An evaluation of the present status of quality assurance program implementation in digital mammography facilities in a developing country.

Quality assurance program (QAP) implementation in mammography is a key aspect to guarantee the acquisition of -quality images and, thus, an opportune diagnosis of breast cancer. A QAP involves planned and systematic actions, such as quality control (QC) tests that will produce consistently high-quality images, while considering low radiation exposure for stakeholders. Currently, there is poor evidence of the current QAP implementation status in developing countries, particularly in Latin America. In this work, 47 Mexican digital mammography facilities were evaluated in terms of their QAP implementation's current status during the period October 2021 to April 2022. A survey of three key indicators of compliance/non-compliance with QAPs was carried out. Also, 17 QC test parameters were assessed in all mammography units according to an international framework. The Kruskal-Wallis test, McNemar test, and Spearman correlation were used to identify the significant correlation between the QC tests and QAP indicators. Statistical analysis showed a significant positive correlation between the QAP indicators and QC parameters that were evaluated, especially associated with an increase in image quality. Almost 90% of the facilities evaluated failed in some QAP indicators, and only 44.68% of the facilities had an updated and current QAP implemented. Successful QAP implementation directly impacted on the QC mammography test results, particularly in terms of image quality, thus conditioning a successful mammography acquisition chain. The results obtained in this work suggest that better regulations need to be implemented to guarantee QAP surveillance, which could mean an increase in opportune diagnosis and management of breast cancer, with improved radiological safety for patients and occupational exposure personnel.

Effect of a hydrophobic bonding resin on the 36-month performance of a universal adhesive-a randomized clinical trial.

OBJECTIVES: To evaluate if the addition of a layer of a hydrophobic bonding resin to the recommended application sequence of a universal adhesive improves the respective clinical behavior in non-carious cervical lesions (NCCLs) after 36 months. MATERIALS AND METHODS: Scotchbond Universal Adhesive (SBU, 3M Oral Care) was applied in NCCLs of 39 subjects using four adhesion strategies: (1) three-step ER (etch-and-rinse), (2) two-step ER, (3) two-step SE (self-etch), and (4) one-step SE. An extra layer of a hydrophobic bonding resin was applied for strategies three-step ER and two-step SE. The same composite resin (Filtek Supreme XTE, 3M Oral Care) was used for all strategies. Restorations were evaluated at baseline and 18 and 36 months using the modified United States Public Health Service (USPHS) criteria. Kruskal-Wallis, Mann-Whitney U, Friedman, and Wilcoxon non-parametric tests were computed. RESULTS: The cumulative failure rate was 8.6%. The 36-month retention rates were 100% for both 3-ER and 2-ER, 76.0% for 2-SE, and 86.2% for 1-SE. A lower retention rate was observed for two-step SE at 36 months compared with both three-ER (p < 0.01) and two-ER (p < 0.01). Identical retention rates were measured for the two SE groups. When retention rate was compared at baseline versus 36 months for each adhesion strategy, a significant decrease was observed for 2-SE. The restorations performed with 3-ER, 2-SE, and 1-SE had a significant deterioration in marginal discoloration at the 18-month recall. CONCLUSIONS: The 36-month clinical performance of Scotchbond Universal Adhesive improved for both etch-and-rinse strategies. CLINICAL RELEVANCE: Phosphoric acid etching is still recommended to provide retention to composite restorations in NCCLs.

Chimeric antigen receptor T-cell therapy for multiple myeloma: a consensus statement from The European Myeloma Network.

Adoptive cellular therapy using chimeric antigen receptor T-cell (CART) therapy is currently being evaluated in patients with relapsed / refractory multiple myeloma (MM). The majority of CAR-T cell programs now being tested in clinical trials are targeting B-cell maturation antigen. Several recent phase I / II trials show promising preliminary results in patients with MM progressing on proteasome inhibitors, immunomodulatory drugs and monoclonal antibodies targeting CD38. CAR-T cell therapy is a potentially life-threatening strategy that can only be administered in experienced centers. For the moment, CAR-T cell therapy for MM is still experimental, but once this strategy has been approved in relapsed/refractory MM, it will become one of the most important indications for this therapy in Europe and world-wide. This manuscript proposes practical considerations for the use of CAR-T cell therapy in MM, and discusses several important issues for its future development.

Cost of incorrect application of antithrombotic prophylaxis prior to invasive procedures.

