Transcriptional Inflammatory Signature in Healthy Donors and Different Radiotherapy Cancer Patients.

Cancer and ionizing radiation exposure are associated with inflammation. To identify a set of radiation-specific signatures of inflammation-associated genes in the blood of partially exposed radiotherapy patients, differential expression of 249 inflammatory genes was analyzed in blood samples from cancer patients and healthy individuals. The gene expression analysis on a cohort of 63 cancer patients (endometrial, head and neck, and prostate cancer) before and during radiotherapy (24 h, 48 h, ~1 week, ~4-8 weeks, and 1 month after the last fraction) identified 31 genes and 15 up- and 16 down-regulated genes. Transcription variability under normal conditions was determined using blood drawn on three separate occasions from four healthy donors. No difference in inflammatory expression between healthy donors and cancer patients could be detected prior to radiotherapy. Remarkably, repeated sampling of healthy donors revealed an individual endogenous inflammatory signature. Next, the potential confounding effect of concomitant inflammation was studied in the blood of seven healthy donors taken before and 24 h after a flu vaccine or ex vivo LPS (lipopolysaccharide) treatment; flu vaccination was not detected at the transcriptional level and LPS did not have any effect on the radiation-induced signature identified. Finally, we identified a radiation-specific signature of 31 genes in the blood of radiotherapy patients that were common for all cancers, regardless of the immune status of patients. Confirmation via MQRT-PCR was obtained for BCL6, MYD88, MYC, IL7, CCR4 and CCR7. This study offers the foundation for future research on biomarkers of radiation exposure, radiation sensitivity, and radiation toxicity for personalized radiotherapy treatment.

Differences in enteric pathogens and intestinal microbiota between diarrheic weaned piglets and healthy penmates.

Postweaning diarrhea (PWD) is a multifactorial disease caused by different aetiological agents, like viruses or bacteria and where the role of the microbiota remains unclear. The aim of this study was to assess differences between healthy and diarrheic weaned pigs concerning the prevalence of pathogens and changes in the intestinal microbiota. Eighteen farms with PWD were selected and 277 fecal samples were collected (152 diarrheic vs 125 healthy). Presence of Rotavirus A (RVA), B (RVB), C (RVC) and Porcine Epidemic Diarrhea Virus (PEDV), virulence factors of Escherichia coli and Clostridioides difficile were analyzed by PCR. Finally, the microbiota composition was also study by 16 S rRNA sequencing on 148 samples (102 diarrheic vs 46 healthy). RVA (53.95 % vs 36 %, p=0.04) and RVB (49.67 % vs 28.8 %, p<0.001) were more frequent in diarrheic animals. Furthermore, RVA viral load was higher in diseased animals. VT2 toxin was significantly associated with diarrhea, whereas other virulence factors were not. Presence of C. difficile and PEDV was almost negligible. Regarding microbiota changes, Fusobacteriota phylum was more frequent in diarrheic samples and Ruminococcaceae family in healthy penmates. During the first week postweaning, Enterobacteriace and Campylobacteria were enriched in animals presenting diarrhea. Furthermore, Lactobacillus was detected in those individuals with no RVA infection. In conclusion, RVA seems to play a primary role in PWD. Classic E. coli virulence factors were not associated with diarrhea, indicating the need for revising their implication in disease. Moreover, Lactobacillus was found frequently in animals negative for RVA, suggesting some protective effect.

Gut microbiome and resistome characterization of pigs treated with commonly used post-weaning diarrhea treatments.

BACKGROUND: The global burden of antimicrobial resistance demands additional measures to ensure the sustainable and conscious use of antimicrobials. For the swine industry, the post-weaning period is critical and for many years, antimicrobials have been the most effective strategy to control and treat post-weaning related infections. Among them, post-weaning diarrhea causes vast economic losses, as it severely compromises piglets' health and growth performance. In this study, 210 piglets were transferred from a farm with recurrent cases of post-weaning diarrhea to an experimental farm and divided into six different treatment groups to determine the effect of the different treatments on the growth performance and survival, the microbiome, and the resistome in a cross-sectional and longitudinal study. The different treatments included antimicrobials trimethoprim/sulfamethoxazole, colistin, and gentamicin, an oral commercial vaccine, a control with water acidification, and an untreated control. An extra group remained at the farm of origin following the implemented amoxicillin routine treatment. A total of 280 fecal samples from pigs at four different sampling times were selected for metagenomics: before weaning-treatment at the farm of origin, and three days, two weeks, and four weeks post-treatment. RESULTS: The control group with water acidification showed a reduced death risk in the survival analyses and non-significant differences in average daily weight gain in comparison to the antibiotic-treated groups. However, the growth-promoting effect among antibiotic-treated groups was demonstrated when comparing against the untreated control group at the experimental farm. After four weeks of treatment, diversity indexes revealed significantly decreased diversity for the untreated control and the group that remained at the farm of origin treated with amoxicillin. For this last group, impaired microbial diversity could be related to the continuous amoxicillin treatment carried out at the farm. Analysis of the resistome showed that both gentamicin and amoxicillin treatments significantly contributed to the emergence of resistance, while trimethoprim/sulphonamide and colistin did not, suggesting that different treatments contribute differently to the emergence of resistance. CONCLUSIONS: Overall, this shotgun longitudinal metagenomics analysis demonstrates that non-antibiotic alternatives, such as water acidification, can contribute to reducing the emergence of antimicrobial resistance without compromising pig growth performance and gut microbiome.

