Aquatic Exercise in Physical Therapy Treatment for Fibromyalgia: Systematic Review.

Fibromyalgia is a chronic condition characterized by musculoskeletal pain. The aim of this study was to synthesize scientific evidence on the effects of aquatic exercise programs on pain and quality of life in individuals with fibromyalgia. This review was carried out using the following databases in January 2024: Cochrane Library, PEDro, PubMed, SCOPUS, and Web of Science. Four clinical trials focusing on aquatic exercise as a treatment for patients with fibromyalgia were selected. These trials were published in English between 2019 and 2024. Pain recorded using the Visual Analog Scale (VAS) and quality of life with the Short Form-36 Health Survey (SF-36) or Fibromyalgia Impact on Quality of Life (FIQ) were the most commonly analyzed variables. This review was carried out according to the PRISMA statement and was registered in PROSPERO (CRD42024510219). The results in terms of pain and quality of life were positive. In conclusion, these findings support the incorporation of aquatic exercise into fibromyalgia physical therapy treatment. However, the benefits could be equivalent to those of other exercise modalities, underscoring the need for individualized adaptation to each patient's needs.

El teléfono inteligente en la obtención de imágenes en oftalmología y su aplicación en el aprendizaje / The Smartphone in Ophthalmology Imaging and its Application in Learning

La imagen es parte de la columna vertebral en la medicina y que llega a su máximo punto en la Oftalmología. La importancia de la fotografía ocular va desde registrar condiciones médicas específicas, rastrear la progresión de enfermedades y crear ilustraciones para la publicación y la enseñanza; en resumen, una herramienta indispensable para el diagnóstico. Los aditamentos que en la presente publicación mostramos, son el resultado de una investigación de desarrollo que se realizó en el Instituto Cubano de Oftalmología "Ramón Pando Ferrer", durante el año 2021 con el objetivo de crear aditamentos que, acoplados a los teléfonos inteligentes, permiten tomar imágenes en el área de la Oftalmología utilizando la tecnología de impresión 3D. Inicialmente se identificaron los lugares que permitan crear imágenes en la especialidad con un aditamento y el teléfono inteligente, posteriormente se procederá a diseñar los aditamentos de acuerdo a las características del lugar donde se van a utilizar y finalmente mostramos la utilidad de los prototipos diseñados en la práctica docente(AU)

Imaging is part of the backbone in medicine and it reaches its peak in Ophthalmology. The importance of ocular photography ranges from recording specific medical conditions, tracking disease progression, and creating illustrations for publication and teaching; in short, an indispensable tool for diagnosis. The attachments, which we show in the present publication, are the result of a development research that was carried out at the Cuban Institute of Ophthalmology "Ramón Pando Ferrer" during the year 2021 with the aim of creating attachments that, coupled to smartphones, allow taking images in the area of Ophthalmology using 3D printing technology. Initially we identified the places that allow creating images in the specialty with an attachment and the smartphone, then we will proceed to design the attachments according to the characteristics of the place where they will be used and finally we show the usefulness of the designed prototypes in the teaching practice(AU)

Targeting Ultrasmall Gold Nanoparticles with cRGD Peptide Increases the Uptake and Efficacy of Cytotoxic Payload.

Cyclic arginyl-glycyl-aspartic acid peptide (cRGD) peptides show a high affinity towards αVß3 integrin, a receptor overexpressed in many cancers. We aimed to combine the versatility of ultrasmall gold nanoparticles (usGNP) with the target selectivity of cRGD peptide for the directed delivery of a cytotoxic payload in a novel design. usGNPs were synthesized with a modified Brust-Schiffrin method and functionalized via amide coupling and ligand exchange and their uptake, intracellular trafficking, and toxicity were characterized. Our cRGD functionalized usGNPs demonstrated increased cellular uptake by αVß3 integrin expressing cells, are internalized via clathrin-dependent endocytosis, accumulated in the lysosomes, and when loaded with mertansine led to increased cytotoxicity. Targeting via cRGD functionalization provides a mechanism to improve the efficacy, tolerability, and retention of therapeutic GNPs.

Inflammatory Response, Immunosuppression and Arginase Activity after Cardiac Surgery Using Cardiopulmonary Bypass.

