Enhancing disinfection and microcontaminant removal by coupling LED driven UVC and UVA/photo-Fenton processes in continuous flow reactors.

For the first time, the sequential combination of UVC-LED (276 nm) and photo-Fenton/UVA-LED (376 nm) process has been assessed in continuous flow mode for wastewater reclamation according to the new European Regulation for reuse in agricultural irrigation (EU 2020/741). The results show that it is possible to obtain water quality class B (Escherichia coli ≤ 100 CFU/100 mL) by UVC-LED irradiation alone, operating the system with a hydraulic residence time (HRT) of 6.5 min and liquid depth of 5 cm in the case of secondary effluents with low Escherichia coli load (8.102-3.1.103 CFU/100 mL). As for high bacteria concentrations (1.2-4.2.104 CFU/100 mL), HRTs longer than 30 min are required. The bacterial load has not influenced decontamination, removing 18 ± 4 % of microcontaminants. Coupling the UVC (30-min HRT and 5.0 cm liquid depth) and the UVA/photo-Fenton (60-min and 15-cm liquid depth) systems allows 58 ± 4 % of real organic microcontaminants to be removed, in addition to achieving water quality class B.

How different countries respond to adverse events whilst patients' rights are protected.

Patient safety is high on the policy agenda internationally. Learning from safety incidents is a core component in achieving the important goal of increasing patient safety. This study explores the legal frameworks in the countries to promote reporting, disclosure, and supporting healthcare professionals (HCPs) involved in safety incidents. A cross-sectional online survey was conducted to ascertain an overview of the legal frameworks at national level, as well as relevant policies. ERNST (The European Researchers' Network Working on Second Victims) group peer-reviewed data collected from countries was performed to validate information. Information from 27 countries was collected and analyzed, giving a response rate of 60%. A reporting system for patient safety incidents was in place in 85.2% (N = 23) of countries surveyed, though few (37%, N = 10) were focused on systems-learning. In about half of the countries (48.1%, N = 13) open disclosure depends on the initiative of HCPs. The tort liability system was common in most countries. No-fault compensation schemes and alternative forms of redress were less common. Support for HCPs involved in patient safety incidents was extremely limited, with just 11.1% (N = 3) of participating countries reporting that supports were available in all healthcare institutions. Despite progress in the patient safety movement worldwide, the findings suggest that there are considerable differences in the approach to the reporting and disclosure of patient safety incidents. Additionally, models of compensation vary limiting patients' access to redress. Finally, the results highlight the need for comprehensive support for HCPs involved in safety incidents.

Enhanced expression of natural cytotoxicity receptors on cytokine-induced memory-like natural killer cells correlates with effector function.

Introduction: Natural killer (NK) cells are a key component of the innate immune system, involved in defending the host against virus-infected cells and tumor immunosurveillance. Under in vitro culture conditions, IL-12/15/18 can induce a memory-like phenotype in NK cells. These cytokine-induced memory-like (CIML) NK cells possess desirable characteristics for immunotherapies, including a longer lifespan and increased cytotoxicity. Methods: In this study, NK cells were isolated from peripheral blood of healthy donors and stimulated with IL-12/15/18 to induce a memory-like phenotype or with IL-15 alone as a control. After seven days of culture, multiparametric flow cytometry analysis was performed to evaluate the phenotypic and functional profiles of CIML and control NK cells. Results: Our results showed a significantly higher expression of CD25, CD69, NKG2D, NKp30, NKp44, NKp46, TACTILE, and Granzyme B in CIML NK cells compared to control NK cells. In contrast, KIR2D expression was significantly lower in CIML NK cells than in control NK cells. Moreover, functional experiments demonstrated that CIML NK cells displayed enhanced degranulation capacity and increased intracellular IFN-γ production against the target cell line K562. Interestingly, the degranulation capacity of CIML NK cells was positively correlated with the expression of the activating receptors NKp46 and NKp30, as well as with the inhibitory receptor TACTILE. Discussion: In conclusion, this study provides a deep phenotypic characterization of in vitro-expanded CIML NK cells. Moreover, the correlations found between NK cell receptors and degranulation capacity of CIML NK cells allowed the identification of several biomarkers that could be useful in clinical settings.

