Proton pump inhibitors decrease efficacy of palbociclib in patients with metastatic breast.

OBJECTIVES: The objective of this investigation was to assess the impact of concurrent proton pump inhibitors (PPIs) on progression-free survival (PFS) in patients with hormone receptor-positive and HER2-negative metastatic breast cancer (mBC) who received palbociclib as first-line or successives therapy. MATERIALS AND METHODS: A retrospective observational study was conducted, enrolling patients diagnosed with estrogen receptor-positive, human epidermal growth factor receptor 2-negative mBC, and eligible for palbociclib treatment. Patients were categorized as "concurrent PPIs" if they received PPIs for at least two-thirds of the palbociclib therapy duration, and as "no concurrent PPIs" if they did not receive PPIs during the course of palbociclib treatment. RESULTS: A total of 165 patients were included in the study. Among first-line patients treated with palbociclib, those using concurrent PPIs exhibited a PFS of 8.88 months, while patients using palbociclib without concurrent PPIs had a PFS of 67.81 months (p < 0.0001). In second-line or subsequent treatments, patients on palbociclib with concurrent PPIs had a PFS of 7.46 months, whereas those using palbociclib without concurrent PPIs had a PFS of 17.29 months (p = 0.122). CONCLUSION: This study demonstrates that the concurrent use of PPIs in mBC patients receiving palbociclib negatively affects PFS, particularly in the first-line setting. Nevertheless, further investigation is warranted to explore the impact of PPIs on cycle-dependent kinase 4/6 inhibitors.

Damage to Sorubim cuspicaudus Sperm Cryopreserved with Ethylene Glycol.

The study aimed to evaluate cryo-injury during the cryopreservation in Sorubim cuspicaudus sperm with ethylene glycol (EG) at different rates (6, 8, 10%). Fresh, prefrozen, and post-thawed sperm quality as motility total, velocities, mitochondria damage (Mit-d), membrane damage (Mem-d), and DNA fragmentation (DNA-f), were examined. The Mit-d, Mem-d, and DNA-f were evaluated through flow cytometry. High motility (>95%) and a low percentage of Mem-d (1.0 ± 0.5%), Mit-d (1.4 ± 0.9%), and DNA-f (2.4 ± 0.8%) were recorded for fresh semen. Prefrozen semen increases in Mit-d and DNA-f were observed compared to fresh semen (p < 0.05). In thawed semen, increased Mit-d (2.6 to 3-fold), Mem-d (6 to 1-fold), and DNA-f (3.3 to 6.6-fold) compared to prefrozen was observed. Thawed semen showed Mit-d (34 to 37-fold), Mem-d (24.5 to 26.6-fold) and DNA-f (13 to 18.5-fold) increased high. In conclusion, the present study demonstrated that mitochondria, membrane, and DNA integrity undergo significant damage during both pre-freezing and freezing/thawing with EG inclusion percentages from 6 to 10% that affect its fertilizing capacity, which is reduced to half of that obtained with fresh semen. It is suggested that a cryoprotective solution composed of 6% EG, 6% glucose, and 5% skimmed milk powder is a useful protocol for the cryopreservation of S. cuspicaudus semen.

Real-world outcomes of abiraterone and enzalutamide in first-line treatment of metastatic castration-resistant prostate cancer: which patients benefit most?

OBJECTIVES: Abiraterone and enzalutamide are two oral novel androgen receptor axis-targeted agents approved for the treatment of castration-resistant prostate cancer (mCRPC). Despite the availability of multiple treatments, there is a need to improve the knowledge and management of these drugs in the real-world setting, especially in patient groups under-represented in clinical trials. Our aim was to review the outcome of patients with chemotherapy-naïve mCRPC treated with abiraterone or enzalutamide in routine clinical practice in order to identify factors that are predictive for response. METHODS: This observational retrospective study was performed in a Spanish tertiary hospital and included men with chemotherapy-naïve mCPRC who started treatment with abiraterone or enzalutamide between September 2012 and November 2018. The study end date was 30 October 2020. RESULTS: Ninety patients with mCRPC were included, 57 with abiraterone and 33 with enzalutamide. Median overall survival (OS) was 26.87 months (95% CI 19.68 to 34.05), with no difference found between the two treatment groups. Nine variables were related to increased OS in the univariate analysis: Eastern Cooperative Oncology Group (ECOG) performance status (0-1 vs 2), pain (need of opioids for cancer pain), visceral disease, ≥3 bone lesions, exclusively lymph node metastases, baseline prostate specific antigen (PSA) (<50 vs ≥50 ng/dL and <20 vs ≥20 ng/dL), haemoglobin (<12 vs ≥12 g/dL) and alkaline phosphatase (≤116 vs >116 IU/L). A PSA response >50% was observed in 65 patients (76.5%). In the multivariate analysis, ECOG performance status, pain, visceral disease and alkaline phosphatase provided independent prognostic information. Median OS by Kaplan-Meier analysis was significantly longer for patients with a PSA response (32.1 vs 17.9 months; HR 0.46, 95% CI 0.27 to 0.78; p=0.003). CONCLUSIONS: This study assessed the efficacy of abiraterone and enzalutamide in a real-world setting, including patients under-represented in pivotal studies. Some clinical factors were correlated with improved OS in chemotherapy-naïve men with mCPRC treated with these drugs.