Background: Major surgeries suppress patients' cellular immunity for several days, but the mechanisms underlying this T-cell dysfunction are not well understood. A decreased L-Arginine (L-Arg) level may inhibit T-cell function. Arginase 1 (Arg 1) is induced after traumatic injury, leading to molecular changes in T cells, including decreased expression of cell surface T-cell receptors (TCRs) and a loss in CD3ζ chain expression. In this study, we examined the temporal patterns of CD3ζ expression and Arg 1 activity in patients undergoing cardiac surgery with cardiopulmonary bypass (CPB). Methods: We determined the CD3ζ chain expression; the Arg 1 activity; and the leukocyte, neutrophil and lymphocyte levels of patients on the day before surgery and at 24, 48 and 72 h after surgery. Results: Fifty adult patients scheduled for elective cardiac surgery with CPB were eligible for enrolment. Arginase activity was significantly increased between the day before surgery and at 24, 48 and 72 h after surgery (p < 0.01), and CD3ζ expression was significantly decreased between the day before surgery and at 24, 48 and 72 h after surgery (p < 0.001). We observed significant leukocytosis, neutrophilia and lymphopenia after surgery. Conclusions: The decreased CD3ζ chain expression could be due to the increased Arg 1 activity secondary to the activation of neutrophils in cardiac surgery under CPB. These findings could explain the limited immune-system-mediated organ damage resulting from systemic inflammatory response to major cardiac surgery with CPB.

Defining a Standard Set of Patient-Reported Outcomes for Patients With Advanced Ovarian Cancer.

Purpose: Advanced ovarian cancer (AOC) and its treatment cause several symptoms and impact on patients' health-related quality of life (HRQoL). We aim to reach a consensus on the most relevant patient-reported outcome (PROs), the corresponding measures (PROMs), and measurement frequency during AOC patients' follow-up from patients' and healthcare professionals' (HCP) perspective. Methods: The project comprised five steps: 1) a literature review, 2) a focus group with patients, 3) a nominal group with HCP, 4) two round-Delphi consultations with patients and HCP, and 5) a final meeting with HCP. Delphi questionnaire was elaborated based on literature review, focus group (n=5 patients), and nominal group (n=16 HCP). The relevance of each PRO and the appropriateness (A) and feasibility (F) of the proposed PROM were assessed (Likert scale 1=strongly agree; 9=strongly disagree). The consensus was reached when at least 75% of the panelists rated it as 'relevant', 'appropriate', or 'feasible' (score 7-9). Results: A total of 56 HCP [51.8% Hospital Pharmacy; 41.1% Oncology; 3.6% Nursing; and 3.6% Psycho-oncology; mean time in specialty 12.5 (8.0) years] and 10 AOC patients [mean time diagnosis 5.4 (3.0) years] participated in the 1st round. All PROs achieved consensus regarding their relevance, except dry skin (58.0%). Agreement was reached for PRO-CTCAE to be used to assess fatigue (A:84.9%; F:75.8%), neuropathy (A:92.4%; F:77.3%), diarrhea (A:87.9%; F:88.7%), constipation (A:86.4%; F:75.8%), nausea (A:89.4%; F:75.8%), insomnia (A:81.8%; F:88.7%), abdominal bloating (A:82.2%; F:82.2%) and sexuality (A:78.8%; F:88.6%); EQ-5D to determine patients' HRQoL (A:87.9%; F:80.3%), pain (A:87.9%; F:75.8%) and mood (A:77.7%; F:85.5%); to assess treatment adherence the Morisky-Green (A:90.9%; F:84.9%) and the dispensing register (A:80.3%; F:80.3%) were chosen. It was agreed to note in the medical record whether the patient's treatment preferences had been considered during decision-making (A:78.8%; F:78.8%) and to use a 5-point Likert scale to assess treatment satisfaction (A:86.4%; F:86.4%). Panelists agreed (A:92.4%; F: 77.3%) to collect these PROs (1) at the time of diagnosis/relapse; (2) one month after starting treatment/change therapeutic strategy; (3) every three months during the 1st-year of treatment; and later (4) every six months until treatment completion/change. Conclusions: The consensus reached represents the first step towards including the patient's perspective in AOC follow-up. The standardized collection of PROs in clinical practice may contribute to optimizing the follow-up of these patients and thus improving the quality of care.

Risk Factors and Predictive Score for Bacteremic Biliary Tract Infections Due to Enterococcus faecalis and Enterococcus faecium: a Multicenter Cohort Study from the PROBAC Project.