Fusariosis in Mexico: A 10-year retrospective series.

Fusarium species represent an opportunistic fungal pathogen. The data in Mexico about Fusarium infections in humans are scarce. Here, we present a retrospective series of patients with a confirmed diagnosis of fusariosis in eight different hospitals in Mexico from January 2010 to December 2019. The diagnosis of proven fusariosis was made according to the European Organization for Research and Treatment of Cancer and the Mycoses Study Group Education and Research Consortium (EORT/MSG) criteria. A total of 49 cases were identified in our series. Most patients had burn injuries (49%), and 37% had hematological malignancies. Most patients had fire injuries (40%), followed by electric injuries (8%), febrile neutropenia (10%), and pancytopenia (6%). Patients had skin and soft tissue involvement in 49%, followed by blood culture isolation and biopsies from different sites of the body (lung, sinuses, bone tissue, and eyes). Febrile neutropenia (10%) and fungemia (8%) were the most common clinical syndromes in immunosuppressed patients. Most patients received monotherapy (67%), where voriconazole was used in 30% of the cases, followed by conventional amphotericin B (16%), and lipidic formulations of amphotericin B in 10% (either liposomal amphotericin B or amphotericin B lipid complex). Combination therapy was used in 20% of the cases, and the most common combination therapy was triazole plus any lipidic formulation of amphotericin B (10%). Mortality related to Fusarium infection occurred in 22% of patients. Fusariosis is a serious threat. Burn injuries and hematologic malignancies represent the most common causes of infection in this small series from Mexico.

This study describes the epidemiological characteristics of patients with fusariosis from a multicenter cohort in Mexico. These findings provide information from this invasive fungal disease that threatens different countries in Latin America.

Accuracy of Narrow-Band Imaging International Colorectal Endoscopic Classification for Predicting the Histology of Colon Polyps by Experienced Endoscopists and Trainees.

BACKGROUND/AIMS: Digital chromoendoscopy has proven to be useful in the histological prediction of premalignant lesions in the colon. The aim of the study was to describe the diagnostic performance of Narrow-Band Imaging International Colorectal Endoscopic Classification in the histological differentiation of colonic lesions, applied by expert endoscopists and trainees. MATERIALS AND METHODS: Cross-sectional study that includes high-definition endoscopic images and histopathological reports of 94 patients over 50 years. Images were evaluated and classified as Narrow-Band Imaging International Colorectal Endoscopic 1, 2, or 3 by 2 experts and 2 trainee endoscopists, all of them blinded to histological results. Diagnostic accuracy for each Narrow-Band Imaging International Colorectal Endoscopic category was calculated for trainees and expert endoscopists. Intra-observer agreement was evaluated by means of Cohen's kappa coefficient; meanwhile, inter-observer agreement was calculated by means of Fleiss' kappa. RESULTS: Evaluations performed by expert and trainee endoscopists showed a performance for Narrow-Band Imaging International Colorectal Endoscopic category 1: sensitivity 62%, specificity 85%, area under receiver operator characteristic 0.73; Narrow-Band Imaging International Colorectal Endoscopic category 2: sensitivity 61%, specificity 73%, area under receiver operator characteristic 0.66; and Narrow-Band Imaging International Colorectal Endoscopic category 3: sensitivity 88%, specificity 91%, area under receiver operator characteristic 0.86. The total agreement of the evaluations was 72.5%, with an inter-observer variability of K 0.60 (95% CI 0.52-0.74). When the diagnostic performance for non-dysplastic lesions and dysplastic lesions (Narrow-Band Imaging International Colorectal Endoscopic 1 vs 2 and 3) was compared, we observed an increase in sensitivity for differentiated adenomas (Narrow-Band Imaging International Colorectal Endoscopic 2). CONCLUSION: Narrow-Band Imaging International Colorectal Endoscopic Classification applied in the histological prediction of static images of colonic lesions has a good diagnostic performance for Narrow-Band Imaging International Colorectal Endoscopic category 3, as well as an acceptable performance for Narrow-Band Imaging International Colorectal Endoscopic category 1, with a moderate agreement among observers.

