ß Symmetry of Supergravity.

Continuous O(d,d) global symmetries emerge in Kaluza-Klein reductions of D-dimensional string supergravities to D-d dimensions. We show that the nongeometric elements of this group effectively act in the D-dimensional parent theory as a hidden bosonic symmetry that fixes its couplings: the ß symmetry. We give the explicit ß transformations to first order in α^{'} and verify the invariance of the action as well as the closure of the transformation rules.

Changes in the epidemiology and distribution of the hepatitis C virus genotypes in North-Eastern Spain over the last 35 years.

BACKGROUND: Genotypic distribution and epidemiology of HCV infection in Western Europe countries has changed over the last decades. AIM: To establish the local genotypic profile and characterize the associated demographic variables. MATERIAL AND METHOD: All the genotyping from 1988 to 2015 were considered. Associated demographic variables were included in logistic regression models. Genotyping was carried out with updated commercial kits. RESULTS: Genotype 1b was the most prevalent (42.4%) followed by 1a (22.5%), 3 (18.6%), 4 (10.6%) and 2 (4.6%). The prevalence of 1a was higher in males, in patients younger than 45 and in intravenous drug users (IDU). 1b was more frequent in older than 45, with transfusion-associated and parenteral/nosocomial infections and in immigrants from Eastern Europe. Genotype 2 was highly prevalent in the postransfusional route (54.9%). Genotype 3 prevalence was high in males, in patients younger than 45, in IDU (69.3%) and in Asian and Eastern European immigrants. Genotype 4 was high in males, in patients younger than 45, and in IDU (63.5%). 1a, 3, 4 were the most prevalent genotypes in HIV-coinfected patients. There was a significant decline in genotype 1b and an increase in genotypes 3 and 4 over time. CONCLUSIONS: There has been a decline of genotype 1b, associated with transfusion or parenteral/nosocomial infections, and increases in the prevalence of genotypes 1a, 3 and 4 associated with male gender and IDU, now the most prevalent infection route. Immigration contributed with genotype 2 infections from Africa and genotype 1b and 3 infections from Eastern Europe and Asia.

High efficacy of Sofosbuvir plus Simeprevir in a large cohort of Spanish cirrhotic patients infected with genotypes 1 and 4.

BACKGROUND AND AIMS: Hepatitis C (HCV) therapy with Sofosbuvir (SOF)/Simeprevir (SMV) in clinical trials and real-world clinical practice, showed high rates of sustained virological response (SVR) in non-cirrhotic genotype (GT)-1 and GT-4 patients. These results were slightly lower in cirrhotic patients. We investigated real-life effectiveness and safety of SOF/SMV with or without ribavirin (RBV) in a large cohort of cirrhotic patients. METHODS: This collaborative multicentre study included data from 968 patients with cirrhosis infected with HCV-GT1 or 4, treated with SOF/SMV±RBV in 30 centres across Spain between January-2014 and December-2015. Demographic, clinical, virological and safety data were analysed. RESULTS: Overall SVR was 92.3%; the majority of patients were treated with RBV (62%) for 12 weeks (92.4%). No significant differences in SVR were observed between genotypes (GT1a:94.3%; GT1b:91.7%; GT4:91.1%). Those patients with more advanced liver disease (Child B/C, MELD≥10) or portal hypertension (platelet count≤100×109 /L, transient elastography≥21 Kpa) showed significantly lower SVR rates (84.4%-91.9%) than patients with less advanced liver disease (93.8%-95.9%, P<.01 in all cases). In the multivariate analysis, the use of RBV, female gender, baseline albumin≥35 g/L, MELD<10 and lack of exposure to a triple therapy regimen were independent predictors of SVR (P<.05). Serious adverse events (SAEs) and SAE-associated discontinuation events occurred in 5.9% and 2.6%. CONCLUSIONS: In this large cohort of cirrhotic patients managed in the real-world setting in Spain, SOF/SMV±RBV yielded to excellent SVR rates, especially in patients with compensated liver cirrhosis. In addition, this combination showed to be safe, with low rates of SAEs and early discontinuations.

Predictive variables of sustained virological response after early discontinuation of triple therapy with telaprevir for genotype-1 HCV infection.

