Implementing a continuous quality-improvement framework for tuberculosis infection prevention and control in healthcare facilities in China, 2017-2019.

BACKGROUND: Tuberculosis (TB) infection prevention and control (IPC) in healthcare facilities is key to reducing transmission risk. A framework for systematically improving TB IPC through training and mentorship was implemented in 9 healthcare facilities in China from 2017 to 2019. METHODS: Facilities conducted standardized TB IPC assessments at baseline and quarterly thereafter for 18 months. Facility-based performance was assessed using quantifiable indicators for IPC core components and administrative, environmental, and respiratory protection controls, and as a composite of all control types We calculated the percentage changes in scores over time and differences by IPC control type and facility characteristics. RESULTS: Scores for IPC core components increased by 72% during follow-up when averaged across facilities. The percentage changes for administrative, environmental, and respiratory protection controls were 39%, 46%, and 30%, respectively. Composite scores were 45% higher after the intervention. Overall, scores increased most during the first 6 months. There was no association between IPC implementation and provincial economic development or volume of TB services. CONCLUSIONS: TB IPC policies and practices showed most improvement early during implementation and did not differ consistently by facility characteristics. The training component of the project helped increase the capacity of healthcare professionals to manage TB transmission risks. Lessons learned here will inform national TB IPC guidance.

Social and Individual Factors Associated with Eating Disorders in Young Athletes: Effects on Concentration and Fatigue.

Eating disorders are a growing societal problem, especially among young people. This study aims to determine the individual and social factors that support and perpetuate the risk of eating disorders (ED) and their possible consequences on an individual's athletic and academic performances. The sample consisted of 395 athletes between 12 and 16 years of age (M = 14.07; SD = 1.35), of whom 142 (35.9%) were female, and 253 (64.1%) were male. A questionnaire was administered to collect information on sociodemographic data, body image, use of social networks, social relationships, sports practice, risk of developing ED, and academic and sports performance. In the resulting analysis, an initial cross-tabulation was carried out to observe the body distortion of the respondents as a function of BMI, followed by a linear regression to analyze the factors influencing the risk of suffering from ED. In addition, correlations were made to determine the relationship between the risk of manifesting ED and academic and sports performance. The main results show that 77.7% of the young athletes present a risk of ED (M = 13.3; DT = 3.33) due to a high body image distortion, which becomes the determining factor. In addition, relationships with family and friends have a significant influence on this. On the other hand, behaviors related with eating disorders affect concentration (r = -0.122; p = 0.01) and fatigue (r = -0.376; p < 0.01). For all these reasons, generating and promoting prevention and early detection guidelines during adolescence is necessary.

[Social inequalities related to road traffic mortality]. / Desigualdades sociales relacionadas con la mortalidad por accidentes de tráfico.

OBJECTIVE: To synthesize the social inequalities related to mortality from traffic accidents reported in scientific publications. METHOD: A scoping review following the PRISMA-ScR guide was carried out. Using the MesH vocabulary, we systematically searched for articles in English, Portuguese and Spanish published in the EBSCO, Scielo, Scopus, Ovid, and PubMed databases. RESULTS: We identified 47,790 records in the initial search, of which 35 articles met the selection criteria. Nine out ten publications are in high-income countries; there is a greater interest in analyzing mortality in occupants and drivers of vehicles and motorcyclists. Half of the publications use race-ethnicity and geolocation as socioeconomic position variables. The articles included in this review indicate that groups of people with low socioeconomic positions have higher mortality due to traffic accidents. CONCLUSIONS: The highest mortality from traffic accidents occurs in people with low socioeconomic positions which suggests the development of road safety actions from a comprehensive, integrative perspective and linked to other political agendas to reduce their incidence by 2030. Although road traffic fatalities are higher in low and middle-income countries, few publications are available in these countries. It is necessary to strengthen the research capacities in these countries.

Assessment of indoor air quality and risk of COVID-19 infection in Spanish secondary school and university classrooms.