Leptin/Ghrelin Axis and Antibodies Reactive to Both Hormones in Relation to Metabolic Syndrome Components in Mexican Children.

Background: Metabolic syndrome (MetS) in children is a rising health issue that is strongly associated with cardiovascular diseases and type 2 diabetes mellitus development. Low-affinity antibodies reactive to leptin and ghrelin are suggested to regulate hormone stability and function; nevertheless, the role of the leptin/ghrelin axis and antibodies reactive to both hormones in relation to MetS or its components in the pediatric population remains unknown. Methods: Fifty-eight children (7-12 years) were included and categorized according to the presence of one or more criteria for the diagnosis of MetS or according to body mass index. Body composition, biochemical variables, and metabolic risk indexes were determined. Antibodies reactive to leptin and ghrelin were quantified by an in-house enzyme-linked immunosorbent assay test. Ratios of leptin/ghrelin hormones and anti-leptin/anti-ghrelin immune complexes were obtained. Results: The biochemical variables glucose (P = 0.0009), insulin (P = 0.0001), leptin (P = 0.0036), HOMA-IR (homeostatic model assessment for insulin resistance) (P < 0.0001), and plasma atherogenic index (P < 0.0001) were significantly higher in children with two or three components of MetS (MetS 2-3) in comparison to children with none or one component (MetS 0-1). Ratios of leptin/ghrelin (P = 0.0307) and anti-leptin/anti-ghrelin immune complexes (P = 0.0338) were higher in MetS 2-3 group versus MetS 0-1 group. In MetS 2-3 group, both insulin (r = 0.4361, P = 0.0293) and HOMA-IR (r = 0.4761, P = 0.0161) were positively correlated with the leptin/ghrelin hormone ratio. Conclusions: The higher leptin/ghrelin hormone ratio scores observed in MetS 2-3 group, along with their correlation with insulin levels and HOMA-IR, highlight the role of leptin and ghrelin on insulin sensitivity and metabolic regulation. An increased ratio of anti-leptin/anti-ghrelin immune complexes suggests affinity changes in these antibodies that may lead to alterations in hormone function.

Swine farm environmental microbiome: exploring microbial ecology and functionality across farms with high and low sanitary status.

Introduction: Stringent regulations in pig farming, such as antibiotic control and the ban on certain additives and disinfectants, complicate disease control efforts. Despite the evolution of microbial communities inside the house environment, they maintain stability over the years, exhibiting characteristics specific to each type of production and, in some cases, unique to a particular company or farm production type. In addition, some infectious diseases are recurrent in specific farms, while other farms never present these diseases, suggesting a connection between the presence of these microorganisms in animals or their environment. Therefore, the aim of this study was to characterise environmental microbiomes of farms with high and low sanitary status, establishing the relationships between both, health status, environmental microbial ecology and its functionality. Methods: For this purpose, 6 pig farms were environmentally sampled. Farms were affiliated with a production company that handle the majority of the pigs slaughtered in Spain. This study investigated the relationship among high health and low health status farms using high throughput 16S rRNA gene sequencing. In addition, to identify ecologically relevant functions and potential pathogens based on the 16S rRNA gene sequences obtained, functional Annotation with PROkaryotic TAXa (FAPROTAX) was performed. Results and Discussion: This study reveals notable differences in microbial communities between farms with persistent health issues and those with good health outcomes, suggesting a need for protocols tailored to address specific challenges. The variation in microbial populations among farms underscores the need for specific and eco-friendly cleaning and disinfection protocols. These measures are key to enhancing the sustainability of livestock farming, ensuring safer products and boosting competitive edge in the market.

An investigation of the transmission of Actinobacillus pleuropneumoniae within vertically integrated systems using whole genome sequencing.

Actinobacillus pleuropneumoniae (APP) causes significant economic losses to the swine industry. Antibiotic treatment can be challenging due to its clinical urgency and the turnover of antimicrobial susceptibility results from the diagnostic laboratory. The aim of this study was to evaluate the vertical transmission of APP within integrated systems as a criterion for optimising antimicrobial treatment in the field, using whole genome sequencing (WGS). Additionally, the genetic variability of Spanish APP isolates has been assessed to decipher antimicrobial resistance (AMR) determinants, toxin presence, serotype, and phenotype/genotype concordance of AMR. A total of 169 isolates from clinical cases of porcine pleuropneumonia with known antimicrobial susceptibility profiles were sequenced. Additionally, 48 NCBI assemblies were included to perform a phylogenetic analysis. Phylogenetic analysis revealed high association between phylogenetic clusters, serotypes, and presence of toxins that are associated within vertically integrated systems by its epidemiological link. Concordance between presence of AMR determinants (genotype) vs in-vitro antimicrobial susceptibility pattern (phenotype) was acceptable for amoxicillin, florfenicol, oxytetracycline, and enrofloxacin using epidemiological cut-off values (ECOFFs), but low concordance was observed for doxycycline and trimethoprim-sulfamethoxazole (T/S). On the other hand, using CLSI clinical breakpoints (CBPs), concordance was acceptable for florfenicol and enrofloxacin and not evaluated for doxycycline, oxytetracycline, trimethoprim-sulfamethoxazole (T/S), and amoxicillin because no CBP are available for them. Finally, WGS has demonstrated the clonality between isolates that shared a common origin (grandmother's farm) and resistance phenotype, suggesting vertical transmission of this pathogen and supporting the use of the epidemiological approach as a good criterion to optimise the antimicrobial use.