BACKGROUND: We analyze the cost of an incorrect application, by the haematologist, of bridging anticoagulation in patients with low-risk atrial fibrillation (AF) needing interruption of treatment prior to a scheduled invasive procedure. Although not recommended, bridging therapy is widely used, resulting in avoidable costs and increased workload. METHODS: Observational retrospective study. We recorded demographic and clinical data including age, sex, type of procedure, use of bridging therapy with low molecular weight heparin (LMWH), and haemorrhagic complications within 30 days of acenocoumarol withdrawal. RESULTS: Acenocoumarol was stopped in 161 patients, 97 (60%) were male and 64 (40%) female. Average age was 76,11 ± 8,45 years. Procedures included: minor surgical intervention 58 (36%), colonoscopy 61 (38%), gastroscopy 11 (7%), breast biopsy 4 (2.5%), prostate biopsy 4 (2.5%), infiltration 5 (3%), and other 18 (11%). All patients received bridging anticoagulation with LMWH (40 mg enoxaparin per day) 3 days before and 3 days after the procedure (6 doses). We used a total of 966 doses, at €4.5 per unit, resulted in €4347 of total cost. No complications occurred in 156 patients (97%). Haemorrhage was observed in 5 cases: 1 major haemorrhage needing 6 days of hospital stay and transfusion, and 4 minor haemorrhages (2 patients needed emergency attendance and 2 required hospital admission for 3 and 2 days, respectively). The cost of emergency care was €237.36, and the cost of hospital stay was €6860.81 (€623.71 per day, for 11 days). The total cost of the incorrect application of the protocol was €11,445.17. CONCLUSION: Guidelines about bridging anticoagulation in low risk AF patients undergoing scheduled invasive procedures were not followed. This practice increments the complications and supposes an increase in costs besides to an inadequate use of the human resources.

IRAK-M mediates Toll-like receptor/IL-1R-induced NFκB activation and cytokine production.

Toll-like receptors transduce their signals through the adaptor molecule MyD88 and members of the IL-1R-associated kinase family (IRAK-1, 2, M and 4). IRAK-1 and IRAK-2, known to form Myddosomes with MyD88-IRAK-4, mediate TLR7-induced TAK1-dependent NFκB activation. IRAK-M was previously known to function as a negative regulator that prevents the dissociation of IRAKs from MyD88, thereby inhibiting downstream signalling. However, we now found that IRAK-M was also able to interact with MyD88-IRAK-4 to form IRAK-M Myddosome to mediate TLR7-induced MEKK3-dependent second wave NFκB activation, which is uncoupled from post-transcriptional regulation. As a result, the IRAK-M-dependent pathway only induced expression of genes that are not regulated at the post-transcriptional levels (including inhibitory molecules SOCS1, SHIP1, A20 and IκBα), exerting an overall inhibitory effect on inflammatory response. On the other hand, through interaction with IRAK-2, IRAK-M inhibited TLR7-mediated production of cytokines and chemokines at translational levels. Taken together, IRAK-M mediates TLR7-induced MEKK3-dependent second wave NFκB activation to produce inhibitory molecules as a negative feedback for the pathway, while exerting inhibitory effect on translational control of cytokines and chemokines.

Self-reported prevalence and risk factors associated with food hypersensitivity in Mexican young adults.

BACKGROUND: Food hypersensitivity (FH) is defined as any unfavorable reaction after the ingestion, contact, or inhalation of a food. Few FH prevalence studies have been performed in the Mexican adult population. OBJECTIVE: To determine the prevalence of self-reported FH and probable food allergy (FA) among a sample of Mexican young adults and to determine the most commonly involved foods, associated symptoms, and risk factors. METHODS: We designed an observational, cross-sectional study in which 1,253 young adults (aged 18-25 years) born in the State of Mexico answered a questionnaire concerning FH. We obtained information on personal and familial histories of allergic diseases, the involved foods, and the subsequent adverse reactions to their consumption. RESULTS: The prevalence of FH was 30.1% and was significantly higher in women than in men (P < .001). The prevalence of probable FA was 5.9% and was also higher in women (P = .02). Gastrointestinal symptoms were reported in 83.1% of FH cases, whereas cutaneous symptoms and oral allergy syndrome were reported in FA cases. The food groups most associated with FH were dairy products (13.2%), vegetables (10.0%), and fruits (8.0%). The food groups most associated with FA were fruits (3.0%) and seafood (1.8%). Female sex, personal history of allergic diseases, maternal history of atopic dermatitis, and parental history of urticaria were significantly associated (P < .05) with the presence of FH. CONCLUSION: FH in young adults might be more common than previously thought, especially in women. However, further studies are needed to confirm this situation in the Mexican population.