BACKGROUND: Pivotal phase studies of telaprevir (TLV) and boceprevir (BOV) showed 10-56% rates of early treatment interruption. However, there have been no reports on the sustained virological response (SVR) rates of these patients. AIM: To assess the SVR rate in a large cohort of patients who discontinued triple therapy with TLV or BOV for reasons other than stopping rules and to identify variables predicting SVR. MATERIAL AND METHOD: A survey was sent to 15 hospitals in Catalonia asking them to report all TLV/BOV treatments finished by 31 May 2014. Demographic, clinical, laboratory, liver fibrosis and therapeutic data were recorded for treatments with early discontinuation. Logistic regression analysis, ROC curves and prognostic assessment of the variables identified were calculated. RESULTS: Twelve hospitals responded to the survey, representing 467 treatments and 121 (21.2%) early discontinuations, 76 (62.8%) due to stopping rules and 45 (37.2%) for other reasons. Early discontinuation was more frequent with BOV [38.2% (50/131) versus 21.1% (71/336) p<0.005], mainly due to stopping rules [78% (39/50) versus 52.1% (37/71); p=0.004]. SVR was achieved in 21/121 patients (17.4%), 19/71 (26.8%) treated with TLV and 2/50 (4.0%) treated with BOV. In patients discontinuing treatment for reasons other than stopping rules, SVR was achieved in 19/37 (55.9%) treated with TLV and in 2/11 (18.2%) treated with BOV. The SVR rate in patients treated with TLV who discontinued due to a severe adverse event was 61.5% (16/26). A logistic regression analysis was performed only with triple therapy with TLV and early discontinuation. The predictive variables of SVR were undetectable HCV-RNA at treatment week 4 and treatment length longer than 11 weeks. Treatment duration longer than 11 weeks showed the best accuracy (0.794), with a positive predictive value of 0.928. CONCLUSIONS: Early discontinuation of TLV-based triple therapy due to reasons other than stopping rules still have a significant SVR rate (55.9%). Undetectable HVC-RNA at week 4 of treatment and treatment duration longer than 11 weeks are predictive of SVR in this subset of patients.

Recombinant monovalent llama-derived antibody fragments (VHH) to rotavirus VP6 protect neonatal gnotobiotic piglets against human rotavirus-induced diarrhea.

Group A Rotavirus (RVA) is the leading cause of severe diarrhea in children. The aims of the present study were to determine the neutralizing activity of VP6-specific llama-derived single domain nanoantibodies (VHH nanoAbs) against different RVA strains in vitro and to evaluate the ability of G6P[1] VP6-specific llama-derived single domain nanoantibodies (VHH) to protect against human rotavirus in gnotobiotic (Gn) piglets experimentally inoculated with virulent Wa G1P[8] rotavirus. Supplementation of the daily milk diet with 3B2 VHH clone produced using a baculovirus vector expression system (final ELISA antibody -Ab- titer of 4096; virus neutralization -VN- titer of 256) for 9 days conferred full protection against rotavirus associated diarrhea and significantly reduced virus shedding. The administration of comparable levels of porcine IgG Abs only protected 4 out of 6 of the animals from human RVA diarrhea but significantly reduced virus shedding. In contrast, G6P[1]-VP6 rotavirus-specific IgY Abs purified from eggs of hyperimmunized hens failed to protect piglets against human RVA-induced diarrhea or virus shedding when administering similar quantities of Abs. The oral administration of VHH nanoAb neither interfered with the host's isotype profiles of the Ab secreting cell responses to rotavirus, nor induced detectable host Ab responses to the treatment in serum or intestinal contents. This study shows that the oral administration of rotavirus VP6-VHH nanoAb is a broadly reactive and effective treatment against rotavirus-induced diarrhea in neonatal pigs. Our findings highlight the potential value of a broad neutralizing VP6-specific VHH nanoAb as a treatment that can complement or be used as an alternative to the current strain-specific RVA vaccines. Nanobodies could also be scaled-up to develop pediatric medication or functional food like infant milk formulas that might help treat RVA diarrhea.

High efficacy and safety of triple therapy in HCV genotype 1 and moderate fibrosis: a multicenter study of clinical practice in Spain.

BACKGROUND AND RATIONAL: Telaprevir-based therapy (TBT) has been extensively evaluated in clinical trials. So we designed a study to compare the efficacy and safety of TBT between patients with moderate fibrosis and those suffering from advanced fibrosis in clinical practice. A multicenter observational and ambispective study was conducted. It included 582 patients with chronic hepatitis C genotype 1, 214 with fibrosis F2, and 368 with F3/F4 (F3: 148; F4: 220). RESULTS: The mean patient age was 55 years, 67% male. Type of prior response was 22% naïve, 57% relapsers, and 21% partial/null responders, 69% had high viral load (> 800,000 IU/mL). HCV genotypes were 1a (19%), 1b (69%), and 1 (12%), respectively. Sixty-five percent were non-CC IL28B genotype. Week-12 sustained virologic response (SVR12) was significantly higher among F2-naïve patients (78%) compared with F3/F4-naïve patients (60%; p = 0.039) and among F2 non-responders (67%) compared with F3/F4 non-responders (42%; p = 0.014). SVR12 among relapsers was remarkably high in both groups (F2:89% vs. F3/F4:78%). Severe anemia and thrombocytopenia were more frequent among patients with F3/F4 than those with F2 (p < 0.01). Overall, 132 patients (22%) discontinued treatment: 58 due to adverse effects, 42 due to the stopping-rule, and 32 due to breakthrough. Premature discontinuation was more frequent among patients with F3/F4 (p = 0.028), especially due to breakthrough (p < 0.001). CONCLUSIONS: This multicenter study demonstrates high efficacy and an acceptable safety profile with regard to TBT in F2-patients in clinical practice.