Despite the risk of transmission of SARS-CoV-2, Spanish educational centers were reopened after six months of lockdown. Ventilation was mostly adopted as a preventive measure to reduce the transmission risk of the virus. However, it could also affect indoor air quality (IAQ). Therefore, here we evaluate the ventilation conditions, COVID-19 risk, and IAQ in secondary school and university classrooms in Toledo (central Spain) from November 2020 to June 2021. Ventilation was examined by monitoring outdoor and indoor CO2 levels. CO2, occupancy and hygrothermal parameters, allowed estimating the relative transmission risk of SARS-CoV-2 (Alpha and Omicron BA.1), H r, under different scenarios, using the web app COVID Risk airborne . Additionally, the effect of ventilation on IAQ was evaluated by measuring indoor/outdoor (I/O) concentration ratios of O3, NO2, and suspended particulate matter (PM). University classrooms, particularly the mechanically ventilated one, presented better ventilation conditions than the secondary school classrooms, as well as better thermal comfort conditions. The estimated H r for COVID-19 ranged from intermediate (with surgical masks) to high (no masks, teacher infected). IAQ was generally good in all classrooms, particularly at the university ones, with I/O below unity, implying an outdoor origin of gaseous pollutants, while the source of PM was heterogeneous. Consequently, controlled mechanical ventilation systems are essential in educational spaces, as well as wearing well-fitting FFP2-N95 masks indoors is also highly recommended to minimize the transmission risk of COVID-19 and other airborne infectious diseases.

Romani Women and Health: The Need for a Cultural-Safety Based Approach.

The Romani are the main European ethnic minority. The Romani people's situation of social vulnerability and their difficulties accessing the health system make their health indicators worse than those of the non-Romani population. The present study will delve into health beliefs, and experiences with health services and professionals, through the perspectives of Romani women. In this qualitative study, 16 women of different ages were interviewed in a city located in the South of Spain. Four themes emerged from the analysis of the data: the construction of the identity of Romani women, difficulties in life, health and disease beliefs and barriers to accessing the health system. We conclude that every project for the improvement of the health of the Romani community must take into account the active participation of Romani women and must consider the principles of Cultural Safety, by delving into the intercultural training of health professionals and addressing the social determinants of health which affect the Romani collective.

Reading Comprehension Impairment in Children With Neurofibromatosis Type 1 (NF1): The Need of Multimodal Assessment of Attention.

Attention span, which has been shown to have an impact on reading quality in many other conditions, is one of the main cognitive disorders of neurofibromatosis type 1 (NF1). The aim of this work is to observe the impact of attention on reading comprehension, in NF1 and non-NF1 children. A multicenter, cross-sectional study was conducted on 150 children (8-12 years old) with or without NF1 (75 NF1 vs 75 non-NF1; 72 female, 78 male), matched for age, sex, handedness, and reading level, thus forming a continuum from good to poor readers in both NF1 and non-NF1 groups. Children with intellectual deficiency or neurologic or psychiatric disorder were excluded. Attentional skills were assessed by combining a parent questionnaire (Child Behavior CheckList) and a performance-based assessment (Conner's Continuous Performance Test-Second Edition). Reading comprehension was assessed through a standardized reading comprehension test (ORLEC Lobrot). The performance-based attention scores were associated with text and sentence comprehension ability (P = .0235 and P = .0164, respectively), while indirect questionnaire attention scores were only associated with sentence comprehension (P = .0263). For both groups, the correlations between questionnaire and performance-based measures were low. We have shown that reading comprehension is greatly influenced by attention in NF1 and non-NF1, even if predictors of good reading comprehension also include IQ score and reading accuracy. Indirect observer-rated questionnaires and direct performance-based measures of attention do not assess the same variables, are linked to different components of reading skills, and are not interchangeable assessments of attention difficulties. Both assessments are complementary and must be used simultaneously, leading to recommendations that support multimodal assessment of attention.

Relative and Absolute Reliability of a Motor Assessment System Using KINECT® Camera.