Outcomes in Patients With Vogt-Koyanagi-Harada Disease From the First-Line Antimetabolites for Steroid-Sparing Treatment Uveitis Trial.

PURPOSE: To compare the effectiveness of methotrexate (MTX) and mycophenolate mofetil (MMF) in achieving corticosteroid-sparing control of uveitis in patients with Vogt-Koyanagi-Harada (VKH) disease. METHODS: A subanalysis of patients with VKH from the First-line Antimetabolites as Steroid-sparing Treatment Uveitis Trial, a randomized, observer-masked, comparative effectiveness trial, with comparisons by treatment (MTX vs MMF) and disease stage (acute vs chronic). Individuals with noninfectious uveitis were placed on a standardized corticosteroid taper and block randomized 1:1 to either 25 mg weekly oral MTX or 1.5 g twice daily oral MMF. The primary outcome was treatment success defined by corticosteroid-sparing control of uveitis at 6 months. Additional outcomes included change in best spectacle-corrected visual acuity (BSCVA), retinal central subfield thickness (CST), and resolution of serous retinal detachment (SRD). RESULTS: Ninety-three out of 216 enrolled patients had VKH; 49 patients were randomized to MTX and 44 to MMF, of which 85 patients (46 on MTX, 39 on MMF) contributed to the primary outcome. There was no significant difference in treatment success by antimetabolite (80.4% for MTX compared to 64.1% for MMF; P = .12) or in BSCVA improvement (P = .78). MTX was superior to MMF in reducing CST (P = .003) and resolving SRD (P = .02). There was no significant difference in treatment success by disease stage (P = .25), but patients with acute VKH had greater improvement in BSCVA (P < .001) and reduction of CST (P = .02) than chronic VKH patients. CONCLUSIONS: MTX and MMF have comparable outcomes as corticosteroid-sparing immunosuppressive therapies for VKH. Visual acuity improvement was greater in acute vs chronic VKH. NOTE: Publication of this article is sponsored by the American Ophthalmological Society TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT00182929.

Secuencia de Pierre Robin: descripción de un caso

Antecedentes. La secuencia Pierre Robin tiene dos modalidades de presentación: sindromática y no sindromática, el diagnóstico es clínico y se realiza al momento del nacimiento y puede afectar el crecimiento y desarrollo del lactante. Cuadro clínico y manejo. Fisura palatina en herradura de 1.5 cm x 2 cm en paladar blando, paladar ojival. Sobremordida horizontal y micrognatia causante de glosoptosis evidenciada por ronquidos intermitentes al mantener al paciente en posición supina, sin insuficiencia respiratoria, succión débil y descoordinación succión-deglución. Manejo con placa ortopédica palatina y control periódico hasta los 18-24 meses de edad por cirugía plástica. Uso de chupón especial NUK para fisura palatina y ejercicios de coordinación para la función succión- deglución. Conclusión. Aún con los avances tecnológicos que apoyan los diagnósticos prenatales, es importante que el Pediatra tenga en mente que la exploración física sigue siendo la piedra angular ante cualquier diagnóstico. También es importante recordar que hay alteraciones físicas no evidentes a primera vista, como las de cavidad oral, por lo que se requiere una exploración detallada de la misma. (provisto por Infomedic International)

Background. There are two modalities of presentation on the Pierre Robin sequence: syndromic and non-syndromic, the diagnosis is clinical and done at birth, and it can affect the growth and development of the infant. Clinical picture and management. Horseshoe cleft palate 1.5 cm x 2 cm in soft palate, high-arched palate. Overbite and micrognathia causing glosoptosis evidenced by intermittent snoring when keeping the patient in a supine position, without respiratory failure, weak sucking, and sucking-swallowing incoordination. Management with palatal orthopedic plate and periodic control until 18-24 months of age by plastic surgery. Use of a special NUK pacifier for cleft palate and coordination exercises for the sucking-swallowing function. Conclusion. Even with the technological advances that support prenatal diagnosis, it is important that the Pediatrician keep in mind that the physical examination continues to be the cornerstone of any diagnosis. It is also important to remember that there are physical alterations that are not evident at first sight, such as those of the oral cavity, for which reason a detailed examination is required. (provided by Infomedic International)

Influencia de los tipos de agrupamiento en la competencia social de futuros docentes de educación física al implementar el aprendizaje cooperativo / Influência dos tipos de agrupamento na competência social dos futuros professores educação física na implementação da aprendizagem cooperativa / Influence of the types of grouping on the social competence of future physical education teachers when implementing cooperative learning