Safe Care and Medication Intake Provided by Caregivers at Home: Reality Care Study Protocol.

JUSTIFICATION: Providing care to patients with several conditions and simultaneously taking several medications at home is inexorably growing in developed countries. This trend increases the chances of home caregivers experiencing diverse errors related with medication or care. OBJECTIVE: To determine the effectiveness of four different educational solutions compared to the natural intervention (absence of intervention) to provide a safer care at home by caregivers. METHOD: Prospective, parallel, and mixed research study with two phases. Candidates: Home-based caregivers caring a person with multiple comorbid conditions or polymedication who falls into one of the three profiles of patients defined for the study (oncology, cardiovascular, or pluripathological patients). First phase: Experts first answered an online survey, and then joined together to discuss the design and plan the content of educational solutions directed to caregivers including the identification of medication and home care errors, their causes, consequences, and risk factors. Second phase: The true experiment was performed using an inter- and intrasubject single-factor experimental design (five groups: four experimental groups against the natural intervention (control), with pre- and post-intervention and follow-up measures) with a simple random assignment, to determine the most effective educational solution (n = 350 participants). The participants will be trained on the educational solutions through 360 V, VR, web-based information, or psychoeducation. A group of professionals called the "Gold Standard" will be used to set a performance threshold for the caring or medication activities. The study will be carried out in primary care centers, hospitals, and caregivers' associations in the Valencian Community, Andalusia, Madrid, and Murcia. EXPECTED RESULTS: We expect to identify critical elements of risk management at home for caregivers and to find the most effective and optimal educational solution to reduce errors at home, increasing caregivers' motivation and self-efficacy whilst the impact of gender bias in this activity is reduced. TRIAL REGISTRATION: Clinical Trial NCT05885334.

Bariatric endoscopic-surgical therapies for NAFLD. Should they be considered viable options among current treatments?

Nowadays, non-alcoholic fatty liver disease is one of the first causes of liver transplant worldwide; many efforts have been done to find the perfect drug for this multifactorial disease. Presently we just have a few drugs that could be used in specific and limited clinical scenarios. Current evidence suggests that bariatric endoscopic and surgical therapies could be strategies with optimal outcomes, with high impact in quality of life, decrease of cardiovascular risk, and improvement in metabolic profile, despite being considered expensive procedures. This review proposes to consider these therapies early together with liver fibrosis evaluation, with long term cost-effectiveness benefits in the absence of response to lifestyle modifications and pharmacological treatments.

The effects of polyphenols against oxidative stress in Caenorhabditis elegans are determined by coexisting bacteria.

Introduction: Increasing evidence supports the role of gut microbiota in many aspects of human health, including immune, metabolic and neurobehavioral traits. Several studies have focused on how different components of the diet, such as polyphenols, can modulate the composition and function of the gut microbiota leading to health benefits. Methods: The effects on the resistance against thermally induced oxidative stress of C. elegans grown in the presence of flavonoids (quercetin or epicatechin) and fed different probiotic strains, namely Lactobacillus plantarum CLC17, Bifidobacterium longum NCIMB 8809 and Enterococcus faecium CECT 410, were explored. Results: Feeding C. elegans with the assayed bacteria in the absence of flavonoids did not significantly affect body size and fertility of the worms neither improve their resistance against oxidative stress compared to E. coli controls. However, increased resistance to stress was found when C. elegans was cultivated in the presence of both L. plantarum and flavonoids, but not with B. longum or E. faecium. An exploratory study revealed the presence of glycosylated and sulfated metabolites together with the aglycone in worms treated with quercetin and fed any of the different assayed LAB strains. However, in the assays with epicatechin a differential metabolite, tentatively identified as 5-(4'-hydroxyphenyl)-γ-valerolactone 3'-O-glucoside, was detected in the worms fed L. plantarum but not with the other bacteria. Conclusion: The obtained results indicated that the interactions bacteria/polyphenol play a key role in the effects produced in C. elegans regarding resistance against oxidative stress, although those effects cannot be only explained by the ability of bacteria to metabolize polyphenols, but other mechanisms should also be involved.

