Timely radiographic detection of developmental dysplasia of the hip in family medicine residents. Educative intervention.

BACKGROUND: Developmental dysplasia of the hip (DDH) is a complex clinical entity that is usually underdiagnosed, if not detected and managed early, will turn the affected individual into a disabled being, with negative social, economic and emotional effects. OBJECTIVE: To determine the capacity for the timely radiographic detection of DDH before and after an educational intervention. METHOD: An educational intervention is carried out in family medicine resident, where they are given training on detection in DDH radiographic projections. Pre- and post-training evaluation is carried out. Statistical analysis is performed using Student's t and χ2, taking p ≤ 0.05 as significant. RESULTS: 94 residents participated. In the pre-intervention evaluation, 87.2% had no knowledge of the early detection protocol (p = 0.525). It was observed that 98.9% incorrectly drew the Perkins line (p = 0.427), 96.8% the Hilgenreiner line (p = 0.177) and 87.2% did not consider the data of bilateral dysplasia (p = 0.956). After the educational intervention, 87.2% correctly drew the Perkins line (p = 0.926), 97.8% the Hilgenreiner line (p = 0.325) and 78.7% if they considered the data of bilateral dysplasia (p = 0.826). CONCLUSIONS: After this training, 80% of family medicine residents were able to detect DDH in a timely manner.

ANTECEDENTES: La displasia del desarrollo de la cadera (DDC) constituye una entidad clínica compleja que suele ser infradiagnosticada que, de no ser precozmente detectadas y manejadas, convertirán al individuo afectado en un ser discapacitado, con efecto negativo social, económico y emocional. OBJETIVO: Determinar la capacidad para la detección radiográfica oportuna de la DDC antes y después de una intervención educativa en médicos residentes de medicina familiar. MÉTODO: Se realizó una intervención educativa en residentes de medicina familiar, en la que se les dio capacitación sobre detección de DDC en proyecciones radiográficas. Se realizó una evaluación previa y posterior a la capacitación. El análisis estadístico se realizó mediante pruebas t de Student y χ2, tomando como significativo un valor de p ≤ 0.05. RESULTADOS: Participaron 94 residentes. El 87.2% dijeron no conocer el protocolo radiológico de detección. En la evaluación preintervención, el 87.2% no tenían conocimiento del protocolo (p = 0.525). Se observó que el 98.9% trazaron de manera incorrecta la línea de Perkins (p = 0.427), el 96.8% la línea de Hilgenreiner (p = 0.177) y el 87.2% no consideraron los datos de displasia bilateral (p = 0.956). Posterior a la intervención educativa, el 87.2% trazaron de manera correcta la línea de Perkins (p = 0.926), el 97.8% la línea de Hilgenreiner (p = 0.325) y el 78.7% sí consideró los datos de displasia bilateral (p = 0.826). CONCLUSIONES: Tras la capacitación, el 80% de los médicos residentes de medicina familiar fueron capaces de detectar oportunamente la DDC.

Associations between Menopausal Hormone Therapy and Colorectal, Lung, or Melanoma Cancer Recurrence and Mortality: A Narrative Review.

Objective: to develop eligibility criteria for use in non-gynecological cancer patients. Methods: We searched all the articles published in peer-reviewed journals up to March 2021. We utilized the PICOS standards and the following selection criteria: menopausal women with a history of non-gynecological and non-breast cancer who underwent hormone replacement therapy (HRT) using various preparations (oestrogens alone or in combination with a progestogen, tibolone, or tissue selective oestrogen complex) and different routes of administration (including oral, transdermal, vaginal, or intra-nasal). We focused on randomized controlled trials as well as relevant extension studies or follow-up reports, specifically examining recurrence and mortality outcomes. Results: Women colorectal cancer survivors who use MHT have a lower risk of death from any cause than those survivors who do not use MHT. Women who are skin melanoma survivors using MHT have a longer survival rate than non-MHT survivors. There is no evidence that women lung cancer survivors who use MHT have a different survival rate than those who do not use MHT. Conclusions: MHT is safe for women who have a history of colorectal, lung, or skin melanoma cancers.