Biliary-tract bloodstream infections (BT-BSI) caused by Enterococcus faecalis and E. faecium are associated with inappropriate empirical treatment and worse outcomes compared to other etiologies. The objective of this study was to investigate the risk factors for enterococcal BT-BSI. Patients with BT-BSI from the PROBAC cohort, including consecutive patients with BSI in 26 Spanish hospitals between October 2016 and March 2017, were selected; episodes caused by E. faecalis or E. faecium and other causes were compared. Independent predictors for enterococci were identified by logistic regression, and a predictive score was developed. Eight hundred fifty episodes of BT-BSI were included; 73 (8.5%) were due to target Enterococcus spp. (48 [66%] were E. faecium and 25 [34%] E. faecalis). By multivariate analysis, the variables independently associated with Enterococcus spp. were (OR; 95% confidence interval): cholangiocarcinoma (4.48;1.32 to 15.25), hospital acquisition (3.58;2.11 to 6.07), use of carbapenems in the previous month (3.35;1.45 to 7.78), biliary prosthesis (2.19;1.24 to 3.90), and moderate or severe chronic kidney disease (1.55;1.07 to 2.26). The AUC of the model was 0.74 [95% CI0.67 to 0.80]. A score was developed, with 7, 6, 5, 4, and 2 points for these variables, respectively, with a negative predictive value of 95% for a score ≤ 6. A model, including cholangiocarcinoma, biliary prosthesis, hospital acquisition, previous carbapenems, and chronic kidney disease showed moderate prediction ability for enterococcal BT-BSI. Although the score will need to be validated, this information may be useful for deciding empirical therapy in biliary tract infections when bacteremia is suspected. IMPORTANCE Biliary tract infections are frequent, and a significant cause of morbidity and mortality. Bacteremia is common in these infections, particularly in the elderly and patients with cancer. Inappropriate empirical treatment has been associated with increased risk of mortality in bacteremic cholangitis, and the probability of receiving inactive empirical treatment is higher in episodes caused by enterococci. This is because many of the antimicrobial agents recommended in guidelines for biliary tract infections lack activity against these organisms. To the best of our knowledge, this is the first study analyzing the predictive factors for enterococcal BT-BSI and deriving a predictive score.

Pseudodrusen reticulares y degeneración macular asociada a la edad / Pseudodrusen reticularis and age-related macular degeneration

Objetivo: Identificar la relación de los pseudodrusen reticulares con la degeneración macular asociada a la edad mediante imágenes tomográficas. Método: Estudio observacional, descriptivo y transversal en pacientes con pseudodrusen reticulares atendidos en consulta de retina a los que se les realizó tomografía de coherencia óptica espectral desde enero de 2009 hasta diciembre de 2014 en el Instituto Cubano de Oftalmología "Ramón Pando Ferrer". La población estuvo constituida por 69 pacientes de 55 años y más con pseudodrusen reticulares en dichas imágenes. Resultados: Los pseudodrusen predominaron en pacientes con edades comprendidas entre los 70 y 79 años para un 49,3 por ciento. El sexo femenino fue el más numeroso con un 76,8 por ciento. De los 122 ojos con pseudodrusen, 86 presentaron algún signo de degeneración macular asociada a la edad representado por el 70,5 por ciento. El 58,1 por ciento de estos últimos tuvo la forma avanzada. La membrana neovascular tipo II fue la más frecuente con un 58,0 por ciento. El grosor coroideo se estimó disminuido en el 77,9 por ciento de los casos. Conclusiones: Los pseudodrusen reticulares mantienen una relación directa con la degeneración macular asociada a la edad e influyen en la progresión de esta(AU)

Objective: To identify the relationship of reticular pseudodrusen with age-related macular degeneration using tomographic imaging. Methods: An observational, descriptive and cross-sectional study was conducted in patients with reticular pseudodrusen seen in retina consultation who underwent spectral optical coherence tomography from January 2009 to December 2014 at the Cuban Institute of Ophthalmology "Ramón Pando Ferrer". The population consisted of 69 patients aged 55 years and older with reticular pseudodrusen in these images. Results: Pseudodrusen predominated in patients between 70 and 79 years of age (49.3 percent). The female gender was the most numerous with 76.8 percent. Out of the 122 eyes with pseudodrusen, 86 showed some sign of age-related macular degeneration (70.5 percent). Out of the latter, 58.1 percent had the advanced form. Type II neovascular membrane was the most frequent with 58.0 percent. Choroidal thickness was estimated decreased in 77.9 percent of cases. Conclusions: Reticular pseudodrusen maintain a direct relationship with age-related macular degeneration and influence its progression(AU)

Estrés, afrontamiento y rendimiento académico en estudiantes adolescentes peruanos durante tiempos de covid-19 / Stress, coping and academic performance in peruvian teenage students in the time of COVID-19 / Estresse, enfrentamento e desempenho acadêmico em estudantes adolescentes peruanos na época de covid-19

Resumen El contexto social y educativo ha cambiado producto del aislamiento social por COVID-19. La investigación pretendió determinar la presencia de estrés académico, identificar los estresores, indagar el proceso de afrontamiento y revisar los resultados del rendimiento académico de los estudiantes peruanos de educación secundaria. El enfoque del trabajo fue mixto con diseño explicativo secuencial y la muestra estuvo constituida por 178 estudiantes de los tres últimos años de secundaria. Los resultados evidenciaron la presencia de estrés académico, siendo las mujeres, los estudiantes de escuelas privadas y de último año escolar quienes presentaban más estrés. Las tareas, el tiempo para desarrollarlas y la poca comprensión de los temas desarrollados fueron los principales estímulos estresores. Las estrategias de afrontamiento se centraron en organizar la carga académica, defender sus ideas y la búsqueda de información. El rendimiento académico mostró una relación inversa con el estrés y los varones presentaron mejor puntuación en el rendimiento. Por otra parte, los estudiantes percibieron que el buen humor y la interacción social con su familia y amigos son aspectos importantes; además, buscaron diversas actividades recreativas para superar los tiempos difíciles considerando las limitaciones de tiempo y espacio.