Survey on Ethical Conduct Thresholds in Cardiologal Medical Practice in Argentina.

The purpose of this study was to analyze the attitude of a group of cardiologists on the ethical conducts they would accept or adopt when encountered with different hypothetical situations of medical practice. Between August and September of 2011, 700 Argentine cardiologists were surveyed in situations which posed ethical dilemmas in the patient-physician relationship, among colleagues or involving financial agreements with employers or the pharmaceutical industry. Ethical conflicts were evidenced in a series of inappropriate conducts such as differential fees, trips and meals sponsored by laboratories, splitting fees, overbilling, self-referral, charging for patient referral, financial compensation for ordering medical procedures, and various situations derived from the relationship with employers. In general, financial compensation from the pharmaceutical industry was more accepted than the conflictive situations which directly involved patients, colleagues or employers. The rejection of these conducts, the physicians' deontological education and the improvement of financial and organizational conditions in medical practice will help to encourage better medical professionalism and avoid unseemly behaviors.

Community-based screening enhances hepatitis B virus linkage to care among West African migrants in Spain.

BACKGROUND: Chronic infection with HBV is responsible for >50% of all hepatocellular cancer cases globally and disproportionately affects sub-Saharan African (sSA) countries. Migration from these countries to Europe has increased substantially in recent years, posing unique challenges to health systems. The aim of this study was to carry out a community-based intervention to increase HBV screening, vaccination, and linkage to care among sSA migrants in Catalonia, Spain. METHODS: This was a prospective cohort study. Participants ≥18 years were offered community-based HBV screening between 20/11/20 and 21/01/22. Rapid HBV testing and blood sample collection utilizing plasma separation cards were carried out and linkage to care was offered to all participants. HBV vaccination and post-test counseling were performed at a second visit in the community. The main outcome was the odds of those with current HBV infection being successfully linked to hepatology. Rates of completing the care cascade of this model were analyzed. RESULTS: In the present study, 444 people undergo screening, with 50.6% of participants showing evidence of past or current HBV infection, including an HBsAg prevalence of 9.2%. Migrants with current HBV infection exhibit 5.2 times higher odds of successful linkage to care compared to those in need of post-test counseling or vaccination. The study achieves a successful linkage to care rate of 72% for all participants, with specialist appointments arranged within 15.5 days. CONCLUSIONS: This community-based HBV screening program provides evidence of a successful model for identifying and providing care, including vaccination, to west African migrants at high risk of HBV infection who may otherwise not engage in care.

A large proportion of hepatitis B virus (HBV) infections occur within countries in sub-Saharan Africa. With recent increased migration from these countries to Catalonia Spain, the prevalence of HBV is greater in migrants than in host populations. However, migrants face additional barriers when trying to access care. We developed a community-based care pathway to provide migrants in Catalonia with access to HBV testing, post-test counseling, vaccinations, and appointments with specialists when needed. The results showed that this strategy was successful in increasing testing, linkage to care, and vaccination among at-risk migrant populations in Catalonia, Spain. It may be worthwhile implementing this strategy on a wider scale and with other at-risk populations to reduce HBV infections and improve outcomes.

Analysis of the experience of the geriatric fracture program in two institutions in Colombia: a reproducible model?

Background: hip fracture is the major cause of morbidity and mortality. Geriatric fracture programs promise to improve the quality of care, health outcomes and reduce costs. Objective: To describe the results related to the Geriatric fracture programs implementation in two Colombian institutions to assess reproducibility. Methods: We performed A retrospective descriptive study of the patients treated under the Geriatric fracture programs in two institutions in Colombia. The information was collected from the initial year of implementation until 2018. Demographic characteristics, length of stay, hospitalization complications, readmissions and mortality were described. Consumption of healthcare resources was defined using base cases determined with local experts and costs were estimated using standard methods. Results: 475 patients were included in the Geriatric fracture programs. We observed an increase in the number of patients. The length of stay decreased between 8.5% and 26.1% as did the proportion of total complications, with delirium having the greatest reduction. A similar situation was seen for first year mortality (from 10.9% to 4.7%), in-hospital deaths and readmissions. Estimates of costs of stay and complications showed reductions in all scenarios, varying between 22% and 68.3%. Conclusions: The present study presents the experience of two institutions that implemented the Geriatric fracture programs with increase in the number of patients treated and reductions in the time of hospital stay, the proportion of complications, readmissions, mortality and estimated costs. These are similar between both institutions and with other published implementations. This could hint that geriatric fracture program may be implemented with reproducible results.