(1) Background: Virtual reality is currently useful in different clinical specialties as a diagnostic and therapeutic tool. In this study, we analyzed the relative and absolute reliability of the motor evaluation with the Kinect camera, a markerless motion system. (2) Methods: Observational study in healthy people, whose inclusion criteria were: healthy people, age 18 to 40 years old without pathologies or injuries in osteoarticular structures or ligamentous muscle and pharmacological treatment with influence on motor skills. Fifty-two subjects were evaluated. (3) Results: The results of the relative reliability were favorable in variables such as the amplitude of passage of the right leg (ICC (Intraclass Correlation Coefficient) = 0.95 ± 0.03), the step width of the left leg (ICC = 0.92 ± 0.04) or balance of the left leg (ICC = 0.90 ± 0.05). Moderate values were found for other variables. The absolute reliability, measured by the coefficient of variation, was favorable in most of the variables. (4) Conclusions: The results reflect a favorable intraclass correlation in the evaluation of the variation and asymmetry of movements of the upper limbs, the balance of both legs, the side step width and the evaluation of the sitting and standing positions. The reliability of the evaluation of the variation of movements and the asymmetry of the lower limbs must be further improved.

Factores que explican el apoyo social del adulto mayor en tres ciudades de Colombia. 2016 / Factors that explain the social support of the elderly in three cities of Colombia. 2016

Resumen Objetivo: Identificar los factores asociados a las dimensiones del apoyo social del adulto mayor en tres ciudades de Colombia: Medellín, Barranquilla y Pasto. Método: Estudio cuantitativo, transversal analítico, de fuente de información primaria, obtenida a partir de encuestas realizadas a adultos mayores sobre aspectos demográficos, familiares y sociales, y escalas de medición validadas que permitieron evaluar aspectos como funcionamiento familiar, felicidad, maltrato, depresión, riesgo nutricional y discriminación. El apoyo social percibido se evaluó mediante el Cuestionario de Estudio de Desenlaces Médicos de Apoyo Social (Medical Outcomes Study- Social Support Survey (MOS)). La muestra fue de 1452 personas seleccionadas por muestreo probabilístico por conglomerado, bietápico, en las ciudades de Medellín, Barranquilla y Pasto (Colombia). Se realizó análisis univariado, bivariado y multivariado, se calcularon medidas estadísticas y epidemiológicas. Se consideraron asociaciones estadísticas aquellas con un valor p inferior a 5%. Resultados: Los adultos mayores participantes percibieron un apoyo social adecuado en sus diferentes dimensiones: 92% emocional, 93,5% instrumental, 92% interacción social positiva y 93% apoyo afectivo, y 91,9% en el índice global de apoyo. Percibir buen apoyo social fue una condición predominante en los adultos mayores: con pareja, sin riesgo de depresión, afiliados al Sistema General de Seguridad Social en Salud, que se sienten felices, que conviven con al menos dos familiares, que perciben un adecuado funcionamiento familiar, no reciben malos tratos al interior de su familia, tienen al menos cuatro amigos cercanos, no se sienten discriminados, que están acompañados y tienen alguien que los cuidan permanentemente.

Abstract Objective: Identify the factors that explain the social support components of the elderly. Methods: Quantitative, cross-sectional, analytical study of a source of primary information, obtained from surveys of older adults. The sample was 1452 people selected by probabilistic sampling by cluster, two-stage. In Medellín, Barranquilla and Pasto. To measure the perceived social support, the Medical. Results Study Social Support Survey was applied. Univariate, bivariate and multivariate analyzes were performed, statistical and epidemiological measures were calculated. Statistical associations considered with a p value of less than 5% were considered. Results: In relation to the social support components of the elderly, with an adequate condition: emotional support (92%); instrumental support (93.2%); positive social interaction (92.2%); affective support (93.2%) and in the total evaluation (91.9%). The city of Pasto was the one that selected the lowest percentages, in the different components. Perceiving good social support was a predominant condition in older adults: with a partner, without depression, affiliated with the General System of Social Security in Health, happy (through the Lima happiness scale), who live with at least two relatives, with proper family functioning, they do not perceive ill-treatment within their family, they have at least four close friends, they do not feel discriminated against, they do not leave them constantly alone and they have someone to take care of them permanently. Conclusion: Being from the city of Medellín, having a partner, feeling happy, not being alone, as well as not having depression, important factors in each of the components of social support.

