Stereolithography of ceramic scaffolds for bone tissue regeneration: Influence of hydroxyapatite/silica ratio on mechanical properties.

In this paper, the results obtained in the development of ceramic resin feedstock for stereolithography are shown. Hydroxyapatite and silica are used as source of ceramic. Hydroxyapatite is extracted from bovine bone, which enhances bioactivity of ceramic scaffold. The influence of hydroxyapatite amount in polymer-based slurry on the viscosity and printability of feedstock is explored. Hydroxyapatite and silica containing scaffolds are successfully obtained by stereolithography. Influence of hydroxyapatite/silica ratio on the bioactivity, biodegradability and mechanical properties of the scaffolds is also studied. It was observed that higher concentrations of hydroxyapatite led to improved mechanical strength of the scuffolds but increased viscosity of the slurry, affecting printability. Cell viability assays and cell visualization experiments indicated that the scaffolds not cause significant cell toxicity.

A protein-protein interaction network aligner study in the multi-objective domain.

BACKGROUND AND OBJECTIVE: The protein-protein interaction (PPI) network alignment has proven to be an efficient technique in the diagnosis and prevention of certain diseases. However, the difficulty in maximizing, at the same time, the two qualities that measure the goodness of alignments (topological and biological quality) has led aligners to produce very different alignments. Thus making a comparative study among alignments of such different qualities a big challenge. Multi-objective optimization is a computer method, which is very powerful in this kind of contexts because both conflicting qualities are considered together. Analysing the alignments of each PPI network aligner with multi-objective methodologies allows you to visualize a bigger picture of the alignments and their qualities, obtaining very interesting conclusions. This paper proposes a comprehensive PPI network aligner study in the multi-objective domain. METHODS: Alignments from each aligner and all aligners together were studied and compared to each other via Pareto dominance methodologies. The best alignments produced by each aligner and all aligners together for five different alignment scenarios were displayed in Pareto front graphs. Later, the aligners were ranked according to the topological, biological, and combined quality of their alignments. Finally, the aligners were also ranked based on their average runtimes. RESULTS: Regarding aligners constructing the best overall alignments, we found that SAlign, BEAMS, SANA, and HubAlign are the best options. Additionally, the alignments of best topological quality are produced by: SANA, SAlign, and HubAlign aligners. On the contrary, the aligners returning the alignments of best biological quality are: BEAMS, TAME, and WAVE. However, if there are time constraints, it is recommended to select SAlign to obtain high topological quality alignments and PISwap or SAlign aligners for high biological quality alignments. CONCLUSIONS: The use of the SANA aligner is recommended for obtaining the best alignments of topological quality, BEAMS for alignments of the best biological quality, and SAlign for alignments of the best combined topological and biological quality. Simultaneously, SANA and BEAMS have above-average runtimes. Therefore, it is suggested, if necessary due to time restrictions, to choose other, faster aligners like SAlign or PISwap whose alignments are also of high quality.

A trimeric glycosylated GH45 cellulase from the red abalone (Haliotis rufescens) exhibits endo and exoactivity.

The red abalone (Haliotis rufescens) represents North America's most important aquaculture species. Its hepatopancreas is rich in cellulases and other polysaccharide-degrading enzymes, which provide it the remarkable ability to digest cellulose-rich macroalgae; nevertheless, its cellulolytic systems are poorly explored. This manuscript describes some functional and structural properties of an endogenous trimeric glycosylated endoglucanase from H. rufescens. The purified enzyme showed a molecular mass of 23.4 kDa determined by MALDI-TOF mass spectrometry, which behaved as a homotrimer in gel filtration chromatography and zymograms. According to the periodic acid-Schiff reagent staining, detecting sugar moieties in SDS-PAGE gel confirmed that abalone cellulase is a glycoprotein. Hydrolysis of cello-oligosaccharides and p-nitrophenyl-ß-D-glucopyranosides confirmed its endo/exoactivity. A maximum enzyme activity toward 0.5% (w/v) carboxymethylcellulose of 53.9 ± 1.0 U/mg was achieved at 45°C and pH 6.0. We elucidated the abalone cellulase primary structure using proteases and mass spectrometry methods. Based on these results and using a bioinformatic approach, we identified the gene encoding this enzyme and deduced its full-length amino acid sequence; the mature protein comprised 177 residues with a calculated molecular mass of 19.1 kDa and, according to sequence similarity, it was classified into the glycosyl-hydrolase family 45 subfamily B. An AlphaFold theoretical model and docking simulations with cellopentaose confirmed that abalone cellulase is a ß-sheet rich protein, as also observed by circular dichroism experiments, with conserved catalytic residues: Asp26, Asn109, and Asp134. Interestingly, the AlphaFold-Multimer analysis indicated a trimeric assembly for abalone cellulase, which supported our experimental findings. The discovery and characterization of these enzymes may contribute to developing efficient cellulose bioconversion processes for biofuels and sustainable bioproducts.

Morphology does not matter: WSe2 luminescence nanothermometry unravelled.