Comparison of the Inflammatory Circuits in Psoriasis Vulgaris, Non‒Pustular Palmoplantar Psoriasis, and Palmoplantar Pustular Psoriasis.

Palmoplantar pustular psoriasis (PPPP) and non‒pustular palmoplantar psoriasis (NPPP) are localized, debilitating forms of psoriasis. The inflammatory circuits involved in PPPP and NPPP are not well-understood. To compare the cellular and immunological features that differentiate PPPP and NPPP, skin biopsies were collected from a total of 30 participants with PPPP, NPPP, and psoriasis vulgaris (PV) and from 10 healthy participants. A subset consented to a second biopsy after 3 additional weeks off medication. Histologic staining of lesional and nonlesional skin showed higher neutrophil counts in PPPP than in NPPP and PV and higher CD8+ T-cell counts in NPPP. RNA sequencing and transcriptional analysis of skin biopsies showed enhanced IFN-γ pathway activation in NPPP lesions but stronger signatures of IL-17 pathway and neutrophil-related genes (e.g., IL36A) in PPPP lesional skin. Serum analysis on the Olink platform detected higher concentrations of T helper type 1, IFN-γ‒inducible chemokines in NPPP, and higher neutrophil-associated cytokines in PPPP. Taken together, this evidence suggests more pronounced T helper 1‒mediated inflammation in NPPP than in PV and PPPP and stronger neutrophil-associated activity in PPPP than in NPPP and PV. These data support targeting inflammatory pathways associated with neutrophilic inflammation (e.g., IL-36 signaling) for therapeutic development in PPPP.

Seric IgG anti-SARS-CoV-2 pre- and post- Covid-19 pandemic from Mexican asymptomatic subjects / IgG sérica anti-SARS-CoV-2 pre y post pandemia de Covid-19 en mexicanos asintomáticos

Abstract: Objective: To detect serum IgG anti-SARS-CoV-2 in pre- and post- Covid-19 pandemic in Mexican asymptomatic subjects in order to know the degree of viral dispersion. Materials and methods: Association of serum IgG antibodies (determined by ELISA) to sociodemographic and clinical data or contact with Covid-19 cases in three groups of subjects: 1) Covid-19 pre-pandemic blood donors (n= 538); 2) Covid-19 post-pandemic blood donors (n= 243); 3) Covid-19 post-pandemic neurological patients (n= 312). None of the subjects studied had been vaccinated. Results: The positive rate of IgG anti-SARS-CoV-2 was notably higher in participants recruited during the pandemic (donors, 29.6%; neurological patients, 15.7%) than in those recruited pre-pandemic (donors 0.6%) (p <0.001). Other conditions associated to antibody positivity were being a worker in sales or services, or having had previous contact with people with Covid-19, for donnors and neurological patients, and having diabetes mellitus, for neurological patients. Higher positivity levels of anti-SARS-CoV-2 IgG were found in females than in males. The highest proportion of subjects with anti-SARS-CoV-2 antibodies was found in central Mexico. Conclusions: The dispersion of SARS-CoV-2 in asymptomatic, unvaccinated subjects (donors and neurological patients) recruited in a Mexican health institution, who work in sales or services or had previously had contact with Covid-19 patients is 16 to 30%. The level of positivity for anti-SARS-CoV-2 IgG is higher in females than in males. SARS-CoV-2 antibody seroprevalence follow-up studies must be favored among the general population, being mandatory for donors.

Resumen: Objetivo: Detectar IgG sérica anti-SARS-CoV-2 antes y después de la pandemia de Covid-19 en sujetos mexicanos asintomáticos, con la intención de conocer el grado de dispersión viral. Material y métodos: Se analizó la asociación de anticuerpos IgG séricos (determinados por ELISA), datos sociodemográficos y clínicos y contacto con casos de Covid-19 en tres grupos de sujetos: 1) donadores de sangre reclutados antes de la pandemia de Covid-19 (n= 538); 2) donadores (n= 243) y 3) pacientes neurológicos (n= 312) reclutados durante la pandemia de Covid-19. Ninguno de los sujetos estudiados había sido vacunado. Resultados: La tasa de positividad de IgG anti-SARS-CoV-2 fue notablemente mayor en los participantes reclutados durante la pandemia (donadores, 29.6%; pacientes neurológicos, 15.7%) que en los reclutados prepandemia (donadores 0.6%). Otras condiciones asociadas con positividad de anticuerpos fueron trabajar en ventas o servicios, o haber tenido contacto previo con pacientes Covid-19, en donadores y pacientes neurológicos, y haber tenido diabetes mellitus, en pacientes neurológicos. Se encontraron mayores niveles de positividad de IgG anti-SARS-CoV-2 en mujeres que en hombres. La mayor proporción de sujetos con anticuerpos anti-SARS-CoV-2 procedía del centro de México. Conclusiones: La dispersión del SARS-CoV-2 en sujetos asintomáticos, no vacunados (donadores y pacientes neurológicos), reclutados en una institución de salud mexicana, que trabajan en ventas o servicios, o tienen contacto previo con pacientes Covid-19 es de 16 a 30%. El nivel de positividad de IgG anti-SARS-CoV-2 es más alto en mujeres que en hombres. Los estudios de seguimiento de la seroprevalencia del SARS-CoV-2 deben favorecerse en la población general, siendo obligatorios en los donadores.