A decision tree for the genetic diagnosis of deficiency of adenosine deaminase 2 (DADA2): a French reference centres experience.

Deficiency of adenosine deaminase 2 (DADA2) is a recently described autoinflammatory disorder. Genetic analysis is required to confirm the diagnosis. We aimed to describe the identifying symptoms and genotypes of patients referred to our reference centres and to improve the indications for genetic testing. DNA from 66 patients with clinically suspected DADA2 were sequenced by Sanger or next-generation sequencing. Detailed epidemiological, clinical and biological features were collected by use of a questionnaire and were compared between patients with and without genetic confirmation of DADA2. We identified 13 patients (19.6%) carrying recessively inherited mutations in ADA2 that were predicted to be deleterious. Eight patients were compound heterozygous for mutations. Seven mutations were novel (4 missense variants, 2 predicted to affect mRNA splicing and 1 frameshift). The mean age of the 13 patients with genetic confirmation was 12.7 years at disease onset and 20.8 years at diagnosis. Phenotypic manifestations included fever (85%), vasculitis (85%) and neurological disorders (54%). Features best associated with a confirmatory genotype included fever with neurologic or cutaneous attacks (odds ratio [OR] 10.71, p = 0.003 and OR 10.9, p < 0.001), fever alone (OR 8.1, p = 0.01), and elevated C-reactive protein (CRP) level with neurologic involvement (OR 6.63, p = 0.017). Our proposed decision tree may help improve obtaining genetic confirmation of DADA2 in the context of autoinflammatory symptoms. Prerequisites for quick and low-cost Sanger analysis include one typical cutaneous or neurological sign, one marker of inflammation (fever or elevated CRP level), and recurrent or chronic attacks in adults.

Estructura interna del Cuestionario de Evaluación de Violencia Escolar Infantil y Primaria en un entorno violento de México / Internal structure of the Childhood and Primary School Violence Assessment Questionnaire

El objetivo de este estudio es validar la estructura interna del Cuestionario de Evaluación de Violencia Escolar en Infantil y Primaria en una muestra del noreste de México. Es un estudio de corte cuantitativo y transversal. Se incluyeron, 733 niños, de los cuales, 49.8% son hombres, 50.2% mujeres, mediante un muestreo intencional, obtenido de 78 instituciones de educación básica de la ciudad de Saltillo, Coahuila, México. La edad promedio fue de 12 años. Los resultados confirmaron una estructura factorial de tres dimensiones que miden situaciones presenciadas, vividas y realizadas. El instrumento se redujo a 30 indicadores de dichas dimensiones conservando la fiabilidad obtenida en estudios previos. La aportación del estudio es la incorporación de una herramienta que permita una valoración del acoso escolar y del daño percibido y sus características, evitando principalmente la subestimación y normalización de la violencia.

The objective of this study is to validate the internal structure of the School Violence Evaluation Questionnaire in Children and Primary in a sample of northeastern Mexico. It is a quantitative and transversal study. A total of 733 children were included, of which 49.8% are men, 50.2% women, through intentional sampling, obtained from 78 basic education institutions in the city of Saltillo, Coahuila, Mexico. The average age was 12 years. The results confirmed a factorial structure of three dimensions that measure situations witnessed, lived and carried out. The instrument was reduced to 27 indicators of these dimensions, conserving the reliability obtained in previous studies. The contribution of the study is validation of the internal structure of the evaluation tool that allows the identification of school bullying and perceived damage and its characteristics, avoiding mainly the underestimation and normalization of violence.

Evaluación posalta del crecimiento en prematuros: implicaciones de adoptar las curvas OMS / Post discharge growth assessment in preterm infants: implications of adopting the WHO standards