Transition metal dichalcogenides, including WSe2, have gained significant attention as promising nanomaterials for various applications due to their unique properties. In this study, we explore the temperature-dependent photoluminescent properties of WSe2 nanomaterials to investigate their potential as luminescent nanothermometers. We compare the performance of WSe2 quantum dots and nanorods synthesized using sonication synthesis and hot injection methods. Our results show a distinct temperature dependence of the photoluminescence, and conventional ratiometric luminescence thermometry demonstrates comparable relative thermal sensitivity (0.68-0.80% K-1) and temperature uncertainty (1.3-1.5 K), irrespective of the morphology of the nanomaterials. By applying multiple linear regression to WSe2 quantum dots, we achieve enhanced thermal sensitivity (30% K-1) and reduced temperature uncertainty (0.1 K), highlighting the potential of WSe2 as a versatile nanothermometer for microfluidics, nanofluidics, and biomedical assays.

A single-blinded, randomized, parallel intervention to evaluate genetics and omics-based personalized nutrition in general population via an e-commerce tool: The PREVENTOMICS e-commerce study.

BACKGROUND: Personalized nutrition (PN) has been proposed as a strategy to increase the effectiveness of dietary recommendations and ultimately improve health status. OBJECTIVES: We aimed to assess whether including omics-based PN in an e-commerce tool improves dietary behavior and metabolic profile in general population. METHODS: A 21-wk parallel, single-blinded, randomized intervention involved 193 adults assigned to a control group following Mediterranean diet recommendations (n = 57, completers = 36), PN (n = 70, completers = 45), or personalized plan (PP, n = 68, completers = 53) integrating a behavioral change program with PN recommendations. The intervention used metabolomics, proteomics, and genetic data to assist participants in creating personalized shopping lists in a simulated e-commerce retailer portal. The primary outcome was the Mediterranean diet adherence screener (MEDAS) score; secondary outcomes included biometric and metabolic markers and dietary habits. RESULTS: Volunteers were categorized with a scoring system based on biomarkers of lipid, carbohydrate metabolism, inflammation, oxidative stress, and microbiota, and dietary recommendations delivered accordingly in the PN and PP groups. The intervention significantly increased MEDAS scores in all volunteers (control-3 points; 95% confidence interval [CI]: 2.2, 3.8; PN-2.7 points; 95% CI: 2.0, 3.3; and PP-2.8 points; 95% CI: 2.1, 3.4; q < 0.001). No significant differences were observed in dietary habits or health parameters between PN and control groups after adjustment for multiple comparisons. Nevertheless, personalized recommendations significantly (false discovery rate < 0.05) and selectively enhanced the scores calculated with biomarkers of carbohydrate metabolism (ß: -0.37; 95% CI: -0.56, -0.18), oxidative stress (ß: -0.37; 95% CI: -0.60, -0.15), microbiota (ß: -0.38; 95% CI: -0.63, -0.15), and inflammation (ß: -0.78; 95% CI: -1.24, -0.31) compared with control diet. CONCLUSIONS: Integration of personalized strategies within an e-commerce-like tool did not enhance adherence to Mediterranean diet or improved health markers compared with general recommendations. The metabotyping approach showed promising results and more research is guaranteed to further promote its application in PN. This trial was registered at clinicaltrials.gov as NCT04641559 (https://clinicaltrials.gov/study/NCT04641559?cond=NCT04641559&rank=1).

Insights into NdIII to YbIII Energy Transfer and Its Implications in Luminescence Thermometry.

This work challenges the conventional approach of using NdIII 4F3/2 lifetime changes for evaluating the experimental NdIII → YbIII energy transfer rate and efficiency. Using near-infrared (NIR) emitting Nd:Yb mixed-metal coordination polymers (CPs), synthesized via solvent-free thermal grinding, we demonstrate that the NdIII [2H11/2 → 4I15/2] → YbIII [2F7/2 → 2F5/2] pathway, previously overlooked, dominates energy transfer due to superior energy resonance and J-level selection rule compatibility. This finding upends the conventional focus on the NdIII [4F3/2 → 4I11/2] → YbIII [2F7/2 → 2F5/2] transition pathway. We characterized Nd0.890Yb0.110(BTC)(H2O)6 as a promising cryogenic NIR thermometry system and employed our novel energy transfer understanding to perform simulations, yielding theoretical thermometric parameters and sensitivities for diverse Nd:Yb ratios. Strikingly, experimental thermometric data closely matched the theoretical predictions, validating our revised model. This novel perspective on NdIII → YbIII energy transfer holds general applicability for the NdIII/YbIII pair, unveiling an important spectroscopic feature with broad implications for energy transfer-driven materials design.

Luminescent Ln3+-based silsesquioxanes with a ß-diketonate antenna ligand: toward the design of efficient temperature sensors.