Nitazoxanide Inhibits the Bifunctional Enzyme GlG6PD::6PGL of Giardia lamblia: Biochemical and In Silico Characterization of a New Druggable Target.

Giardiasis, which is caused by Giardia lamblia infection, is a relevant cause of morbidity and mortality worldwide. Because no vaccines are currently available to treat giardiasis, chemotherapeutic drugs are the main options for controlling infection. Evidence has shown that the nitro drug nitazoxanide (NTZ) is a commonly prescribed treatment for giardiasis; however, the mechanisms underlying NTZ's antigiardial activity are not well-understood. Herein, we identified the glucose-6-phosphate::6-phosphogluconate dehydrogenase (GlG6PD::6PGL) fused enzyme as a nitazoxanide target, as NTZ behaves as a GlG6PD::6PGL catalytic inhibitor. Furthermore, fluorescence assays suggest alterations in the stability of GlG6PD::6PGL protein, whereas the results indicate a loss of catalytic activity due to conformational and folding changes. Molecular docking and dynamic simulation studies suggest a model of NTZ binding on the active site of the G6PD domain and near the structural NADP+ binding site. The findings of this study provide a novel mechanistic basis and strategy for the antigiardial activity of the NTZ drug.

Eligibility criteria for Menopausal Hormone Therapy (MHT): a position statement from a consortium of scientific societies for the use of MHT in women with medical conditions. MHT Eligibility Criteria Group.

This project aims to develop eligibility criteria for menopausal hormone therapy (MHT). The tool should be similar to those already established for contraception A consortium of scientific societies coordinated by the Spanish Menopause Society met to formulate recommendations for the use of MHT by women with medical conditions based on the best available evidence. The project was developed in two phases. As a first step, we conducted 14 systematic reviews and 32 metanalyses on the safety of MHT (in nine areas: age, time of menopause onset, treatment duration, women with thrombotic risk, women with a personal history of cardiovascular disease, women with metabolic syndrome, women with gastrointestinal diseases, survivors of breast cancer or of other cancers, and women who smoke) and on the most relevant pharmacological interactions with MHT. These systematic reviews and metanalyses helped inform a structured process in which a panel of experts defined the eligibility criteria according to a specific framework, which facilitated the discussion and development process. To unify the proposal, the following eligibility criteria have been defined in accordance with the WHO international nomenclature for the different alternatives for MHT (category 1, no restriction on the use of MHT; category 2, the benefits outweigh the risks; category 3, the risks generally outweigh the benefits; category 4, MHT should not be used). Quality was classified as high, moderate, low or very low, based on several factors (including risk of bias, inaccuracy, inconsistency, lack of directionality and publication bias). When no direct evidence was identified, but plausibility, clinical experience or indirect evidence were available, "Expert opinion" was categorized. For the first time, a set of eligibility criteria, based on clinical evidence and developed according to the most rigorous methodological tools, has been defined. This will provide health professionals with a powerful decision-making tool that can be used to manage menopausal symptoms.

La superación profesional dirigida a docentes de Enfermería como vía para mejorar la atención del adulto mayor

RESUMEN El artículo constituye un acercamiento a las razones que respaldan la necesidad de resaltar el proceso de superación profesional para el tratamiento de estilos de vida saludables del adulto mayor en los docentes de la carrera de Enfermería, como una alternativa permanente encaminada al progreso profesional y humano que debe responder a las transformaciones que se requieren en los conocimientos, habilidades, prácticas y cualidades profesionales de educadores. Por la importancia del tema se persigue como objetivo valorar la pertinencia de una estrategia para la superación profesional de los docentes de la enseñanza de la carrera de Enfermería, sustentada en un modelo de igual denominación, que coherentemente atienda todo lo relacionado con el fomento de estilos de vida saludables del adulto mayor. Se emplearon los métodos investigativos como el análisis documental; análisis y síntesis; la inducción y deducción. Entre los resultados se destaca el perfeccionamiento del desempeño de los docentes, a partir del tratamiento integrado a la relación enfermedad - rehabilitación - estilos de vida saludables en el adulto mayor para favorecer el logro de una longevidad satisfactoria desde la integración hombre, familia y comunidad en la atención primaria de salud.