Resumen El objetivo de esta investigación fue comprobar la incidencia del aprendizaje cooperativo (AC) en la competencia social en función de los tipos de agrupamiento del alumnado. Participaron 53 estudiantes de tercer curso del Grado de Magisterio Educación Primaria de la mención de Educación Física (EF). Se utilizó un diseño cuasi-experimental donde se implementó una intervención durante cuatro meses con medidas pre-test y post-test a través de un cuestionario sociométrico. El tratamiento de datos se realizó mediante el software Sociomet. Los resultados obtenidos indican que los seminarios que han utilizado agrupamientos libres y heterogéneos han obtenidos mejores puntuaciones de percepción de competencia social que el seminario organizado en subgrupos homogéneos. Así pues, se considera que el criterio de homogeneidad debe ser descartado a la hora de implementar el AC en EF. (AU)

Resumo O objetivo desta pesquisa foi verificar a incidência da aprendizagem cooperativa (LC) na competência social em função dos tipos de agrupamento de alunos. Participaram 53 alunos do terceiro ano do Ensino Fundamental da Licenciatura da menção à Educação Física (EF). Foi utilizado um desenho quase experimental onde foi implementada uma intervenção durante quatro meses com medidas pré-teste e pós-teste através de um questionário sociométrico. O processamento dos dados foi realizado por meio do software Sociomet. Os resultados obtidos indicam que os seminários que utilizaram agrupamentos livres e heterogêneos obtiveram melhores pontuações para a percepção de competência social do que o seminário organizado em subgrupos homogêneos. Assim, considera-se que o critério de homogeneidade deve ser descartado na implementação da AC em EF. (AU)

Abstract The objective of this research was to verify the incidence of cooperative learning (CL) in social competence depending on the types of grouping of students. Fifty-three (53) third-year students of the Primary Education Teaching Degree participated with the mention of Physical Education (PE). A quasi-experimental design was used where intervention was implemented for four months with pre-test and post-test measures through a sociometric questionnaire. Data processing was performed using Sociomet software. The results obtained indicate that the seminars that have used free and heterogeneous groupings have obtained better scores for the perception of social competence than the seminar organized in homogeneous subgroups. Thus, it is considered that the homogeneity criterion should be discarded when implementing CA in PE. (AU)

Utilización de medicamentos off-label y unlicensed en una unidad de cuidados intensivos pediátricos de un hospital de alta complejidad español. Estudio descriptivo / Off-label and unlicensed drug use in a pediatric intensive care unit of a tertiary care Spanish hospital. A descriptive study

Introducción. En las unidades de cuidados intensivos pediátricos, se utiliza gran cantidad de medicamentos, muchos prescritos fuera de las condiciones establecidas en su ficha técnica (prescripciones off-label y unlicensed). El objetivo de este estudio fue describir el uso de medicamentos y estimar la prevalencia de fármacos off-label y unlicensed en una unidad de cuidados intensivos pediátricos de un hospital de tercer nivel español. Población y métodos. Estudio transversal, observacional, de una cohorte de niños ingresados en una unidad de cuidados intensivos pediátricos. El estudio se llevó a cabo en 2017. Se revisó cada fármaco prescrito, sus condiciones de uso y administración. Además, se analizaron las fichas técnicas de los fármacos implicados con la finalidad de identificar si el uso de los medicamentos se realizaba según sus condiciones de autorización, o bien se hacía fuera de prospecto (off-label) o como unlicensed. Resultados. La muestra fue de 97 pacientes. El 74,2 % (n = 72) de los pacientes recibieron algún fármaco off-label o unlicensed. El 23,8 % (n = 243) de las prescripciones fueron off-label y el 8,7 % (n = 89), unlicensed. El subanálisis realizado por grupos de edad mostró que el grupo de edad que recibió mayor número de prescripciones totales (n = 611) y el mayor porcentaje de fármacos prescritos en condiciones off-label y/o unlicensed (38,4 %) fue el de menores de 2 años. Conclusiones. La prescripción de fármacos off-label y/o unlicensed es una práctica habitual en la unidad de cuidados intensivos pediátricos. Este estudio permite documentar la complejidad de la terapéutica en niños.

Introduction. In pediatric intensive care units, a large number of drugs are used, many of which are prescribed for condition beyond those established in their summary of product characteristics (off-label and unlicensed drug prescriptions). The objective of this study was to describe drug use and estimate the prevalence of off-label and unlicensed drugs in a pediatric intensive care unit of a tertiary care Spanish hospital. Population and methods. Cross-sectional, observational study with a single cohort of children admitted to a pediatric intensive care unit. The study was conducted in 2017. Each drug prescription, its conditions of use and administration were reviewed. In addition, the summary of product characteristics of drugs used were analyzed in order to identify whether they were used according to their conditions of authorization, or whether they were used in an off-label or unlicensed manner. Results. The sample included 97 patients. At least one off-label or unlicensed drug was administered to 74.2% (n = 72) of patients; 23.8% (n = 243) corresponded to off-label prescriptions and 8.7% (n = 89), unlicensed prescriptions. A sub-analysis by age group showed that the age group that received a higher number of total prescriptions (n = 611) and a higher percentage of off-label and/or unlicensed drug prescriptions (38.4%) was under 2 years of age. Conclusions. Off-label and/or unlicensed drug prescription is a common practice in the pediatric intensive care unit. This study allowed us to document the complexity of therapeutics in children.