We report the synthesis and single-crystal X-ray diffraction, magnetic, and luminescence measurements of a novel family of luminescent cage-like tetranuclear silsesquioxanes (PhSiO1.5)8(LnO1.5)4(O)(C5H8O2)6(EtOH)2(CH3CN)2⋅2CH3CN (where Ln = Tb, 1; Tb/Eu, 2; and Gd, 3), featuring seven-coordinated lanthanide ions arranged in a one-capped trigonal prism geometry. Compounds 1 and 2 exhibit characteristic Tb3+ and Tb3+/Eu3+-related emissions, respectively, sensitized by the chelating antenna acetylacetonate (acac) ligands upon excitation in the UV and visible spectral regions. Compound 3 is used to assess the energies of the triplet states of the acac ligand. For compound 1, theoretical calculations on the intramolecular energy transfer and multiphonon rates indicate a thermal balance between the 5D4 Stark components, while the mixed Tb3+/Eu3+ analog 2, with a Tb:Eu ratio of 3:1, showcases intra-cluster Tb3+-to-Eu3+ energy transfer, calculated theoretically as a function of temperature. By utilizing the intensity ratio between the 5D4→7F5 (Tb3+) and 5D0→7F2 (Eu3+) transitions in the range 11-373 K, we demonstrate the realization of a ratiometric luminescent thermometer with compound 2, operating in the range 11-373 K with a maximum relative sensitivity of 2.0% K-1 at 373 K. These findings highlight the potential of cage-like silsesquioxanes as versatile materials for optical sensing-enabled applications.

Exploring the Luminescence, Redox, and Magnetic Properties in a Multivariate Metal-Organic Radical Framework.

Persistent neutral organic radicals are excellent building blocks for the design of functional molecular materials due to their unique electronic, magnetic, and optical properties. Among them, triphenylmethyl radical derivatives have attracted a lot of interest as luminescent doublet emitters. Although neutral organic radicals have been underexplored as linkers for building metal-organic frameworks (MOFs), they hold great potential as organic elements that could introduce additional electronic properties within these frameworks. Herein, we report the synthesis and characterization of a novel multicomponent metal-organic radical framework (PTMTCR@NR-Zn MORF), which is constructed from the combination of luminescent perchlorotriphenylmethyl tricarboxylic acid radical (PTMTCR) and nonemissive nonradical (PTMTCNR) organic linkers and Zn(II) ions. The PTMTCR@NR-Zn MORF structure is layered with microporous one-dimensional channels embedded within these layers. Kelvin probe force microscopy further confirmed the presence of both organic nonradical and radical linkers in the framework. The luminescence properties of the PTMTCR ligand (first studied in solution and in the solid state) were maintained in the radical-containing PTMTCR@NR-Zn MORF at room temperature as fluorescence solid-state quenching is suppressed thanks to the isolation of the luminescent radical linkers. In addition, magnetic and electrochemical properties were introduced to the framework due to the incorporation of the paramagnetic organic radical ligands. This work paves the way for the design of stimuli-responsive hybrid materials with tunable luminescence, electrochemical, and magnetic properties by the proper combination of closed- and open-shell organic linkers within the same framework.

Not Every Day is Monday for Employees Confined due to COVID-19: Anticipatory Happiness Matters / No todos los días son lunes para los empleados confinados por la COVID-19: la felicidad anticipatoria importa

This study focuses on anticipatory happiness during the week (current happiness but considering the rest of the week) in employees confined due to COVID-19. In Diary Study 1, 71 employees with home-based telework participated on five consecutive workdays (Monday-Friday). We found a quadratic change pattern with an acceleration of the increase in anticipatory happiness right before the weekend. Results also confirmed a positive association between daily variability in anticipatory happiness and daily fluctuations in job satisfaction and positive affect. In Diary Study 2, 83 employees who carried out an essential activity outside the home participated for two consecutive weeks. Our findings showed a cubic change pattern where anticipatory happiness reaches its highest average score on Friday, dropping sharply on Monday, and then the cycle (rhythm) begins again. Changes in anticipatory happiness were positively associated with changes in job satisfaction and positive affect, and negatively related to fluctuations in negative affect.(AU)

El estudio se centra en la felicidad anticipatoria durante la semana (felicidad actual, pero considerando el resto de la semana) en empleados confinados por la COVID-19. En el Estudio de diario 1 participaron 71 empleados con teletrabajo en el hogar durante cinco días laborables consecutivos (de lunes a viernes). Encontramos un patrón de cambio cuadrático con una aceleración de la felicidad anticipatoria justo antes del fin de semana. Los resultados también confirmaron una asociación positiva entre la variabilidad diaria en la felicidad anticipatoria y las fluctuaciones diarias en la satisfacción laboral y el afecto positivo. En el Estudio de diario 2 participaron 83 empleados que realizaban una actividad esencial fuera del hogar durante dos semanas consecutivas. Los resultados muestran un patrón de cambio cúbico en el que la felicidad anticipatoria alcanza la puntuación promedio más alta el viernes, cae bruscamente el lunes y luego el ciclo (ritmo) comienza nuevamente. Los cambios en la felicidad anticipatoria se asociaron positivamente con los cambios en la satisfacción laboral y el afecto positivo y negativamente con las fluctuaciones en el afecto negativo.(AU)

