A Viral-Encoded Homologue of IPS-1 Modulates Innate Immune Signaling During KSHV Lytic Replication.

Modulation of innate immunity is critical for virus persistence in a host. In particular, viral-encoded disruption of type I interferon, a major antiviral cytokine induced to fight viral infection, is a key component in the repertoire of viral pathogenicity genes. We have identified a previously undescribed open reading frame within the Kaposi's sarcoma-associated herpesvirus (KSHV) genome that encodes a homologue of the human IPS-1 (also referred to as MAVS) protein that we have termed viral-IPS-1 (v-IPS-1). This protein is expressed during the lytic replication program of KSHV, and expression of v-IPS-1 blocks induction of type I interferon upstream of the TRAF3 signaling node including signaling initiated via both the RLR and TLR3/4 signaling axes. This disruption of signaling coincides with destabilization of the cellular innate signaling adaptors IPS-1 and TRIF along with a concatenate stabilization of the TRAF3 protein. Additionally, expression of v-IPS-1 leads to decreased antiviral responses indicating a blot to type I interferon induction during viral infection. Taken together, v-IPS-1 is the first described viral homologue of IPS-1 and this viral protein leads to reprogramming of innate immunity through modulation of type I interferon signaling during KSHV lytic replication.

Impact of early palliative care intervention in autologous bone marrow transplantation: feasibility of a multicentric study.

INTRODUCTION: This prospective multicentre study evaluates the impact of Palliative Care Unit (PCU) intervention (Experimental Group, EG), during autologous hematopoietic stem cell transplantation (AHSCT) on quality of life (QoL), symptom control and healthcare resource use compared to standard practice (Control Group, CG). We used validated scales on Days 0 (stem cell infusion), + 7 (bone marrow aplasia, acute symptoms) and + 21 (aplasia recovery). RESULTS: In 40 patients (20 EG/ 20 CG: 45%/25% female, median age 57.5/59), QoL differed significantly at Day + 7 (EG: median 0.50; CG: -63.00; p < 0.001) and Day + 21 (EG: -2.00; CG: -129.00; p < 0.001). On Day 0, mean FACT-BMT scores were CG/EG: 131/ 89.35, reflecting the pre-transplant intervention of the PCU in EG patients. For pain (EG median 0.00, CG median 2.50; p = 0.01), 45% EG patients used opioids on day 0 (mean 38.5 mg morphine/day/patient). Reduced pain control impacted nutritional support (parenteral nutrition 45% CG, 5% EG; p = 0.08). Hospitalisation duration was longer in CG (median 18.5; EG median 13.00; p < 0.001). Despite the short follow-up and small sample size, PCU and HD collaboration improves QoL and symptom management during acute AHSCT, evident through pain control, analgesia management, reduced parenteral nutrition need and shorter hospital stays.

Prognostic Factors of Morbimortality in Patients Treated for Xanthogranulomatous Pyelonephritis.

Background: Nephrectomy is the treatment for xanthogranulomatous pyelonephritis (XGP), but the surgery is often technically complex and associated with a high incidence of postoperative complications. The objective of this study was to determine factors that can predict the probability of major postoperative complications, admission to intensive care, or mortality. Methods: We conducted a retrospective observational study of patients with XGP who underwent simple nephrectomy in a tertiary care hospital in Mexico from 2015 to 2022. We analyzed preoperative and transoperative variables to determine their relationship with postoperative complications. Results: A total of 39 patients with a mean age of 44.33 ± 12.6 years were included. In the comparative analysis of the variables, we found a significant difference in the amount of intraoperative bleeding between the types of surgical approaches-a median of 1,200 mL with the transperitoneal approach vs 525 mL with the retroperitoneal approach (P=0.02)-but we found no significant differences in the need for blood transfusion or other complications associated with surgical approach. In both the univariate and multivariate analyses, patients with positive urine cultures prior to surgery had a higher rate of complications requiring surgical, endoscopic, or radiologic intervention. No significant differences in outcomes were found between patients who underwent early vs delayed nephrectomy. Conclusion: The surgical approach for nephrectomy, transperitoneal or retroperitoneal, and early vs delayed surgery did not affect postoperative complications in our patients with XGP. However, the presence of positive urine cultures prior to surgery was associated with major complications.

Renal functional and cardiovascular outcomes of partial nephrectomy versus radical nephrectomy for renal tumors: a systematic review and meta-analysis.

