudiante y calificación del examen de grado (p= 0,012), y entre calificación del internado y examen de grado (p= 0,029). No hubo relaciones significativas entre semestres cursados, asignaturas reprobadas y promedio al 8vo semestre con calificación del examen de grado. Conclusiones: Antes del examen de grado, los estudiantes de enfermería perciben su competencia como excelente o buena. Esto se relaciona con calificación en este examen y del internado. La calificación del examen de grado no se relaciona con los semestres cursados, nota al 8vo semestre, ni asignaturas reprobadas.

Objective: To analyze the relationship between academic profile, perception of competence in nursing students, with their performance in the final exam, based on high-fidelity simulation. Material and Method: A quantitative, cross-sectional, and correlational study following the STROBE guidelines. The study measured academic profile variables (number of semesters completed, failed subjects, internship grade and 8th semester grade) and the perception of competence in a probabilistic sample of 101 nursing students, prior to the final exam, based on high-fidelity clinical simulation. They were then related to the final exam grades. Results: 36.6% of students took 14 or more semesters to graduate, and 52.4% had failed more than 5 subjects. In the 8th semester, 58.4% obtained a sufficient grade. During the internship, 55.4% received a very good grade. 94% of students perceived their competence as good or excellent before the final exam, and in the final exam, 67.1% had a very good grade, and 6.9% had an excellent grade. Significant relationships were found between students' perceptions of competence and final exam grades (p= 0.012), and between internship grades and final exam grades (p= 0.029). There were no significant relationships between semesters completed, failed subjects, and 8th semester grade with the final exam grade. Conclusion: Before the final exam, nursing students perceive their competence as excellent or good. This perception is related to their performance in the exam and during the internship. The final exam grade is not related to the number of semesters completed, the 8th semester grade or the failed subjects.

Objetivo: Analisar a relação entre o perfil académico, a percepção de competências dos estudantes de enfermagem e seu desempenho no exame de graduação, com base na simulação de alta fidelidade. Material e Método: Estudo quantitativo, transversal e correlacional que seguiu o guia STROBE. O estudo mediu variáveis de perfil académico (número de semestres cursados, disciplinas reprovadas, nota do estágio e nota do 8° semestre) e a percepção de competência em uma amostra probabilística de 101 estudantes de enfermagem, antes do exame de graduação, com base em simulação clínica de alta fidelidade. Em seguida, essas variáveis foram relacionadas com a nota do exame de graduação. Resultados: 36,6% dos estudantes levaram 14 semestres ou mais para concluir o programa de estudos, e 52,4% tiveram mais de 5 disciplinas reprovadas. No 8° semestre, 58,4% obtiveram uma nota suficiente. Durante o estágio, 55,4% receberam uma nota muito boa. 94% dos estudantes perceberam suas competências como boas ou excelentes antes do exame de graduação. No exame de graduação, 67,1% obtiveram uma nota muito boa e 6,9% uma nota excelente. Foram encontradas relações significativas entre a percepção de competência do estudante e a nota do exame de graduação (p= 0,012), e entre a nota do estágio e o exame de graduação (p= 0,029). Não houve relações significativas entre semestres cursados, disciplinas reprovadas e a nota do 8° semestre com a nota do exame de graduação. Conclusão: Antes do exame de graduação, os estudantes de enfermagem percebem suas competências como excelentes ou boas. Isso está relacionado com a nota neste exame e no estágio. A nota do exame de graduação não está relacionada com os semestres cursados, a nota no 8° semestre ou as disciplinas reprovadas.

Síndrome de hipersecreción de lipasa y lesiones óseas en el cáncer de células acinares del páncreas / Lipase hypersecretion syndrome and bone lesions in acinar cell cancer of the pancreas. Report of one case

Lipase hypersecretion syndrome (LHS) is a rare paraneoplastic syndrome, associated with acinar cell carcinoma of the pancreas (ACCP) in 10% to 15% of patients. Clinically, LHS manifests itself with the appearance of subcutaneous fibrocystic nodules, associated with trophic changes in the overlying skin, such as ulcers or fistulas that are difficult to manage, mainly affecting the lower extremities. Additionally, lipolysis near the joints and in the intraosseous adipose tissue can cause bilateral arthralgias, especially of the knees and ankles. We report a 57-year-old man, with a history of insulin resistance and allergic rhinitis, who presented in June 2019 with multiple subcutaneous nodules in the lower extremities, predominantly in both ankles, associated with arthralgia in that region. Additionally, a CT scan of the abdomen revealed a significant abdominal mass, measuring approximately 17 cm and in contact with the body and tail of the pancreas, pathologically compatible with an ACCP. Treatment with capecitabine was started with a favorable progression. The patient currently presents a small left lateral retro malleolar fistula, which, given the analyzes, studies and reviewed literature is concluded to be a lesion in the context of LHS.