Componentes de fragilidad, sarcopenia y su asociación con insuficiencia de vitamina D. Estudio transversal analítico / Components of frailty, sarcopenia and their association with vitamin D deficiency. Cross-sectional, analytical study

Resumen Introducción: En adultos mayores, la asociación de fragilidad y sarcopenia con deficiencia de vitamina D es conocida, pero poco se ha estudiado la asociación de los componentes del síndrome de fragilidad. Objetivo: Determinar la asociación entre los componentes de fragilidad, sarcopenia e insuficiencia de vitamina D en adultos mayores. Métodos: Se estudiaron adultos de quienes se registró edad, escolaridad, estado civil, antecedentes de fracturas, hospitalizaciones, indicadores antropométricos, sarcopenia, índice de Charlson, polifarmacia, fenotipo de fragilidad de Fried y vitamina D plasmática; cifras < 30 ng/mL se consideraron indicativas de insuficiencia de vitamina D. Para el análisis estadístico se utilizó estadística descriptiva e inferencial. La asociación fue determinada mediante regresión logística binaria. Resultados: Se estudiaron 175 adultos con un promedio de edad de 71.7 ± 6.7 años (IC 95 % = 60-90 años). La regresión logística binaria demostró que las variables asociadas a insuficiencia de vitamina D fueron agotamiento (RM = 2.6, IC 95 % = 1.0-6.5, p = 0.03), fragilidad (RM = 9.2, IC 95 % = 2.5-34.1, p = 0.001) y prefragilidad (RM = 4.6, IC 95 % = 2.1-10.0, p < 0.001). Conclusión: Los fenotipos frágil, prefrágil y agotamiento se asocian a insuficiencia de vitamina D.

Abstract Introduction: In older adults, the association of frailty and sarcopenia with vitamin D deficiency is well known, but the association of the components of frailty syndrome has been poorly studied Objective: To determine the association of the components of frailty and sarcopenia with vitamin D insufficiency in older adults. Methods: Adults were studied, in whom age, education, marital status, history of fractures, hospitalizations, anthropometric indicators, sarcopenia, Charlson index, polypharmacy, Fried's frailty phenotype, and plasma vitamin D were recorded; figures < 30 ng/mL were considered indicative of vitamin D insufficiency. Descriptive and inferential statistics were used for statistical analysis. The association was determined by binary logistic regression. Results: One-hundred and seventy-five adults with a mean age of 71.7 ± 6.7 years (95% CI = 60-90 years) were studied. Binary logistic regression showed that the variables associated with vitamin D deficiency were exhaustion (OR = 2.6, 95% CI = 1.0-6.5, p = 0.03), frailty (OR = 9.2, 95% CI = 2.5-34.1, p = 0.001) and pre-frailty (OR = 4.6, 95% CI = 2.1-10.0, p < 0.001). Conclusion: The frail and pre-frail phenotypes, as well as exhaustion, are associated with vitamin D insufficiency.

Reacción sistémica tras la ingesta de una oruga procesionaria del pino: ¿Manejo conservador? / Systemic reaction after pine processionary caterpillar ingestion: Conservative management?

La oruga procesionaria del pino, forma larvaria de la mariposa nocturna Thaumetopoea pityocampa, es una de las principales plagas forestales del sur de Europa. Con frecuencia, estas orugas producen reacciones locales en humanos debidas a los pelillos urticantes microscópicos que las recubren. La mayoría de los síntomas ocasionados son cutáneos, como urticaria aguda, y son mucho más infrecuentes las reacciones sistémicas. Se presenta un caso de reacción sistémica, con edema orofacial, babeo y urticaria tras la ingesta de una oruga procesionaria del pino en un lactante de 11 meses, en el cual el tratamiento farmacológico fue suficiente para la resolución de los síntomas. No tuvo, en ningún momento, compromiso de la vía aérea ni otros datos de anafilaxia, por lo que se desestimaron actuaciones más agresivas, como intubación orotraqueal, endoscopía o laringoscopía.

The larval form of the moth Thaumetopoea pityocampa, known as pine processionary caterpillar, is one of the main forest pests in southern Europe. Often, these caterpillars cause local reactions in humans, due to their microscopic stinging hairs. Most symptoms affect skin, in form of acute urticaria. Systemic reactions are rare. An eleven month old infant with a systemic reaction after ingestion of a pine processionary caterpillar is presented. The boy reached the Emergency Room with orofacial edema, drooling and urticaria. Drug treatment was enough to resolve the symptoms. The patient did not present airway commitment, nor anaphylaxis data at any moment, so more aggressive actions, such as endotracheal intubation, endoscopy or laryngoscopy, were rejected.