This systematic review and meta-analysis aimed to evaluate the postoperative renal and cardiovascular outcomes of partial nephrectomy (PN) versus radical nephrectomy (RN) for the treatment of renal carcinoma. A systematic literature search was performed on scientific databases including Scopus, Web of Science, MEDLINE, and EMBASE from their inception to September 2021. Studies comparing renal and cardiovascular outcomes between PN and RN in patients with renal cancer were included. The generic inverse variance method with random-effects models was used to determine the pooled hazard ratios and odds ratio for each outcome. Quality Assessment for observational studies was guided by the New-Castle Ottawa Scale. Overall, a total of 31 studies (n=51,866) reported renal outcomes, while 11 studies (n= 101,678) reported cardiovascular outcomes. When compared to PN, RN had a higher rate of new-onset postoperative EGFR <60 mL/min/1.73 m2 (HR 3.39; CI 2.45 - 4.70; I2=93%; P=<0.00001) and EGFR <45 mL/min/1.73 m2 (HR 4.70; CI 2.26 - 9.79; I2=98%; P=<0.0001). No difference was observed in new-onset advanced kidney disease and end-stage renal disease. A 19% reduction in cardiovascular events was observed in the PN group (HR 0.81; CI 0.70 - 0.93, P=0.002). No protective effect of PN was observed in new-onset or worsening hypertension (HR 0.85; CI 0.64 - 1.14, P=0.28) nor myocardial infarction (HR 0.86; CI 0.71 - 1.04, P=0.13). PN was associated with a decreased risk of postoperative early-stage CKD and cardiovascular events compared with RN. However, no benefit of PN over RN was observed in advanced CKD, new-onset or worsening hypertension, myocardial infarction, and cardiovascular mortality.

Perioperative predictors for complications in patients with Xanthogranulomatous Pyelonephritis treated with nephrectomy.

INTRODUCTION: Xanthogranulomatous pyelonephritis is an inflammatory disease characterized by chronic obstruction and infection. This pathology is a life-threatening condition when surgical treatment is carried out. We decided to retrospectively evaluate whether there were perioperative factors that predict complications in patients who undergo nephrectomy. METHODS: We reviewed all nephrectomies done in the period of 2013-2018, in a tertiary referral Hospital with the histopathological diagnosis of Xanthogranulomatous Pyelonephritis. RESULTS: The presence of renal abscess at admission was observed as a risk factor associated with perioperative complications (p = 0.002), presence of abscess was observed in 47.4% of subjects without complications compared to 89.3% of the perioperative complication group. Higher rates of blood transfusion requirement were observed in the perioperative complication group, 89.3% compared to 68.4% (p = 0.029), furthermore, perioperative bleeding was slightly greater in the complication group compared to its counterpart, 700 mL, and 600 mL, respectively (p = 0.01). CONCLUSIONS: Anemia and the presence of abscess were important perioperative factors that predict perioperative complications.

Predictive factors for nephrectomy in renal trauma; assessment of a 6-point score.

PURPOSE: To evaluate predictive and associated risk factors for nephrectomy in renal trauma and assess a 6-point score for surgical decision-making. PATIENTS AND METHODS: This multicenter, retrospective, and observational study assessed 247 subjects with blunt or penetrating kidney trauma. Kidney injuries were classified according to the American Association for the Surgery of Trauma (AAST) Injury Scoring Scale. Renal trauma was classified as "low-grade" (Grades I-III), Grade IV, and Grade V. Subjects were compared according to conservative treatment (CTrt.) or nephrectomy. Predictive factors were evaluated with a multiple regression model. A 6-point score was evaluated with a ROC analysis. RESULTS: Patients requiring nephrectomy had a lower mean arterial pressure MAP compared to CTrt, 64.71 mmHg (SD ± 10.26) and 73.86 (SD ± 12.42), respectively (p = < 0.001). A response to IV solutions was observed in 90.2% of patients undergoing CTrt. (p = < 0.001, OR = 0.211, 95%CI = 0.101-0.442). Blood lactate ≥ 4 mmol/L was associated with nephrectomy (p = < 0.001). A hematoma ≥ 25 mm was observed in 41.5% of patients undergoing nephrectomy compared to 20.1% of CTrt. (p = 0.004, OR = 9.29, 95% CI = 1.37-5.58). A logistic regression analysis (p = < 0.001) showed that blood lactate ≥ 4 mmol/L (p = 0.043), an inadequate response to IV solutions (p = 0.041) and renal trauma grade IV-V (p = < 0.001), predicted nephrectomy. A 6-point score with a cut-off value ≥ 3 points showed 83% sensitivity and 87% specificity for nephrectomy with an AUC of 89.9% (p = < 0.001). CONCLUSIONS: An inadequate response to IV solutions, a lactate level ≥ 4 mmol/L, and grade IV-V renal trauma predict nephrectomy. A score ≥ 3 points showed a good performance in this population.