Factores socio demográficos y de estilos de vida asociados a un bajo nivel de actividad física durante el confinamiento producto del COVID-19 en adultos latinoamericanos / Factors associated with inactivity during COVID-19 confinement among Latin American adults

BACKGROUND: The confinement caused by the COVID-19 pandemic changed the lifestyles of the population affecting their levels of physical activity. AIM: To determine the factors associated with a low level of physical activity in adults during confinement during the COVID-19 pandemic. MATERIAL AND METHODS: Adults from Chile, Colombia, México and Perú were invited through social networks to answer an online survey. Questions about sociodemographic, health status and lifestyle variables were included. The level of physical activity and sedentary behavior were determined through the short version of the International Physical Activity Questionnaire (IPAQ). Results: The survey was answered by 3,362 adults aged between 18 and 60 years. Respondents more likely to be inactive were women, those with less than eight years of education, those with overweight or obesity, those who smoked at least one cigarette a day, consumed alcohol four or more times a week, slept less than six hours per day and spent more than 6 hours per day in sedentary behaviors. CONCLUSIONS: These findings provide a sociodemographic and lifestyle profile associated with physical inactivity during the period of confinement in Latin American adults. The results confirm the need to promote healthy lifestyles in the population during periods of confinement.

Ustekinumab reduces serum protein levels associated with cardiovascular risk in psoriasis vulgaris.

Psoriasis increases the risk of cardiovascular disease (CVD). Biomarkers for cardiovascular (CV) risk stratification in psoriasis are lacking, and the effects of psoriasis biologics on CV risk reduction remain unclear. The goal of this study was to identify biomarkers of CV risk in psoriasis blood that are reduced by ustekinumab. We quantified 276 inflammatory and CV-related serum proteins with Olink's multiplex assay in 10 psoriasis patients (vs. 18 healthy controls) and after 12 weeks of ustekinumab treatment. For each protein down-regulated after treatment, the literature was reviewed for studies assessing the protein's association with CVD. Data were collected from each study to calculate CV risk thresholds for each protein, which were compared with protein levels in psoriasis patients before and after treatment. Our results showed that 43 out of 276 proteins were down-regulated after treatment, 25 of which were initially up-regulated at baseline (vs. controls, all p-values ≤0.1). 8 down-regulated proteins were initially elevated above thresholds associated with enhanced CV risk in the literature (myeloperoxidase, C-X-C motif chemokine 10, E-selectin, interleukin-6, cystatin B, von Willebrand factor, tumor necrosis factor receptor 1 and N-terminal prohormone brain natriuretic peptide). Treatment lowered these proteins to below their risk thresholds, except for IL-6, which was lowered but remained at its risk threshold despite successful psoriasis skin treatment. In summary, 12 weeks of ustekinumab treatment reduced serum proteins present at levels associated with CV risk in psoriasis patients. Further studies can evaluate these proteins as potential ustekinumab-modulated biomarkers of CV risk in psoriasis and the impact of ustekinumab on CV risk reduction.

Intervention by a clinical pharmacist carried out at discharge of elderly patients admitted to the internal medicine department: influence on readmissions and costs.

BACKGROUND: Patient education on pharmacological treatment could reduce readmissions. Our objective was to carry out a pharmacist intervention focused on providing information about high-risk medications to chronic patients and to analyse its influence on readmissions and costs. METHODS: A single-centre study with an intervention group and a retrospective control group was conducted. The intervention was carried out in all polymedicated patients ≥ 65 years who were admitted to internal medicine and signed the informed consent between June 2017 and February 2018. Patients discharged to nursing homes or long-term hospitals were excluded. The control group were all the patients who were admitted during the same months of 2014 who met the same inclusion criteria. The patients were classified according to the HOSPITAL score as having a low, intermediate, or high risk of potentially avoidable readmission. Outcome measures were 30-day readmission and cost data. To analyse the effect of the intervention on readmission, a logistic regression was performed. RESULTS: The study included 589 patients (286 intervention group; 303 control group). The readmission rate decreased from 20.13% to 16.43% in the intervention group [OR = 0.760 95% CI (0.495-1.166); p = 0.209)]. The incremental cost for the intervention to prevent one readmission was €3,091.19, and the net cost saving was €1,301.26. In the intermediate- and high-risk groups, readmissions were reduced 10.91% and 10.00%, and the net cost savings were €3,3143.15 and €3,248.71, respectively. CONCLUSIONS: The pharmacist intervention achieved savings in the number of readmissions, and the net cost savings were greater in patients with intermediate and high risks of potentially avoidable readmission according to the HOSPITAL score.

[Factors associated with inactivity during COVID-19 confinement among Latin American adults]. / Factores socio demográficos y de estilos de vida asociados a un bajo nivel de actividad física durante el confinamiento producto del COVID-19 en adultos latinoamericanos.