Antecedentes: las fracturas de cadera son una causa importante de morbilidad y mortalidad. Los programas de fracturas geriátricas prometen mejorar la calidad de la atención, los desenlaces clínicos y reducir costos. Objetivos: Describir los resultados relacionados con la implementación de un programa de fracturas geriátricas en dos instituciones en Colombia para evaluar la reproducibilidad. Métodos: Realizamos un estudio retrospectivo descriptivo de los pacientes atendidos en el programa de fracturas geriátricas en dos instituciones en Colombia. Se obtuvo información desde el año de implementación hasta 2018. Se describió información demográfica, de estancia hospitalaria, de complicaciones, de rehospitalizaciones y de mortalidad. Se determinó un caso base de consumo de recursos con expertos y se costeó usando métodos estandarizados. Resultados: Se incluyeron 475 pacientes. Se observó un aumento en la cantidad de pacientes. La duración de estancia disminuyó entre 8.5% y 26.1%, así como la frecuencia de complicaciones. Se encontraron reducciones en mortalidad en el primer año (entre 10.9% y 4.7%), muertes hospitalarias y rehospitalizaciones. Los costos estimados mostraron reducciones entre 22% y 68.3%. Conclusiones: El presente estudio muestra la experiencia de implementación de programa de fracturas geriátricas en dos instituciones en Colombia, mostrando aumento en cantidades de pacientes y reducciones en estancia hospitalaria, frecuencia de complicaciones, rehospitalizaciones, mortalidad y costos estimados. Los resultados fueron similares en las dos instituciones y comparables con otros descritos en literatura. Esto sugiero que los programas de fracturas geriátricas se pueden implementar con resultados reproducibles.

[Survey of medical attitudes towards a "case scenario" of encephalopathy after cardiac arrest]. / Encuesta sobre las actitudes médicas ante un caso hipotético de encefalopatía post-reanimación.

Recent studies have shown that the timing of death is often under the control of the physicians who treat the patient in intensive care unit (ICU), where death is commonly preceded by decisions either not to start an aggressive therapy or to discontinue life-sustaining therapy. The objective was to study end-of-life decisions and attitudes of Argentinian cardiologists when treating terminal patients in the ICU. During 2007, a survey by e-mail was carried out among 967 cardiologists across Argentina. The questionnaire consisted of the case scenario of a vegetative patient with no family and no advance directives, so the responsibility for decision making would depend exclusively on the physician or health care team. 72.7% answered the survey; 72.0% of physicians preferred to share decisions with other doctors or with an ethical committee, nevertheless they rarely involved nurses in decisions. Besides, 85.4% of cardiologists would apply the do-not-resuscitate order and 8% would choise the terminal weaning or extubation. Comparatively, these results were similar to those previously reported in Southern Europe. In conclusion, most physicians would decide with other doctors or would ask for an ethical consultant; in the same way, most of respondents would apply the do-not-resuscitate order, though a few times they would choise the terminal weaning or extubation. Since regional and international survey opinions on these issues remain highly variable, it seems difficult to reach a global consensus regarding end-of-life care in the ICU.

[Food, nutrition and gastronomy: three sociocultural value for the region of Segovia]. / Alimentación, nutrición y gastronomía: tres valores socioculturales para la población de la provincia de Segovia.

INTRODUCTION: The diet of the population at Segovia has had two special changes, one at the XVI century because of foods from America were incorporated to their diet and another with the high distribution and sale has been done since the 1980s-90s. The survey data referred to food consumption allows us to evaluate the amount of food and drink groups consumed in the year 1964-65. Energy intake was higher than now. These same foods are those that have endured as a basis for cuisine and gastronomy at Segovia, being one of the most characteristic of the VI regional territory and the national scope. The most significant recipes of the gastronomy at Segovia have been written in handbooks in the same period as the survey, so the existing relationship for that period of food, nutrition and gastronomy is evident. Today all gastronomy has been relegated to occasional celebrations or special moments or to that referred to the restaurants as the economic engine of the city and the province.

INTRODUCCIÓN: La alimentación de la población segoviana ha tenido dos cambios significativos: el primero, a finales de la Edad media, con la incorporación de alimentos provenientes de América; el otro, con la gran distribución y la venta que se produce desde los años 1980-1990. Los datos de la encuesta referida a consumo de alimentos en los años 1964-1965 nos permite evaluar la cantidad de los grupos de alimentos y bebidas que se consumían en dicho periodo, y que conllevaban una alta ingesta de energía. Estos mismos alimentos son los que han perdurado como base de la cocina y de la gastronomía segovianas, unas de las más características del territorio regional VI y del ámbito nacional. Las recetas más significativas de la gastronomía segoviana se han plasmado en manuales en el mismo periodo que el de la encuesta, por lo que la relación existente para ese periodo de alimentación, nutrición y gastronomía es evidente. Hoy toda la gastronomía ha quedado relegada a celebraciones puntuales o a momentos especiales, o a la referida a la restauración como motor económico de la ciudad y de la provincia.