Rapid antigen test as a tool for the identification of SARS-CoV-2 infection and its potential as a self-testing device

ABSTRACT Background: SARS-CoV-2 virus originated in Wuhan (China) in December (2019) and quickly spread worldwide. Antigen tests are rapid diagnostic tests (RDT) that produce results in 15-30 min and are an important tool for the scale-up of COVID-19 testing. COVID-19 diagnostic tests are authorized for self-testing at home in some countries, including Brazil. Widespread COVID-19 diagnostic testing is required to guide public health policies and control the speed of transmission and economic recovery. Methods: Patients with suspected COVID-19 were recruited at the Hospital da Baleia (Belo Horizonte, Brazil). The SARS-CoV-2 antigen-detecting rapid diagnostic tests were evaluated from June 2020 to June 2021 using saliva, nasal, and nasopharyngeal swab samples from 609 patients. Patient samples were simultaneously tested using a molecular assay (RT-qPCR). Sensitivity, specificity, accuracy, and positive and negative predictive values were determined using the statistical program, MedCalc, and GraphPad Prism 8.0. Results: The antigen-detecting rapid diagnostic tests displayed 98% specificity, 60% sensitivity, 96% positive predictive value, and moderate concordance with RT-qPCR. Substantial agreement was found between the two methods for patients tested < 7 days of symptom onset. Conclusions: Our findings support the use of Ag-RDT as a valuable and safe diagnostic method. Ag-RDT was also demonstrated to be an important triage tool for suspected COVID-19 patients in emergencies. Overall, Ag-RDT is an effective strategy for reducing the spread of SARS-CoV-2 and contributing to COVID-19 control.

Manifestación cutánea de histoplasmosis diseminada en un paciente con trasplante renal / Cutaneous manifestation of disseminated histoplasmosis in a renal transplant patient

Introducción: La infección por Histoplasma capsulatum ocurre con frecuencia en pacientes con inmunosupresión por VIH o en trasplantados que reciben tratamiento inmunosupresor. La infección primaria se adquiere por vía inhalatoria con afectación pulmonar y posteriormente puede diseminarse a otros órganos como hígado, intestinos, corazón, riñones, piel o tejido óseo. Es muy raro que ocurra en pacientes con trasplante renal, aunque sí es común en el trasplante pulmonar. Objetivo: Presentar el caso de un paciente con antecedente de trasplante renal 9 años antes que ingresó por presentar lesiones cutáneas no típicas de histoplasmosis, quien desarrolló 2 semanas después histoplasmosis diseminada, sin compromiso pulmonar. Caso clínico: Paciente masculino de 65 años de edad postrasplante renal, que desarrolló manifestación cutánea caracterizada por pápulas y placas eritematodescamativas con superficies costrosas y atróficas, acompañado de fiebre persistente y adenopatías. No presentó signos o síntomas pulmonares como manifestación de infección primaria. El diagnóstico definitivo se estableció mediante histopatología de piel y ganglios cervicales, además del crecimiento de H. capsulatum en hemocultivos específicos para hongos. Recibió tratamiento con anfotericina B liposomal y posteriormente con itraconazol de forma ambulatoria con evolución favorable. Conclusión: El caso descrito es importante, ya que no se asemeja a la presentación típica de esta entidad, es decir, con afectación pulmonar primaria y posteriormente cutánea. Se espera haber enriquecido el conocimiento de esta enfermedad en pacientes trasplantados.

Introduction: Histoplasma capsulatum infection frequently occurs in patients with HIV immunosuppression or in transplant recipients receiving immunosuppressive therapy. Primary infection is acquired by inhalation with pulmonary involvement, and may subsequently spread to other organs such as liver, intestines, heart, kidneys, skin or bone tissue. It is very rare in renal transplant patients, although it is common in lung transplantation. Objective: To present the case of a patient with a history of renal transplantation nine years earlier, who was admitted for presenting skin lesions not typical of histoplasmosis, developing disseminated histoplasmosis two weeks later, without pulmonary involvement. Clinical Case: Post-renal transplant male patient, aged 65, who developed cutaneous manifestations characterized by erythematous and scaly papules and plaques with crusty and atrophic surfaces, accompanied by persistent fever and lymphadenopathy. There were no pulmonary signs or symptoms of a primary infection. The definitive diagnosis was made by histopathology of skin and cervical nodes, in addition to the growth of H. capsulatum in specific blood cultures for fungi. The patient was treated with liposomal amphotericin B and later with itraconazole on an outpatient basis with favorable evolution. Conclusion: The case described is important since it does not resemble the typical presentation of this entity, that is, with primary pulmonary and subsequently cutaneous involvement. It is expected to have enriched the knowledge of this disease in transplanted patients.

Risk factors associated with urethral stricture recurrence after end-to-end urethroplasty and buccal mucosal graft urethroplasty.