Caracterización de pacientes con infarto agudo de miocardio atendidos en el Hospital General Universitario Dr. Gustavo Aldereguía Lima

Fundamento: el infarto agudo de miocardio con elevación del segmento ST impone un gran desafío a los sistemas de salud, por tanto, su diagnóstico y manejo son importantes. Objetivo: determinar las principales características clínico-epidemiológicas de pacientes con diagnóstico de infarto agudo de miocardio con elevación del segmento ST. Métodos: se realizó un estudio descriptivo y transversal sobre una serie de pacientes atendidos en el Hospital General Universitario Dr. Gustavo Aldereguía Lima de Cienfuegos, en el periodo de enero a junio de 2021. El universo estuvo constituido por 77 pacientes. Se estudiaron variables como: edad, sexo, color de la piel, procedencia, comorbilidades, hábitos tóxicos, manifestaciones clínicas, trombolisis, lugar donde se trombolizaron, causas de no trombolisis, topografía del infarto agudo de miocardio, estado al egreso, complicaciones del infarto y del tratamiento trombolítico. Para el procesamiento y análisis de la información se creó una base de datos en el paquete estadístico SPSS versión 21.0 que permitió el cálculo de las frecuencias absolutas y los porcentajes. Resultados: la media de edad fue 66,08 (±9,43). Hubo un predominio del sexo masculino (64,7 %); el 59,7 % de los pacientes fueron trombolizados; el dolor torácico típico fue la principal manifestación clínica con un 71,4 %; fallecieron 12 pacientes, de ellos el 10,4 % no recibió tratamiento trombolítico. Conclusiones: el principal motivo de consulta sigue siendo el dolor torácico. La edad y las comorbilidades son factores de riesgo a tener en cuenta a la hora de prevenir esta entidad. La trombolisis es una medida terapéutica que tiene repercusión directa en el estado al egreso de los pacientes, este procedimiento se realiza en su mayoría en el hospital.

Background: ST-segment elevation acute myocardial infarction poses a great challenge to health systems, therefore its diagnosis and management are important. Objective: to determine the main clinical-epidemiological characteristics of patients diagnosed with ST-segment elevation acute myocardial infarction. Methods: a descriptive and cross-sectional study was carried out on a series of patients treated at the Dr. Gustavo Aldereguía Lima University General Hospital in Cienfuegos, from January to June 2021. The universe consisted of 77 patients. Variables such as: age, sex, skin color, origin, comorbidities, toxic habits, clinical manifestations, thrombolysis, place where they were thrombolyzed, causes of non-thrombolysis, topography of acute myocardial infarction, discharge status, infarction complications and of thrombolytic treatment. For the processing and analysis of the information, a database was created in the statistical package SPSS version 21.0 that allowed the calculation of the absolute frequencies and the percentages. Results: the mean age was 66.08 (±9.43). There was a predominance of the male sex (64.7 %); 59.7 % of the patients were thrombolyzed; typical chest pain was the main clinical manifestation with 71.4 %; 12 patients died, of which 10.4 % did not receive thrombolytic treatment. Conclusions: the main reason for consultation continues to be chest pain. Age and comorbidities are risk factors to take into account when preventing this entity. Thrombolysis is a therapeutic measure that has a direct impact on the state at discharge of patients, this procedure is performed mostly in the hospital.

Resultados de una encuesta nacional sobre conocimiento y uso de pseudociencias por parte de los pediatras / Results of a national survey on knowledge and use of complementary and alternative medicine by paediatricians

Introducción: El uso de determinadas pseudociencias en niños está documentado en España. El objetivo principal del estudio es estimar el grado de conocimiento, la recomendación y el uso de algunas pseudoterapias por parte de los pediatras españoles. Material y métodos: Estudio transversal, descriptivo y de ámbito nacional, mediante encuesta en línea, enviada por correo electrónico a pediatras socios de la Asociación Española de Pediatría (AEP), entre junio y julio de 2020. (AU)

Introduction: The use of certain Complementary and Alternative Medicines (CAM) in children has been documented in Spain. The main aim of this study is to estimate the knowledge, recommendations, and use of CAM by Spanish paediatricians. Material and methods: A national study was conducted from June to July 2020 using an online questionnaire. Two e-mails were sent to paediatricians who were members of the Spanish Association of Paediatrics (AEP). (AU)

Barreras para la atención de las conductas suicidas en Ciudad de México: experiencias del personal de salud en el primer nivel de atención / Barriers to Care of Suicidal Behavior in Mexico City: Health Personnel Experiences at the First Level of Care / Barreiras para a atenção das condutas suicidas na Cidade do México: experiências dos profissionais de saúde na atenção básica

Resumen Objetivo: Identificar las barreras que existen para la atención de las conductas suicidas, desde la perspectiva de las/los profesionales de la salud mental del primer nivel de atención de la Ciudad de México. Metodología: Estudio cualitativo exploratorio, basado en 35 entrevistas semiestructuradas, dirigidas a personal de salud de dos unidades de salud mental de referencia nacional. El análisis de la información se hizo mediante el Framework Analysis. Resultados: Las/los participantes consideraron que las conductas suicidas no han sido definidas como una prioridad dentro de los trastornos de salud mental. La ausencia de políticas públicas, la sobrecarga de trabajo, la falta de seguimiento a las/los pacientes, entre otras, fueron identificadas como barreras para una atención adecuada y oportuna. Conclusiones: Los programas de prevención de las conductas suicidas deben tomar en cuenta el contexto socioeconómico de la población y las características de los servicios de salud, así como las necesidades de las personas prestadoras de servicios de salud. Se requiere ampliar el entrenamiento profesional y mejorar el sistema de referencia y contrarreferencia entre los distintos niveles de atención.