ABSTRACT The article constitutes an approach to the reasons that support the need to highlight the process of professional improvement for the treatment of healthy lifestyles of the elderly in Nursing teachers, as a permanent alternative aimed at professional and human progress that It must respond to the transformations that are required in the knowledge, skills, practices and professional qualities of educators Due to the importance of the subject, the objective is to reflect on the relevance of a strategy for the professional improvement of teachers of career teaching Nursing, based on a model of the same name, which consistently addresses everything related to the promotion of healthy lifestyles of the elderly. Investigative methods such as documentary analysis were used; analysis and synthesis; induction and deduction. Among the results, the improvement of the theoretical-practical experience of the teachers stands out, from the integrated treatment to the relationship between disease - rehabilitation - healthy lifestyles in the elderly to favor the achievement of a satisfactory longevity from the integration of man, family and community in primary health care.

Validation and Selection of New Reference Genes for RT-qPCR Analysis in Pediatric Glioma of Different Grades.

Gliomas are heterogeneous, solid, and intracranial tumors that originate from glial cells. Malignant cells from the tumor undergo metabolic alterations to obtain the energy required for proliferation and the invasion of the cerebral parenchyma. The alterations in the expression of the genes related to the metabolic pathways can be detected in biopsies of gliomas of different CNS WHO grades. In this study, we evaluated the expression of 16 candidate reference genes in the HMC3 microglia cell line. Then, statistical algorithms such as BestKeeper, the comparative ΔCT method, geNorm, NormFinder, and RefFinder were applied to obtain the genes most suitable to be considered as references for measuring the levels of expression in glioma samples. The results show that PKM and TPI1 are two novel genes suitable for genic expression studies on gliomas. Finally, we analyzed the expression of genes involved in metabolic pathways in clinical samples of brain gliomas of different CNS WHO grades. RT-qPCR analysis showed that in CNS WHO grade 3 and 4 gliomas, the expression levels of HK1, PFKM, GAPDH, G6PD, PGD1, IDH1, FASN, ACACA, and ELOVL2 were higher than those of CNS WHO grade 1 and 2 glioma biopsies. Hence, our results suggest that reference genes from metabolic pathways have different expression profiles depending on the stratification of gliomas and constitute a potential model for studying the development of this type of tumor and the search for molecular targets to treat gliomas.

Identification and In Silico Characterization of Novel Helicobacter pylori Glucose-6-Phosphate Dehydrogenase Inhibitors.

Helicobacter pylori (H. pylori) is a pathogen that can remain in the stomach of an infected person for their entire life. As a result, this leads to the development of severe gastric diseases such as gastric cancer. In addition, current therapies have several problems including antibiotics resistance. Therefore, new practical options to eliminate this bacterium, and its induced affections, are required to avoid morbidity and mortality worldwide. One strategy in the search for new drugs is to detect compounds that inhibit a limiting step in a central metabolic pathway of the pathogen of interest. In this work, we tested 55 compounds to gain insights into their possible use as new inhibitory drugs of H. pylori glucose-6-phosphate dehydrogenase (HpG6PD) activity. The compounds YGC-1; MGD-1, MGD-2; TDA-1; and JMM-3 with their respective scaffold 1,3-thiazolidine-2,4-dione; 1H-benzimidazole; 1,3-benzoxazole, morpholine, and biphenylcarbonitrile showed the best inhibitory activity (IC50 = 310, 465, 340, 204 and 304 µM, respectively). We then modeled the HpG6PD protein by homology modeling to conduct an in silico study of the chemical compounds and discovers its possible interactions with the HpG6PD enzyme. We found that compounds can be internalized at the NADP+ catalytic binding site. Hence, they probably exert a competitive inhibitory effect with NADP+ and a non-competitive or uncompetitive effect with G6P, that of the compounds binding far from the enzyme's active site. Based on these findings, the tested compounds inhibiting HpG6PD represent promising novel drug candidates against H. pylori.

