The transCampus Metabolic Training Programme Explores the Link of SARS-CoV-2 Virus to Metabolic Disease.

Currently, we are experiencing a true pandemic of a communicable disease by the virus SARS-CoV-2 holding the whole world firmly in its grasp. Amazingly and unfortunately, this virus uses a metabolic and endocrine pathway via ACE2 to enter our cells causing damage and disease. Our international research training programme funded by the German Research Foundation has a clear mission to train the best students wherever they may come from to learn to tackle the enormous challenges of diabetes and its complications for our society. A modern training programme in diabetes and metabolism does not only involve a thorough understanding of classical physiology, biology and clinical diabetology but has to bring together an interdisciplinary team. With the arrival of the coronavirus pandemic, this prestigious and unique metabolic training programme is facing new challenges but also new opportunities. The consortium of the training programme has recognized early on the need for a guidance and for practical recommendations to cope with the COVID-19 pandemic for the community of patients with metabolic disease, obesity and diabetes. This involves the optimal management from surgical obesity programmes to medications and insulin replacement. We also established a global registry analyzing the dimension and role of metabolic disease including new onset diabetes potentially triggered by the virus. We have involved experts of infectious disease and virology to our faculty with this metabolic training programme to offer the full breadth and scope of expertise needed to meet these scientific challenges. We have all learned that this pandemic does not respect or heed any national borders and that we have to work together as a global community. We believe that this transCampus metabolic training programme provides a prime example how an international team of established experts in the field of metabolism can work together with students from all over the world to address a new pandemic.

The future of dementia risk reduction research: barriers and solutions.

BACKGROUND: We examine why dementia prevention and risk reduction are relatively underfunded and suggest potential remediation strategies. The paper is aimed at researchers, funders and policy-makers, both within dementia and also the wider health prevention field. METHODS: A discussion-led workshop, attended by 58 academics, clinicians, funders and policy-makers. RESULTS: The key barriers identified were the gaps in understanding the basic science of dementia; the complex interplay between individual risk factors; variations in study methodology; disincentives to collaboration; a lack of research capacity and leadership and the broader stigma of the condition. Recommendations were made to encourage strategic leadership, provide greater support for grant applications, promote collaboration and support randomized control trials for the research field. CONCLUSION: Having identified the barriers, the key challenge is how to implement the potential solutions. This will require engagement with decision-makers within funding, policy and research to ensure that action takes place.

Influenza vaccine effectiveness in Spain 2013/14: subtype-specific early estimates using the cycEVA study.

Adjusted early estimates of the 2013/14 influenza vaccine effectiveness (VE) in Spain for all age groups was 35% (95% CI: -9 to 62), 33% (95% CI: -33 to 67) and 28% (95% CI: -33 to 61) against any influenza virus type, A(H1N1)pdm09 and A(H3N2) viruses, respectively. For the population targeted for vaccination, the adjusted VE was 44% (95% CI: -11 to 72), 36% (95% CI: -64 to 75) and 42% (95% CI: -29 to 74), respectively. These preliminary results in Spain suggest a suboptimal protective effect of the vaccine against circulating influenza viruses.

[Bringing clinical simulation into anesthesiology and postoperative recovery care residency training]. / Integración de la simulación clínica en el programa formativo de la especialidad de anestesiología y reanimación.

This article describes the use of clinical simulations for training residents in anesthesiology and postoperative recovery care at Hospital Universitario Marqués de Valdecilla. A working group defined criteria for the competencies residents would acquire by means of simulation training, designed the scenarios to be used, and took responsibility for coordinating and funding the program. We used the platform of the Critical Events Training Center of the Marcelino Botin Foundation, now part of our center's virtual hospital. The simulation-based training modules include 4 activities in the residents' first year, 3 in each of the second and third years, and 4 in the fourth year; all center on acquisition of the identified competencies and take into consideration the time availability of residents and instructors and the budget. We have concluded that integrating clinical simulations into residency training is a challenge for educators, given that a large part of the benefit derived from this tool comes from complementing it with other instructional resources and adapting it to the syllabus. More studies are required to establish criteria to guide the integration of this tool into the curriculum in those areas of the specialty where it can work most efficiently; the effectiveness of the approach also needs to be assessed. Simulations facilitate training without putting patients at risk and provide residents with early exposure to situations that might otherwise be difficult to observe. This tool also encourages the practice of reflective clinical decision-making.