Hydrogels based on poly(ethylene glycol) as scaffolds for tissue engineering application: biocompatibility assessment and effect of the sterilization process.

Hydrogels are suitable materials to promote cell proliferation and tissue support because of their hydrophilic nature, porous structure and sticky properties. However, hydrogel synthesis involves the addition of additives that can increase the risk of inducing cytotoxicity. Sterilization is a critical process for hydrogel clinical use as a proper scaffold for tissue engineering. In this study, poly(ethylene glycol) (PEG), poly(ethylene glycol)-chitosan (PEG-CH) and multi-arm PEG hydrogels were synthesized by free radical polymerization and sterilized by gamma irradiation or disinfected using 70 % ethanol. The biocompatibility assessment in human fibroblasts and hemocompatibility studies (hemolysis, platelet aggregation, morphology of mononuclear cells and viability) in peripheral blood from healthy volunteers (ex vivo), were performed. The sterilization or disinfection effect on hydrogel structures was evaluated by FT-IR spectroscopy. Results indicated that hydrogels do not induce any damage to fibroblasts, erythrocytes, platelets or mononuclear cells. Moreover, there was no significant difference in the biocompatibility after the sterilization or disinfection treatment. However, after gamma irradiation, several IR spectroscopic bands were shifted to higher or lower energies with different intensity in all hydrogels. In particular, several bands associated to carboxyl or hydroxyl groups were slightly shifted, possibly associated to scission reactions. The disinfection treatment (70 % ethanol) and γ-irradiation at 13.83 ± 0.7 kGy did not induce morphological damages and yielded sterile and biocompatible PEG hydrogels potentially useful for clinical applications.

Executive summary of the consensus document on post-exposure prophylaxis against HIV, HBV and HCV in adults and children.

Post-exposure prophylaxis (PEP) can be a secondary measure to prevent infection by human immunodeficiency virus (HIV) when primary prevention has failed. PEP is advised for people with sporadic and exceptional risk exposure to HIV. This consensus document about occupational and non-occupational PEP recommendations aims to be a technical document for healthcare professionals. Its main objective is to facilitate the appropriate use of PEP. To this end, some recommendations have been established to assess the risk of transmission in different types of exposure, situations where PEP should be recommended, special circumstances to take into account, antiretroviral (ARV) guidelines including start and end of the treatment, early monitoring of tolerance and adherence to the treatment, subsequent monitoring of people exposed, independently of having received PEP or not, and need of psychological support. This document is intended for all professionals who work in clinical practice in the field of HIV infection.

Programmed cell death in kiwifruit stigmatic arms and its relationship to the effective pollination period and the progamic phase.

BACKGROUND AND AIMS: Kiwifruit is a crop with a highly successful reproductive performance, which is impaired by the short effective pollination period of female flowers. This study investigates whether the degenerative processes observed in both pollinated and non-pollinated flowers after anthesis may be considered to be programmed cell death (PCD). METHODS: Features of PCD in kiwifruit, Actinidia chinensis var. deliciosa, were studied in both non-pollinated and pollinated stigmatic arms using transmission electron microscopy, DAPI (4',6-diamidino-2-phenylindole) staining, TUNEL (terminal deoxynucleotidyl transferase-mediated dUTP nick end labelling) assays, DNA gel electrophoresis and caspase-like activity assays. KEY RESULTS: In the secretory tissues of the stigmatic arms, cell organelles disintegrated sequentially while progressive vacuolization was detected. At the same time, chromatin condensation, nuclear deformation, and DNA fragmentation and degradation were observed. These features were detected in both non-pollinated and pollinated stigmatic arms; they were evident in the stigmas of pollinated flowers by the second day after anthesis but only by 4 d after anthesis in non-pollinated flowers. In addition, in pollinated stigmatic arms, these features were first initiated in the stigma and gradually progressed through the style, consistent with pollen tube growth. This timing of events was also observed in both non-pollinated and pollinated stigmatic arms for caspase-3-like activity. CONCLUSIONS: The data provide evidence to support the hypothesis that PCD processes occurring in the secretory tissue of non-pollinated kiwifruit stigmatic arms could be the origin for the observed short effective pollination period. The results obtained in the secretory tissue of pollinated kiwifruit stigmatic arms upon pollination support the idea that PCD might be accelerated by pollination, pointing to the involvement of PCD during the progamic phase.