Beliefs, knowledge and the impact of COVID19 on menopause therapies in Spanish women: COMEM-treatment study.

OBJECTIVE: To study what women think about menopause treatments and assess their knowledge about them. To analyze adherence to treatment during COVID-19 confinement as a secondary objective. METHODS: A multi-center cross-sectional observational study was conducted using a survey of 2500 women between January and June 2019. This was administered following a non-probability sampling procedure including women between 35 and 75 years. An extension study was conducted during the coronavirus pandemic, between March and June 2020. RESULTS: The responses of 2355 surveyed women were analyzed. Of this sample, 42% knew about menopause hormone therapy (MHT). The most frequently identified indication was the treatment of hot flashes (65.6%). The MHT risks most frequently perceived were weight gain (24.2%) and breast cancer (21.7%); the main reason for rejecting MHT was a lack of information (96.1%). Comparative analyses were conducted according to age, menopausal status, type of menopause, place of residence, type of health care and level of education. During the coronavirus confinement period, 85 women using MHT were located, of which 84.7% continued it. CONCLUSIONS: Women hold certain false beliefs about menopause, and their knowledge of the available treatments is somewhat limited. Adherence to MHT during the COVID-19 confinement in Spain has been high.

Disseminated Cryptococcosis After Liver Transplant: A Case Report.

Cryptococcosis is an opportunistic infection caused by the Basidiomycota Cryptococcus neoformans (Cryptococcus gattii), which affects immunosuppressed patients and less frequently immunocompetent patients. Solid-organ transplant recipients are a particularly high-risk group, depending on the net state of immunosuppression. In these patients, the infection usually appears after the first year after transplant, although it may occur earlier in liver transplant recipients. In most cases, the infection is secondary to the reactivation of a latent infection, although it may be due to an unidentified pretransplant infection by primary infection. Less frequently, it may be transmitted by the graft. The lung and central nervous system are most frequently involved. Extrapulmonary involvement is seen in 75% of the cases, and disseminated disease occurs in 61%, with mortality ranging from 17% to 50% when the central nervous system is involved. Here, we report a case of disseminated cryptococcosis (lymphadenitis, meningitis, pulmonary nodules, and possibly sacroiliitis) in a patient after liver transplant, with good clinical and microbiological outcomes and without relapse.

Contraception in cancer survivors - an expert review Part II. Skin, gastrointestinal, haematological and endocrine cancers.

Objective: The efficacy of treatment for many cancers has increased dramatically in recent decades and there is a growing number of cancer survivors who need effective contraception. In this paper, a group of experts from the European Society of Contraception set out to define the most frequent cancers in women and summarise the guidelines, reviews and studies that provide information and guidance on contraception for each cancer. Methods: Epidemiological studies were analysed to determine the frequency of cancers in women of reproductive age. A narrative review was performed for each cancer, collecting data about the treatment of the disease, its impact on fertility, and the efficacy, health risks, possible benefits and contraindications of the contraceptive methods available. The recommendations were then summarised. Results: Owing to the large amount of information the results are presented in two parts. Part 1 includes contraception after breast and gynaecological cancers. Part 2 summarises the findings and recommendations regarding contraception in women with skin, gastrointestinal, haematological and endocrine cancers.

Contraception in cancer survivors - an expert review Part I. Breast and gynaecological cancers.