Rv3134c/devR/devS operon of Mycobacterium bovis BCG is differentially transcribed under "in vitro" stress conditions.

DevR is a transcriptional regulator that mediates the genetic response of Mycobacterium tuberculosis and Mycobacterium bovis to oxygen limitation and nitric oxide exposure. devR is part of an operon that includes the genes devS and Rv3134c, which encode an oxygen sensor protein and a protein that contains a universal stress protein domain, respectively. Here, we report the transcriptional analysis and quantitative expression of Rv3134c/devR/devS under in vitro stress conditions including oxygen limitation, low nutrients and ex vivo macrophage infection. At least three different promoters were found to control Rv3134c/devR/devS expression under the stresses tested. Two promoters were identified upstream of devR, one was active under hypoxia and the other under nutrient starvation. A single promoter was identified upstream of Rv3134c, and transcripts from this promoter were detected only under hypoxia. Rv3134c to devR were found to be co-transcribed only under hypoxia, whereas devR/devS were co-transcribed both in aerobiosis and starvation. RT-qPCR showed an increase in the ratio hypoxia/aerobiosis and in starvation/nutrients in all genes. devR/devS showed transient expression in the first days of macrophage infection. Our results indicate that Rv3134c/devR/devS of M. bovis BCG constitutes an operon with complex regulation that participates in bacterial response against a wide range of stresses.

Parasite risk factors for stunting in grade 5 students in a community of extreme poverty in Peru.

Malnutrition in school-age children is common in developing countries and includes both stunting and underweight. Stunting, which represents a chronic state of nutritional stress, leads to adverse health, educational and cognitive effects. Although much research is focused on preschool-age children, recent studies show both the high prevalence of stunting and the effectiveness of interventions in school-age children. The objectives of the current study were to determine the risk factors for stunting only, and stunting and underweight. A survey was conducted in 1074 grade 5 children (mean age 10 years) from 17 schools in Belen, Peru, a community of extreme poverty. Prevalence of underweight and stunting were 10.5 and 34.5%, respectively, co-prevalence was 9.3%. Based on multivariable logistic regression analyses, significant independent risk factors (odds ratio: OR) for stunting and underweight were: age (per 1 year increment) (OR=1.55; 95% confidence interval (CI): 1.33, 1.81); diarrhoea in the last week (OR=1.96; 95% CI: 1.17, 3.29) and hookworm infection (OR=1.74; 95% CI: 1.05, 2.86). Significant independent risk factors for stunting only were: age (per 1 year increment) (OR=1.51; 95% CI: 1.35, 1.70); anaemia (OR=1.98; 95% CI: 1.26, 3.11); and moderate and heavy Trichuris and Ascaris co-infection (OR=1.95; 95% CI: 1.35, 2.82). Our results indicate a high prevalence of stunting, in addition to other adverse health indicators, in the study population. Due to the interrelation between many of these health and nutrition problems, interventions at both the school and community levels, including de-worming, feeding programs and health and hygiene education, are needed to reduce malnutrition in this and other similar populations living in conditions of extreme poverty.

Analysis of the experience of the geriatric fracture program in two institutions in Colombia: a reproducible model? / Análisis de la experiencia del programa de fracturas geriátricas en dos instituciones en Colombia: ¿un modelo reproducible?

Abstract Background: hip fracture is the major cause of morbidity and mortality. Geriatric fracture programs promise to improve the quality of care, health outcomes and reduce costs. Objective: To describe the results related to the Geriatric fracture programs implementation in two Colombian institutions to assess reproducibility. Methods: We performed A retrospective descriptive study of the patients treated under the Geriatric fracture programs in two institutions in Colombia. The information was collected from the initial year of implementation until 2018. Demographic characteristics, length of stay, hospitalization complications, readmissions and mortality were described. Consumption of healthcare resources was defined using base cases determined with local experts and costs were estimated using standard methods. Results: 475 patients were included in the Geriatric fracture programs. We observed an increase in the number of patients. The length of stay decreased between 8.5% and 26.1% as did the proportion of total complications, with delirium having the greatest reduction. A similar situation was seen for first year mortality (from 10.9% to 4.7%), in-hospital deaths and readmissions. Estimates of costs of stay and complications showed reductions in all scenarios, varying between 22% and 68.3%. Conclusions: The present study presents the experience of two institutions that implemented the Geriatric fracture programs with increase in the number of patients treated and reductions in the time of hospital stay, the proportion of complications, readmissions, mortality and estimated costs. These are similar between both institutions and with other published implementations. This could hint that geriatric fracture program may be implemented with reproducible results.