OBJECTIVES: (1) Assess risk factors associated with urethral stricture recurrence (USR). (2) Assess urethral stricture recurrence after end-to-end urethroplasty (EE) and buccal mucosal graft urethroplasty (BMG). SUBJECTS AND METHODS: A total of 29 males with urethral stricture who underwent either an end-to-end urethroplasty or a buccal mucosal graft urethroplasty were included in this study and followed for 18 months. The association between risk factors and stricture recurrence was assessed. RESULTS: Overall mean patient age was 51.69 ± 14.22 years, time to recurrence was 3 months (IQR: 1-6.25), and stricture length was 2.57 ± 1.30 cm. Important risk factors for USR were stricture length ⩾ 2 cm (p = 0.024), older age (p = 0.042), BMI > 25 kg/m2 (p = 0.021), Qmax after catheter removal <15 ml/s (χ2 = 14.87 p ⩽ <0.001) and previous urethral procedures adjusted for re-do BMG urethroplasty (χ2 = 6.10, p = 0.021). End-to-end urethroplasty showed less USR than BMG, however, these differences were not statistically significant (41.6% vs 22.2%, respectively, p ⩾ 0.05). CONCLUSIONS: Stricture length, age, BMI, and previous urethral procedures predict USR, furthermore, an initial Qmax after catheter removal is an objective measure predictive of USR. There's no difference in USR rate between BMG and EE urethroplasties.

Comunicación asertiva en directivos de la Escuela de Iniciación Deportiva Provincial / Comunicação assertiva nos gestores da Escola Provincial de Iniciação ao Esporte / Assertive communication in managers of the Provincial School of Sport Initiation

RESUMEN La asertividad es una habilidad social clave para la promoción del desarrollo humano y la prevención de problemas psicosociales en los diversos ámbitos del desarrollo humano. El objetivo de este trabajo es determinar las características que asume la comunicación asertiva en directivos de la Escuela de Iniciación Deportiva Escolar "Ormani Arenado Llonch" de Pinar del Río. Se realizó un estudio observacional, descriptivo, transversal en el periodo comprendido entre abril y junio de 2018. Para ello, se utilizó un muestreo no probabilístico por conveniencia, quedando conformada la muestra por 12 directivos. Como métodos empíricos de obtención de información, se utilizaron: la observación, la Escala de Asertividad de Rathus y la entrevista semiestructurada. En la investigación, se mostró predominio de directivos que se encontraban entre los 50 y 60 años de edad (33 %) y que pertenecían al género masculino (67 %). Los cargos ocupados fueron fundamentalmente Subdirector en Formación Integral, Jefe de Grado y Jefe de Departamento (25 %). La totalidad de la muestra recibió cursos de superación de postgrado (100 %). Primaron los participantes que tenían entre 21 y 30 años de experiencia laboral. Prevaleció el estilo comunicativo asertivo confrontativo (42 %). El desarrollo económico y social en la Cuba de hoy necesita de directivos que actúen alejados de posturas agresivas y egoístas; pero también que dejen atrás posturas acríticas y pasivas, necesita de hombres y mujeres asertivos.

RESUMO A assertividade é uma habilidade social chave para a promoção do desenvolvimento do homem e a prevenção de problemas psicossociais em diferentes áreas da evolução humana. O objetivo deste trabalho é determinar as características que a comunicação assertiva assume nos dirigentes da Escola de Iniciação ao Esporte "Ormani Arenado Llonch" de Pinar del Río. Um estudo observacional, descritivo e transversal foi realizado entre abril e junho de 2018. Para este fim, foi utilizada uma amostragem de conveniência não-probabilística, e a amostra consistiu de 12 diretores. Os métodos empíricos utilizados para obter informações foram: a observação, a Escala de Assertividade de Rathus e a entrevista semiestruturada. A pesquisa mostrou uma predominância de gerentes entre 50 e 60 anos de idade (33 %) e pertencentes ao sexo masculino (67 %). Os cargos ocupados foram principalmente o de Chefe Adjunto de Treinamento Integral, Chefe de Grau e Chefe de Departamento (25 %). A amostra inteira recebeu treinamento de pós-graduação (100 %). Os participantes com entre 21 e 30 anos de experiência de trabalho foram predominantes. Prevaleceu o estilo de comunicação assertiva e confrontacional (42 %). O desenvolvimento econômico e social na Cuba de hoje precisa de gestores que estejam longe de posturas agressivas e egoístas; mas também que deixem para trás posturas acríticas e passivas; precisa de homens e mulheres assertivos.