Objective: The efficacy of treatment for many cancers has increased dramatically in recent decades and there are a growing number of cancer survivors who need effective contraception. In this paper, a group of experts from the European Society of Contraception set out to define the most frequent cancers in women and summarise the guidelines, reviews and studies that provide information and guidance on contraception for each cancer. Methods: Epidemiological studies were analysed to determine the frequency of cancers in women of reproductive age. A narrative review was performed for each cancer, collecting data about the treatment of the disease, its impact on fertility, and the efficacy, health risks, possible benefits and contraindications of the contraceptive methods available. The recommendations were then summarised. Results: Owing to a large amount of information, the results are presented in two parts. Part 1 includes contraception after breast and gynaecological cancers. Part 2 summarises the findings and recommendations regarding contraception in women with skin, gastrointestinal, haematological and endocrine cancers.

Successful treatment of pulmonary invasive fungal infection by Penicillium non-marneffei in lymphoblastic lymphoma: case report and literature review.

Penicillium non-marneffei species rarely cause disease in humans and are encountered most commonly in the clinical laboratory as culture contaminants; however, recently they have emerged as opportunistic pathogens in immunocompromised hosts; therefore, it should not be routinely disregarded without a thorough investigation, especially if normally sterile sites are involved.

Effectiveness of an educational group intervention in primary healthcare for continued exclusive breast-feeding: PROLACT study.

BACKGROUND: The World Health Organization leads a global strategy to promote the initiation and maintenance of breast-feeding. Existing literature shows that education and supportive interventions, both for breast-feeding mothers as well as for healthcare professionals, can increase the proportion of women that use exclusive breast-feeding, however, more evidence is needed on the effectiveness of group interventions. METHODS: This study involves a community-based cluster randomised trial conducted at Primary Healthcare Centres in the Community of Madrid (Spain). The project aims to evaluate the effectiveness of an educational group intervention performed by primary healthcare professionals in increasing the proportion of mother-infant pairs using exclusive breastfeeding at six months compared to routine practice. The number of patients required will be 432 (216 in each arm). All mother-infant pairs using exclusive breastfeeding that seek care or information at healthcare centres will be included, as long as the infant is not older than four weeks, and the mother has used exclusive breastfeeding in the last 24 h and who gives consent to participate. The main response variable is mother-infant pairs using exclusive breast-feeding at six months. Main effectiveness will be analysed by comparing the proportion of mother-infant pairs using exclusive breast-feeding at six months between the intervention group and the control group. All statistical tests will be performed with intention-to-treat. The estimation will be adjusted using an explanatory logistic regression model. A survival analysis will be used to compare the two groups using the log-rank test to assess the effect of the intervention on the duration of breastfeeding. The control of potential confounding variables will be performed through the construction of Cox regression models. DISCUSSION: We must implement strategies with scientific evidence to improve the percentage of exclusive breast-feeding at six months in our environment as established by the WHO. Group education is an instrument used by professionals in Primary Care that favours the acquisition of skills and modification of already-acquired behaviour, all making it a potential method of choice to improve rates of exclusive breast-feeding in this period. TRIAL REGISTRATION: The trial was registered with ClinicalTrials.gov under code number NCT01869920 (Date of registration: June 3, 2013).

Malakoplakia after kidney transplantation: Case report and literature review.

Malakoplakia is a granulomatous disease associated with an infectious etiology, usually involving the urinary tract. It reveals itself as a recurrent urinary tract infection (r-UTI), and in some cases, it is associated with impairment of renal function. Immunosuppression is one of its main associated factors, and it has been increasingly described in patients with solid organ transplantation (SOT), mainly kidney transplantation. Macroscopically, it can form masses and sometimes it may be confused with neoplasia, which is why histological findings are fundamental for the diagnosis. Here, we present a case of bladder malakoplakia, manifested by r-UTI from Escherichia coli in a patient with renal transplantation, refractory to long-term antibiotic treatment and reduction in immunosuppression, which resolved after surgical management. We also summarize the clinical characteristics of malakoplakia and compare them with previous reports in the literature on SOT.