Abstract Objective: To identify the existing barriers to the care of suicidal behavior from the perspective of mental health professionals at the first level of care in Mexico City. Methodology: Qualitative exploratory study based on 35 semi-structured interviews conducted on health personnel from two national reference mental health facilities. The data were analyzed with Framework Analysis. Results: The participants considered that suicidal behavior has not been prioritized among mental health disorders. The absence of public policies, work overload, lack of patient follow-up, among others, were identified as barriers to adequate and timely care. Conclusions: Suicidal behavior prevention programs should consider the socioeconomic context of the population, the characteristics of health services, and the needs of health care providers. Professional training should be enhanced, and the referral and counter-referral system across levels of care should be improved.

Resumo Objetivo: Identificar as barreiras existentes para a atenção das condutas suicidas, desde a perspectiva dos profissionais de saúde mental de atenção básica da Cidade do México. Metodologia: Estudo qualitativo exploratório, baseado em 35 entrevistas semiestruturadas, dirigidas a profissionais de saúde de duas unidades de saúde mental de referência nacional. A análise da informação foi feita através do Framework Analysis. Resultados: Os participantes consideraram que as condutas suicidas não têm sido definidas como uma prioridade dentro dos transtornos de saúde mental. A ausência de políticas públicas, a sobrecarga de trabalho, a falta de seguimento aos pacientes, entre outras, foram identificadas como barreiras para uma atenção adequada e oportuna. Conclusões: Os programas de prevenção das condutas suicidas devem considerar o contexto socioeconômico da população e as características dos serviços de saúde, além das necessidades dos profissionais de saúde. É necessário ampliar o treinamento profissional e melhorar o sistema de referência e contrarreferência entre os diferentes níveis de atenção.

Percepciones del personal sanitario sobre el manejo familiar del aislamiento social infantil durante la COVID-19 / Perceptions of Health Personnel on Family Management of Children's Social Isolation during COVID-19

Introducción: La propagación del nuevo coronavirus responsable de la COVID-19, amenaza la vida de millones de infantes, por lo cual, en la mayoría de los países, los niños han sido confinados en sus casas, lo que favorece de manera proporcional su protección. En sentido general, la familia no ha mostrado preparación para manejar con calidad la convivencia permanente de los niños en casa y se manifiestan violaciones del aislamiento físico de los menores. Objetivo: Analizar las percepciones del personal de salud sobre el cuidado y protección familiar de los niños a través del aislamiento social. Métodos: Se realizó un estudio de tipo exploratorio bajo un diseño transversal descriptivo, en el Consejo Popular 26 de Julio del municipio Holguín en el periodo comprendido entre diciembre de 2020 y mayo de 2021. Se aplicó una encuesta al personal sanitario (n = 17) asociado a las pesquisas en dicha área de salud. Resultados: Se identificaron fortalezas y debilidades en la atención médica a las familias con niños en la zona estudiada. El 100 por ciento de los participantes identificaron las pesquisas como una excelente herramienta para la promoción del cumplimiento del aislamiento de los pequeños. Según el criterio del 96,1 por ciento de los encuestados ocurrieron violaciones en el distanciamiento físico infantil en el área de salud seleccionada. Conclusiones: La familia tiene un rol primordial en el cumplimiento del confinamiento de los pequeños, a la vez, tiene la responsabilidad de lograr calidad en este proceso. No obstante, se evidencia la violación del distanciamiento infantil como resultado de la indisciplina familiar, que incrementa la vulnerabilidad de la infancia(AU)

Introduction: The spread of the new coronavirus responsible for COVID-19 threatens the lives of millions of infants, for which, in most countries, children have been confined to their homes, which proportionally favors their protection. In general terms, the family has not shown preparation to handle with quality the permanent coexistence of the children at home and there are violations of the physical isolation of the minors. Objective: To analyze the perceptions of health personnel about the family care and protection of children through social isolation. Methods: An exploratory study was carried out under a descriptive cross-sectional design, in 26 de Julio People´s Council in Holguín municipality from December 2020 to May 2021. A survey was applied to health personnel (n = 17) associated with the investigations in said health area. Results: Strengths and weaknesses in medical care for families with children in the studied area were identified. One hundred percent of the participants identified the studies as an excellent tool for promoting compliance with the isolation of children. According to the criteria of 96.1percent of the respondents, violations of children's physical distancing occurred in the selected health area. Conclusions: The family has a fundamental role in the fulfillment of the isolation of the children and, at the same time, it is committed to achieving quality in this process. However, the violation of childhood distancing is evident as a result of family indiscipline, which increases the vulnerability of childhood(AU)