BACKGROUND: The confinement caused by the COVID-19 pandemic changed the lifestyles of the population affecting their levels of physical activity. AIM: To determine the factors associated with a low level of physical activity in adults during confinement during the COVID-19 pandemic. MATERIAL AND METHODS: Adults from Chile, Colombia, México and Perú were invited through social networks to answer an online survey. Questions about sociodemographic, health status and lifestyle variables were included. The level of physical activity and sedentary behavior were determined through the short version of the International Physical Activity Questionnaire (IPAQ). RESULTS: The survey was answered by 3,362 adults aged between 18 and 60 years. Respondents more likely to be inactive were women, those with less than eight years of education, those with overweight or obesity, those who smoked at least one cigarette a day, consumed alcohol four or more times a week, slept less than six hours per day and spent more than 6 hours per day in sedentary behaviors. CONCLUSIONS: These findings provide a sociodemographic and lifestyle profile associated with physical inactivity during the period of confinement in Latin American adults. The results confirm the need to promote healthy lifestyles in the population during periods of confinement.

Caracterización de habilidades comunicativas en estudiantes de Medicina / Characterization of communicative skills in medical students

RESUMEN Fundamento: la comunicación médica efectiva durante la promoción y prevención en salud constituye un reto profesional que enfrenta la educación médica superior en Cuba. Objetivo: caracterizar el desarrollo de habilidades comunicativas en estudiantes de Medicina de la Filial de Ciencias Médicas del municipio Palma Soriano, provincia Santiago de Cuba. Métodos: se realizó una investigación descriptiva, durante el curso 2018-2019. Se emplearon métodos teóricos: análisis-síntesis e inductivo-deductivo, y empíricos: observación, entrevista a profundidad para profesores y estudiantes y grupo focal; se realizó la triangulación de fuentes y metodológica y todo se sustentó en el enfoque dialéctico- materialista. Resultados: se identificaron dificultades en el desempeño comunicativo de los estudiantes, se aprecia que poseen dominio teórico sobre las habilidades comunicativas, pero las relegan a un segundo plano respecto a las habilidades clínicas y técnicas. Se considera que los profesores están insatisfechos con la preparación que muestran los estudiantes en su desempeño comunicativo comunitario y reconocen que es insuficiente el tratamiento didáctico en favor de las habilidades comunicativas. También se constató que en opinión de los estudiantes las habilidades comunicativas serán adquiridas y desarrolladas durante la práctica médica cotidiana del posgrado, y no realizaban un esfuerzo activo y consciente para su perfeccionamiento. Conclusiones: se caracterizaron las habilidades comunicativas de los estudiantes, insuficientes aún para la comunicación efectiva en la relación médico-comunidad; existe un insuficiente tratamiento didáctico y teórico-práctico de estas habilidades.

ABSTRACT Background: effective medical communication during health promotion and prevention is a professional challenge faced by higher medical education in Cuba. Objective: to characterize the development of communication skills in Medicine students of the Medical Sciences Branch of Palma Soriano municipality, Santiago de Cuba province. Methods: a descriptive research was carried out during the 2018-2019 academic year. Theoretical methods were used: analysis-synthesis and inductive-deductive, and empirical ones: observation, in-depth interviews with teachers and students, and focal group; the comparison of sources and methodology was carried out and everything was based on the dialectical-materialist approach. Results: difficulties were identified in the communicative performance of the students, it is appreciated that they have theoretical mastery over communicative skills, but relegate them to the background with respect to clinical and technical skills. It is considered that the professors are dissatisfied with the preparation that the students show in their community communicative performance and recognize that the didactic treatment in favor of communicative skills is insufficient. It was also found that, in the opinion of the students, communication skills will be acquired and developed during the daily postgraduate medical practice, and they did not make an active and conscious effort to improve them. Conclusions: the communication skills of the students were characterized, still insufficient for effective communication in the doctor-community relationship; there is insufficient didactic and theoretical-practical treatment of these skills.

Narrativa de enfermería: visión y patrones de conocimiento en la experiencia de cuidado de una persona con colostomía. Reporte de caso / A Nursing Narrative: Vision and Patterns of Knowledge in the Care Experience of a Patient with Colostomy. A case report

RESUMEN La narrativa de las situaciones de enfermería resalta las vivencias y significados de la persona objeto de cuidado con un proceso de enfermedad y da cuenta de la relación de cuidado enfermero-paciente como aspecto clave para la recuperación de la salud física, mental y espiritual, teniendo como base el proceso de atención de enfermería. Se presenta la situación de enfermería de una persona mayor de 74 años de edad, posquirúrgica de laparotomía exploratoria más resección de masa en colon sigmoide, que derivó en una colostomía. Se resaltan situaciones relacionadas con la ansiedad y preocupación de parte de una de sus hijas por el estado de salud de su madre. Con base en la narrativa se analizaron los patrones de conocimiento personal, empírico, ético y estético, la visión del mundo de enfermería integrativa-interactiva, así como la aplicación de la teoría de rango medio de las transiciones; los supuestos de las propiedades de la transición de Afaf Meleis.

ABSTRACT The narrative of nursing situations highlights the experiences and meanings of the person object of care with a disease process, and accounts for the caring relationship between the nurse and the patient in need of nursing care as a key aspect for the recovery of physical, mental, and spiritual health, based on the nursing care process. The nursing situation of a 74-year-old woman after a laparotomy surgery plus resection of a mass in the sigmoid colon, that led to a colostomy, is presented. Situations related to anxiety and concern of one of her daughters about the state of health of her mother are highlighted. Based on the narrative, we analyzed the fundamental patterns of personal, empirical, ethical, and aesthetic knowledge; and also the Interactive-Integrative Nursing Worldview, as well as the application of Afaf Meleis' Transitions mid-range Theory and its assumptions of the transition properties.