Clima y satisfacción laboral en el contexto universitario / Climate and job satisfaction in university environment

El objetivo del estudio es comprobar la relación del clima y la satisfacción laboral en el contexto de una universidad pública. Los datos fueron recogidos de 318 empleados públicos del personal de administración y servicios. Se realizaron análisis multinivel para comprobar los efectos transnivel del clima, operacionalizado a nivel de las áreas administrativas, y la satisfacción laboral individual. El modelo de Kopelman, Brief y Guzzo (1990) sirve de marco teórico para mostrar las relaciones entre el clima y los estados cognitivos y afectivos, como la satisfacción laboral. Los resultados muestran que el clima de las áreas tiene una relación positiva y significativa con la satisfacción laboral, lo que tiene implicaciones para el desarrollo de prácticas innovadoras de recursos humanos que fomenten el bienestar y el compromiso de los empleados, en la construcción de una organización saludable y responsable socialmente (AU)

The aim of this paper is to determine the relationship between climate and job satisfaction in the context of a public university. Data were collected from 318 administrative and technical employees. Multilevel analyses were conducted to test the cross level effects of climate −occurring at a level of administrative areas− and individual job satisfaction. Kopelman, Brief and Guzzo’s (1990) model provides a theoretical framework to show the relationships between climate and cognitive and affective states, such as job satisfaction. Results show that climate in administrative areas has a significant and possitive effect on job satisfaction, which has important implications for the development of innovative practices of human resources that encourage the welfare and commitment of employees on the building of a healthy and socially responsible organization (AU)

Evaluación del programa de mantenimiento con metadona del Hospital Mental de Risaralda / Evaluation of the Methadone Maintenance Program of the Risaralda Mental Hospital

Introducción: La atención psicosocial y el tratamiento de mantenimiento con metadona (TMM) son las estrategias preferidas para el manejo de adictos a heroína, pero los resultados siguen siendo insatisfactorios, lo que justifica la búsqueda e intervención sobre los factores que influyen en la respuesta al tratamiento. Métodos: Con el propósito de determinar la contribución de una serie de variables demográficas, clínicas y genéticas en las concentraciones séricas y la respuesta a la metadona, estudiamos a pacientes del TMM que estuvieran recibiendo metadona con supervisión y sin cambios en las dosis por lo menos durante las últimas 2 semanas. Se les registró edad, sexo, índice de masa corporal (IMC), tiempo de abuso de heroína, adicción a otras drogas, antecedentes delictivos, dosis diaria actual de metadona, tiempo de permanencia en el TMM, comorbilidad y comedicación. Se les tomaron muestras de sangre para determinar concentraciones séricas de metadona racémica y sus enantiómeros R-y S-, y para la tipificación de alelos candidatos de los genes POR, CYP2B6, ABCB1, GRIN1, OPRM1, SLC6A3, DßH y ARRB2, todos ellos asociados con el metabolismo, la distribución tisular y el mecanismo de acción de la metadona. La cuantificación de metadona se hizo mediante HPLC-DAD y la detección de los marcadores genéticos por los métodos de PCR en tiempo real y VNTR. Resultados: Se incluyó a 80 personas de 23,5 ± 5a ˜nos (el 86% varones), todos policonsumidores de sustancias adictivas, el 60% con antecedentes delictivos, con 5,1 ± 2,9 años de consumo de heroína y 5,3 ± 4 meses de ingreso al TMM, con 41 ± 12 mg/día de meta-dona tomada con supervisión. Las concentraciones valle de RS-, R-y S-metadona fueron, respectivamente, 168 ± 77, 84 ± 40 y 84 ± 42 ng/ml. Todos los genotipos estuvieron en equilibrio de Hardy-Weinberg. Las dos pruebas de orina fueron negativas para heroína en el 61,3% (49/80) de los voluntarios; el descenso en el consumo de cocaína/basuco fue del 83%; el de marihuana, del 30% y el de otros psicoactivos (inhalantes, benzodiacepinas, anfetaminas) bajó a cero, mientras el consumo de tabaco permaneció en el 93,5% (75/80). Las concentraciones de metadona racémica y sus enantiómeros se correlacionaron significativamente con las dosis diaria del fármaco, pero ninguna de las demás variables demográficas, clínicas o genéticas incidió en la concentración sérica de metadona. En cuanto a los resultados del TMM, los no consumidores y los consumidores ocasionales de heroína, así como los que abandonaron el consumo de otros psicoactivos y los que no, tuvieron características similares con respecto a las variables demográficas, genéticas y clínicas, incluidas las concentraciones sanguíneas de metadona, con excepción de los individuos que no disminuyeron el consumo de otros psicoactivos distintos de heroína, quienes tuvieron significativamente (p = 0,03) mayores concentraciones sanguíneas de S-metadona que quienes sí abandonaron el consumo. Conclusiones: Hubo importante reducción en los consumos de heroína y otros psicoactivos y reinserción social de los pacientes; sin embargo, la amplia superposición entre las dosis efectivas e inefectivas de metadona apunta a la presencia de variables personales y sociales que trascienden el simple manejo farmacológico y probablemente deban ser abordadas con más éxito desde lo psicosocial, particularmente en lo que tiene que ver con la identificación y superación de las experiencias detonantes de recaídas y con ciertos rasgos del paciente, tales como su nivel de estrés psicológico o sus trastornos psiquiátricos.