Introducción. Los estándares para evaluar el crecimiento en los prematuros se han utilizado como referencia desde el año 1986. La introducción de las curvas OMS en la Argentina podría incrementar la detección de los niños con crecimiento subóptimo. Objetivo. Comparar la proporción de retraso del crecimiento en peso, longitud corporal y perímetro cefálico en prematuros con peso al nacer menor de 1500 g (RNMBPN) evaluados por las curvas OMS y las curvas SAP. Pacientes y métodos. Estudio de cohorte en RNMBPN. Se incluyeron las mediciones de peso, longitud corporal y perímetro cefálico, realizadas a las 40, 53, 66, 79 y 92 semanas posmenstruales (± 1 semana). Se registró como variable independiente el sexo para ambas curvas (OMS y SAP). Se analizaron las medias del puntaje Z para ambas curvas mediante la prueba de Student y la diferencia de proporciones mediante la prueba de la χ² (OR; IC 95%). Resultados. Ingresaron 204 niños. Las variables antropométricas al nacer divididas por sexo no mostraron diferencias. El peso y la longitud mostraron una apreciación mayor del crecimiento por las curvas SAP vs. OMS, más en los varones que en las mujeres, y se atenuaron al año de edad. La estatura evaluada por OMS presentó retraso en ambos sexos. La circunferencia craneal no arrojó diferencias. Se encontró una mayor proporción de pacientes con peso por debajo de 2 desviaciones estándar a los 3 meses de edad según OMS (p < 0,01; OR 0,36; IC 95% 0,15 a 0,78), no así para la longitud y el perímetro cefálico. Conclusiones. Este estudio permite sugerir que el cambio de estándar no implicaría una modificación significativa a nuestras prácticas de seguimiento durante el primer año de edad.

Introduction. The WHO standards have been used as a gold standard for growth assessment in preterm infants since 1986. The introduction of the WHO standards in Argentina could improve detection of sub-optimal growth. Objective. To compare the proportion of growth retardation in terms of weight, body height and head circumference in preterm infants with a birth weight less than 1500 g (VLBW) assessed according to the WHO standards and the Sociedad Argentina de Pediatría (SAP) standards. Population and methods. Cohort study in VLBW newborn infants. Measurements included were weight, height and head circumferences measured at 40, 53, 66, 79 and 92 postmenstrual weeks (±1 week). Sex was recorded as an independent outcome measure for both standards (WHO and SAP). Mean Z scores were analyzed for both standards using Student's test, and the difference of proportions was assessed using the c2 test (OR; 95% CI). Results. Two hundred and four infants were included. No differences were observed in anthropometric outcome measures at birth by sex. A greater growth was seen in terms of weight and height as per the SAP standards compared to the WHO standards, which was more marked in male infants than female infants, and which diminished around their first year of life. Growth retardation in terms of height was observed in both males and females assessed with the WHO standards. No differences were observed in head circumference. A higher proportion of patients with a weight below 2 standard deviations at 3 months old was found as per the WHO (p < 0.01; OR: 0.36; 95% CI: 0.150.78), but that was not the case with height and head circumference. Conclusions. This study allows to suggest that changing the standards does not imply a significant modification in our follow-up practice over the first year of life of an infant.

Post discharge growth assessment in preterm infants: implications of adopting the WHO standards.

INTRODUCTION: The WHO standards have been used as a gold standard for growth assessment in preterm infants since 1986. The introduction of the WHO standards in Argentina could improve detection of sub-optimal growth. OBJECTIVE: To compare the proportion of growth retardation in terms of weight, body height and head circumference in preterm infants with a birth weight less than 1500 g (VLBW) assessed according to the WHO standards and the Sociedad Argentina de Pediatría (SAP) standards. POPULATION AND METHODS: Cohort study in VLBW newborn infants. Measurements included were weight, height and head circumferences measured at 40, 53, 66, 79 and 92 postmenstrual weeks (±1 week). Sex was recorded as an independent outcome measure for both standards (WHO and SAP). Mean Z scores were analyzed for both standards using Student's test, and the difference of proportions was assessed using the c2 test (OR; 95% CI). RESULTS: Two hundred and four infants were included. No differences were observed in anthropometric outcome measures at birth by sex. A greater growth was seen in terms of weight and height as per the SAP standards compared to the WHO standards, which was more marked in male infants than female infants, and which diminished around their first year of life. Growth retardation in terms of height was observed in both males and females assessed with the WHO standards. No differences were observed in head circumference. A higher proportion of patients with a weight below 2 standard deviations at 3 months old was found as per the WHO (p < 0.01; OR: 0.36; 95% CI: 0.150.78), but that was not the case with height and head circumference. CONCLUSIONS: This study allows to suggest that changing the standards does not imply a significant modification in our follow-up practice over the first year of life of an infant.