ABSTRACT Assertiveness is a key social skill for the promotion of human development and the prevention of psychosocial problems in the various areas of human development. The aim of this paper is to determine the characteristics that assertive communication assumes in managers of the Sports Initiation School "Ormani Arenado Llonch" of Pinar del Río. An observational, descriptive, cross sectional study was conducted in the period between April and June 2018. For this purpose, a non-probabilistic convenience sampling was used, and the sample consisted of 12 managers. The empirical methods used to obtain information were: observation, the Rathus Assertiveness Scale and the semi-structured interview. It was shown a prevalence of managers between 50 and 60 years of age (33 %) and belonging to the male gender (67 %). The positions held were mainly Assistant Director in Integral Formation, Head of Grade and Head of Department (25 %). The totality of the sample received postgraduate courses (100 %). Participants with between 21 and 30 years of work experience prevailed. The assertive confrontational communicative style prevailed (42 %). Economic and social development in today's Cuba needs managers who act away from aggressive and selfish postures; but also who leave behind uncritical and passive postures; rather it is needed assertive men and women.

Metastatic Penile Adenocarcinoma in the Context of Rectal Cancer.

The presence of penile metastatic lesions proceeding from primary rectal tumors is a rare entity usually associated with a poor prognosis. Clinical presentation and localization may vary. There exists no consensus gold standard treatment for penile metastatic lesions, and there is continuous debate on whether lesions should undergo surgical, chemotherapeutic or palliative management.

Uso de casos clínicos en inglés como herramienta para desarrollar la competencia comunicativa profesional / The use of clinical cases in english as a tool for developing professional communicative competence

Introducción: En el contexto del dominio del inglés no todos los egresados satisfacen las exigencias de un profesional competente desde el punto de vista comunicativo. Ante tales evidencias, en los cursos de posgrados se han buscados otras vías para profundizar en el inglés de la especialidad, que permitan perfeccionar la competencia comunicativa profesional. Objetivo: Exponer algunas consideraciones sobre el uso de los casos clínicos en inglés como herramienta para desarrollar la competencia comunicativa profesional. Métodos: Estudio descriptivo en la Facultad de Estomatología de La Habana en el primer semestre del curso académico 2020-2021. La información se obtuvo mediante métodos teóricos de análisis, y síntesis de revisiones bibliográficas y documentales sobre el tema. Resultados: El uso de casos clínicos en inglés propició el enriquecimiento del vocabulario técnico de la especialidad; y estimuló el empleo de sinónimos relacionados con el lenguaje estomatológico, y la diferencia entre el lenguaje del estomatólogo y del paciente. Además, se diseñó una guía didáctica en inglés con el vocabulario utilizado para la presentación de casos clínicos que sirve como material de consulta para los estomatólogos y profesores que imparten inglés con fines específicos. Conclusiones: Sin lugar a dudas, el uso de casos clínicos con todas las discusiones que genera, ayuda a desarrollar la competencia comunicativa profesional en inglés(AU)

Introduction: In the context of mastering English, not all graduates meet the demands of a professional who is competent from a communication point of view. With such evidence, in postgraduate courses other ways have been sought to deepen the English of the specialty, which allows perfecting professional communicative competence. Objective: To present some considerations about the use of clinical cases in English as a tool for developing professional communicative competence. Methods: Descriptive study carried out at the Dental School of Havana during the first semester of the 2020-2021 academic year. The information was obtained through theoretical methods of analysis, as well as synthesis of bibliographic and documental reviews on the subject. Results: The use of clinical cases in English led to the enrichment of the technical vocabulary of the specialty. It stimulated the use of synonyms related to the dental terminology, and the difference between the language of the dental doctor and the patient. In addition, a didactic guide in English was designed with the vocabulary used for the presentation of clinical cases, which serves as reference material for dental doctors and professors who teach English for specific purposes. Conclusions: Undoubtedly, the use of clinical cases with all the discussions that it generates, helps develop professional communicative competence in English(AU)

Validez de apariencia y de contenido de la escala de resiliencia SV-RES en cuidadores cubanos / Face and content validity of the SV-RES resilience scale in cuban caregivers

A pesar de los esfuerzos realizados en las últimas décadas por conocer en profundidad la resiliencia, existen problemas metodológicos en su estudio. En este sentido, el presente artículo se propuso determinar la validez de apariencia y la validez de contenido de la Escala de Resiliencia SV-RES en cuidadores cubanos de pacientes con discapacidad motora hospitalizados. Se analizó la validez de apariencia para explorar la aplicabilidad y viabilidad del instrumento a partir de un análisis cualitativo de las respuestas emitidas por 15 sujetos que conformaron el pilotaje. Para la determinación de la validez de contenido se empleó el Índice de Validez de Contenido; en efecto, la muestra estuvo conformada por 11 expertos. En ambos casos la muestra fue no probabilística por conveniencia. Como resultados encontramos que la caracterización sociodemográfica de los cuidadores concordó con lo referido en estudios previos. Al validar la apariencia, las principales dificultades estuvieron vinculadas con la extensión de la escala y la comprensión de determinados ítems. Se mostraron evidencias de validez de contenido al obtener resultados cercanos a la unidad. La resiliencia está siendo una de las variables más estudiadas en la actualidad por las implicaciones que tiene para la salud humana, requiriendo para su evaluación rigor científico.