Application of machine learning to predict aneuploidy and mosaicism in embryos from in vitro fertilization cycles.

BACKGROUND: The factors associated with embryo aneuploidy have been extensively studied. Mostly maternal age and to a lesser extent male factor and ovarian stimulation have been related to the occurrence of chromosomal alterations in the embryo. On the other hand, the main factors that may increase the incidence of embryo mosaicism have not yet been established. OBJECTIVE: This study aimed to establish a machine learning model that would allow prediction of aneuploidies and mosaicism in embryos conceived via in vitro fertilization, and thus help to determine which variables are associated with these chromosomal alterations. STUDY DESIGN: The study design was observational and retrospective. A total of 6989 embryos from 2476 cycles of preimplantation genetic testing for aneuploidies were included (January 2013 to December 2020). The trophoectoderm biopsies on day-5, -6, or -7 blastocysts were analyzed by preimplantation genetic testing for aneuploidies (PGT-A). The different maternal, paternal, couple, embryo, and in vitro fertilization cycle characteristics were recorded in a database (22 predictor variables) from which predictive models of embryo aneuploidy and mosaicism were developed; 16 different unsupervised classification machine learning algorithms were used to establish the predictive models. RESULTS: Two different predictive models were performed: one for aneuploidy and the other for mosaicism. The predictor variable was of multiclass type because it included the segmental- and whole-chromosome alteration categories. The best predicting models for both aneuploidies and mosaicism were those obtained from the Random Forest algorithm. The area under ROC curve (AUC) value was 0.792 for the aneuploidy explanatory model and 0.776 for mosaicism. The most important variable in the final aneuploidy model was maternal age, followed by paternal and maternal karyotype and embryo quality. In the predictive model of mosaicism, the most important variable was the technique used in preimplantation genetic testing for aneuploidies and embryo quality, followed by maternal age and day of biopsy. CONCLUSION: It is possible to predict embryo aneuploidy and mosaicism from certain characteristics of the patients and their embryos.

Incremental levels of diagnostic information incentivize health-seeking in non-alcoholic fatty liver: a randomized clinical trial.

Patients with chronic disorders like non-alcoholic fatty liver disease (NAFLD) face important challenges adhering to diagnostic and treatment tracks. As NAFLD increases, the need to incentivize health-seeking behaviors grows. No evidence-based interventions to address this gap exist. The aim of the study was to estimate the effect of providing increasing levels of diagnostic information on medical care-seeking in adults newly diagnosed with NAFLD. We randomly assigned adults with a sonographic diagnosis of NAFLD at a check-up unit in Mexico to one of five groups. All groups received medical consultation. A: no further interventions; B: received multimedia educational material (MEM); C: MEM + NAFLD-fibrosis-score (NFS); D: MEM + transient elastography (TE); E: MEM + NFS + TE. 1209 participants were randomized, follow-up rate 91%; 82% male, BMI 30.5 ± 4 kg/m2. There were no differences in the proportion of patients undergoing further diagnostic evaluation of liver fibrosis (A 0.4%, E 0.4%, P-for-trend = 0.269). Groups who received more information sought specialized medical care more frequently: A 22%, E 30% (P-for-trend = 0.047). A trend to receive treatment was also observed at higher levels of information: A 26.7%, E 36.3% (P-for-trend = 0.134). Increasing the amount of diagnostic information seemed to increase patient's health-seeking. Tailoring the communication of information obtained for diagnosis could help to increase health-seeking in chronic disease patients.Trial registration: NCT01874249 (full date of first registration 11-06-2013).