Atmospheric chemistry and environmental assessment of inhalational fluroxene.

Smog chamber/gas chromatography techniques are used to investigate the atmospheric degradation of fluroxene, an anesthetic, through oxidation with OH and Cl radicals at 298 K and under atmospheric pressure of N2 or air. The measured rate constants (k) are: k(fluroxene+OH(.) )=(2.96±0.61)×10(-11) and k(fluroxene+Cl(.) )=(1.62±0.19)×10(-10) cm(3) molecule(-1) s(-1) . The only product detected after the oxidation of fluroxene with OH radicals is 2,2,2-trifluoroethyl formate (79 % and 83 % molar yield in the absence and presence of NOx, respectively). However, after oxidation with Cl radicals, the detected products are 2,2,2-trifluoroethyl formate (78 %), 2,2,2-trifluoroethyl-1-chloroacetate (5 %), and chloroacetaldehyde (4 %), in the absence of NOx, and 2,2,2-trifluoroethyl formate (93 %), 2,2,2-trifluoroethyl-1-chloroacetate (6 %), and chloroacetaldehyde (5 %), in the presence of NOx. The results indicate that, both in the absence and presence of NOx, the main fate of fluroxene is the addition of the oxidant to the double bond and, once the alkoxy radical is formed, the main decomposition pathway is by means of degradation. Moreover, it is expected that 2,2,2-trifluoroethyl formate is the only oxidation product able to actively contribute to climate change. To successfully assess the contribution of fluroxene to global warming, we measure the infrared spectra of fluroxene and 2,2,2-trifluoroethyl formate, and calculate the radiative efficiencies (REs) to be 0.27 and 0.28 W m(-2) ppbv(-1) , respectively. In addition, the cumulative effect owing to the formation of 2,2,2-trifluoroethyl formate is investigated, and the direct, indirect, and net global-warming potentials are calculated by using the REs and lifetimes of fluroxene and 2,2,2-trifluoroethyl formate.

Impaired ultrasonographic cervical assessment after voiding: a randomized controlled trial.

OBJECTIVE: To estimate whether the timing of bladder emptying affects focal myometrial contraction development and image adequacy. METHODS: Women at 14 0/7-32 0/7 weeks of gestation undergoing a transvaginal ultrasound examination from January 1, 2012, to September 1, 2012, were eligible for this blinded randomized controlled trial. Participants were randomly assigned to undergo transvaginal imaging immediately after urination (within 5 minutes) or to defer the imaging by at least 15 minutes. The primary outcome was focal myometrial contraction development as determined by two independent blinded reviews of the images. Secondary outcomes included image adequacy and the diagnosis of placenta previa. Relative risks (RRs) and 95% confidence intervals (CIs) were calculated using repeated-measures log binomial regression. RESULTS: Two hundred twenty-one women provided 335 randomized encounters for analysis. Women in the deferred scan group were 30% less likely to experience a focal myometrial contraction (28.1% compared with 40.5%, RR 0.70, 95% CI 0.52-0.93) and 41% less likely to have inadequate images (18.6% compared with 31.5%, RR 0.59, 95% CI 0.40-0.86). The two groups were equally likely to be diagnosed with placenta previa (P=.13). However, participants in the deferred scan group were 76% less likely to have images demonstrating a placenta previa and focal myometrial contraction (3.0% compared with 12.5%, RR 0.24, 95% CI 0.09-0.62) than participants in the immediate scan group. Eight women would need to defer imaging for 15 minutes from bladder voiding to prevent one focal myometrial contraction of the lower uterine segment or inadequate imaging. CONCLUSIONS: A brief interval (at least 15 minutes) between voiding and transvaginal cervical evaluation is associated with decreased risk for focal myometrial contractions and improved imaging. CLINICAL TRIAL REGISTRATION: ClinicalTrials.gov, www.clinicaltrials.gov, NCT01513395. LEVEL OF EVIDENCE: I.