Background: Psychosocial care and methadone maintenance treatment (MMT) are the preferred strategies for the management of heroin addicts, but the results are still unsa-tisfactory, justifying the search and intervention of the factors influencing the response to treatment. Methodology: In order to determine the contribution of demographic, clinical and genetic variables on serum concentrations and response to methadone, we investigated patients on MMT, who were receiving methadone in supervised and unchanged doses at least during the previous two weeks. The age, gender, body mass index (BMI), duration of heroin abuse, addiction to other drugs, criminal background, current daily methadone doses, time spent in the TMM, comorbidity and concomitant medication were recorded. Blood samples were taken for the determination of serum levels of racemic methadone and its R and S-enantiomers, and for typing of candidate alleles of POR, CYP2B6, ABCB1, GRIN1, OPRM1, SLC6A3, DßH and ARRB2 genes, all associated with the metabolism, tissue distribution and mechanism of action of methadone. Methadone quantification was by HPLC-DAD, and the detection of genetic markers by Real Time PCR and VNTR methods. Results: A total of 80 subject volunteers were enrolled, with a mean age of 23.5 (5) years (86% male), all of them were addicts of multiple drugs, 60% with a criminal background, 5.1 (2.9) years taking heroin, and 5.3 (4) months on MMT, and taking a supervised dose of 41 (12) mg/day methadone. The (R), (S) and (R, S) methadone enantiomer trough plasma levels were, 84 (40), 84 (42), and 168 (77) ng/mL, respectively. All genotypes were in Hardy-Weinberg equilibrium. The two urine tests were negative for heroin in 61.3% (49/80) of the volunteers, the decline in cocaine/crack use was 83%, 30% of marijuana, and other psychoactives (inhalants, benzodiazepines, amphetamines) decreased to zero, while the consumption of snuff remained at 93.5% (75/80). Blood concentrations of racemic methadone and its enantiomers were significantly associated with the dose/day of the medication, but none of the other demographic, clinical or genetic variables impacted on serum levels of methadone. As for the results of the MMT, non-users and occasional users of heroin, as well as those who stopped taking other psychoactive drugs, and the ones who did not, were similar as regards the demographic, genetic and clinical variables. This included the blood metahdone concentrations, except for individuals who did not reduce their consumption of other psychoactives other than heroin, who had significantly (P = .03) higher blood levels of S-methadone, compared with those who did stop taking them. Conclusions: There was a significant reduction in the consumption of heroin and other psychoactives, and social rehabilitation of patients. However, the extensive overlap between effective and ineffective doses of methadone suggests the presence of personal and social variables that transcend the simple pharmacological management. These probably need to be addressed more successfully from the psychosocial features, particularly as regards to identifying and overcoming relapse-trigger experiences, as well as certain features of the patient, such as their psychological distress level or their psychiatric disorders.

Ictus en pacientes pediátricos con anemia falciforme / Stroke in paediatric patients with sickle-cell anaemia

Introducción. La anemia falciforme es la forma homocigota, grave, de drepanocitosis, un trastorno genético, frecuente en raza negra, caracterizado por la producción de hemoglobina S, anemia hemolítica crónica e isquemia tisular por alteración del flujo sanguíneo. Una cuarta parte de los pacientes presenta manifestaciones neurológicas; el 8-10% de los niños sufrirá un ictus. Objetivo. Analizar los casos de ictus en niños con anemia falciforme en nuestro centro. Pacientes y métodos. Estudio descriptivo retrospectivo de niños con anemia falciforme e ictus. Resultados. Se recogieron cinco pacientes (dos dominicanos y tres guineanos) con anemia falciforme e ictus; un paciente sufrió dos episodios ictales. La edad media fue de 27 meses. Cinco episodios fueron infartos isquémicos. El ictus fue la forma de inicio de la drepanocitosis en tres ocasiones. Dos de los ictus ocurrieron en un contexto de meningitis neumocócica. En cuatro pacientes hubo fiebre previa. La clínica inicial fue hemiparesia en cuatro casos. La hemoglobina media al diagnóstico de ictus fue de 6,5 g/dL. En tres pacientes se hallaron alteraciones en la ecografía transcraneal y, en todos los pacientes, lesiones en la resonancia magnética, que en la mitad eran bilaterales. Tras el ictus se inició un protocolo de régimen hipertransfusional, y sólo un paciente presentó un nuevo ictus, que desarrolló un síndrome moya-moya y fue sometido a una revascularización indirecta, con buena evolución, sin presentar nuevos eventos isquémicos posteriores. Conclusiones. La drepanocitosis es una enfermedad emergente en nuestro medio debido a la inmigración. Debe sospecharse en ictus pediátricos asociados a anemia, sobre todo en menores de 5 años de raza negra no sometidos a cribado neonatal (AU)