Impacto del índice de masa corporal en el uso del prono vigil y cánula nasal de alto flujo en pacientes con COVID-19 / Impact of body mass index on the use of prone vigil and high-flow nasal cannula in pattients with COVID-19

RESUMEN: El objetivo del estudio fue determinar si la composición corporal es una condición que influye en el efecto del posicionamiento en prono vigil (PPV) en pacientes con COVID-19 conectados a cánula nasal de alto flujo (CNAF). Se realizó un estudio observacional retrospectivo y se analizaron los resultados terapéuticos de 83 pacientes tratados con CNAF en el servicio de medicina del Hospital El Carmen (HEC), Santiago de Chile. Desde la ficha clínica electrónica (Florence clínico versión 19.3) y registro kinésico, se obtuvo la siguiente información: i) antecedentes del paciente, ii) diagnóstico médico, iii) índice de masa corporal (IMC), iv) características del PPV y v) características del proceso de conexión a CNAF. Se observó que existían diferencias significativas en pacientes con sobrepeso y obesos que usaron el PPV (p=0,001) a través del índice de ROX (IROX) al finalizar el tratamiento con CNAF, ocurriendo de igual manera al evaluar los efectos del PPV y en la PAFI en estos mismos grupos. En conclusión el IMC es un factor más agravante que condiciona la salud de los pacientes con COVID-19, y el IMC elevado puede afectar de manera negativa el tratamiento de estos pacientes. Por otra parte, el uso de PPV y CNAF demostraron ser efectivas en los pacientes con COVID-19.

SUMMARY: The aim of the study was to determine whether body composition is a condition influencing the effect of awake prone positioning (APP) in patients with COVID-19 connected to high-flow nasal cannula (HFNC). We conducted a retrospective observational study and analyzed the therapeutic outcomes of 83 patients treated with HFNC in the medicine department of Hospital El Carmen (HEC), Santiago, Chile. The following information was obtained from the electronic clinical record (Florence clinical version 19.3) and the kinesic registry: i) patient history, ii) medical diagnosis, iii) body mass index (BMI), iv) characteristics of the APP and v) characteristics of the process of connection to CNAF. It was observed that there were significant differences in overweight and obese patients who used the PPV (p=0.001) through the ROX index (IROX) at the end of treatment with CNAF, occurring in the same way when evaluating the effects of the APP and in the PAFI in these same groups. In conclusion, BMI is a further aggravating factor that conditions the health of patients with COVID-19, and elevated BMI can negatively affect the treatment of these patients. On the other hand, the use of APP and CNAF proved to be effective in patients with COVID-19.

Evaluación de experiencias formativas en enfermería para el cuidado de personas mayores / Evaluation of Nursing training experiences for the care of the elderly

Resumen Introducción: La formación de pregrado en enfermería requiere del desarrollo de prácticas pedagógicas en las que se incorporen aspectos que permitan fomentar sus características como profesión, disciplina y arte. Objetivo: Analizar los resultados de la evaluación realizada a un grupo de estudiantes de enfermería respecto a experiencias formativas en el contexto de una asignatura donde se aborda el cuidado de personas mayores en una universidad pública en la Región de Los Lagos en Chile. Metodología: Se implementó una pauta de valoración clínica con el uso de lenguaje estandarizado y el desarrollo de un trabajo artístico; al finalizar la asignatura se desarrolló la evaluación cuanti-cualitativa de dicha experiencia, a través de un cuestionario y la realización de grupos focales y entrevistas individuales. De un curso de 22 estudiantes, 18 respondieron el cuestionario y 8 participaron en grupos focales y entrevistas individuales. Resultados: La experiencia en general fue valorada positivamente por los estudiantes, se evidenció que el 80 % refirió que la pauta de valoración empleada facilitó la aplicación del proceso de enfermería. Respecto del trabajo artístico se apreciaron las estrategias metodológicas que permitieron el desarrollo de este y el aporte que el trabajo representó para la gestión del cuidado, la asignatura y los ámbitos personales. Discusión: Se evidencia los aportes que podría tener la metodología empleada en aspectos como la resolución de problemas relacionados con la implementación del lenguaje estandarizado en el ejercicio profesional y la formación de las competencias del ser. Conclusiones: Se requiere incorporar prácticas pedagógicas en la formación de enfermería que potencien tanto el fortalecimiento disciplinar como las competencias del ser.