Despite the efforts in the last decades to know resilience in-depth, there are methodological problems in its study. In this sense, the present article aimed to determine the SV-RES Resilience Scale's face validity and content validity in Cuban caregivers of hospitalized patients with motor disabilities. The face validity was analyzed to explore the applicability and feasibility of the instrument based on a qualitative analysis of the answers given by 15 subjects who made up the pilot test. To determine de content's validity, we used the Content Validity Index; in fact, the sample consisted of 11 experts. In both cases, the sample was non-probabilistic by convenience. As a result, we found that the sociodemographic characterization of the caregivers was in agreement with previous studies. When validating the appearance, the main difficulties were related to the scale's length and the comprehension of certain items. There was evidence of content validity by obtaining results close to unity. Resilience is currently one of the most studied variables due to its implications for human health, requiring scientific rigour in its evaluation.

Effect of nanoemulsion modification with chitosan and sodium alginate on the topical delivery and efficacy of the cytotoxic agent piplartine in 2D and 3D skin cancer models.

Due to the limited options for topical management of skin cancer, this study aimed at developing and evaluating nanoemulsions (NE) for topical delivery of the cytotoxic agent piplartine (piperlongumine). NEs were modified with chitosan or sodium alginate, and the effects on the physicochemical properties, piplartine delivery and formulation efficacy were evaluated. The nanoemulsion droplets displayed similar size (96-112 nm), but opposite charge; the polysaccharides improved piplartine penetration into and across the skin (1.3-1.9-fold) in a similar manner, increasing the ratio "drug in the skin/receptor phase" by 1.4-1.5-fold compared to the plain NE and highlighting their relevance for cutaneous localization. Oleic acid addition to the chitosan-containing NE further increased drug penetration (~1.9-2.0-fold), as did increases in drug content from 0.5 to 1%. The cytotoxicity of piplartine was ~2.8-fold higher when the drug was incorporated in the chitosan-containing NE compared to its solution (IC50 = 14.6 µM) against melanoma cells. The effects of this nanocarrier on 3D melanoma tissues were concentration-related; at 1%, piplartine elicited marked epidermis destruction. These results support the potential applicability of the chitosan-modified nanoemulsion containing piplartine as a new strategy for local management of skin cancer.

Response to the letter to the editor: "Score risk scale as a prognostic factor after sudden sensorineural hearing loss".

We appreciate the opportunity to comment the observations on our paper entitled "Score risk scale as a prognostic factor after sudden sensorineural hearing loss", by Capuano et al. This letter highlights several important points, including the role of hyperbaric oxygen therapy and the possible association between patent foramen ovale and sudden sensorineural hearing loss (SSHL). Further research is needed to strengthen the association between cardiovascular risk and SSHL. We thank the authors for their insights into our paper and for adding their experience and observations on the potential role of cardiovascular risk in the etiology of SSHL.

SCORE risk scale as a prognostic factor after sudden sensorineural hearing loss.

INTRODUCTION: Sudden sensorineural hearing loss (SSHL) is an otologic urgency whose treatment is still controversial. Its etiology remains largely unknown in most cases and predicting its prognosis is still a challenge. Cardiovascular risk factors (CVRF) have been implicated in the etiopathogenesis of this entity. OBJECTIVES: Application of the SCORE (Systematic Coronary Risk Evaluation) risk scale in patients with SSHL and evaluation of its potential prognostic value in recovery in patients with CVRF. MATERIALS AND METHODS: Prospective analysis of patients with SSHL admitted for protocol treatment including intravenous corticosteroid therapy associated to weekly intratympanic injection in the event of therapeutic failure or severe hearing loss at admission. Demographic, audiometric, clinical and imaging data were assessed. The SCORE risk scale was applied and the audiometric recovery was compared among different risk groups. RESULTS: Our overall complete and partial recovery rates were 35.9% and 26%, respectively. More than a half of our patients had at least one CVRF. Of these, overweight/obesity, hyperlipidemia and hypertension were the most common. In our sample, patients with CVRF and higher SCORE risk presented higher PTA at admission and also worse hearing outcome, although these results were not statically significant. CONCLUSION: This preliminary study could not confirm the validity for SCORE scale for cardiovascular risk assessment in predicting audiometric recovery in patients with SSHL with multiple comorbidities. Further research with larger samples are needed to elucidate the etiology of SSHL and the exact role of cardiovascular risk factors in the pathophysiology of SSHL. LEVEL OF EVIDENCE: 4.