Introduction. Sickle-cell anaemia is the severe homozygotic form of drepanocytosis, a genetic disorder that often occurs among black people and which is characterised by the production of haemoglobin S, chronic hemolytic anaemia and tissue ischaemia due to alterations in blood flow. A quarter of the patients presented neurological manifestations; 8-10% of children will have a stroke. Aim. To analyse the cases of stroke in children with sickle-cell anaemia in our centre. Patients and methods. We conducted a retrospective descriptive study of children with sickle-cell anaemia and stroke. Results. Five patients (two Dominicans and three Guineans) with sickle-cell anaemia and stroke; one patient suffered two episodes of stroke. The mean age was 27 months. Five of the episodes were ischaemic infarctions. Stroke was the initial form of presentation of drepanocytosis on three occasions. Two of the strokes occurred within a context of pneumococcal meningitis. Four of the patients had previously reported fever. The initial clinical picture was hemiparesis in four cases. Mean haemoglobin on diagnosing the stroke was 6.5 g/dL. Transcranial ultrasound imaging revealed alterations in three patients and, in all the patients, magnetic resonance imaging revealed lesions, which were bilateral in half the cases. Following the stroke, a hypertransfusion regimen protocol was established and only one patient presented a new stroke. This same patient went on to develop moya-moya disease and was submitted to an indirect revascularisation; the patient progressed well, without presenting any new ischaemic events. Conclusions. Drepanocytosis is a disease that is emerging in our setting as a result of immigration. It should be suspected in cases of paediatric strokes associated to anaemia, above all in black children under the age of five who were not submitted to neonatal screening (AU)

La aplicación del método clínico en la investigación científica de la salud / Applying the clinical method in the health scientific investigation

Con el objetivo de certificar la acreditación docente del Hospital de Cárdenas realizamos un estudio basado en un trabajo investigativo y tomando los métodos de la dialéctica para el ejercicio, y demostrar cómo los profesionales de la Salud pueden con una concepción dialéctico materialista, utilizando los métodos generales de la dialéctica, realizar una investigación científica que pueda elevar la calidad de la atención a los pacientes dentro de los principios éticos, minimizando los efectos indeseables, inclusive de los costos hospitalarios. Enumeramos y ejemplificamos los pasos del método clínico a través de un estudio comparativo de 160 pacientes que se les administró para la interrupción de embarazo Anestesia General contra el Bloqueo Paracervical, tratando de esta forma de incentivar al personal docente a la aplicación del conocimiento de la dialéctica materialista como método universal del conocimiento científico que nos sirve metodológicamente para demostrar que la práctica (médica) es punto de partida del conocimiento y criterio valorativo de la verdad, aplicable al trabajo cotidiano y de esta forma mejorar la salud humana en la relación sujeto-objeto (médico–paciente).

With the objective of certifying the educational accreditation of Cárdenas' Hospital carry out a study layout based on one investigative work and we take the methods of the dialectical one for the exercise, as the professionals of the health they can with a conception dialectical materialist using the general methods of the dialectical one to carry out a scientific investigation that can elevate the quality from the attention to the patients inside the ethical principles minimizing the undesirable goods, inclusive of the hospital costs. Let us enumerate and let us exemplify the steps of the clinical method through a comparative study of 160 patients that they are administered for the interruption of pregnancy General Anaesthesia against the Blockade Paracevical, being this way and to motivate the educational personnel to the application of the materialistic knowledge of the dialectical one as having put universal of the scientific knowledge that it is good us methodologically to demonstrate that he/she practices it (medical) it is starting point of the knowledge and approach validation of the truth, applicable to the daily work and this way to improve the human health in the relationship fellow-object (doctor-patient).

Ética, tecnología y clínica / Ethics, technology and clinics

Con la aparición y desarrollo de la revolución científico-técnica en la medicina, se asiste a un severo deterioro de la relación médico-paciente, a un abandono creciente del interrogatorio, del examen físico y del conocimiento clínico, así como una utilización y dependencia irracional y excesiva de los análisis complementarios por parte de un gran número de médicos, que configuran un verdadero fetichismo de la tecnología. Todo ello tiene muy importantes y sensibles implicaciones éticas en la práctica médica. En el presente trabajo se analizan, sucintamente, algunas razones de este fenómeno; se abordan las relaciones entre la clínica y la tecnología, se enfatiza la importancia del conocimiento clínico como componente esencial del diagnóstico y guía imprescindible para la indicación de los exámenes complementarios, a la vez que se destaca el gran valor de los análisis de laboratorio, los cambios que se han producido en el proceso del razonamiento clínico y la definitiva complementariedad de la clínica y el laboratorio como los dos componentes principales del método clínico.

With the emergence and development of the scientific-technical revolution in medicine, one witnesses severe deterioration of the physician-patient relationship, increasing neglect of questioning, physical exam and clinical knowledge as well as irrational and excessive use of & dependence on supplementary tests by a high number of phusicians,all of which shapes a real fetishism of technology. The above-mentioned has very important and sensitive ethical implications in medical practice. The present paper concisely analyzed some reasons for this phenomenon; addressed the relations between clinics and technology and it emphasized the importance of the clinical knowledge as an essential component of diagnosis and indispensable guide to prescribe supplementary tests. At the same time, the article outlined the great value of lab tests, the changes that have occured in the process of clinical reasoning and how clinics and the lab complement each other as the two main components of the clinical method.