Abstract The social and educational context have changed as a result of social isolation due to COVID-19. The research aimed to determine the presence of academic stress, identify stressors, investigate the coping process and review the results of the academic performance of Peruvian students. The research approach was mixed with sequential explanatory scope and the sample consisted of 178 students from the final three year of study of high school. The results evidenced the presence of academic stress in the sample, being the women, the students of private schools and the students in their final year of study who presented more stress. The homework, the time to carry them out and the poor understanding of the topics developed were the main stressors. The coping strategies focused on organizing the courses load, defending their ideas and search information. Academic performance showed an inverse relationship with stress, and men had better performance scores. On the other hand, the students perceived that good humor and social interaction with their family and friends are important aspects; furthermore, they seek various leisure and recreational activities to overcome difficult times considering the limitations of time and space.

Resumo O contexto social e educacional mudou em decorrência do isolamento social devido ao COVID-19. Portanto, o objetivo principal da investigação foi verificar a presença de estresse acadêmico, identificar estressores, investigar o processo de enfrentamento e revisar os resultados do desempenho acadêmico de estudantes peruanos do ensino médio. O trabalho teve uma abordagem mista com um desenho explicativo sequencial e a amostra foi composta por 178 alunos dos três últimos anos do ensino médio. Os resultados mostraram a presença de estresse acadêmico, sendo as mulheres, alunos de escolas privadas e alunos do último ano letivo os que mais apresentaram estresse. As tarefas, o tempo para desenvolvê-las e a pouca compreensão dos temas desenvolvidos foram os principais estressores. As estratégias de enfrentamento focaram em organizar a carga acadêmica, defender suas ideias e buscar informações. O desempenho acadêmico apresentou relação inversa com o estresse e os meninos apresentaram melhores escores de desempenho. Por outro lado, os alunos perceberam que o bom humor e a interação social com a família e amigos são aspectos importantes; além disso, buscaram diversas atividades recreativas para superar momentos difíceis, considerando as limitações de tempo e espaço.

Estrés, afrontamiento y rendimiento académico en estudiantes adolescentes peruanos durante tiempos de covid-19

El contexto social y educativo ha cambiado producto del aislamiento social por COVID-19. La investigación pretendió determinar la presencia de estrés académico, identificar los estresores, indagar el proceso de afrontamiento y revisar los resultados del rendimiento académico de los estudiantes peruanos de educación secundaria. El enfoque del trabajo fue mixto con diseño explicativo secuencial y la muestra estuvo constituida por 178 estudiantes de los tres últimos años de secundaria. Los resultados evidenciaron la presencia de estrés académico, siendo las mujeres, los estudiantes de escuelas privadas y de último año escolar quienes presentaban más estrés. Las tareas, el tiempo para desarrollarlas y la poca comprensión de los temas desarrollados fueron los principales estímulos estresores. Las estrategias de afrontamiento se centraron en organizar la carga académica, defender sus ideas y la búsqueda de información. El rendimiento académico mostró una relación inversa con el estrés y los varones presentaron mejor puntuación en el rendimiento. Por otra parte, los estudiantes percibieron que el buen humor y la interacción social con su familia y amigos son aspectos importantes; además, buscaron diversas actividades recreativas para superar los tiempos difíciles considerando las limitaciones de tiempo y espacio.

The social and educational context have changed as a result of social isolation due to COVID-19. The research aimed to determine the presence of academic stress, identify stressors, investigate the coping process and review the results of the academic performance of Peruvian students. The research approach was mixed with sequential explanatory scope and the sample consisted of 178 students from the final three year of study of high school. The results evidenced the presence of academic stress in the sample, being the women, the students of private schools and the students in their final year of study who presented more stress. The homework, the time to carry them out and the poor understanding of the topics developed were the main stressors. The coping strategies focused on organizing the courses load, defending their ideas and search information. Academic performance showed an inverse relationship with stress, and men had better performance scores. On the other hand, the students perceived that good humor and social interaction with their family and friends are important aspects; furthermore, they seek various leisure and recreational activities to overcome difficult times considering the limitations of time and space.

O contexto social e educacional mudou em decorrência do isolamento social devido ao COVID-19. Portanto, o objetivo principal da investigação foi verificar a presença de estresse acadêmico, identificar estressores, investigar o processo de enfrentamento e revisar os resultados do desempenho acadêmico de estudantes peruanos do ensino médio. O trabalho teve uma abordagem mista com um desenho explicativo sequencial e a amostra foi composta por 178 alunos dos três últimos anos do ensino médio. Os resultados mostraram a presença de estresse acadêmico, sendo as mulheres, alunos de escolas privadas e alunos do último ano letivo os que mais apresentaram estresse. As tarefas, o tempo para desenvolvê-las e a pouca compreensão dos temas desenvolvidos foram os principais estressores. As estratégias de enfrentamento focaram em organizar a carga acadêmica, defender suas ideias e buscar informações. O desempenho acadêmico apresentou relação inversa com o estresse e os meninos apresentaram melhores escores de desempenho. Por outro lado, os alunos perceberam que o bom humor e a interação social com a família e amigos são aspectos importantes; além disso, buscaram diversas atividades recreativas para superar momentos difíceis, considerando as limitações de tempo e espaço.