Essential role of hyperacetylated microtubules in innate immunity escape orchestrated by the EBV-encoded BHRF1 protein.

Innate immunity constitutes the first line of defense against viruses, in which mitochondria play an important role in the induction of the interferon (IFN) response. BHRF1, a multifunctional viral protein expressed during Epstein-Barr virus reactivation, modulates mitochondrial dynamics and disrupts the IFN signaling pathway. Mitochondria are mobile organelles that move through the cytoplasm thanks to the cytoskeleton and in particular the microtubule (MT) network. MTs undergo various post-translational modifications, among them tubulin acetylation. In this study, we demonstrated that BHRF1 induces MT hyperacetylation to escape innate immunity. Indeed, the expression of BHRF1 induces the clustering of shortened mitochondria next to the nucleus. This "mito-aggresome" is organized around the centrosome and its formation is MT-dependent. We also observed that the α-tubulin acetyltransferase ATAT1 interacts with BHRF1. Using ATAT1 knockdown or a non-acetylatable α-tubulin mutant, we demonstrated that this hyperacetylation is necessary for the mito-aggresome formation. Similar results were observed during EBV reactivation. We investigated the mechanism leading to the clustering of mitochondria, and we identified dyneins as motors that are required for mitochondrial clustering. Finally, we demonstrated that BHRF1 needs MT hyperacetylation to block the induction of the IFN response. Moreover, the loss of MT hyperacetylation blocks the localization of autophagosomes close to the mito-aggresome, impeding BHRF1 to initiate mitophagy, which is essential to inhibiting the signaling pathway. Therefore, our results reveal the role of the MT network, and its acetylation level, in the induction of a pro-viral mitophagy.

Antihyperalgesic and Antiallodynic Effects of Amarisolide A and Salvia amarissima Ortega in Experimental Fibromyalgia-Type Pain.

Salvia amarissima Ortega is an endemic species of Mexico used in folk medicine to alleviate pain and as a nervous tranquilizer. The S. amarissima extract and one of its abundant metabolites, identified and isolated through chromatographic techniques, were investigated to obtain scientific evidence of its potential effects to relieve nociplastic pain such as fibromyalgia. Then, the extract and amarisolide A (3-300 mg/kg, i.p.) were pharmacologically evaluated in reserpine-induced fibromyalgia-type chronic pain and in depressive-like behavior (as a common comorbidity) by using the forced swimming test in rats. The 5-HT1A serotonin receptor (selective antagonist WAY100635, 1 mg/kg, i.p.) was explored after the prediction of a chemical interaction using in silico analysis to look for a possible mechanism of action of amarisolide A. Both the extract and amarisolide A produced significant and dose-dependent antihyperalgesic and antiallodynic effects in rats, as well as significant antidepressive behavior without sedative effects when the antinociceptive dosages were used. The 5-HT1A serotonin receptor participation was predicted by the in silico descriptors and was corroborated in the presence of WAY100635. In conclusion, S. amarissima possesses antihyperalgesic, antiallodynic, and anti-depressive activities, partially due to the presence of amarisolide A, which involves the 5-HT1A serotonin receptor. This pharmacological evidence suggests that S. amarissima and amarisolide A are both potential alternatives to relieve pain-like fibromyalgia.

Commercially Available Eye Drops Containing Trehalose Protect Against Dry Conditions via Autophagy Induction.