Resumen Antecedentes: las fracturas de cadera son una causa importante de morbilidad y mortalidad. Los programas de fracturas geriátricas prometen mejorar la calidad de la atención, los desenlaces clínicos y reducir costos, Objetivos: Describir los resultados relacionados con la implementación de un programa de fracturas geriátricas en dos instituciones en Colombia para evaluar la reproducibilidad Métodos: Realizamos un estudio retrospectivo descriptivo de los pacientes atendidos en el programa de fracturas geriátricas en dos instituciones en Colombia. Se obtuvo información desde el año de implementación hasta 2018. Se describió información demográfica, de estancia hospitalaria, de complicaciones, de rehospitalizaciones y de mortalidad. Se determinó un caso base de consumo de recursos con expertos y se costeó usando métodos estandarizados. Resultados: Se incluyeron 475 pacientes. Se observó un aumento en la cantidad de pacientes. La duración de estancia disminuyó entre 8.5% y 26.1%, así como la frecuencia de complicaciones. Se encontraron reducciones en mortalidad en el primer año (entre 10.9% y 4.7%), muertes hospitalarias y rehospitalizaciones. Los costos estimados mostraron reducciones entre 22% y 68.3%. Conclusiones: El presente estudio muestra la experiencia de implementación de programa de fracturas geriátricas en dos instituciones en Colombia, mostrando aumento en cantidades de pacientes y reducciones en estancia hospitalaria, frecuencia de complicaciones, rehospitalizaciones, mortalidad y costos estimados. Los resultados fueron similares en las dos instituciones y comparables con otros descritos en literatura. Esto sugiero que los programas de fracturas geriátricas se pueden implementar con resultados reproducibles.

Measurement of empathy among Argentine cardiologists: Psychometrics and differences by age, gender, and subspecialty.

BACKGROUND: Cardiologists are involved in the management of patients with multiple cardiovascular risk factors and chronic heart diseases, so empathy is a necessary feature to deal with them. The aim of the study was to evaluate the validity and reliability of the Spanish version of the Jefferson Scale of Physician Empathy (JSPE) among Argentine cardiologists and to explore the potential differences by age, gender, and subspecialty. METHODS: Between August and September 2012, we performed a survey in a non-randomized sample of 566 Spanish-speaking cardiologists of Argentina. A Principle Component Analysis (PCA) was used to explore the link between observed variables and latent variables in order to identify the factor structure. The PCA criteria for identifying the factor structure were examined with the Kaiser-Meyer-Olkin (KMO) analysis. RESULTS: The KMO measure of sampling adequacy was 0.86 and Bartlett's test of sphericity was highly significant (p = 0.000), determining the suitability of the data set for factor analysis. The PCA of 20 items yielded a three factor model that accounted for 40.6% of the variance. The JSPE mean rank score for women was 307.9 vs. 275.0 for men (p = 0.017). The comparison of mean rank score according to age (quartiles) showed a significant relation between older age and empathy. No difference was found when the mean rank scores were compared by respondent subspecialty. CONCLUSIONS: JSPE provides a valid and reliable scale to measure Argentine cardiologists' attitudes towards empathy. Female cardiologists seem to be more empathic than their male colleagues, and a positive relationship between age and empathy was found.

Anticancer bisquaternary heterocyclic compounds: a ras-ional design.

A new family of symmetrical bisquaternary compounds with semirigid linkers have shown to be highly specific for Choline Kinase (ChoK) inhibition and to exert antitumoural activity in cell lines and in mice. A three-parameter regression equation has been derived which satisfactorily describes the ex vivo inhibitory potency of ChoK of the title compounds. The electronic effect of the group at position 4 of the cationic head plays a critical role although the hydrophobic contribution, especially that of the linker, favors the ChoK inhibitory activity. The antiproliferative activity (in vitro assay) is correlated with the ChoK inhibition (ex vivo assay) through the electronic effect and a squared term of the overall lipophilicity of the molecules. We also provide in vivo evidence that ChoK is a novel target for the design of antitumoural drugs. All these results suggest that ChoK plays a crucial role in the onset of carcinogenesis.