Gender Incongruity in a Person with 46,XY and Complete Androgen Insensitivity Syndrome Raised as a Female.

We present the case of a patient with female sex assignment at birth whose parents consulted with a pediatrician when the child was 12 years old, indicating that despite female sex assignment, she felt that she (henceforth "he") had a male gender identity and was gynephilic. Medical examination revealed a 46XY karyotype, a primary amenorrhea and an appropriate testosterone increase after HCG stimulation test. The patient was diagnosed then with a 46,XY disorder of sex development with androgen insensitivity syndrome, but then he missed subsequent appointments. At the age of 24, he resumed medical follow-up to reaffirm his male gender identity through sex reassignment surgery. His physical examination showed a Tanner stage III-IV breast development, vulva, clitoris, normal-sized vagina, absence of uterus and ovaries on transvaginal ultrasound, bilateral cryptorchidism on abdominal-pelvic MRI and osteoporosis on bone densitometry. The results of the blood tests were LH 24.5 mIU/mL [normal range, 1.7-8.6 mIU/mL for men] and testosterone 8.8 nmol/L [8.7-33 nmol/L]; conversely, FSH, estradiol, progesterone, and prolactin levels were normal. The molecular genetic analysis revealed an androgen receptor gene mutation associated with complete androgen insensitivity syndrome. At present, the patient has undergone bilateral orchiectomy and has initiated treatment with topical testosterone and bisphosphonates. We have yet to evaluate the effects and decide the best therapy taking into account that he has a male gender identity but complete androgen insensitivity syndrome.

Elevated levels of arginase activity are related to inflammation in patients with COPD exacerbation.

INTRODUCTION: Within the pathogenesis of the chronic obstructive pulmonary disease (COPD) there are interactions between different inflammatory mediators that are enhanced during an exacerbation. Arginase is present in bronchial epithelial cells, endothelial, fibroblasts and alveolar macrophages, which make it a probable key enzyme in the regulation of inflammation and remodelling. We aimed to find a potential relationship between arginase activity, inflammatory mediators in COPD patients in stable phase and during exacerbations. METHODS: We performed a prospective, observational study of cases and controls, with 4 study groups (healthy controls, stable COPD, COPD during an exacerbation and COPD 3 months after exacerbation). We measured arginase, inflammation markers (IL-6, IL-8, TNF-∝, IFN-γ and C reactive protein), and mediators of immunity: neutrophils, monocytes, total TCD3 + lymphocytes (CD3ζ), CD4 + T cells, CD8 + T cells, NK cells. RESULTS: A total of 49 subjects were recruited, average age of 69.73 years (59.18% male). Arginase activity is elevated during an exacerbation of COPD, and this rise is related to an increase in IL-6 production. The levels of IL-6 and IL-8 remained elevated in patients with COPD at 3 months after hospital exacerbation. We did not find a clear relationship between arginase activity, immunity or with the degree of obstruction in COPD patients. CONCLUSIONS: Arginase activity is elevated during an exacerbation of COPD, and it could be related to an increase in the production of IL-6. Levels of IL-6, IL-8, and arginase activity remain elevated in patients with COPD at 3 months after hospital exacerbation. Arginase activity could contribute to the development of COPD.

Peptide VSAK maintains tissue glucose uptake and attenuates pro-inflammatory responses caused by LPS in an experimental model of the systemic inflammatory response syndrome: a PET study.

The present investigation using Positron Emission Tomography shows how peptide VSAK can reduce the detrimental effects produced by lipopolysaccharides in Dutch dwarf rabbits, used to develop the Systemic Inflammatory Response Syndrome (SIRS). Animals concomitantly treated with lipopolysaccharides (LPS) and peptide VSAK show important protection in the loss of radiolabeled-glucose uptake observed in diverse organs when animals are exclusively treated with LPS. Treatment with peptide VSAK prevented the onset of changes in serum levels of glucose and insulin associated with the establishment of SIRS and the insulin resistance-like syndrome. Treatment with peptide VSAK also allowed an important attenuation in the circulating levels of pro-inflammatory molecules in LPS-treated animals. As a whole, our data suggest that peptide VSAK might be considered as a candidate in the development of new therapeutic possibilities focused on mitigating the harmful effects produced by lipopolysaccharides during the course of SIRS.