Abstract Introduction: Undergraduate nursing training requires the development of pedagogical practices in which aspects are incorporated to promote its characteristics as a profession, discipline, and art. Objective: To analyze the educational experiences in a group of nursing students on the subject of elderly care at a public university in the Los Lagos Region in Chile. Methodology: A clinical assessment guideline was implemented with the use of standardized language and the development of an artistic assignment; at the end of the course, the quantitative-qualitative evaluation of the experience was developed, through a questionnaire and the carrying out of focus groups and individual interviews. Of the 22 students in the course, 18 answered the questionnaire and 8 participated in focus groups and individual interviews. Results: The overall experience was positively valued by the students; it was evidenced that 80% reported that the assessment guideline used facilitated the application of the nursing process. Regarding the artistic work, the methodological strategies that allowed its development were appreciated, plus the contribution of the work represented for the management of care, the subject and personal areas. Discussion: The contributions that the methodology used could benefit by: solving problems related to the implementation of standardized language in professional practice and the formation of the competencies of being, are evident. Conclusions: It is necessary to incorporate pedagogical practices in nursing training that enhance both disciplinary strengthening and the competencies of being.

Salud desde una mirada integral: Experiencia en comunidades originarias del área operativa VIII, provincia de Salta, Argentina / Health from an integrated perspective: Experience in ethnic group communities of the operational area VIII, province of Salta, Argentina

INTRODUCCIÓN: Entre septiembre de 2020 y febrero de 2021, en el área operativa VIII de la provincia de Salta se desplegaron acciones sanitarias vinculadas al cuidado de la salud en comunidades de las etnias wichí, chorote, toba y chulupí. Componentes de la Atención Primaria, Sistemas de Información en Salud y la Epidemiología Comunitaria fueron tomados como marco conceptual para el desarrollo de la experiencia. MÉTODOS: Se conformó un equipo itinerante e interdisciplinario, que realizó acciones asistenciales, de promoción y prevención desde un enfoque individual, familiar y comunitario. La sistematización de la información permitió redefinir los criterios de selección de las comunidades a visitar. RESULTADOS: Se realizaron 124 visitas a 36 comunidades, en las cuales se atendió a 2101 personas. En febrero, el 47% del total de embarazadas evaluadas correspondió a población en riesgo. También se logró dar seguimiento al 61% de la cohorte de infantes en riesgo por bajo peso. Se desarrollaron cuatro capacitaciones a agentes sanitarios, con niveles de participación superior al 70% del total de convocados. DISCUSIÓN: La presencia del sistema local en las comunidades es una acción relevante de Salud Pública. Las visitas permitieron lograr un acercamiento a las comunidades, y el uso de información sistematizada incrementó la accesibilidad al sistema. El trabajo conjunto y de capacitación de agentes sanitarios, en su mayoría pertenecientes a las comunidades, constituyó un primer paso hacia una salud intercultural.

[Characterization of third molar extraction]. / Caracterización de exodoncia de terceros molares.

The aim of this study was to characterize the main indications, contraindications and prophylactic actions for third molar extraction according to the literature. The Pubmed, Scopus and Web of Science databases were searched using a total of 3 search keys, including publications up to 5 years old, in English or Spanish, with availability of full text. Eighteen articles were selected and showed that the most frequent indication for third molar extraction was the diagnosis of pericoronaritis, followed by distal cervical caries in the lower second molar, and root resorption in adjacent teeth and cysts. In turn, it may be indicated to facilitate other types of dental treatment, such as orthodontics, orthognathic surgery and rehabilitation. In relation to contraindications, the risk of intraoperative complications was associated with the inferior alveolar nerve, advanced age and the predomination of systemic involvement. Prophylactic extraction was included in the analysis in 72.2% of the articles, with a predominance of exodontia of asymptomatic and disease-free third molars. Finally, there are clear indications and contraindications for third molar extraction, being mainly associated with pathological changes, indications for orthodontic treatment, orthognathic surgery and rehabilitative treatment. However, there is controversy in the literature regarding prophylactic extraction, emphasizing that not all retained and asymptomatic third molars should be extracted. Third molar extraction should be evaluated on a case by case basis, considering the benefits, the patient's characteristics and the risk of postoperative complications.

Evaluación de un programa de educación ambiental desde la voz del alumnado / Evaluation of an environmental education program through the voices of students / Avaliação de um programa de educação ambiental desde a voz dos alunos

Resumen (analítico) Los niños, niñas y adolescentes no participan activamente de los sistemas, proyectos y políticas ambientales que se implementan, lo que supone una vulneración de derechos y un erreur fatale para la retroalimentación de estas intervenciones. La presente investigación describe los resultados de una evaluación cualitativa realizada a un programa de educación ambiental local, mediante asambleas infantiles en las que participaron 150 escolares de entre 6 y 14 años. Estos y estas fueron capaces de detectar ciertas dificultades y activos del programa, algunos vacíos y buenas prácticas presentes en la escuela, así como también mencionaron una serie de problemáticas socio-ambientales tanto locales como globales. Se concluye que estas personas son totalmente válidas para participar en la evaluación de programas sociales; así mismo, la necesidad de incluir sus opiniones en la mejora de los proyectos ambientales.