Índices de shock prehospitalario y hospitalario como predictores de transfusión masiva en la atención inicial del paciente politraumático / Prehospital and hospital shock indices as predictors of massive blood transfusion during the initial treatment of polytrauma patients

OBJETIVOS: Establecer la posible relación entre el Índice de Shock (IS) con los requerimientos de transfusión masiva, estancia hospitalaria y en unidad de críticos, y mortalidad. MÉTODO: Estudio observacional de los pacientes mayores de 18 años con traumatismos de alta energía del registro TraumCat atendidos en el Hospital Universitario de Bellvitge entre 2012 y 2016. Se recogió el IS prehospitalario (PH), a la llegada al hospital (H) y en la unidad de reanimación (IS-C), y la cantidad de transfusión las primeras 24 horas. RESULTADOS: Se recogieron 184 pacientes y 75 (41%) recibieron transfusión sanguínea. Las medianas de los IS para todos los pacientes del estudio fueron: IS-PH 0,77 (Q1-Q3; 0,61-1,01), IS-H 0,78 (Q1-Q3; 0,64-1), IS-C 0,92 (Q1-Q3;0,76-1,13). Fallecieron 46 pacientes (25%). El IS-PH y el IS-H fueron los que diferenciaron de manera significativa la cantidad de transfusión. El valor 0,9 mostró una especificidad/sensibilidad del 73%/66% para el IS-PH y del 74%/80%para el IS-H. El área bajo la curva ROC para el IS-PH y el IS-H fue del 68% (IC 95% 61-75) y del 72% (IC 95% 65-79) respectivamente. No hubo relación significativa de los IS con la mortalidad y la estancia hospitalaria. CONCLUSIÓN: El IS es una herramienta útil y accesible para identificar pacientes politraumatizados con requerimientos transfusionales de manera temprana y optimizar el tratamiento. Para evaluar estancias hospitalarias o mortalidad, podrían ser más útiles otros índices

OBJECTIVES: To explore a possible association between the shock index and a need for massive blood transfusion, duration of hospital stay in the critical care unit, and mortality. METHODS: Observational study of data for all patients over the age of 18 years with multiple high-energy injuries included in the TraumCat Registry who were treated in Hospital Universitario de Bellvitge between 2012 and 2016.We calculated shock index values before hospital emergency department arrival, on arrival at the hospital, and on admission to the critical care unit for resuscitation. The amount of blood transfused in the first 24 hours was also obtained from the registry. RESULTS: Of 184 polytrauma patients, 75 (41%) received blood transfusions. Median (interquartile range) shock indices were as follows: prehospital, 0.77 (0.61-1.01); on hospital arrival, 0.78 (0.64-1); and on critical care admission, 0.92 (0.76-1.13). Forty-six patients (25%) died. A prehospital shock index of 0.9 was significant, differentiating the amount of blood transfused. The specificity and sensitivity of the cut off were 73% and 66%,respectively, at the prehospital recording and 74% and 80% on hospital arrival. The areas under the receiver operating characteristic curve and 95% CIs were as follows for prehospital and on-arrival shock indices: 68% (61%-75%) and 72% (65%-79%). Mortality and hospital stay were not significantly associated with shock indices. CONCLUSIONS: The shock index is a useful, easy-to-obtain predictor to identify polytrauma patients who need early blood transfusion for optimal treatment. Hospital stay and mortality might be better predicted by other indicators

Percepciones de los profesionales de enfermería sobre los cuidados en el paciente geriátrico / Perceptions of Nursing professionals about care in the geriatric patient

Objetivos: Conocer y describir cómo perciben las enfermeras que trabajan con pacientes geriátricos los cuidados de enfermería proporcionados, los problemas con los que se encuentran, así como las soluciones para mejorarlos. Métodos: Estudio cualitativo de tipo fenomenológico basado en entrevistas semiestructuradas. La información obtenida se analizó mediante análisis de contenido y se verificó con la triangulación de los resultados. Resultados: Emergieron siete categorías coincidentes en todas las entrevistas realizadas: percepciones de las enfermeras sobre los cuidados de enfermería en el paciente geriátrico, calidad de los cuidados de enfermería, dificultades al proporcionar los cuidados de enfermería, propuestas de mejoras de enfermería, satisfacción del paciente y familia con la enfermera, presente y futuro de la profesión enfermera, y el trabajo de equipo. Las enfermeras consideran el cuidado como un arte y la esencia de la profesión; la persona enferma es la pieza clave que justifica la profesión. Conclusiones: os profesionales consideran que son fundamentales: el reconocimiento de las especialidades de enfermería, la formación continua, que las administraciones motiven a sus profesionales, prevenir el síndrome de estar quemado, enseñar a trabajar en equipo y avanzar hacia la seguridad del paciente y del profesional (AU)