Exámenes clínicos preoperatorios para la cirugía de catarata / Routine preoperative clinical tests for cataract surgery

La catarata senil es la primera causa de ceguera reversible en el mundo y la cirugía constituye el único método para solucionar esta enfermedad, con alto nivel de seguridad y elevada mejoría en calidad visual y de vida. Por ser una afectación que ocurre en pacientes de la tercera edad, con frecuencia presentan enfermedades sistémicas como hipertensión arterial, diabetes mellitus, enfermedades cardiovasculares, entre otras. Hasta esta fecha se indican exámenes de laboratorio de rutina en el preoperatorio que para algunas instituciones son innecesarios por el bajo riesgo de esta técnica quirúrgica. Se realizó una búsqueda bibliográfica en Pubmed, Cochrane y Google Académico con el objetivo de revisar lo relacionado con la necesidad de efectuar estos exámenes de laboratorio como rutina antes de la cirugía de catarata. Existen pocos artículos referentes al tema, por lo que se seleccionaron los de mayor evidencia científica. Se pudo concluir que no hay evidencia sobre los requerimientos y necesidades de estudios de laboratorio en el preoperatorio, ya que sus resultados no aportan la capacidad de predecir la morbilidad o de cambiar la conducta relacionada con el proceder quirúrgico o anestésico(AU)

Senile cataract is the leading cause of reversible blindness worldwide. Surgery is the only method available to heal this condition, with a high level of safety and considerable improvement in visual quality and quality of life. Being as it is a condition occurring in elderly patients, systemic diseases such as hypertension, diabetes mellitus and cardiovascular diseases, among others, are usually present. Routine preoperative laboratory tests are customarily indicated which some institutions consider unnecessary due to the low risk of this surgical procedure. A bibliographic search was conducted in PubMed, Cochrane and Google Scholar with the purpose of reviewing published information about the need to conduct these laboratory tests as routine practice before cataract surgery. Since few papers about the topic were available, a selection was made of the ones providing the most relevant scientific evidence. It was concluded that no evidence exists about the requirements of and need for preoperative laboratory studies, since their results do not contribute to the ability to predict morbidity or change the conduct related to the surgical or anesthetic procedure(AU)

Drug Prescription Profiles in Patients with Polypharmacy in Spain: A Large-Scale Pharmacoepidemiologic Study Using Real-World Data.

We aimed to identify and compare medication profiles in populations with polypharmacy between 2005 and 2015. We conducted a cross-sectional study using information from the Computerized Database for Pharmacoepidemiologic Studies in Primary Care (BIFAP, Spain). We estimated the prevalence of therapeutic subgroups in all individuals 15 years of age and older with polypharmacy (≥5 drugs during ≥6 months) using the Anatomical Therapeutic Chemical classification system level 4, by sex and age group, for both calendar years. The most prescribed drugs were proton-pump inhibitors (PPIs), statins, antiplatelet agents, benzodiazepine derivatives, and angiotensin-converting enzyme inhibitors. The greatest increases between 2005 and 2015 were observed in PPIs, statins, other antidepressants, and ß-blockers, while the prevalence of antiepileptics was almost tripled. We observed increases in psychotropic drugs in women and cardiovascular medications in men. By patient´s age groups, there were notable increases in antipsychotics, antidepressants, and antiepileptics (15-44 years); antidepressants, PPIs, and selective ß-blockers (45-64 years); selective ß-blockers, biguanides, PPIs, and statins (65-79 years); and in statins, selective ß-blockers, and PPIs (80 years and older). Our results revealed important increases in the use of specific therapeutic subgroups, like PPIs, statins, and psychotropic drugs, highlighting opportunities to design and implement strategies to analyze such prescriptions' appropriateness.

A Silent Corticotroph Pituitary Carcinoma: Lessons From an Exceptional Case Report.

Nowadays, neither imaging nor pathology evaluation can accurately predict the aggressiveness or treatment resistance of pituitary tumors at diagnosis. However, histological examination can provide useful information that might alert clinicians about the nature of pituitary tumors. Here, we describe our experience with a silent corticothoph tumor with unusual pathology, aggressive local invasion and metastatic dissemination during follow-up. We present a 61-year-old man with third cranial nerve palsy at presentation due to invasive pituitary tumor. Subtotal surgical approach was performed with a diagnosis of silent corticotroph tumor but with unusual histological features (nuclear atypia, frequent multinucleation and mitotic figures, and Ki-67 labeling index up to 70%). After a rapid regrowth, a second surgical intervention achieved successful debulking. Temozolomide treatment followed by stereotactic fractionated radiotherapy associated with temozolomide successfully managed the primary tumor. However, sacral metastasis showed up 6 months after radiotherapy treatment. Due to aggressive distant behavior, a carboplatine-etoposide scheme was decided but the patient died of urinary sepsis 31 months after the first symptoms. Our case report shows how the presentation of a pituitary tumor with aggressive features should raise a suspicion of malignancy and the need of follow up by multidisciplinary team with experience in its management. Metastases may occur even if the primary tumor is well controlled.