In vitro anti-HIV-1 properties of ethnobotanically selected South African plants used in the treatment of sexually transmitted diseases.

ETHNOPHARMACOLOGICAL RELEVANCE: [corrected The plants selected in this study are used traditionally in the treatment of sexually transmitted diseases and traditional healers interviewed claimed these plants can also help AIDS patients. AIM: To evaluating the in vitro anti-HIV properties of selected plants in various bioassays. MATERIALS AND METHODS: The extracts were evaluated for their inhibition against alpha-glycohydrolase, reverse transcriptase and viral proteins (NF-kappaB and Tat) which play a significant role in the HIV life cycle. RESULTS: Terminalia sericea extract (IC(50)=92mg/ml) exhibited a considerable alpha-glucosidase inhibitory activity which was better than acarbose (IC(50)=131mg/ml) under our assay conditions. In the reverse transcriptase assay, T. sericea also showed good inhibitory activity (IC(50)=43mg/ml), which was higher than that of the reference drug, Adriamycin (IC(50)=100mg/ml). The ethyl acetate extract of Elaeodendron transvaalense exhibited the most potent inhibitory activity in both the NF-kappaB and Tat assays with inhibitory activity of 76% and 75% respectively at a concentration of 15mg/ml. The acetone and chloroform extracts of E. transvaalense and Zanthoxylum davyi also showed good activity in the NF-kappaB and Tat assays.

Learning outcomes evaluation of a simulation-based introductory course to anaesthesia. / Evaluación de los resultados de aprendizaje de un curso de introducción a la anestesiología basado en simulación clínica.

OBJECTIVE: An increased number of errors and reduced patient safety have been reported during the incorporation of residents, as this period involves learning new skills. The objectives were to evaluate the learning outcomes of an immersive simulation boot-camp for incoming residents before starting the clinical rotations. Airway assessment, airway control with direct laryngoscopy, and epidural catheterization competencies were evaluated. MATERIAL AND METHOD: Twelve first-year anaesthesiology residents participated. A prospective study to evaluate transfer of endotracheal intubation skills learned at the simulation centre to clinical practice (primary outcome) was conducted. A checklist of 28 skills and behaviours was used to assess the first supervised intubation performed during anaesthesia induction in ASA I/II patients. Secondary outcome was self-efficacy to perform epidural catheterization. A satisfaction survey was also performed. RESULTS: Seventy-five percent of residents completed more than 21 out of 28 skills and behaviours to assess and control the airway during their first intubation in patients. Twelve items were performed by all residents and 5 by half of them. More than 83% of participants reported a high level of self-efficacy in placing an epidural catheter. All participants would recommend the course to their colleagues. CONCLUSIONS: A focused intensive simulation-based boot-camp addressing key competencies required to begin anaesthesia residency was well received, and led to transfer of airway management skills learned to clinical settings when performing for first time on patients, and to increased self-reported efficacy in performing epidural catheterization.

Human herpes virus-8 serology and DNA analysis in recipients of renal allografts showing Kaposi's sarcoma and their respective donors.

Kaposi's sarcoma (KS) developed among 11 of 416 renal allograft recipients transplanted between 1985 and 2000. Only 3 among 364 Caucasian recipients developed KS, while it affected 8 of 52 Black patients, all of whom had been born in African countries (P <.001). All patients had their immunosuppression reduced; two also received daunorubicin and one received electrotherapy. Three patients developed accelerated renal allograft dysfunction, probably due to the reduced immunosuppression. Remission of KS was observed in seven patients, while lesions stabilized or improved partially in the other four. After resuming dialysis 2 of 11 patients died; both were in KS remission. Human herpes virus-8 (HHV-8) serology and DNA analysis was evaluated in sera obtained from seven donors: all were negative. Conversely, among eight sera collected pretransplant from the nine living recipients, HHV-8 IgG was detected in six and DNA was present in one. HHV-8 IgG was expressed in all patients (9/9) at some point posttransplant; DNA was detected in three patients. Therefore, the robust ethnic predisposition to KS was associated with a high pretransplant prevalence of HHV-8 among African recipients. Although some seroconversions were detected posttransplant, there was no evidence for donor-to-recipient transmission.