Deficiencias en la entrevista médica: un aspecto del método clínico / Shortcomings in medical interview: a feature of clinical method

Se utilizó una lista de 44 deficiencias para evaluar, bajo observación directa, las entrevistas médicas que 48 internos realizaron a 96 pacientes hospitalizados. Las deficiencias estaban referidas al contenido de la HEA, los tipos de preguntas y aspectos generales y se clasificaron en mayores, importantes y menores. Se presentaron 783 deficiencias, para una media de 8,1 por entrevista; 29,6 porciento correspondieron a la HEA, 20 porciento a los tipos de preguntas y 50,4 porciento a los aspectos generales. El 27 porciento fueron mayores, 46,4 porciento importantes y 26,6 porciento menores. Se evidenció que existe la tendencia a obtener la información por preguntas breves y cerradas, que inducen respuestas y dar inicio por los antecedentes patológicos personales, así como serias dificultades en las habilidades del interrogatorio. Algunas deficiencias no debieran presentarse o ser tan frecuentes en el último año de estudios. Más de la tercera parte de los internos no fueron supervisados nunca a la hora de hacer una historia clínica. Se concluyó que existe necesidad de incrementar la observación directa de los alumnos al hacer historias clínicas como medida fundamental para mejorar sus habilidades clínica

Luxación AcromioClavicular. Tratamiento quirúrgico mediante cerclaje con cinta de dacrón (Cervi-set ) / Dislocation Acromioclavicular n. Surgical treatment by Dacra cerclage tape n (Cervi-set)

Objetivos: 1. Revisar las implicaciones dentro de la biomecánica de hombro, de la integridad y de la lesión del complejo capsuloligamentoso de la articulación acromio – clavicular. 2. Elaborar un protocolo para el diagnóstico preciso, clínico y radiológico, y el seguimiento de pacientes con luxación acromioclavicular G III tratados quirúrgicamente. 3. Evaluar los resultados clínicos y radiológicos en pacientes con luxación acromio-clavicular G III tratados quirúrgicamente mediante reducción abierta, reparación de los ligamentos y cerclaje coracoclavicular con cinta de dacrón (Cervi-set ). Materiales y métodos: De 1985 a 1987, se operaron 23 paciente con luxación acromio clavicular, en el servicio de ortopedia y traumatología del Hospital Clínica San Rafael de Bogotá, de los cuales se lograron seguir 15. De los 23 pacientes, 21 son hombres y 2 mujeres, cuyas edades variaron entre los 23 y los 65 años con un promedio de 43 años, sin encontrar diferencia notable en cuanto al hombro comprometido. La mayoría de las lesiones se debieron a accidentes de tránsito y deportivos. Todos los pacientes ingresaron por el servicio de urgencias siendo avaluados según parámetros clínicos y radiológicos establecidos dentro del protocolo que se expone a continuación...

Diferencias en la calidad de la anamnesis en alumnos de tercer y sexto años de medicina / Differences in the quality of medical history taking in third- and sixth-year medical students

Es de esperar que exista una línea de desarrollo ascendente de las habilidades para interrogar y la calidad de la anamnesis recogida por los alumnos al avanzar en la carrera de Medicina. Con el objetivo de comparar la calidad de la anamnesis reciente, recogida por alumnos de tercer y sexo años, 19 pacientes fueron interrogados por igual número de alumnos de cada año de forma secuencial. Las anamnesis recientes recogidas fueron comparadas tomando en cuenta criterios cualitativos y cuantitativos. En sentido general las anamnesis recogidas por los internos fueron de mejor calidad, fundamentalmente porque recogieron más información primaria y establecieron mejor el cronopatograma de los datos clínicos, excepto en 4 casos en que las de los alumnos de tercer año fueron ligeramente superiores. En el resto de las 15 anamnesis revisadas, la calidad de las pertenecientes a los internos fue marcadamente superior en 7 y en la fundamental en una, en las 7 restantes la superioridad fue ligera. Se insiste en la necesidad de dar continuidad a la enseñanza y evaluación de las habilidades para entrevistar en cada estancia del área clínica y en buscar los métodos más eficaces para lograrlo

El comentario medico en las evoluciones de las historias clinicas: analisis critico / Medical commentaries in the evolution of medical records: a critical analysis

Se analizaron los comentarios medicos en 50 historias clinicas seleccionadas aleatoriamente de pacientes fallecidos por bronconeumonia en el Hospital Militar Central "Carlos J. Finlay" durante el primer semestre de 1994 para investigar cuantitativamente y cualitativamente los comentarios realizados en un grupo de historias clinicas. El 15,4 por ciento considero sin valor; el 32,9 por ciento de poco valor; el 21,3 por ciento aceptable; el 7,4 por ciento justificativo; el 18,2 por ciento valioso y el 4,8 por ciento de rediscusion. Se hallo una diferencia significativa (p=0,00024) entre los sin valor, de poco valor y aceptables en relacion con los valiosos y de rediscusion. Se analizan las posibles causas que pudieron influir en la pobreza general de los comentarios medicos evolutivos y se considera que intervienen la poca atencion, jerarquizacion y exigencia por parte de los jefes de grupos basicos de trabajo, especialistas y residentes de anos superiores