Propiedades psicométricas de una escala de compromiso académico en estudiantes universitarios peruanos / Psychometric properties of an academic engagement scale in peruvian university students / Propriedades psicométricas de uma escala de engajamento acadêmico em estudantes universitários peruanos

El objetivo principal de la investigación fue analizar la estructura factorial y la consistencia de una escala de compromiso académico a través del análisis factorial exploratorio, confirmatorio y multigrupo; y también, con el coeficiente Alfa. La muestra estuvo conformada por 1110 estudiantes de diversas universidades de Lima, Perú y el instrumento analizado fue la Escala de Utrecht de Engagement Académico (UWES-S) de 17 ítems. Durante el análisis factorial exploratorio, se evidenció que los ítems se agrupan en tres factores: dedicación, vigor y absorción; y se eliminó el ítem 10 por presentar carga factorial en más de una dimensión. El análisis factorial confirmatorio indicó que el modelo es óptimo; por otra parte, el análisis factorial multigrupo señaló que el instrumento presenta un ajuste adecuado para la muestra de varones y mujeres. Además, la escala final de 16 ítems obtuvo un coeficiente Alfa igual a .83. Con lo anterior, se aporta un instrumento válido para la evaluación del compromiso académico en estudiantes universitarios peruanos.

The main purpose of the research was to analyze the factor structure and consistency of an academic engagement scale through exploratory, confirmatory and multigroup factor analysis; and also, with the Alpha coefficient. The sample consisted of 1,110 students from several universities in Lima, Peru and the instrument analyzed was the Utrecht Academic Engagement Scale (UWES-S) of 17 items. During the exploratory factor analysis, it was evident that the items are grouped into three factors: dedication, vigor and absorption; and item 10 was eliminated for presenting factor loading in more than one dimension. Confirmatory factor analysis indicated that the model is optimal; on the other hand, the multigroup factor analysis indicated that the instrument presents an appropriate adjustment for a sample of men and women. Furthermore, the final scale of 16 items obtained an alpha coefficient equal to .83. With the above, a valid instrument is provided for the evaluation of academic engagement in Peruvian university students.

O principal objetivo da investigação foi analisar a estrutura fatorial e a consistência de uma escala de engajamento acadêmico por meio de análise fatorial exploratória, confirmatória e multigrupo; e também com o coeficiente alpha. A amostra foi composta por 1110 estudantes de várias universidades de Lima, Peru, e o instrumento analisado foi a Escala Utrecht de Engajamento Acadêmico (UWES-S) de 17 itens. Durante a análise fatorial exploratória, demonstrou-se que os itens estão agrupados em três fatores: dedicação, vigor e absorção; e o item 10 foi eliminado por apresentar carga fatorial em mais de uma dimensão. A análise fatorial confirmatória indicou que o modelo é ótimo; Por outro lado, a análise fatorial multigrupo indicou que o instrumento apresenta um ajuste adequado para a amostra de homens e mulheres. Além disso, a escala final de 16 itens obteve um coeficiente alfa igual a .83. Com o exposto, este trabalho fornece um instrumento válido para avaliar o engajamento acadêmico em estudantes universitários peruanos.

The osteotomy diameter in the transcanalicular laser dacryocystorhinostomy. Our experience in 192 lacrimal pathways.

OBJECTIVES: We want to evaluate the influence of the size of the osteotomy on the postsurgical outcomes. METHODS: A retrospective study was performed in patients who underwent TCL-DCR from January 1, 2008, to March 1, 2019. The patients were divided into two groups: the patients in one group were subjected to LP surgery with an osteotomy diameter equal to 9 mm ± 1 mm (group A), and the patients in the other group were subjected to surgery with an osteotomy diameter equal to 14 mm ± 1 mm (group B). RESULTS: A total of 159 lacrimal pathways (LPs) were operated on in group A with a success rate (SR) of 66.6%. Thirty-three LPs were operated on in group B with an SR of 81.8%. CONCLUSION: An osteotomy diameter equal to 14 mm ± 1 mm achieved better postoperative results than an osteotomy diameter equal to 9 mm ± 1 mm.