Desarrollo tecnológico de una formulación de diclofenaco de sodio 0, 1 por ciento para administración oftálmica / Technological development of a 0.1 percent sodium diclophenac formulation for opththalmological use

Introducción: el diclofenaco de sodio es un derivado del ácido fenilacético que pertenece al grupo de los antiinflamatorios no esteroideos con propiedades antirreumáticas, antiinflamatorias, analgésicas y antipiréticas pronunciadas. Al nivel ocular se indica para el tratamiento de conjuntivitis, queratoconjun­tivitis, úlceras corneales, y en el de inflamación de la córnea y la conjuntiva por traumatismos. Además, es empleado en la inflamación subsecuente a la cirugía de cataratas y para inhibir la miosis intraoperativa y el edema macular cistoide posoperativo. Objetivo: diseñar una formulación de diclofenaco de sodio 0,1 por ciento colirio, que cumpla con los índices de control de calidad para esta forma farmacéutica y que proporcione el efecto terapéutico deseado. Métodos: se realizaron cinco ensayos tecnológicos en los que se ajustó el pH y la isotonicidad de la formulación según las exigencias de un preparado oftálmico. La isotonicidad se ajustó con ácido bórico y el pH de máxima estabilidad se logró empleando la trometamina. Resultados: el desarrollo tecnológico de la formulación resultó satisfactorio, y se obtuvo un producto que cumplió con todas las especificaciones descritas en la técnica desarrollada por el fabricante para el control de la calidad del producto. La preparación mantuvo sus propiedades físicas, químicas y microbiológicas inalterables por un período de 12 meses, almacenada a una temperatura controlada por debajo de 25 °C. Conclusiones: la formulación de un medicamento obtenida en forma de colirio, que contiene diclofenaco de sodio como principio activo, empleado en diferentes afecciones al nivel ocular, cumple con todas las especificaciones de calidad para este tipo de forma farmacéutica, lo cual puede aumentar el arsenal terapéutico de Cuba

Introduction: Sodium diclophenac derives from the phenylacetic acid belonging to the non-steroid anti-inflammatories that have notable anti-rheumatic, anti-inflammatory, analgesic and antipyretic properties. It is prescribed to treat conjunctivitis, keratoconjunctivitis, corneal ulcers, corneal and conjunctival inflammation due to traumas. Additionally, it is used in reducing inflammation after the cataract surgery and in inhibiting the intraoperative myosis and the postoperative cystoid macular edema. Objective: to design a formulation of 0.1 percent sodium diclophenac eye drops that meets the quality control parameters for this pharmaceutical form and that provides the desired therapeutic effect. Methods: five technological assays were conducted to adjust for the pH and the isotonicity of the formulation as required for an ophthalmologic preparation. Isotonicity was adjusted with boric acid, and Trometamin served to obtain highly stable pH. Results: the technological development of the formulation was satisfactory. There was obtained a product that met all the specifications described in the manufacturer's technique for the quality control. The physical, chemical and microbiological properties of the preparation remained unchanged for 12 months under storage conditions below 25 °C. Conclusions: the eye drop formulation, with sodium diclophenac as active principle, meets all the quality specifications for this pharmaceutical form to treat various eye diseases. This might broadens the therapeutic options in Cuba

Computational prediction and experimental assessment of secreted/surface proteins from Mycobacterium tuberculosis H37Rv.

The mycobacterial cell envelope has been implicated in the pathogenicity of tuberculosis and therefore has been a prime target for the identification and characterization of surface proteins with potential application in drug and vaccine development. In this study, the genome of Mycobacterium tuberculosis H37Rv was screened using Machine Learning tools that included feature-based predictors, general localizers and transmembrane topology predictors to identify proteins that are potentially secreted to the surface of M. tuberculosis, or to the extracellular milieu through different secretory pathways. The subcellular localization of a set of 8 hypothetically secreted/surface candidate proteins was experimentally assessed by cellular fractionation and immunoelectron microscopy (IEM) to determine the reliability of the computational methodology proposed here, using 4 secreted/surface proteins with experimental confirmation as positive controls and 2 cytoplasmic proteins as negative controls. Subcellular fractionation and IEM studies provided evidence that the candidate proteins Rv0403c, Rv3630, Rv1022, Rv0835, Rv0361 and Rv0178 are secreted either to the mycobacterial surface or to the extracellular milieu. Surface localization was also confirmed for the positive controls, whereas negative controls were located on the cytoplasm. Based on statistical learning methods, we obtained computational subcellular localization predictions that were experimentally assessed and allowed us to construct a computational protocol with experimental support that allowed us to identify a new set of secreted/surface proteins as potential vaccine candidates.