Purpose: Evaluation of marketed eye drops with or without trehalose, a nonreducing natural osmoprotector disaccharide, in autophagy modulation and its role in cell survival during desiccation. Methods: Eye drops containing either sodium hyaluronate (SH) (Hyabak®, Thea, France) or a combination of SH with trehalose (Thealose Duo®, Thea, France) were compared with control conditions to evaluate the ability to modulate autophagy in human epithelial cells in vitro. Autophagy was monitored using LC3, a marker of the autophagic machinery, by fluorescence microscopy and immunoblot analysis. Control and autophagy-deficient cells treated with eye drops were exposed to desiccation to mimic dry eyes and cell survival was evaluated by thiazolyl blue tetrazolium bromide (MTT) assay. Trehalose, a known autophagy inducer was used as a positive control. Results: Artificial tears containing SH with and without trehalose induce a complete autophagic flux, as indicated by an increase in the number of autophagosomes and autolysosomes, and the accumulation of the lipidated form of LC3 associated with complete autophagy. In addition, there was a synergistic effect of SH for autophagy induction when combined with trehalose, compared with each of the components alone. Survival of cells treated with both eye drops and exposed to desiccation was decreased in autophagy-deficient cells, demonstrating the essential role of autophagy on eye drop protection. Conclusions: Autophagic flux is induced by SH-containing eye drops, and this phenomenon is enhanced in combination with trehalose. We also demonstrated that autophagy induction is involved in the osmoprotective effects of both trehalose and SH-containing eye drops, to maintain epithelial cell homeostasis in dry conditions.

G protein-coupled receptors: Key molecules in metabolic associated fatty liver disease development.

Metabolic associated fatty liver disease (MAFLD) is a range of hepatic disorders with progression to steatohepatitis with risk of development of fibrosis, cirrhosis, and hepatocellular carcinoma. MAFLD is strongly related to metabolic disorders of active fatty acids, which seem to be selective according to their specific ligand of G protein-coupled receptors (GPRs) located in immune response cells. An approach to study the pathophysiological mechanisms of MAFLD could be through the expression of active fatty acids ligands. The expression of GPRs is associated with obesity, microbiota environment, and dietary characteristics in patients with MAFLD. More specifically, GPR41, GPR43, GPR20, and GPR120 have been associated with alteration of lipid metabolism in hepatic and intestinal cells, and consequently they have a key role in metabolic diseases. We observed that GPR120 is not expressed in nonoverweight/obese patients, regardless of the presence of MAFLD; meanwhile the expression of GPR41 is increased in patients with lean MAFLD. GPRs role in liver disease is intriguing and a field of research opportunity. More studies are necessary to define the role of active fatty acids in the development of metabolic diseases.

Mannich bases of hydroxycoumarins: synthesis, DFT/QTAIM computational study and assessment of biological activity.

The synthesis of six Mannich bases derived from hydroxycoumarins was carried out in moderate yields, two of these derivatives were described for the first time. Conformational analysis was performed through DFT theoretical calculations explaining the formation of stable six membered rings based on intramolecular hydrogen bonds within the structure. These findings were correlated with the antiproliferative activity. The biological activity of the Mannich bases through their antiproliferative activity in the HeLa cancer cell line is described for the first time, showing that the compounds were able to inhibit proliferation in cervical cancer by more than 60%. Likewise, the theoretical modeling of the photophysical properties was realized with promising results, showing that the HOMO-LUMO energies of the new compounds present the lowest electronic gap values for those with donor groups in their structure, which makes them potential fluorophores.

Single port endoscopic mastectomy: surgical technique and first case in Mexico.

Las innovaciones técnicas han permitido realizar un sinnúmero de cirugías endoscópicas y laparoscópicas, entre ellas la mastectomía preservadora de piel y pezón por puerto único, que ha sido reportada como bien tolerada, con un excelente resultado cosmético y con el mismo pronóstico oncológico que la cirugía tradicional. Esta técnica, común en Asia, presenta diversos retos técnicos y económicos. Presentamos la primera aproximación en nuestro país sobre este abordaje en una paciente con cáncer de mama. Para realizar esta cirugía es preciso el entrenamiento en mínima invasión y en cirugía mamaria, así como una adecuada selección de las pacientes.Technical innovations and scientific advances have allowed to perform countless endoscopic and laparoscopic surgical procedures. Among these, Single port endoscopic Mastectomy has been reported as well tolerated, with great aesthetic results and the same oncologic prognosis as traditional surgery. This popular approach in Asian countries presents many technical and economic challenges. We present the first endoscopic approach in our country: a female patient with infiltrating ductal carcinoma in the left breast. We understand that to carry out this procedure, adequate patient selection, great minimal invasive and breast surgery skills are necessary.