Is curettage and high-speed burring sufficient treatment for aneurysmal bone cysts?

BACKGROUND: To decrease the recurrence rate after intralesional curettage for aneurysmal bone cysts, different adjuvant treatments have been recommended. Liquid nitrogen spray and argon beam coagulation have provided the lowest recurrence rates, but unlike the high-speed burr, these adjuvants are not always available in operating rooms. QUESTIONS/PURPOSES: We asked: (1) Is high-speed burring alone sufficient as an adjuvant to curettage with respect to recurrence rates? (2) What is the complication rate from this technique? (3) What are the risk factors for local recurrence? METHODS: A retrospective review of the database of the University Musculoskeletal Tumor Unit and the private files of the senior author (EHW) for a period of 19 years (1993-2011) was performed to identify all patients histologically diagnosed with primary aneurysmal bone cyst. During that period, patients with aneurysmal bone cysts were treated with intralesional curettage, burring, and bone grafting if the lesions showed an adequate cortical wall or a wall with thinned out portions which could be reconstructed with bone grafting. Based on those indications, we treated 54 patients for this condition. Of those, 18 were treated using approaches other than burring because they did not meet the defined indications, and an additional five patients were lost to followup before 2 years, leaving 31 patients for analysis, all of whom were followed up for at least 2 years (mean, 7 years; range, 2-18 years). RESULTS: Of these 31 patients, one had a recurrence (3.2%). Complications using this approach occurred in three patients (9.7%), and included growth plate deformity (1) and genu varus (2) secondary to collapse of the reconstructed condyle. With only one recurrence, we cannot answer what the risk factors might be for recurrence; however, the one patient with recurrence presented with a large lesion and a pathologic fracture. CONCLUSIONS: Curettage, burring, and bone grafting compare favorably in the literature with other approaches for aneurysmal bone cysts, such as cryotherapy and argon-beam coagulation. We conclude that high-speed burring alone as an adjuvant to intralesional curettage is a reasonable approach to achieving a low recurrence rate for aneurysmal bone cysts. LEVEL OF EVIDENCE: Level IV, therapeutic study. See the Instructions for Authors for a complete description of levels of evidence.

Comparison of intraocular lens tilt after capsular sutured scleral fixation with capsular segments versus uneventful cataract surgery.

PURPOSE: To evaluate and compare intraocular lens (IOL) tilt between uneventful phacoemulsification with in-the-bag IOL implantation and sutured scleral fixation (SSF) of the lens bag with a capsular tension segment (type 6 D / Morcher) using a Sheimpflug camera. SETTING: Clinical Practice, Hospital. Barcelona and A Coruña, Spain. DESIGN: Retrospective, comparative multicenter study. METHODS: IOL tilt was compared between patients who underwent sutured scleral fixation with a capsular tension segment in a single eye (SSF group, n = 15) with patients who underwent uneventful IOL implantation (control group, n = 12) that were matched by biometric measurements. Post-operative refractive accuracy of biometric formulas by means of mean absolute error (MAE) was also reported. All patients underwent a general ophthalmic evaluation, anterior segment photography, and postoperative optical biometry (Zeiss IOLMaster® 500). In addition, IOL tilt was measured with a Scheimpflug camera (Pentacam R, Oculus Optikgerate Gmbh). RESULTS: Mean vertical tilt was similar in both groups (2.20+/-2.47° SSF vs 1.97 +/- 1.79° control; p = 0.836) but mean horizontal tilt tended to higher values in the SSF series (2.09 +/- 2.74° vs 0.94 +/- 1.17°; p = 0.139). Considering post-operative refractive error in diopters by MAE calculations, there was an underestimation of IOL power in the SSF group which was only statistically significant for Barrett Universal II (1.07 vs 0.32; p = 0.028) and Hill-RBF (0.95 vs 0.26; p = 0.024) formulas, but not for SRK/T (0.99 vs 0.42; p = 0.285) and Kane (0.96 vs 0.33; p = 0.083). CONCLUSION: Sutured scleral fixation of capsular tension segments in the presence of zonular instability does not seem to induce clinically significant IOL tilt compared to uneventful cataract extraction cases.

A descriptive analysis of a novel intervention to help residents become evidence users.