[Effectiveness assessment of a neonatal intensive care program for very low birth weight infants. Impact of surfactant administration]. / Evaluación de la efectividad de un programa de cuidado intensivo neonatal. Impacto de la incorporación de surfactante.

INTRODUCTION: Although many therapeutic interventions have proven efficacy through randomized control trials (RCT) with extensive use in Neonatal Intensive Care Units (NICU) for Very Low Birth Weight Infants (VLBWI), doubts remain about its overall effectiveness. OBJECTIVE: To determine changes in the effectiveness of NICU practices on VLBWI over 14 years in the quality of neonatal survival in a General Hospital, with emphasis in the change in reanimation practices by the introduction of the spread use of surfactant. METHODS: We included all consecutive VLBWI admitted in our NICU during a period of 14 years: 1989-1992 (n= 145); 1993-2002 (n= 342). All survivors were included in our follow-up program; 80% and 85% were available for assessment at two years of corrected age. The patients were assigned to 4 groups by weight in 250 g categories, between 500 and 1500 g. OUTCOME MEASURES: Survival and adjusted quality of survival (QS). The QS was expressed in life-years gained. We create categories for the estimation of disabilities. We also analyzed time of NICU stay by weight and mortality categories during the 2 periods. RESULTS: The survival rate improved significantly between the 2 periods (23%) from 52% to 75%. The actuarial survival showed a significant increase in all weight groups (p <0.001), especially between 500-749 g (4% vs. 33%). The life-years gained showed differences in the BW <750 g (p <0.002, 3.6 vs. 23.4) y 750-999 g (p <0.001, 22.3 vs. 48); no differences were found in the others groups. The time of stay showed an increase of 30 days in the <750 g group (p <0.01) and decreased 8 days in the> or =1250 g group (p <0.01). CONCLUSION: The effectiveness of neonatal intensive care for VLBWI improved in the period 1993-2002, after surfactant introduction, especially in the group <1000 g.

Efectos de la contención en hopoxia percutánea posterior a la aspiración endotraqueal en neonatos / Effects of containment on percutaneous hipoxia after endotracheal suctioning in neonates

Objetivo: Verificar la efectividad de la contención en el tiempo de recuperación de la hipoxia percutánea de neoatos prematuros con Síndrome de Dificultad Respiratoria, posterior a la aspiración con y sin bolsa de oxígeno pre-aspiración. La contención es una técnicaque limita los movimientos del neonato simulando el ambiente uterino y se propone como ayuda para inducir la relajación en los prematuros. Material y métodos: Se diseñó un estudio de mediciones repetidas con un grupo; cada neonato fue su propio control. Se estudiaron 30 neonatos nacidos entre la semana 26 y 36 de gestaciónen una Unidad de Cuidados Intensivos Neonatal de un Hospitalde Seguridad Social de Monterrey, de agosto a diciembre de 2002.Se observaron cuatro procedimientos de aspiración endotraqueal:dos sin contención y dos con contención. Resultados: El peso al nacer de los neonatos osciló entre .790 y 3.275 Kg. De acuerdocon el expediente, 25 de ellos (83.30 porciento) presentaron Síndrome deDificultad Respiratoria moderado. La prueba de análisis de varianza,F(3,87)= 7.77, p < 0.001, mostró medias significativamente menor espara los procedimientos de contención. El tiempo de recuperación dela hipoxia se redujo significativamente en los procedimientos de contención.Conclusiones: Los resultados indican que la contenciónpuede ayudar en el tiempo de recuperación de hipoxia percutáneadel neonato con Síndrome de Dificultad Respiratoria.