Validez y confiabilidad del Beliefs About Medicines Questionnaire en pacientes hipertensos colombianos / Validity and reliability of the Beliefs About Medicines Questionnaire in Colombian hypertensive patients

Introducción. El Beliefs about Medicines Questionnaire (BMQ) permite valorar las representaciones cognitivas que engloban las creencias sobre la medicación de los pacientes, sobre tomar medicamentos para su enfermedad en diferentes culturas. Objetivo. Determinar la validez de constructo y confiabilidad del cuestionario BMQ adaptado a pacientes hipertensos colombianos. Materiales y métodos. Estudio psicométrico de tipo instrumental, realizado en una muestra de 238 pacientes hipertensos en edad promedio de 65 años (DE= 11,4) con predominio del sexo femenino (70%). La validez de constructo se evaluó mediante Análisis Factorial Exploratorio y Confirmatorio. Se calculó la confiabilidad utilizando el método coeficiente de alfa de Cronbach. Resultados. Se obtuvo una versión reducida de 16 ítems; en la sección BMQ-General los 7 ítems se agruparon en dos factores que explicó el 64% de la varianza común y buen ajuste (χ2= 61.46; gl = 13; p = 0.000; CFI = 0.917; NNFI = 0.89; CFI=0.917; SRMR=0.054; RMSEA = 0.125; IC 90% [0,10, 0,16]). En el BMQ-Específico los 9 ítems agrupados en dos factores que explicaron el 63,17% de la varianza común con un ajuste aceptable (χ2 = 122.4; gl = 26; p = 0.000; CFI = 0.88; NNFI = 0.84; CFI=0.88; SRMR=0.106; RMSEA = 0.125; IC 90% [0.10, 0.15]). La confiabilidad por alfa de Cronbach para el BMQ-General y Específico fue de 0.82 y 0.78 respectivamente. Discusión y conclusiones. La versión del BMQ adaptada a pacientes hipertensos colombianos, poseen características psicométricas adecuadas, su uso es recomendado en la investigación.

Introduction. The Beliefs about Medicines Questionnaire (BMQ) allows the assessment of cognitive representations encompassing patients' medication beliefs about taking medication for their disease in different cultures. Objective. To determine the construct validity and reliability of the BMQ questionnaire adapted to Colombian hypertensive patients. Materials and methods. An instrumental psychometric study was carried out in a sample of 238 hypertensive patients with an average age of 65 years (SD= 11.4), with a predominance of women (70%). Construct validity was assessed by exploratory and confirmatory factor analysis. Reliability was calculated using Cronbach's alpha coefficient method. Results. A reduced version of 16 items was obtained; in the BMQ-General section the 7 items were grouped into two factors that explained 64% of the common variance and good fit (χ2= 61.46; gl = 13; p = 0.000; CFI = 0.917; NNFI = 0.89; CFI=0.917; SRMR=0.054; RMSEA = 0.125; IC 90% [0,10, 0,16]). In the BMQ-Specific the 9 items grouped into two factors explained 63.17% of the common variance with an acceptable fit (χ2 = 122.4; gl = 26; p = 0.000; CFI = 0.88; NNFI = 0.84; CFI=0.88; SRMR=0.106; RMSEA = 0.125; IC 90% [0.10, 0.15]). The Cronbach's alpha reliability for the BMQ-General and Specific was 0.82 and 0.78, respectively. Discussion and conclusions. The version of the BMQ adapted to Colombian hypertensive patients has adequate psychometric characteristics and its use is recommended in research.

Introdução. O Beliefs About Nedicines Questionnaire (BMQ) permite a avaliação de representações cognitivas abrangendo as crenças dos pacientes sobre os de medicamentos e seu uso para suas doenças em diferentes culturas. Objetivo. Determinar a validade de constructo e a confiabilidade do questionário BMQ adaptado a pacientes hipertensos colombianos. Materiais e métodos. Foi realizado um estudo psicométrico instrumental em uma amostra de 238 pacientes hipertensos com idade média de 65 anos (DE = 11,4), com predominância de mulheres (70%). A validade de constructo foi avaliada mediante Análise Fatorial Exploratória e Confirmatória de Fatores. A confiabilidade foi calculada usando o método do coeficiente alfa de Cronbach. Resultados. Uma versão reduzida de 16 itens foi obtida; na seção BMQ-General os 7 itens foram agrupados em dois fatores que explicaram 64% da variância comum e bom ajuste (χ2= 61.46; gl = 13; p = 0.000; CFI = 0.917; NNFI = 0.89; CFI=0.917; SRMR=0.054; RMSEA = 0.125; IC 90% [0,10, 0,16]). No BMQ-Específico os 9 itens agrupados em dois fatores explicaram 63,17% da variância comum com um ajuste aceitável (χ2 = 122.4; gl = 26; p = 0.000; CFI = 0.88; NNFI = 0.84; CFI=0.88; SRMR=0.106; RMSEA = 0.125; IC 90% [0.10, 0.15]).. A confiabilidade alfa de Cronbach para o BMQ-General e Específico foi de 0,82 e 0,78 respectivamente. Discussão e conclusões. A versão do BMQ adaptada aos pacientes hipertensos colombianos tem características psicométricas adequadas e seu uso é recomendado na pesquisa.