Consideraciones sobre calidad del programa del curso de posgrado "Inglés técnico para profesionales de Estomatología" / Considerations about the quality of the program for the postgraduate course technical English for Dental Practitioners

Introducción: Un programa educativo será considerado de calidad si logra sus metas y los objetivos previstos; si incluye contenido valioso y útil, que responda a los requerimientos necesarios para formar de manera integral al estudiante. Objetivo: Caracterizar algunas variables de calidad del programa del curso de posgrado "Inglés Técnico para profesionales de Estomatología". Métodos: Estudio descriptivo de corte transversal en la Facultad de Estomatología de La Habana en el segundo semestre del curso académico 2016-2017. Se analizaron las variables siguientes: pertinencia e impacto social del programa, programa del curso, tradición de la institución sede donde se desarrolla el programa, perfil laboral y académico de los profesores que impartieron el curso y el respaldo material y administrativo del programa. Resultados: Las variables analizadas fueron evaluadas de bien, aunque existe dificultad con la producción científica-investigativa de los profesores de inglés que impartieron el curso. De los 45 profesionales que participaron en el curso 33 de ellos evaluaron las condiciones físicas de las aulas y el acceso a la tecnología entre los números 8 y 9 lo que representa un 73,3 por ciento y 12 entre 6 y 7 para un 26, por ciento. Conclusiones: Las variables investigadas demuestran la calidad del programa del curso de posgrado "Inglés Técnico para Profesionales de Estomatología". Sin embargo, se evidencia la necesidad de la climatización de las aulas y el mejoramiento del horario docente, asimismo se manifiesta la diferencia en el perfil académico laboral de los profesores que imparten el curso(AU)

Introduction: an educative program will be considered to have a good quality if it achieves the planned goals and objectives; if it has valuable and useful contents which respond to the necessary requirements to train the student comprehensively. Objective: to characterize some variables concerning the quality of the syllabus of the postgraduate course "Technical English for Dental Professionals" Methods: a cross sectional and descriptive study was conducted in the Dental Faculty of Havana in the second semester of the academic year 2016-2017. The following variables were analyzed: pertinence and social impact of the syllabus, syllabus of the course, academic tradition of the institution where the course was taught, work and academic background of the teachers that taught the course and the material and administrative backup for the syllabus. Results: the studied variables were evaluated as good, although there are difficulties with the scientific and research production of the English teachers that taught the course. Thirty-three of the forty-five of the participants of the course evaluated the physical conditions of the classrooms and the access to technology between 8 and 9 (73,3 percent) and 12 of them between 6 and 7 (26 percent). Conclusion: the variables studied show the quality of the syllabus of the postgraduate course "Technical English for Dental Professionals". Nevertheless, the need for air conditioning of the classrooms and the improvement of the timetable are evident. At the same time there are differences in the work and academic background of the teachers who taught the course(AU)

Host membrane glycosphingolipids and lipid microdomains facilitate Histoplasma capsulatum internalisation by macrophages.

Recognition and internalisation of intracellular pathogens by host cells is a multifactorial process, involving both stable and transient interactions. The plasticity of the host cell plasma membrane is fundamental in this infectious process. Here, the participation of macrophage lipid microdomains during adhesion and internalisation of the fungal pathogen Histoplasma capsulatum (Hc) was investigated. An increase in membrane lateral organisation, which is a characteristic of lipid microdomains, was observed during the first steps of Hc-macrophage interaction. Cholesterol enrichment in macrophage membranes around Hc contact regions and reduced levels of Hc-macrophage association after cholesterol removal also suggested the participation of lipid microdomains during Hc-macrophage interaction. Using optical tweezers to study cell-to-cell interactions, we showed that cholesterol depletion increased the time required for Hc adhesion. Additionally, fungal internalisation was significantly reduced under these conditions. Moreover, macrophages treated with the ceramide-glucosyltransferase inhibitor (P4r) and macrophages with altered ganglioside synthesis (from B4galnt1-/- mice) showed a deficient ability to interact with Hc. Coincubation of oligo-GM1 and treatment with Cholera toxin Subunit B, which recognises the ganglioside GM1, also reduced Hc association. Although purified GM1 did not alter Hc binding, treatment with P4 significantly increased the time required for Hc binding to macrophages. The content of CD18 was displaced from lipid microdomains in B4galnt1-/- macrophages. In addition, macrophages with reduced CD18 expression (CD18low ) were associated with Hc at levels similar to wild-type cells. Finally, CD11b and CD18 colocalised with GM1 during Hc-macrophage interaction. Our results indicate that lipid rafts and particularly complex gangliosides that reside in lipid rafts stabilise Hc-macrophage adhesion and mediate efficient internalisation during histoplasmosis.

Breaking Barriers: Prospective Study of a Cohort of Advanced Chronic Obstructive Pulmonary Disease Patients To Describe Their Survival and End-of-Life Palliative Care Requirements.