BACKGROUND AND OBJECTIVES: To evaluate the educational and clinical effectiveness of the 'Brief Evidence-Based Assessment of Research' (BEAR), a template to assist residents in searching, evaluating and integrating relevant medical literature into daily practice. METHODS: We completed a descriptive analysis of BEARs submitted by first year residents between 2005 and 2007 at the University of Alberta Family Medicine Residency program. RESULTS: 317 BEARs were analyzed. The most common type of question for which information was searched was therapy (59%). Residents searched Pubmed most often (38%) followed by Summary (i.e. Clinical Evidence) (22%) and Filtered sites (i.e. ACP Journal Club) (19%). Original research articles were the largest resource category used to answer questions (41%). Secondary peer-reviewed resources (filtered articles, summary sites, reviews/meta-analysis and guidelines) accounted for 48% of all resources used. 19% of residents reported a large change in practice with completion of the BEAR, 50% reported a small change, 12% stated they were reassured and 8% reported that the intervention was of no help to them. CONCLUSIONS: The BEAR facilitates the use of a variety of resources in answering clinical questions. 69% of users reported at least a small change in clinical practice, suggesting that the BEAR may be a useful tool in evidence-based resident education.

[Sick leaves caused by psychiatric diseases in Spain during 2011]. / La incapacidad temporal en España por algunas enfermedades psiquiátricas. (Trastornos esquizofrénicos, trastorno bipolar y trastornos ansiosos, depresivos y adaptativos).

BACKGROUND: Psychiatric and mood disorders may hamper the efficiency of workers and cause absenteeism. MATERIAL AND METHODS: Revision of sick leaves related to schizophrenia, bipolar diseases, anxiety, depression and adaptive disorders that were granted in Spain in the period January- December 2011. The mean number of days off work for each disease and the costs per each labor day lost were calculated. RESULTS: The total number of labor days lost for schizophrenia, bipolar diseases and mood disorders were 72,831; 899,107 and 3,666,055 days, respectively. The mean duration of sick leaves for the same diagnoses were 84; 100 and 64 days/year respectively. The total indirect costs of sick leaves for psychiatric diseases during 2011 were € 100 million approximately, corresponding to 4% of costs for all diseases. CONCLUSIONS: The high costs of absenteeism derived from psychiatric diseases should prompt measures to promote a better adaptation to work environments of people suffering these ailments.

Multimodal imitative learning and synchrony in cetaceans: A model for speech and singing evolution.

Multimodal imitation of actions, gestures and vocal production is a hallmark of the evolution of human communication, as both, vocal learning and visual-gestural imitation, were crucial factors that facilitated the evolution of speech and singing. Comparative evidence has revealed that humans are an odd case in this respect, as the case for multimodal imitation is barely documented in non-human animals. While there is evidence of vocal learning in birds and in mammals like bats, elephants and marine mammals, evidence in both domains, vocal and gestural, exists for two Psittacine birds (budgerigars and grey parrots) and cetaceans only. Moreover, it draws attention to the apparent absence of vocal imitation (with just a few cases reported for vocal fold control in an orangutan and a gorilla and a prolonged development of vocal plasticity in marmosets) and even for imitation of intransitive actions (not object related) in monkeys and apes in the wild. Even after training, the evidence for productive or "true imitation" (copy of a novel behavior, i.e., not pre-existent in the observer's behavioral repertoire) in both domains is scarce. Here we review the evidence of multimodal imitation in cetaceans, one of the few living mammalian species that have been reported to display multimodal imitative learning besides humans, and their role in sociality, communication and group cultures. We propose that cetacean multimodal imitation was acquired in parallel with the evolution and development of behavioral synchrony and multimodal organization of sensorimotor information, supporting volitional motor control of their vocal system and audio-echoic-visual voices, body posture and movement integration.

Omega 3 fatty acids on child growth, visual acuity and neurodevelopment.