Validez y confiabilidad del Self- Care of Hypertension Inventory, versión español colombiano / Validade e confiabilidade da Escala de Autocuidado de Hipertensão, versão em espanhol colombiano / Validity and reliability of the Self-Care of Hypertension Inventory, Colombian Spanish version

Objetivo: determinar la validez de constructo y la consistencia interna del instrumento Self-Care of Hypertension Inventory (SC-HI v.2.0), traducido al español, en adultos colombianos con hipertensión arterial. Materiales y métodos: estudio de tipo metodológico en el que se realizó traducción, adaptación cultural y validez de contenido mediante juicio de expertos. Con una muestra de 290 personas hipertensas, se determinó la validez de constructo mediante análisis factorial exploratorio (análisis de componentes principales con rotación Varimax con normalización Kaiser) y confirmatorio (análisis de máxima verosimilitud). La consistencia interna se calculó a través del coeficiente alfa de Cronbach. Resultados: en la escala Mantenimiento del autocuidado resultó una estructura de dos factores (varianza acumulada 61 %) con buen ajuste (χ2 = 104,570; p = 0,000; RMSEA = 0,125; SRMR = 0,156; CFI = 0,856; NNFI = 0,767). En Gestión del autocuidado se obtuvo una estructura bifactorial (varianza acumulada 71 %) igualmente con buen ajuste (χ2 = 6,598; p = 0,582; RMSEA = 0,000; SRMR = 0,072; CFI = 1,000; NNFI = 1,032). En Confianza resultó una estructura bifactorial (varianza acumulada 82%) también con buen ajuste (χ2 = 94,991; p = 0,000; RMSEA = 0,194; SRMR = 0,106; CFI = 0,934; NNFI = 0,876). El alfa de Cronbach para mantenimiento (0,64), gestión (0,70) y confianza (0,86) fue aceptable. Conclusiones: el SC-HI v.2.0 versión español colombiano posee propiedades psicométricas adecuadas, por lo que su uso es recomendado en la investigación para medir el autocuidado en poblaciones con características similares.

Objetivo: determinar a validade de construto e a consistência interna do instrumento Escala de Autocuidado de Hipertensão (SC-HI v.2.0) traduzido para o espanhol, em adultos colombianos com hipertensão arterial. Materiais e métodos: estudo metodológico em que se realizou tradução, adaptação cultural e validade de conteúdo por meio do julgamento de especialistas. Com uma amostra de 290 hipertensos, a validade de construto foi determinada mediante análise fatorial exploratória (análise de componentes principais com rotação Varimax com normalização Kaiser) e confirmatória (análise de máxima verossimilhança). A consistência interna foi calculada por meio do coeficiente alfa de Cronbach. Resultados: a escala de manutenção do autocuidado resultou em uma estrutura de dois fatores (variância acumulada 61 %), com bom ajuste (χ2 = 104,570; p = 0,000; RMSEA = 0,125; SRMR = 0,156; CFI = 0,856; NNFI = 0,767). Na gestão do autocuidado, foi obtida uma estrutura bifatorial (variância acumulada 71 %), com bom ajuste (χ2 = 6,598; p = 0,582; RMSEA = 0,000; SRMR = 0,072; CFI = 1,000; NNFI = 1,032). Na confiança, resultou uma estrutura bifatorial (variância acumulada 82 %), com bom ajuste (χ2 = 94,991; p = 0,000; RMSEA = 0,194; SRMR = 0,106; CFI = 0,934; NNFI = 0,876). O alfa de Cronbach para manutenção (0,64), gerenciamento (0,70) e confiança (0,86) foi aceitável. Conclusões: o SC-HI v.2.0 versão em espanhol variante colombiana apresenta propriedades psicométricas adequadas, portanto seu uso é recomendado em pesquisas para mensurar o autocuidado em populações com características semelhantes às do presente estudo.

Objective: To determine the construct validity and internal consistency of the instrument Self- Care of Hypertension Inventory (SC-HI v.2.0) translated into Spanish in Colombian adults with arterial hypertension. Materials and methods: Methodological study in which translation, cultural adaptation and content validity were carried out through expert judgment. With a sample of 290 hypertensive individuals, construct validity was determined by exploratory (principal component analysis with Varimax rotation with Kaiser normalization) and confirmatory factor analysis (maximum likelihood analysis). Internal consistency was calculated through Cronbach's alpha coefficient. Results:The self-care maintenance scale resulted in a two-factor structure (accumulated variance 61%) with good fit (χ2 = 104.570; p = 0.000; RMSEA = 0.125; SRMR = 0.156; CFI = 0.856; NNFI = 0.767). Self-care management reported a bifactorial structure (accumulated variance 71%) with good fit (χ2 = 6.598; p = 0.582; RMSEA = 0.000; SRMR = 0.072; CFI = 1.000; NNFI = 1.032). Finally, confidence scale also resulted in a bifactorial structure (accumulated variance 82%) with good fit (χ2 = 94.991, p = 0.000; RMSEA = 0.194; SRMR = 0.106; CFI = 0.934; NNFI = 0.876). Cronbach's alpha for maintenance (0.64), management (0.70), and confidence (0.86) was acceptable. Conclusions: The SC-HI v.2.0 in Spanish has adequate psychometric properties. Therefore, its use is recommended in research studies aimed at measuring self-care in populations with similar characteristics to that addressed in this study.