[An interdisciplinary approach to reconciling chronic medications on admission to Mora d'Ebre local hospital]. / Abordaje interdisciplinar de la conciliación de la medicación crónica al ingreso en un hospital.

OBJECTIVES: To reduce medication errors and prevent interactions and duplications using a Chronic Medication Reconciliation Program on patient admission. To create an updated reconciled medications by resolving discrepancies within 24 hours of admission to the ward. To ensure the necessary medication is given at the dose, route and at the correct intervals depending on the clinical situation of the patient. MATERIAL, PATIENTS AND METHODS: Prospective observational, non-randomised and uncontrolled study during the period from October 2008 to March 2009 (both included) in a primary level local hospital, in which all patients admitted to the hospital who met the inclusion criteria had their chronic medication reconciled on hospital admission. RESULTS: A total of 469 patients were included, with 3609 medications being reconciled, of which 2466 (68.33%) had discrepancies: 667 (27.0%) unjustified and 1799 (72.9%) justified. There were no discrepancies in 1143 (31.6%). The majority of unjustified discrepancies were prescription omissions in 662 (26.8%) and duplications in 5 (0.2%). On 640 (25.9%) occasions the error reached the patient without causing any harm, and only 4 (0.16%) required monitoring. DISCUSSION: Using an interdisciplinary approach in the reconciliation of chronic medication, many medication errors have been detected and neutralised. Discrepancies have been resolved, neutralising omissions, interactions and duplications. Drugs with a low intrinsic pharmacological value were withdrawn, and the list of reconciled medications recorded in the clinical notes.

Evaluación de los resultados de aprendizaje de un curso de introducción a la anestesiología basado en simulación clínica / Learning outcomes evaluation of a simulation-based introductory course to anaesthesia

Objetivo. Se han evidenciado más errores y menor seguridad de los pacientes durante el periodo de incorporación de los residentes. Se evaluaron los resultados de aprendizaje de las competencias de valoración y control de la vía aérea, y cateterización epidural tras un curso de introducción a la anestesiología basado en simulación clínica antes de comenzar las rotaciones. Material y método. Participaron 12 residentes de anestesiología. Se estudió la transferencia de las competencias aprendidas durante el curso a la clínica (variable principal). Se utilizó una rúbrica de 28 habilidades y comportamientos para evaluar la primera intubación supervisada en pacientes ASA I/II. La variable secundaria fue el grado de autoeficacia para realizar la cateterización epidural y se valoró mediante preguntas de autoevaluación. Se realizó una encuesta de satisfacción. Se describieron las variables cualitativas (método Wilson) y las numéricas con la media y la desviación estándar (tras la prueba de Shapiro-Wilk). Resultados. Durante la primera intubación en pacientes se encontró que el 75% de los participantes completaron más de 21 habilidades de valoración y control de la vía aérea de un total de 28. Doce fueron completadas por todos ellos y 5 por la mitad. Más del 83% de los participantes refirieron un alto grado de autoeficacia para la cateterización epidural. Todos los participantes recomendarían el curso. Conclusiones. El rendimiento de los residentes de anestesiología al realizar por primera vez en pacientes la valoración y control de la vía aérea, y el grado de autoeficacia para la cateterización epidural fueron elevados tras un curso intensivo de simulación al comenzar la residencia (AU)