Perfil demográfico del cáncer de ovario en la Unidad de Tomografía por Emisión de Positrones Ciclotrón Hospital Carlos Andrade Marín / Demographic profile of ovarian cancer in the Positron Emission Tomography and Cyclotron Unit Carlos Andrade Marin Hospital

INTRODUCCIÓN. El cáncer de ovario es uno de los principales diagnósticos de malignidad en mujeres en nuestro país. La Tomografía por Emisión de Positrones -Tomografía Computarizada es importante porque puede establecer de manera correcta el estadio de la enfermedad así como puede determinar la recurrencia, incluso mejor que métodos diagnósticos como la Tomografía Simple o la Resonancia Magnética. OBJETIVO. Establecer los principales aspectos demográficos de los pacientes diagnosticados con cáncer de ovario que fueron evaluados en la Unidad Tomografía por Emisión de Positrones Ciclotrón del Hospital de Especialidades Carlos Andrade Marín de Quito-Ecuador. MATERIALES Y MÉTODOS. Estudio descriptivo retrospectivo. El número total de la población fue de 166 pacientes, y una muestra de 103 pacientes con criterios de inclusión y exclusión en la Unidad PET Ciclotrón del Hospital de Especialidades Carlos Andrade Marín de la ciudad de Quito, desde 2013 al 2018, obtenidas de bases estadísticas de la Unidad PET Ciclotrón y en la base de datos del sistema AS400 del Hospital. RESULTADOS. La mediana de edad de las pacientes con cáncer de ovario fue de 56 años (IQR 48 ­ 64; mínima: 13 y máxima 85). Al momento del estudio estuvieron casadas el 58,3% (60;103). El 43,7% (45;103) tuvieron un hijo. El 47,6% (49;103) tuvieron estudios de tercer nivel. El 64,0% (66;103) residieron en Quito. CONCLUSIÓN. Este perfil demográfico resaltó el poco acceso de este tipo de tecnología diagnóstica en pacientes con bajo nivel educativo y en lugares geográficamente alejados de Quito.

INTRODUCTION. Ovarian cancer is one of the main diagnoses of malignancy in women in our country. Positron Emission Tomography - Computed Tomography is important because it can correctly establish the stage of the disease as well as determine recurrence, even better than diagnostic methods such as Simple Tomography or Magnetic Resonance. OBJECTIVE. To establish the main demographic aspects of the patients diagnosed with ovarian cancer that were evaluated in the Cyclotron Positron Emission Tomography Unit of the Carlos Andrade Marín Specialty Hospital of Quito-Ecuador. MATERIALS AND METHODS. Retrospective descriptive study. The total number of the population was 166 patients, and a sample of 103 patients with inclusion and exclusion criteria in the PET Cyclotron Unit of the Carlos Andrade Marín Specialty Hospital of the city of Quito, from 2013 to 2018, obtained from statistical bases PET Cyclotron Unit and in the database of the AS400 system of the Hospital. RESULTS Hospital. The median age of ovarian cancer patients was 56 years (IQR 48-64; minimum: 13 and maximum 85). At the time of the study, 58,3% were married (60; 103). 43,7% (45; 103) had a child. 47,6% (49; 103) had third level studies. 64,0% (66; 103) resided in Quito. CONCLUSION. This demographic profile highlighted the little access of this type of diagnostic technology in patients with low educational level and in geographically remote places of Quito.

Uso de Tomografía por emisión de positrones en melanoma maligno cutáneo en el Hospital Carlos Andrade Marín / Use of Positron emission tomography for cutaneous malignant melanoma at the Carlos Andrade Marin Hospital

INTRODUCCIÓN. La Tomografía por Emisión de Positrones ­Tomografía Computarizada, 18 Flúor-Deoxiglucosa, es utilizado para estadiaje, re-estadiaje, seguimiento y respuesta a tratamiento del melanoma cutáneo. OBJETIVO. Valorar la utilidad de la Tomografía por Emisión de Positrones ­Tomografía Computarizada, en la detección de metástasis en los pacientes con melanoma cutáneo. MATERIALES Y MÉTODOS. Estudio observacional, retrospectivo. Información obtenida de la base estadística de la Unidad de Tomografía por Emisión de Positrones­Tomografía Computarizada del Hospital Carlos Andrade Marín, de Quito-Ecuador, desde enero de 2016 hasta junio de 2018. RESULTADOS. Se recopiló la información de 100 pacientes, 48 pacientes cumplieron los criterios de inclusión. La media de edad general fue 64 años (SD 12,5 años). El 35,4% de los pacientes tuvieron ganglio centinela positivo con una frecuencia de secundarismo en el 29,4% (p=0,43). El 60% de pacientes acudió por re-estadiaje. Pacientes con y sin melanoma ulcerado tuvieron un promedio de edad de 67,8 años y 59,8 años, respectivamente. La presencia de metástasis a distancia presenta una estimación de riesgo calculada de 1,57 (IC 95% 1,005 a 2,45) (p = 0,001). DISCUSIÓN. A mayor edad de los pacientes, mayor porcentaje de melanomas ulcerados, siendo estadísticamente significativo. Sin embargo, ninguna de las dos variables tuvo relación estadística con la presencia de metástasis a distancia. No se encontró relación con el espesor de Breslow y presencia de metástasis a distancia. CONCLUSIÓN. El estudio por Tomografía por Emisión de Positrones ­Tomografía Computarizada es el más sensible para la detección de metástasis a distancia, su presencia representa un mayor riesgo de mortalidad.