BACKGROUND AND AIM: Consensus has been reached on the need to integrate palliative care in the follow-up examinations of chronic obstructive pulmonary disease (COPD) patients. We analyzed the survival from the initiation of follow-up by a palliative home care team (PHCT) and described the needs and end-of-life process. SETTING AND DESIGN: This study was a prospective observational cohort study of advanced COPD patients referred to a PHCT. Sociodemographic variables, survival from the start date of follow-up using the Kaplan-Meier model, health resource consumption, perceived quality of life, main symptomatology, opioid use, and advanced care planning (ACP) were analyzed. RESULTS: Sixty patients were included. The median survival was 8.3 months. Forty-two patients died at the end of the study (85% at home or in palliative care units). The most frequent cause of death was respiratory failure in 39 patients (93%), with 29 of these patients requiring sedation (69%). Dyspnea at rest, with an average of 5 (standard deviation [SD] 2) points, was the main symptom. Fifty-five patients (91%) required opioids for symptom control. The median score in the St. George's Respiratory Questionnaire was 72 (SD 13). The mean number of visits by the home team was 7 (SD 6.5). The mean number of admissions during the monitoring period was 1.5 (SD 0.15). CONCLUSIONS: The characteristics of the cohort appear suitable for a PHCT. The follow-up care provided by our multidisciplinary unit decreased the number of hospitalizations, favored the development of ACP, and enabled death at home or in palliative care units.

Educação e saúde na escola e a contrarreforma do ensino médio: resistir para não retroceder / Education and health in schools and the counter-reformation of secondary education: resisting in order not to regress / Educación y salud en la escuela y la contrarreforma de la educación secundaria: resistir para no retroceder

Resumo O artigo analisa o impacto das mudanças em curso, com base na aprovação da lei n. 13.415, de 16 de fevereiro de 2017, na formação dos jovens, em particular na abordagem da saúde na escola. Debatemos como as alterações na Lei de Diretrizes e Bases da Educação Nacional, introduzidas pela referida lei, poderão afetar a educação em saúde no ambiente escolar, retomando o debate sobre a educação em saúde na escola, a proposição da saúde como tema transversal e a abordagem da saúde nos livros didáticos. A contrarreforma do ensino médio significará, na prática, a flexibilização ou a supressão de conteúdos anteriormente obrigatórios a partir da instauração de itinerários formativos e arranjos curriculares com potencial para subtrair o debate do campo das ciências sociais e humanas, das quais comumente têm-se a expectativa de contribuir para a superação das concepções e práticas estritamente biomédicas do processo saúde-doença. Consideramos que profissionais de saúde, professores, pesquisadores e estudantes devam ampliar esse debate e participar efetivamente da luta pela reversão da contrarreforma tal como aprovada.

Abstract This article analyzes the impact of the ongoing changes, with the enactment of Brazilian Federal Law no. 13415, from February 16th, 2017, in the training of youths, especially regarding the approach to health in schools. We discuss how the changes in the Law of National Education Guidelines and Foundations (Lei de Diretrizes e Bases da Educação Nacional, in Portuguese), introduced by the aforementioned law will affect education in health in school settings, reviving the debate about education in health in schools, the proposal of health as a cross-sectional topic, and the approach to health in schoolbooks. The counter-reformation of secondary education will mean, in practice, the adaptation or suppression of content that was previously mandatory with the establishment of training itineraries and syllabus arrangements with a potential to take the debate away from the fields of Social Sciences and Humanities, fields that are commonly expected to contribute to overcome the strictly biomedical conceptions and practices of the health-illness process. We consider that health professionals, teachers, researchers and students should expand this debate and effectively take part in the struggle for the reversal of the counter-reformation as it was enacted.

Resumen El artículo analiza el impacto de los cambios en curso en la formación de los jóvenes, en particular en el abordaje de la salud en la escuela, a partir de la aprobación de la ley n° 13.415 del 16 de febrero del 2017. Debatimos la forma en la que las modificaciones en la Ley de Directrices y Bases de la Educación Nacional, introducidas por la ley antes mencionada, podrán afectar la educación en salud en el ambiente escolar, retomando el debate sobre la educación en salud en la escuela, la propuesta de la salud como un tema transversal y el abordaje de la salud en los libros didácticos. La contrarreforma de la educación secundaria significará, en la práctica, la flexibilización o la eliminación de contenidos anteriormente obligatorios a partir de la instauración de itinerarios de formación y planes de estudio con potencial para retirar el debate del ámbito de las ciencias sociales y humanas, de las que comúnmente se espera que contribuyan a superar las concepciones y prácticas estrictamente biomédicas del proceso de salud-enfermedad. Consideramos que los profesionales de la salud, profesores, investigadores y estudiantes, deben ampliar este debate y participar efectivamente de la lucha para revertir la contrarreforma tal como ha sido aprobada.