Objective. An increased number of errors and reduced patient safety have been reported during the incorporation of residents, as this period involves learning new skills. The objectives were to evaluate the learning outcomes of an immersive simulation boot-camp for incoming residents before starting the clinical rotations. Airway assessment, airway control with direct laryngoscopy, and epidural catheterization competencies were evaluated. Material and method. Twelve first-year anaesthesiology residents participated. A prospective study to evaluate transfer of endotracheal intubation skills learned at the simulation centre to clinical practice (primary outcome) was conducted. A checklist of 28 skills and behaviours was used to assess the first supervised intubation performed during anaesthesia induction in ASA I/II patients. Secondary outcome was self-efficacy to perform epidural catheterization. A satisfaction survey was also performed. Results. Seventy-five percent of residents completed more than 21 out of 28 skills and behaviours to assess and control the airway during their first intubation in patients. Twelve items were performed by all residents and 5 by half of them. More than 83% of participants reported a high level of self-efficacy in placing an epidural catheter. All participants would recommend the course to their colleagues. Conclusions. A focused intensive simulation-based boot-camp addressing key competencies required to begin anaesthesia residency was well received, and led to transfer of airway management skills learned to clinical settings when performing for first time on patients, and to increased self-reported efficacy in performing epidural catheterization (AU)

Determination of the percentage of milk (cow's, ewe's and goat's) in cheeses with different ripening times using near infrared spectroscopy technology and a remote reflectance fibre-optic probe.

In the present work we studied the use of near infrared spectroscopy (NIRS) technology employing a remote reflectance fibre-optic probe (with a 5 cm x 5 cm quartz window) for the analysis of the percentage of milk (cow's, ewe's and goat's) used in the elaboration of cheeses with different ripening times. To do so, cheeses with known and varying percentages of cow's, ewe's and goat's milk were elaborated (112 samples with milk collected in winter and 112 samples with milk collected in summer) and used as reference material, and ripening controls were performed over 6 months. The method allows immediate control of the cheese without prior sample treatment or destruction by direct application of the fibre-optic probe to the sample. The regression method employed was modified partial least squares (MPLS). Of all the samples (224), 200 formed to so-called calibration set and the other 24 were used for external validation. The calibration results obtained using 200 samples of cheese allowed the percentage of cow's, ewe's and goat's milk to be measured. The multiple correlation coefficients (RSQ) and prediction corrected standard errors (SEP(C)) obtained were respectively, 0.834 and 11.6% for cow's milk; 0.871 and 9.8% for goat's milk; 0.880 and 10.6% for ewe's milk. The ratio performance deviation (RPD) values obtained indicate that the NIRS equations can be applied to unknown samples.

Risk factors in neuroleptic malignant syndrome. A case-control study.

OBJECTIVE: To determine whether environmental temperature, agitation, neuroleptic use, mental retardation, and affective disorders were risk factors for neuroleptic malignant syndrome (NMS). METHOD: Cases and age- and sex-matched psychiatric controls admitted to a regional acute psychiatric unit over a 10-year period. RESULTS: Both uni- and multivariate analysis revealed statistically significant differences between patients with NMS (n=15) and controls (n=45) with regard to the presence of mental retardation, psychomotor agitation, and a number of variables relating to neuroleptic use (newly introduced or increased, intramuscular administration, and dosage). We found no differences between NMS patients and psychiatric controls in respect of changes in environmental temperature. CONCLUSION: Our study supports the need for caution when using intramuscularly administered, abruptly increasing, high-dose neuroleptics, particularly in mentally retarded or agitated patients, regardless of environmental temperature.

[Skin lesions in epidemic Kaposi's sarcoma (AIDS): local control assessment and esthetic results of a schedule of superficial radiotherapy]. / Lesiones cutáneas del sarcoma epidémico de Kaposi (SIDA): valoración del control local y resultados estéticos de un esquema de radioterapia superficial.

This prospective study was undertaken to evaluate the clinical response of 51 cutaneous lesions of epidemic Kaposi sarcoma in patients with AIDS (EKS/AIDS), obtained with the use of a scheme of superficial radiotherapy (3 Gy/fraction, three fractions weekly up to a total dose of 30 Gy). The mean follow-up time was 9.3 months and the mean time to progression of EKS/AIDS disease was 7-8 months. The initial clinical parameters (pain, size, edema, and esthetics) of each cutaneous lesion were compared with those obtained after one week, one month and three months of therapy. An objective pain improvement was observed in 72% of early lesions and with statistic significance (after one week p = 0.003). After one month of therapy a decrease in lesion size, edema, and esthetic improvement was observed in 78%, 71% and 77%, respectively. Although the evolution and prognosis of EKS/AIDS remains unchanged, it indeed provided palliation, with improvement of local control and esthetics, which together with the simplicity of its application and absence of untoward effects render this radiotherapy technique a very useful indication.