Objectives: Objectives: to know and describe how nurses perceive the care they provide in the daily work with geriatric patients, the problems they find as well as the solutions to improve them. Methods: qualitative phenomenological study based on semi-structured interviews. The information obtained was analyzed by content analysis and verified with the triangulation of the results. Results: Seven matching categories emerged in all the conducted interviews: nurses perceptions about the care of geriatric patient, quality of nursing care, difficulties to apply nursing care, proposals for improvement of nursing, patient and family satisfaction with the nurse work, present and future of the nursing profession, and the teamwork. Nurses consider care as an art and the essence of the profession; the sick person is the key piece that justifies the profession. Conclusions: professionals believe that, are fundamental: the recognition of nursing specialties, continuous education and training, that the administrations to motivate their professionals, prevention of the burnt-out syndrome, teach to work as a team, and move towards patient and professional safety (AU)

Experiencias sobre la aplicación de una guía de estudio para examen de premio en Microbiología / Experiences based on the application of a study guide for the prize exam in Microbiology

RESUMEN Los exámenes de premio, los cuales constituyen una vía para elevar la calidad de los egresados de la educación superior, tienen como objetivo estimular a los estudiantes para que profundicen en el estudio de las asignaturas y disciplinas que conforman su plan de estudio. El colectivo de Microbiología de la Facultad de Ciencias Médicas "Mariana Grajales Coello", de la provincia Holguín, como parte del perfeccionamiento de la asignatura, se propuso motivar y promover la participación de los estudiantes que cursan el segundo año de la carrera de Estomatología en el curso 2018-2019, y poseen los requisitos establecidos para realizar el examen de premio, a través de la elaboración de una guía de contenidos como punto de partida para el estudio independiente. Los autores se propusieron como objetivo socializar esta experiencia a fin de que se generalice en otros espacios académicos y/o asignaturas, por sus buenos resultados.

ABSTRACT The prize exams, which constitute a way to raise the quality of higher education graduates, aim at stimulating the students so as to deepen in the learning of the subjects and disciplines of their study program. The professors of the Microbiology department of the Medical Sciences Faculty in Holguin province, as part of the perfectioning of the subject had the purpose to motivate and to promote the participation of the students, who take the second year of the Dentistry degree and the ones that possess the established requirements, to accomplish the prize exams in the academic year 2018-2019, through the elaboration of a guide of contents as a starting point for their independent study. The authors have the objective to socialize this experience in order to generalize it in other academic spaces and/or subjects because of the good results obtained.

Fungemia causada por Rhodotorula en un lactante crítico / Fungemia caused by Rhodotorula in a critical infant

Introducción: Rhodotorula es considerada un microorganismo contaminante no virulento. Forma parte de la microbiota de la piel, las uñas y las mucosas. Se aísla con frecuencia del ambiente humanizado. Estas levaduras han surgido como patógenos oportunistas en pacientes con inmunodeficiencias, portadores de catéteres intravenosos de larga duración y otros. Objetivo: Informar a la comunidad pediátrica un nuevo caso de fungemia causada por Rhodotorula. Presentación del caso: lactante de 2 meses de edad, pretérmino de 32,1 semanas, con un peso al nacer de 1 800 gramos, que ingresa en la sala de cuidados intensivos del Hospital Pediátrico Provincial, Cienguegos, con el diagnóstico de una sepsis sin un foco primario definido. Después de 5 días de tratamiento con meropenem y vancomicina la fiebre cede y reaparece nuevamente pasados otros 5 días. En el momento en que la fiebre se reanuda tenía un catéter centrovenoso de ocho días de duración. En los hemocultivos realizados en esa fecha se aisló una Rhodotorula sp. Conclusiones: A pesar de que Rhodotorula es un microorganismo de baja virulencia, debe considerarse un potencial patógeno en pacientes con inmunosupresión y catéteres venosos centrales. Las especies de Rhodotorula se consideran intrínsecamente resistentes a los azoles y las equinocandinas, pero susceptibles a anfotericina B y flucitosina. En consecuencia, el tratamiento de elección preferido es con cualquier tipo de preparación de anfotericina B. El resultado alcanzado constituye un llamado de atención para la comunidad pediátrica nacional y foránea(AU)

ABSTRACT Introduction: Rhodotorula is considered a contaminating, non-virulent microorganism. It is part of the microbiota of the skin, nails and mucous membranes. It is often isolated from the humanized environment. These yeasts have emerged as opportunistic pathogens in patients with immunodeficiencies carrying long-term intravenous catheters. Objective: To inform to the pediatricians´ community a new case of fungemia due to Rhodotorula. Case presentation: 2-month-old, preterm infant of 32.1 weeks, with a birth weight of 1800 grams, who was admitted to Intensive Care service in Provincial Pediatric Hospital of Cienfuegos province with a diagnosis of sepsis without a defined primary focus. After 5 days of treatment with meropenem and vancomycin, the fever subsides and reappears again after another 5 days. By the time the fever reappears he had an 8-day central venous catheter. In the blood cultures carried out on that date a Rhodotorulasp was isolated. Conclusions: Although Rhodotorula is a low virulence microorganism, it should be considered as a potential pathogen in patients with immunosuppression and central venous catheters. Rhodotorula species are considered intrinsically resistant to azoles and echinocandins, but sensitive to amphotericin B and flucytosine. Consequently, the preferred treatment of choice is with any type of amphotericin B preparations. The results achieved constitute a call of attention to the national and foreign pediatrics´ community(AU)