Abstract (analytical) Children and adolescents do not actively participate in environmental systems, projects and policies that are implemented, which implies a violation of their rights and a fatal mistake in the evaluations of these interventions. This research describes the results of a qualitative assessment of a local environmental education program through Children's Assemblies that involved the participation of 150 students between 6 and 14 years of age. These children were able to identify certain difficulties with the components of the program, gaps and best practices in their schools and a series of local and global socio-environmental problems. The authors conclude that these children are fully valid participants in the evaluation of social programs while identifying the need to include their opinions in the improvement of environmental projects.

Resumo (analítico): Este estudo examina o conhecimento sobre as propriedades formais e a função referencial de desenho, escrita e numerais que mães, filhos e filhas (2 anos e meio e 4 anos) apresentados em tarefa de produção conjunta. O método comparativo constante foi utilizado para a construção do sistema de codificação; se analisou mediante provas não paramétricas. As duplas do grupo de 2 anos e meio conversaram sobre a função referencial dos três sistemas, especialmente do desenho. No grupo de 4 anos aumentaram o interesse pela escrita, a consideração das propriedades formais da escrita e dos numerais e as produções independentes de desenho e escrita. O estudo mostrou a produção gráfica conjunta como uma interação educacional na família que estimula a apropriação precoce de sistemas de representação externa.

Utilización de láser diodo en tejidos blandos: reporte de 3 casos / Use of diode laser in soft tissue: report of 3 cases

Existen diversas condiciones anatómicas o alteraciones mucogingivales que pueden afectar tanto el normal funcionamiento como la estética gingival de piezas dentarias e implantes dentales. Si bien los tratamientos de estas condiciones se han realizado tradicionalmente con bisturí, el desarrollo tecnológico ha permitido que actualmente se pueden realizar con láser. Existen diferentes tipos de láser, siendo el diodo uno de los más utilizados debido a su menor tamaño, portabilidad, fácil configuración y menor costo. El láser ha adquirido mayor popularidad en cirugías de tejido blando dado sus múltiples beneficios: menor tiempo operatorio, control del sangrado y de la hemostasia, reducción de la cantidad de anestesia, posibilidad de no requerir suturas y minimización del dolor e inflamación postquirúrgica. El propósito de este trabajo es presentar la resolución de tres casos clínicos a los cuales se les realizaron los procedimientos de frenectomía labial, remoción de melanosis gingival y resección de fibroma irritativo mediante el uso de láser diodo. Para desarrollar todos los procedimientos se utilizó un equipo de láser diodo de 940 nm (Biolase®, USA) con una potencia que varió entre 2 y 2.5 W en modo continuo utilizando una pieza quirúrgica con una punta de 300 µm (E 3-4), la que fue activada antes de empezar. Posterior a la cirugía se bioestimuló para disminuir el dolor y edema postoperatorio utilizando la punta de dolor a 4 W por 30 segundos a una distancia de 1 cm directo en la zona intervenida a todos los casos. La conclusión arroja que en todos los casos, el láser de diodo permitió un resultado exitoso. El procedimiento fue seguro, la técnica fue sencilla y de tiempo clínico reducido. El postoperatorio ocurrió con ausencia de dolor o molestias, generando una mayor satisfacción del paciente. Cabe señalar que la técnica depende de la habilidad del profesional que la realiza.

There are various anatomical conditions or mucogingival alterations that can affect the normal functioning and the gingival aesthetics of teeth and dental implants. Although the treatments of these conditions have been traditionally performed with a scalpel, technological development has allowed that they can be now performed with lasers. There are different types of lasers, being the diode one of the most used due to its smaller size, portability, easy configuration, and lower cost. The laser has become more popular in soft tissue surgeries due to its multiple benefits: shorter operating time, control of bleeding and hemostasis, reduction in the amount of anesthesia, possibility of not requiring sutures, and minimization of post-surgical pain and inflammation. The purpose of this work is to present the resolution of three clinical cases which underwent labial frenectomy procedures, removal of gingival melanosis and resection of irritative fibroma using diode laser. To develop all the procedures, a 940 nm diode laser equipment (Biolase®, USA) was used with a power that varied between 2 and 2.5 W in continuous mode, using a 300 µm tip (E 3-4), which was activated before starting. After surgery, biostimulation was carried out to reduce postoperative pain and edema using the pain tip at 4 W for 30 seconds at a distance of 1 cm directly in the operated area in all cases. In all cases, the diode laser allowed a successful result. The procedure was safe, the technique was simple, and the clinical time was short. The postoperative period occurred with the absence of pain or discomfort, generating greater patient satisfaction. It should be noted that the technique depends on the skill of the professional who performs it.