Diseño y validación de un dispositivo específico de inmovilización para radioterapia de la mama en decúbito prono / No disponible

Objetivo: El objetivo de este estudio es comparar los resultados obtenidos en la planificación de la radioterapia del cáncer de mama realizada en decúbito supino frente a decúbito prono en pacientes con mamas grandes y/o péndulas, así como la utilidad de un inmovilizador específicamente diseñado para la radioterapia de la mama en decúbito prono. Material y métodos: Se ha diseñado un inmovilizador para el posicionamiento de la mama en decúbito prono comparándolo con la inmovilización tradicional en decúbito supino conseguida mediante cuna-alfa o plano inclinado. Se analizaron los datos de 10 pacientes a las que se les realizó una doble planificación, en supino y prono, tras una cirugía conservadora de la mama. En la TAC obtenida para la planificación, se definió la totalidad de la mama como volumen blanco de planificación (PTV), así como el pulmón ipsilateral, el corazón y el tejido blando circundante a la mama como órganos críticos. La planificación en ambos casos se realizó empleando una técnica de campos tangenciales conformados con multisegmentos para obtener la máxima homogeneidad de la dosis administrada. Resultados: La homogeneidad de dosis alcanzada en el PTV, medida de acuerdo al V95%-107%, fue similar en las dos planificaciones, aunque la dosis máxima en la mama tratada fue mayor en el plan realizado en decúbito supino. El posicionamiento de las pacientes en decúbito prono redujo el porcentaje del pulmón ipsilateral que recibía dosis igual o superior a 20 Gy (V20Gy), pasando del 26,5 al 2,9% (p = 0,007). Del mismo modo, el posicionamiento en decúbito prono redujo el porcentaje del corazón que recibía dosis igual o superior a 35 Gy (V35Gy), desde el 3,4 al 1,2% (p = 0,038). Finalmente, la existencia de áreas de sobredosificación fuera de la mama también se redujeron significativamente con la posición en decúbito prono (p = 0,012). Conclusiones: El empleo de un sistema sencillo de inmovilización en decúbito prono para pacientes que precisen radioterapia de la mama tras cirugía conservadora en el caso de mamas grandes, permite mantener una homogeneidad de dosis adecuada en el volumen blanco al mismo tiempo que disminuye las dosis administradas a órganos sanos críticos como pulmón y corazón(AU)

Objective: The aim of this study is to compare two radiotherapy plans for breast cancer performed in both supine and prone position and the usefulness of a specifically designed device for prone breast radiotherapy. Material and methods: We designed an immobilization device for the positioning of the breast in the prone position comparing it with the traditional supine immobilization. We have analyzed data from 10 patients who underwent a double planning, supine and prone, after breast-conserving surgery. Radiotherapy planning in both cases was performed by using a multiple-segmented tangential-fields technique for maximum uniformity of the administered dose. Dose distributions for PTV (ipsilateral breast) and organs at risk (i.e. ipsilateral lung, heart and extramammary soft tissue) were compared for both plans. Results: The dose homogeneity achieved in the PTV, as measured according to V95%-107%, was similar in the two plans, although the maximum dose in the treated breast was higher for the supine plan. Prone positioning reduced the percentage of ipsilateral lung receiving doses equal to or greater than 20 Gy (V20Gy), from 26.5 to 2.9% (p = 0.007). Similarly, the prone position reduced the percentage of heart receiving doses equal to or greater than 35 Gy (V35Gy), from 3.4 to 1.2% (p = 0.038). Finally, the existence of overdosage areas outside the breast were also significantly reduced by the prone position (p = 0.012). Conclusions: The use of a simple system of breast immobilization in prone position for patients with large or pendulous breasts, can maintain adequate dose homogeneity in the target volume while decreasing the dose administered to critical healthy organs such as lung and heart (AU)