The aim of this review is to evaluate the effects of omega-3 long chain polyunsaturated fatty acids (n-3 LCPUFA) supplementation in pregnant and lactating women and infants during postnatal life, on the visual acuity, psychomotor development, mental performance and growth of infants and children. Eighteen publications (11 sets of randomized control clinical trial [RCTs]) assessed the effects of the n-3 LCPUFA supplementation during pregnancy on neurodevelopment and growth, in the same subjects at different time points; 4 publications (2 data sets from RCTs) addressed physiological responses to n-3 LCPUFA supplementation during pregnancy & lactation and 5 publications (3 data sets from RCTs) exclusively during lactation. Some of these studies showed beneficial effects of docosahexaenoic acid (DHA) supplementation during pregnancy and/or lactation especially on visual acuity outcomes and some on long-term neurodevelopment; a few, showed positive effects on growth. There were also 15 RCTs involving term infants who received infant formula supplemented with DHA, which met our selection criteria. Many of these studies claimed a beneficial effect of such supplementation on visual, neural, or developmental outcomes and no effects on growth. Although new well designed and conducted studies are being published, evidence from RCTs does not demonstrate still a clear and consistent benefit of n-3 LCPUFA supplementation during pregnancy and/or lactation on term infants growth, neurodevelopment and visual acuity. These results should be interpreted with caution due to methodological limitations of the included studies.

Dental implant stability is influenced by implant diameter and localization and by the use of plasma rich in growth factors.

PURPOSE: The objective was to analyze the factors that influence the stability of dental implants at 12 weeks after implant placement as measured by resonance frequency analysis using the Osstell system. MATERIALS AND METHODS: This prospective clinical study was performed in 235 implants placed in 93 patients at the Oral Surgery and Implantology Clinic of the University of Granada. The gathered predictor variables were grouped into patient variables, implant variables, operative variables, and baseline implant stability quotient (ISQ). All variables were analyzed in a multivariate model to determine their influence on the ISQ score at 12 weeks after implant insertion (outcome variable). SUDAAN software was used for clustered sampling (multiple implants in patients). RESULTS: Two hundred thirty-five dental implants were placed in 47 men (50.5%) and 46 women (49.5%; total, 93 patients; mean age, 52.13 ± 11.23 years; range, 27 to 76 years). No association was found between the patient variables and the ISQ values at 12 weeks. Among implant variables, worse ISQ values at 12 weeks were observed for a narrow diameter (P < .001) and maxillary implants (P = .006). Among surgical technique variables, the use of plasma rich in growth factors (P = .011) showed the best ISQ values at 12 weeks. CONCLUSIONS: The diameter and localization of implants and the application of plasma rich in growth factors influenced the stability of implants measured at 12 weeks of wound healing. Accordingly, stability was less with a narrower implant diameter and maxillary localization and greater with implants humidified with plasma rich in growth factors.

Residents' clinical questions: how are they answered and are the answers helpful?

OBJECTIVE: To assess residents' clinical questions, where they get their answers, the utility of those answers, and if an evidence-based medicine (EBM) workshop improves the use of evidence-based electronic resources. DESIGN: Prospective observational cohort study. SETTING: Urban family medicine teaching clinics in Edmonton, Alta, in 2007. PARTICIPANTS: First- and second-year family medicine residents training in the family medicine teaching units. METHODS: An observer recorded clinical questions posed by residents in clinic, the resources used to answer these questions, and how residents thought the answers modified practice. Resources were categorized broadly as colleagues, electronic, or paper. Answer utility was ranked in decreasing order as large change, small change, confirmed, expanded knowledge, or no help. Use of resources was compared before and after an EBM workshop, and between residents under normal supervision and those in semi-independent clinics. RESULTS: Thirty-eight residents from 5 sites were observed addressing 325 questions in 114 clinical half-day sessions (420 patients). Residents had 0.8 questions per patient and answered 83.4% of questions with 1 resource (range 1 to 6). Residents made 406 attempts to answer questions, using colleagues 65.5% of the time (93.6% were preceptors), electronic resources 20.7% of the time, and paper resources 13.8% of the time. Answers from colleagues were least likely to require secondary resources (F test, P < .001). The utility of answers from colleagues (F test, P = .002) was superior to that of answers from electronic resources, and this difference remained significantly higher in sensitivity analysis. The EBM workshop training did not influence electronic resource use (17.8% before and 15.1% after, Fisher-Freeman-Halton test, P = .18), but semi-independence from preceptors increased the use of electronic resources from 16.5% to 51.0% (Fisher-Freeman-Halton test, P < .001). CONCLUSION: Residents have many questions during clinical practice. Preceptors were used more commonly than all other resources combined and were the most dependable resource for residents to obtain answers. Although an EBM workshop was not associated with increased use of electronic evidence-based resources, semi-independent work appeared to be.