Diferencias en la ansiedad y depresión por variables contextuales en mujeres con cáncer de mama / Differences in Anxiety and Depression by Contextual Variables in Women with Breast Cancer

Resumen. Objetivo. Identificar las diferencias en la ansiedad y depresión de acuerdo con variables contextuales en mujeres con cáncer de mama que se encuentran bajo tratamiento. Método. Estudio comparativo realizado en 91 mujeres con cáncer de mama, en tres unidades de atención del Noreste de México. Se utilizó la Escala Hospitalaria de Ansiedad y Depresión. Resultados. El 51.6% (f = 47) resultó con ansiedad y el 25.3% (f = 23) depresión. La ansiedad y depresión no es diferente de acuerdo con el grado de escolaridad (p > .05) y estado civil (p > .05). La depresión (p = .001) y ansiedad (p =.05) es diferente de acuerdo con la unidad de atención. Se concluye que es importante cuidar el estado emocional de las pacientes con cáncer, ya que se observó que la mitad de las pacientes presentaron ansiedad y una cuarta parte depresión. Es necesario analizar el contexto, ya que la depresión y ansiedad son diferentes de acuerdo con la unidad de atención.

Abstract. Objective. The aim is to identify the differences between anxiety and depression according to contextual variables in women with breast cancer who are under treatment. Method. A comparative study was carried out in 91 women with breast cancer in three care units in Northeast Mexico. The Hospital Anxiety and Depression Scale were used. Results. The 51.6% (f = 47) resulted in anxiety and 25.3% (f = 23) depression. Anxiety and depression are not different according to the degree of schooling (p > .05) and marital status (p > .05). Depression (p = .001) and anxiety (p = 05) is different according to the unit of attention. In conclusion, it is important to take care of the emotional state of cancer patients since it was observed that half of the patients presented anxiety and a quarter with depression. It is necessary to analyze the context because depression and anxiety are different regarding the unit of attention.

Human Cytomegalovirus Inhibits Autophagy of Renal Tubular Epithelial Cells and Promotes Cellular Enlargement.

Human Cytomegalovirus (HCMV) is a frequent opportunistic pathogen in immunosuppressed patients, which can be involved in kidney allograft dysfunction and rejection. In order to study the pathophysiology of HCMV renal diseases, we concentrated on the impact of HCMV infection on human renal tubular epithelial HK-2 cells. Our aim was to develop a model of infection of HK-2 cells by using the viral strain TB40/E, that contains the extended cell tropism of clinical isolates and the efficient viral multiplication in cell culture of laboratory-adapted strains. We observed that HK-2 cells can be infected by HCMV and expressed viral antigens, but they do not produce extracellular viral particles. We then studied the interplay of HCMV with ciliogenesis and autophagy. Primary cilium (PC) is a stress sensor important to maintain renal tissue homeostasis that projects from the apical side into the lumen of tubule cells. PC formation and length were not modified by HCMV infection. Autophagy, another stress response process critically required for normal kidney functions, was inhibited by HCMV in HK-2 cells with a reduction in the autophagic flux. HCMV classically induces an enlargement of infected cells in vivo and in vitro, and we observed that HCMV infection led to an enlargement of the HK-2 cell volume. Our results constitute therefore an excellent starting point to further explore the role of these mechanisms in renal cells dysfunction.