Adsorción de Cd(II) y Pb(II) presentes en solución acuosa con hueso de nanche (Byrsonima crassifolia) / Adsorption of Cd(ll) and Pb(ll) present in aqueous solution with nanche stone (Byrsonima crassifolia) / Adsorção de Cd(ll) e Pb(ll) presente em solução aquosa com osso nanche (Byrsonima crassifolia)

Resumen El hueso de nanche es un residuo agrícola con gran potencial de uso como adsorbente. Al respecto, se evaluó la capacidad de adsorción de iones Cd(II) y Pb(II), presentes en solución acuosa, utilizando este residuo. Las pruebas realizadas en este estudio fueron: la determinación del punto de carga cero (pHPZC), determinación de sitios activos (método de Boehm y espectroscopía FTIR) y el desarrollo de los modelos matemáticos de Langmuir, Freundlich y Prausnitz-Radke, a través de isotermas de adsorción. Los resultados obtenidos del pHPZC del hueso de nanche estuvieron en un rango ácido (6,0), mientras que la concentración de sitios ácidos y básicos fue de 0,1037 y 0,046 mol/g, respectivamente. Los espectros infrarrojos (FTIR) detectaron sitios funcionales ácidos asociados al grupo fenol, ácidos carboxílicos y lactonas. Finalmente, la capacidad de adsorción del hueso de nanche para Cd(II) y Pb(II) se incrementó con el pH y alcanzó porcentajes de remoción hasta de 84 % para Cd(II) a pH 8, y de 82% para Pb(II) a pH 5. En conclusión, el pH y la presencia de sitios funcionales ácidos fueron determinantes en la eliminación de los iones Pb(II) y Cd(II).

Abstract The nanche stone is an agricultural residue that has great potential as adsorbent. Then, the adsorption capacity of Cd(II) and Pb(II) ions present in aqueous solution was evaluated, using the stone as adsorbent. The tests performed for this purpose were the determination of point of zero charge (pHPZC), determination of active sites (Boehm method and FTIR spectroscopy), and the development of the mathematical models of Langmuir, Freundlich, and Prausnitz-Radke through adsorption isotherms. The results obtained from the pHPZC of the nanche stone were in an acidic range (6,0), while the concentration of acid and basic sites were 0.1037 and 0.046 mol/g respectively. The infrared spectra (FTIR) detected acid functional sites associated with the phenol group, carboxylic acids, and lactones. Finally, the adsorption capacity of nanche stone to Cd(II) and Pb(II), increased with the pH, achieving percentages of removal up to 84% for Cd (II) to pH 8, and of 82% for Pb(II) to pH 5. In conclusion, the pH and the presence of acidic functional sites were decisive in the elimination of the Pb(II) and Cd(II) ions.

Resumo O osso Nanche é um resíduo agrícola que possui grande potencial como adsorvente, neste respeito, a capacidade de adsorção de íons Cd(II) e Pb(II) presentes em solução aquosa foi avaliada, utilizando osso como adsorvente. Os testes realizados para este fim foram a determinação do ponto zero de carga (pHPZC), a determinação de sites ativos (método Boehm e espectroscopia FTIR) e o desenvolvimento dos modelos matemáticos de Langmuir, Freundlich e Prausnitz-Radke através de isotermas de adsorção. Os resultados obtidos do pHPZC do osso nanche foram em uma faixa ácida (6,0), enquanto a concentração de ácidos e sites básicos foram 0,1037 e 0,046 mol / g, respectivamente. Os espectros de infravermelho (FTIR) detectaram sites funcionais ácidos associados ao grupo fenol, ácidos carboxílicos e lactonas. Finalmente, a capacidade de adsorção do osso nanche para Cd(II) e Pb(II), aumentou com o pH, atingindo porcentagens de remoção de até 84% para o Cd(II) em pH 8, e 82% para Pb(II) a pH 5. Em conclusão, o pH e a presença de sites funcionais ácidos foram decisivos na eliminação dos íons Pb (II) e Cd (II).

Evolution of polypharmacy in a spanish population (2005-2015): A database study.

PURPOSE: To analyze the evolution of the prevalence of polypharmacy and excessive polypharmacy in a Spanish population, and to improve the identification of patients with polypharmacy. METHODS: A descriptive, annual cross-sectional observational study was carried out. PATIENTS: individuals over 14 years of age included in a multiregional primary care database of the Spanish population (BIFAP). ANALYSIS: prescription data. Period 2005-2015. VARIABLES: proportion of patients with polypharmacy (simultaneous prescription of ≥5 drugs) and excessive polypharmacy (≥10 drugs) for at least 6 months, according to sex and age groups. A trend analysis of the studied period was performed (overall, and by sex and age groups). RESULTS: The data are reported on a comparative basis (2005 vs 2015). Number of patients analyzed: 2664743 vs 4 002 877. The prevalence of polypharmacy increased significantly (2.5% vs 8.9%, P-value for trend <0.001), being greater in females throughout the study period and in the group aged ≥80 years (P-value for trends <0.001). The prevalence of excessive polypharmacy also increased significantly (0.1% vs 1%, P-value for trend <0.001), being higher in the group aged ≥80 years (P-value for trend <0.001). The proportion of patients with no chronic treatment decreased (80.2% vs 63.1%). CONCLUSIONS: The prevalence of polypharmacy in this Spanish population has tripled in the period 2005-2015, while excessive polypharmacy has increased 10-fold. These increments are seen in both sexes and in all age groups, particularly in individuals over 80 years of age. The proportion of patients without chronic treatments has decreased.