[Self-reported prevalence of fructan food hypersensitivity in university students from the State of Mexico]. / Prevalencia de hipersensibilidad alimentaria a fructanos en estudiantes universitarios del Estado de México.

OBJECTIVE: To determine the self-reported prevalence of fructans food hypersensitivity in a sample of Mexican university students and to investigate the most frequent symptoms, the related foods involved, risk factors and gastrointestinal function status. METHODS: A cross-sectional, descriptive study was conducted in a convenience sample of 412 university students aged from 18 to 35 years. Data were collected about their personal and family history of gastrointestinal diseases, the presence of symptoms after consumption of certain foods, and the severity of their symptoms. RESULTS: The prevalence of fructans food hypersensitivity was 31.1 %; it was higher in women than in men. The most frequent gastrointestinal symptoms were bloating and flatulence. The most frequent extra-intestinal symptoms were fatigue and stress. The food groups related to the occurrence of symptoms were legumes, vegetables, and fruits. Significant association was found between female sex, personal and family history of gastrointestinal diseases and the presence of fructans food hypersensitivity (p < 0.05). Most individuals with fructans food hypersensitivity had mild gastrointestinal dysfunction (67.2 %). CONCLUSIONS: FFH is a common condition, it was found in one third of university students and occurs mainly in women. More research and diffusion about this pathology is required.

OBJECTIVO: Determinar la prevalencia por autorreporte de hipersensibilidad alimentaria a fructanos en una muestra de estudiantes universitarios e investigar los síntomas más frecuentes, los alimentos relacionados, los factores de riesgo y su función gastrointestinal. MÉTODOS: Se realizó un estudio transversal, descriptivo, en una muestra elegida por conveniencia de 412 estudiantes universitarios, de 18 a 35 años. Se recopilaron datos sobre antecedentes personales y familiares de enfermedades gastrointestinales, síntomas secundarios al consumo de ciertos alimentos y severidad de sus síntomas. RESULTADOS: La prevalencia de hipersensibilidad alimentaria a fructanos fue de 31.1 %, mayor en mujeres que en hombres. Los síntomas gastrointestinales más frecuentes fueron distensión y flatulencias y los extraintestinales, fatiga y estrés. Los grupos de alimentos relacionados con la aparición de síntomas fueron leguminosas, vegetales y frutas. Se encontró asociación significativa entre el sexo femenino, la historia personal y familiar de enfermedades gastrointestinales y la presencia de hipersensibilidad alimentaria a fructanos (p < 0.05). La mayoría de los individuos con hipersensibilidad alimentaria a fructanos tuvieron una disfunción gastrointestinal leve (67.2 %). CONCLUSIONES: La hipersensibilidad alimentaria a fructanos es común; se encontró en un tercio de los estudiantes universitarios, principalmente en mujeres. Se necesita mayor investigación y difusión sobre esta patología.

Practical considerations to establish a validated platform for pooled detection of SARS-CoV-2 by droplet digital PCR.

Detection of SARS-CoV-2 has created an enormous workload for laboratories worldwide resulting in a restriction at the time of massive testing. Pool testing is a strategy that reduces time and costs. However, beyond the detection of infectious diseases in blood banks, this approach is rarely implemented in routine laboratories. Therefore, what was learned from the SARS-CoV-2 pool testing should represent an opportunity to increase diagnostic capabilities. The present work, carried out in the context of a diagnostic laboratory of a public hospital during the COVID-19 pandemic, represents a contribution to this end. The main limitation of pool testing is the risk of false negatives that could have been identified by individual tests. These limitations are the dilution of samples with a low virus load during pooling and that the integrity of the sample may be affected by the quality of the sample collection. Fortunately, both limitations coincide with the main strengths of droplet digital PCR (ddPCR). ddPCR is a third-generation PCR that splits the amplification into thousands of droplets that work in parallel, increasing sensitivity and resistance to inhibitors. Therefore, ddPCR is particularly useful for pool testing. Here we show how to factor between test sensitivity and savings in test time and resources. We have identified and optimized critical parameters for pool testing. The present study, which analyzed 1000 nasopharyngeal samples, showed that the pool testing could detect even a single positive sample with a CT value of up to 30 in pools of 34 samples. This test was performed using three different standard extraction methods, the simplest being heating only, which resulted in substantial savings of extraction reagents in addition to PCR reagents. Moreover, we show that pooling can be extended to use saliva, which is less invasive and allows self-collection, reducing the risk for health personnel.