Conocimientos sobre la COVID 19 en pacientes del CMF No. 12 y acciones preventivas del trío de pesquisa / Knowledge about COVID 19 in CMF No. 12 patients and preventive actions of the research trio / Conhecimento sobre COVID 19 em pacientes com CMF nº 12 e ações preventivas do trio de pesquisa

RESUMEN Introducción: los grandes asesinos de la historia son las bacterias y los virus, a mediados de diciembre la humanidad comenzó a ser azotada por un nuevo virus SARS-CoV-2, originando una enfermedad llamada COVID 19. Objetivo: evaluar el nivel de conocimientos y el cumplimiento de las medidas preventivas sobre la COVID-19 en los pacientes antes y después de tener la presencia en el área de salud de un caso positivo a la Covid-19. Método: se realizó un estudio descriptivo con fase de intervención a los pacientes de tres Manzanas del consultorio # 12 del policlínico Ángel Ortiz Vázquez del municipio Manzanillo, de la provincia Granma. Resultados: los resultados obtenidos fueron de 583 pacientes un 55,5 por ciento presentan factores de riesgo, antes de la intervención un 34,8% desconocen vías de trasmisión, además un 44.0 % usan el nasobuco de forma inadecuado, lo cual aumento después de la pesquisa fortalecida aumento a un 97.7%, al igual que el nivel de conocimientos que aumento a un 91.0% y satisfacción de la comunidad con las acciones educativas a un 100%. Conclusiones: se observó después de las acciones educativas un aumento en el conocimiento de la enfermedad empoderando a la población de conocimientos y prácticas necesarias, los pacientes cumplieron adecuadamente las medidas preventivas y la satisfacción de la comunidad con el trabajo de los tríos participantes fue favorable.

ABSTRACT Introduction: the greatest killers in history are bacteria and viruses, in mid-December humanity began to be hit by a new SARS-CoV-2 virus, causing a disease called COVID 19. Objective: to assess the level of knowledge and compliance with preventive measures on COVID-19 in patients before and after having the presence in the health area of ​​a positive case for Covid-19. Method: a descriptive study with intervention phase was carried out on the patients of three apples from office # 12 of the Ángel Ortiz Vázquez polyclinic in the Manzanillo municipality, Granma province. Results: the results obtained were from 583 patients, 55.5 percent presented risk factors, before the intervention 34.8% were unaware of transmission routes, and 44.0% used the nasobuco improperly, which increased after the strengthened research increased to 97.7%, as did the level of knowledge that increased to 91.0% and satisfaction of the community with the educational actions to 100%. Conclusions: after the educational actions, an increase in the knowledge of the disease was observed, empowering the population with the necessary knowledge and practices, the patients adequately complied with the preventive measures and the satisfaction of the community with the work of the participating trios was favorable.

RESUMO Introdução: os maiores assassinos da história são bactérias e vírus. Em meados de dezembro, a humanidade começou a ser atingida por um novo vírus SARS-CoV-2, causando uma doença chamada COVID 19. Objetivo: avaliar o nível de conhecimento e a adesão às medidas preventivas do COVID-19 em pacientes antes e depois da presença na área da saúde de um caso positivo para o Covid-19. Método: foi realizado um estudo descritivo com uma fase de intervenção em pacientes de três maçãs do consultório nº 12 da policlínica Ángel Ortiz Vázquez no município de Manzanillo, província de Granma. Resultados: os resultados obtidos foram de 583 pacientes, 55,5 por cento apresentavam fatores de risco, antes da intervenção 34,8% desconheciam as vias de transmissão e 44,0% usavam indevidamente o nasobuco, que aumentava após a pesquisa reforçada aumentou para 97,7%, assim como o nível de conhecimento que aumentou para 91,0% e a satisfação da comunidade com as ações educativas para 100%. Conclusões: após as ações educativas, observou-se um aumento no conhecimento da doença, capacitando a população com os conhecimentos e práticas necessários, os pacientes cumpriram adequadamente as medidas preventivas e a satisfação da comunidade com o trabalho dos trios participantes foi favorável.