In-Depth Analysis of the Hidradenitis Suppurativa Serum Proteome Identifies Distinct Inflammatory Subtypes.

Hidradenitis suppurativa is a chronic inflammatory dermatosis with presentations ranging from painful nodules and abscesses to draining tunnels. Using an unbiased proteomics approach, we assessed cardiovascular-, cardiometabolic-, and inflammation-related biomarkers in the serum of patients with moderate-to-severe hidradenitis suppurativa. The serum of patients with hidradenitis suppurativa clustered separately from that of healthy controls and had an upregulation of neutrophil-related markers (Cathepsin D, IL-17A, CXCL1). Patients with histologically diagnosed dermal tunnels had higher serum lipocalin-2 levels compared with those without tunnels. Consistent with this, patients with tunnels had a more neutrophilic-rich serum signature, marked by Cathepsin D, IL-17A, and IL-17D alterations. There was a significant serum‒skin correlation between proteins in the serum and the corresponding mRNA expression in skin biopsies, with healthy-appearing perilesional skin demonstrating a significant correlation with neutrophil-related proteins in the serum. CSF3 mRNA levels in lesional skin significantly correlated with neutrophil-related proteins in the serum, suggesting that CFS3 in the skin may be a driver of neutrophilic inflammation. Clinical significantly correlated with the levels of lipocalin-2 and IL-17A in the serum. Using an unbiased, large-scale proteomic approach, we demonstrate that hidradenitis suppurativa is a systemic neutrophilic dermatosis, with a specific molecular signature associated with the presence of dermal tunnels.

Safety and effectiveness of a four-factor prothrombin complex concentrate for vitamin K antagonist reversal following a fixed-dose strategy.

OBJECTIVES: Early reversal of anticoagulation improves outcomes in major bleeding and emergency surgery. To reverse vitamin K antagonists (VKA), vitamin K in addition to prothrombin complex concentrate (PCC) is recommended. Dosing recommendations for VKA reversal provided by the manufacturer are 25-50 IU/kg depending on the baseline international normalised ratio (INR). Nevertheless, we recommend an initial fixed dose of 1000 IU, and additional 500 IU doses evaluated on a case-by-case basis. As there is a paucity of clinical data demonstrating the efficacy and safety of this strategy, we designed this study to assess the effectiveness and safety of a four-factor (4F)-PCC for VKA reversal following a fixed-dose strategy. METHODS: This was a retrospective study of adult patients who received 4F-PCC for VKA reversal. The primary outcome was INR correction. INR correction was achieved if the first INR draw after 4F-PCC was ≤1.5. Safety outcome was any confirmed thromboembolic event within 3 months after 4F-PCC. Secondary outcomes included activated partial thromboplastin time (aPTT) correction, as well as haemostatic effectiveness for bleeding patients. RESULTS: A total of 145 patients were included: 106 (73.1%) in the bleeding group and 39 (26.9%) in the emergency surgery group. The INR target was reached in 102 (70.3%) patients (p<0.0001). In one case, a thromboembolic complication was possibly related to 4F-PCC. The aPTT ratio target was reached in 113 (77.9%) patients (p<0.0001), and 79 of the 106 (74.5%) patients reversed for bleeding achieved haemostatic effectiveness. CONCLUSIONS: After 4F-PCC, the majority of patients achieved the target INR, meaning 4F-PCC is a useful modality for rapid INR reduction. The safety profile may be considered acceptable. Fixed-dose 4F-PCC was able to restore haemostasis rapidly while minimising the risk of adverse events and optimising available resources.

La Educación en el Trabajo en la asignatura de Ortodoncia / In-service education in the subject of Orthodontics

RESUMEN Introducción: la Educación en el Trabajo es la Forma Organizativa de la Actividad Docente donde se aplica fundamentalmente el principio marxista y martiano de combinar el estudio con el trabajo bajo la dirección del Profesor o Tutor. Esta Organizativa de la Actividad, y el sistema de evaluación de la asignatura de Ortodoncia funcionan como un engranaje, al ser un aspecto fundamental para la formación del educando. Objetivo: describir la organización de la Educación en el Trabajo de la asignatura de Ortodoncia de la carrera de Estomatología, según horas y temas, y su sistema de evaluación. Métodos: búsqueda bibliográfica en textos impresos y digitales junto al método análisis y síntesis. Resultados: el Plan D de Estudio de la asignatura de Ortodoncia dedica el 72 % del total de horas de su programación a la Educación en el Trabajo, vincula armónicamente la teoría con la práctica y establece un Sistema de Evaluación que controla eficazmente la adquisición de habilidades y conocimientos de manera individual en los estudiantes. Con su aplicación se ha logrado el total de estudiantes aprobados desde el curso 2014-2015 hasta el curso 2017-2018 y una mejor calidad del proceso docente. Conclusiones: la Educación en el Trabajo es la Organizativa de la Actividad primordial en el Plan D de Estudio, elaborado por la Facultad de Estomatología de La Habana junto con el Plan Calendario de Actividades y la Tarjeta de Evaluación de Habilidades. Estos documentos regulan y controlan el proceso docente educativo al garantizar una óptima evaluación y preparación del educando.