Toxoplasmosis gastrointestinal en un paciente trasplantado renal / Gastrointestinal toxoplasmosis in a renal transplant patient

Resumen La toxoplasmosis posterior al trasplante renal es una condición infrecuente, pero asociada con alta morbilidad y mortalidad. Generalmente ocurre en los primeros tres meses cuando la inmunosupresión es mayor, siendo más común la presentación con encefalitis y neumonitis. El compromiso del tracto gastrointestinal es inusual y con síntomas inespecíficos. Su diagnóstico es un reto pues no siempre existe seroconversión en estadios tempranos de la infección o no hay evidencia histológica del parásito; es aquí donde la biología molecular y la historia clínica pueden resultar útiles para el diagnóstico oportuno que favorezca un buen desenlace. Describimos el caso de un paciente con síntomas generales, náuseas y emesis en el periodo postrasplante renal temprano atribuidos primero a reactivación de citomegalovirus con diagnóstico posterior de gastritis por Toxoplasma gondii. Recibió tratamiento con trimetoprim sulfametoxazol por seis semanas con resolución completa de los síntomas. (Acta Med Colomb 2016; 40: 266-268).

Abstract Toxoplasmosis following renal transplantation is an uncommon condition, but is associated with high morbidity and mortality. It usually occurs in the first three months when immunosuppression is greater, being more common the presentation with encephalitis and pneumonitis. The involvement of the gastrointestinal tract is unusual and with nonspecific symptoms. Its diagnosis is a challenge because there is not always seroconversion in the early stages of infection or there is no histological evidence of the parasite; it is here that molecular biology and clinical history can be useful for a timely diagnosis that may favor a good outcome. The case of a patient with general symptoms, nausea and emesis in the early renal transplant period attributed initially to reactivation of cytomegalovirus with subsequent diagnosis of gastritis by Toxoplasma gondii, is described. He received treatment with trimethoprim sulfamethoxazole for six weeks with complete resolution of symptoms. (Acta Med Colomb 2016; 40: 266-268).

[Epidemiology of febrile neutropenia in adult patients with hematologic neoplasms in a period of 26 months in Hospital Pablo Tobón Uribe, Colombia]. / Epidemiología de la neutropenia febril en pacientes adultos con neoplasia hematológica, en un período de 26 meses en el Hospital Pablo Tobón Uribe, Colombia.

BACKGROUND: Febrile neutropenia (FN) is a significant adverse effect post-chemotherapy due to its high morbidity and mortality. There are few studies in our country with these kind of patients. OBJECTIVE: To describe the characteristics and mortality in patients with hematologic neoplasms who developed FN post-chemotherapy. METHODOLOGY: A descriptive case series in patients with hematologic neoplasms who developed FN post-chemotherapy in Hospital Pablo Tobón Uribe. RESULTS: 101 episodes of FN in 43 patients. The median age was 44 years. 63.5% of patients had no apparent clinical focus of infection at admission, 11.8% had soft tissue compromise and 8.9% urinary tract infection. Bacteremia was documented in 41.5% and catheter-associated bacteremia in 3.9%. The most common organisms were Escherichia coli 43.4%, Klebsiella pneumoniae 17.3% and Staphylococcus aureus 8.6%. Of those isolated in blood 84.7% were Gram negative rods and 15.2% were Gram positive bacteria. Piperacillin/tazobactam was the most common empirically prescribed antibiotic (81.1%). Mortality of FN episodes occurred in 8 (7.92%) patients, 5 (62.5%) attributable to infection and 3 (37.5%) due to progression of hematologic malignancy with a resolution of FN. CONCLUSIONS: In our case series of FN the microbiological characteristics differed significantly from developed countries, but a similar mortality rate per episode was observed.