INTRODUCTION. Positron-Emission Tomography- Computerized Tomography, is used for staging, re-staging, follow-up and response to treatment in patients with cutaneous melanoma. OBJECTIVE. To evaluate the usefulness of Positron-Emission Tomography-Computer Tomography in the detection of metastasis in patients with cutaneous melanoma. MATERIALS AND METHODS. Observational retrospective study. Information obtained from the statistical base of Positron-Emission Tomography- Computerized Tomography Unit of the Carlos Andrade Marin, Hospital Specialty in Quito-Ecuador, from January 2016 to June 2018. RESULTS. Information was collected from 100 patients, 48 met the inclusion criteria. The general average age was 64,19 years (SD 12,5 years). 35,4% of the patients had a positive sentinel lymph node and 64,6% with a secondary frequency in 29,4% (p = 0,43). In 60% of patients, the reason for the request was re-staging. Patients with and without ulcerated melanoma had an average age of 67,8 years and 59,8 years, respectively. The presence of distant metastasis presents a calculated risk estimate of 1,57 (95% CI 1,005 to 2,45) (p = 0,001). DISCUSSION. The higher percentage of ulcerated melanomas was found in older people, being statistically significant; however, none of the two variables had a statistical relationship with the presence of distant metastases. No relationship was found with the Breslow thickness and the presence of distant metastasis. CONCLUSION. The study by Positron-Emission Tomography- Computerized Tomography, is the most sensitive for the detection of distant metastasis; they represent a higher risk of mortality.

Niveles de plomo en sangre, malondialdehido y vitaminas antioxidantes en escolares / Blood lead levels, malondialdehyde and antioxidant vitamins in schoolchildren

El Plomo (Pb) es un metal altamente tóxico que afecta diversos órganos y tejidos. Aún no se ha descrito un mecanismo único para su toxicidad, pero se ha evidenciado que el estrés oxidativo cumple un rol fundamental. El objetivo fue relacionar niveles de plomo en sangre (PbS), malondialdehido (MDA) y vitaminas antioxidantes (A, E y C) en escolares del Municipio Naguanagua, Estado Carabobo, Venezuela. Fue un estudio descriptivo y correlacional, en el cual participaron 147 niños. Se tomaron muestras de sangre venosa para determinar PbS, MDA y vitaminas antioxidantes. El 89,8% de los niños presentaron niveles de PbS (9,85 ± 5,31 μg/dL) estadísticamente superiores (P<0,05) al límite permisible (<5 μg/dL), establecido por el Centro para el Control y Prevención de Enfermedades (CDC). El 49,6% de los escolares vivían cerca de un taller mecánico, 34,1% de un taller de latonería y pintura, 38,3 % de una parada de autobús, 49,6% de una avenida o calle muy transitada y 39,0% manifestó hábito mano-boca. Los niveles de MDA fueron significativamente superiores (P<0,05) en los niños que presentaron niveles de PbS por encima del límite permisible. Se observó correlación negativa (P<0,05) entre vitamina C y PbS y correlación positiva (P<0,05) entre MDA y PbS. Los hallazgos sugieren que el Pb puede ser capaz de producir peroxidación lipídica y que la Vitamina C parece actuar como un protector ante tal proceso. Se debe mejorar el aporte dietético de vitaminas A y E para garantizar protección antioxidante sinérgica ante la exposición al plomo.

Lead (Pb) is a highly toxic metal that affects various organs and tissues. Not yet described a unique mechanism for its toxicity, but has been demonstrated that oxidative stress plays a fundamental role. The objective was to relate blood lead levels (PbS), malondialdehyde (MDA) and antioxidant vitamins (A, E and C) in school children Naguanagua, Carabobo State, Venezuela. It was a descriptive and correlational study in which 147 children participated. Venous blood samples were taken to determine PbS, MDA and antioxidant vitamins. 89.8% of children had BPb levels (9.85 ± 5.31 mg / dL) statistically higher (P<0.05) than the permissible limit (<5 μg/dL), established by the Center for Disease Control and Prevention (CDC). 49.6% of the school children lived near a garage, 34.1% of an autobody and painting workshop, 38.3% of a bus stop, 49.6% of a busy street or avenue and 39.0% said hand-mouth habit. MDA levels were significantly higher (P<0.05) in children who had BPb levels above the allowable limit. Negative correlation (P<0.05) between vitamin C and PbS and positive correlation (P<0.05) between PbS and MDA were observed. The findings suggest that Pb may be able to produce lipid peroxidation and that vitamin C appears to act as a protector against such a process. An improvement in the dietary intake of vitamins A and E will ensure synergistic antioxidant protection from exposure to lead.