ABSTRACT Introduction: in-service education is a type of organization of the teaching-learning process where the Marxist and Martian principle of combining study and work under the direction of the professor or tutor is basically applied. This type of organization of the teaching-learning process, and the evaluation system of the subject of Orthodontics, both work as a top gear, constituting a fundamental characteristic for the training of the student. Objective: to describe the organization of the teaching-learning process related to in-service education of the subject of Orthodontics in dentistry major, according to teaching hours and topics, along with its evaluation system. Methods: literature searching in printed and digital texts together with the analysis and synthesis method. Results: program-D of study of the subject of Orthodontics dedicates 72% of the total of teaching hours for in-service education to train students, linking theory with practice and it establishes an Evaluation System that efficiently controls the acquisition of skills and knowledge in an individual way in the students. With its application, the total number of students passed from 2014-2015 to 2017-2018 academic years, where the quality of the teaching-learning process improved. Conclusions: in-service education is the organization of the main teaching activity in the program-D of study, established by La Habana School of Dentistry together with the schedule of activities and the card for the evaluation of skills. These documents regulate and control the teaching-learning process, guaranteeing a most favorable evaluation and training of the student.

Paraneoplastic Cerebellar Degeneration Secondary to BRAF Mutant Melanoma Metastasis from an Occult Primary Cancer.

Melanoma metastasis from an unknown primary cancer has an incidence of 3.2% among melanoma patients. Furthermore, paraneoplastic neurological syndromes (PNS) are rare, occurring in 1-3% of patients with malignancies. Paraneoplastic cerebellar degeneration (PCD) is one of the classic PNS and is characterized by acute or subacute onset of ataxia and/or presence of onconeural antibodies. A 61-year-old male with ataxia, vertigo, and headache later developed dysarthria, multidirectional nystagmus, hyperactive delirium, auditory hallucinations, psychomotor agitation, and myoclonus. Toxicological, metabolic, infectious, and autoimmune etiologies were assessed and reported negative. An osteolytic lesion was observed in the right iliac crest via computed tomography (CT). A positron emission tomography-CT reported increased fluorodeoxyglucose uptake of a right iliac and right inguinal ganglion. After biopsy of the right inguinal ganglion, a BRAF mutation-positive melanoma metastasis from an occult primary cancer was diagnosed. Dermatologic, ophthalmologic, and endoscopic gastrointestinal assessment did not reveal a primary malignant melanoma. The patient's movement disorders and neuropsychiatric symptoms improved with quetiapine, prednisone, azathioprine, and cyclophosphamide. Oncological management was conducted with MAPK pathway inhibitors (i.e., dabrafenib and trametinib). Movement disorders associated with neuropsychiatric symptoms are complex to diagnose. PNS are rare and often associated with antibodies against neural antigens expressed by the tumor. The case presented above describes a patient with a BRAF-positive malignant melanoma metastasis from an occult primary associated with PCD - to the best of our knowledge, the first reported in the literature.

La actuación profesional de los docentes universitarios y su preparación para la educación intercultural / Professional action of university teachers and preparation for intercultural education

RESUMEN Fundamento: La práctica de la educación intercultural en Cuba es un campo disciplinar que demanda mayor preparación en el modo de actuación profesional de los docentes universitarios. Objetivo: Construir un programa de preparación, centrado en la solución de conflictos, para perfeccionar el modo de actuación profesional de los docentes universitarios para la educación intercultural. Metodología: Se realizó una investigación en la Universidad de Sancti Spíritus José Martí Pérez, en la que se utilizó la metodología cualitativa basada en el estudio de caso del modo de actuación profesional de los docentes para la educación intercultural. Resultados: El diagnóstico pedagógico integral no se tuvo en cuenta para la identificación y solución de los conflictos interculturales, dependiendo del estatus de igualdad grupal alcanzado. La preparación en educación intercultural, centrada en la solución de conflictos, demostró la efectividad de trabajar en correspondencia al sistema de acciones propias de la dirección del proceso pedagógico. Conclusiones: El programa de preparación permitió reconocer la validez de la experiencia pedagógica practicada, así como la pertinencia de otras perspectivas foráneas compatibles y el manejo conceptual de los principios y competencias para la educación intercultural.

ABSTRACT Background: The practice of intercultural education in Cuba is a disciplinary field that requires greater preparation in the professional way of acting of university teachers. Objective: To build a preparation program, focused on conflicts resolution, to improve the professional performance of university teachers for intercultural education. Methodology: An investigation was carried out at the University of Sancti Spíritus José Martí Pérez, using the qualitative methodology based on the case study of the professional performance of teachers for intercultural education. Results: The comprehensive pedagogical diagnosis was not taken into account for the identification and solution of intercultural conflicts, depending on the group equality status achieved. The preparation in intercultural education, focused on conflict resolution, demonstrated the effectiveness of working in correspondence with the system of actions proper to the direction of the pedagogical process. Conclusions: The preparation program allowed to recognize the validity of the pedagogical experience practiced, as well as the relevance of other compatible foreign perspectives and the conceptual handling of the principles and competences for intercultural education.