Intravenous Vitamin C as an Add-on Therapy for the Treatment of Sepsis in an Intensive Care Unit: A Prospective Cohort Study.

Background and Objectives: According to the Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3), sepsis is defined as "life-threatening organ dysfunction caused by a dysregulated host response to infection". The increased presence of free radicals causes an increase in oxidative stress. Vitamin C is an essential water-soluble vitamin with antioxidant activity and immunoregulatory effects that plays a potential role in the treatment of bacterial infections. Our aim was to evaluate the effectiveness of adding vitamin C to the conventional treatment of sepsis to decrease its mortality rate. Materials and Methods: In a prospective cohort study, we included patients with a diagnosis of sepsis and a SOFA score ≥ 9 who were evaluated in an Intensive Care Unit at a secondary-care hospital. According to the intensive care specialist, they were treated using two different strategies: Group 1-patients with sepsis treated with conventional treatment without vitamin C; Group 2-patients with sepsis with the addition of vitamin C to conventional treatment. Results: We included 34 patients with sepsis. The incidence of mortality was 38%, and 47% of patients used vitamin C as an adjuvant to the basic treatment of sepsis. In the basal analyses, patients treated with use of vitamin C compared to patients treated without vitamin C required less use of glucocorticoids (75% vs. 100%, p = 0.039). At follow-up, patients treated without vitamin C had higher mortality than patients treated with vitamin C as an adjuvant for the treatment of sepsis (55.6% vs. 18.8%, p = 0.03). We observed that the use of vitamin C was a protective factor for mortality in patients with sepsis (RR: 0.54, 95% CI: 0.31-0.96, p = 0.03). Conclusions: The use of vitamin C as an adjuvant to treatment decreases the risk of mortality by 46% in patients with sepsis and SOFA ≥ 9 compared to patients treated without vitamin C as an adjuvant to sepsis.

Total and segmental phase angle in a cohort of hospitalised patients with COVID-19: mortality prediction and changes throughout hospitalisation.

Body composition and phase angle (PhA) have been used to predict mortality in multiple diseases. However, little has been studied regarding segmental measurements, which could potentially help assess subtle changes in specific tissue segments. This study aimed to identify the total PhA cut-off point associated with mortality risk and changes in body composition within a week of hospitalisation in non-critical hospitalised patients with COVID-19. A cohort study was conducted where patients underwent to a complete nutritional assessment upon admission and after seven days, and followed up until hospital discharge or death. A receiver operating characteristic curve was constructed to determine the PhA cut-off point, and the Kaplan­Meier estimator was used to determine survival analysis. Segmental and complete body compositions on admission and after 7 d were compared. We included 110 patients (60 men) with a mean age of 50·5 ± 15·0 years and a median BMI of 28·5 (IQR, 25·6­33·5) kg/m2. The median length of hospital stay was 6 (IQR, 4­9) d, and the mortality rate was 13·6 %. The PhA cut-off point obtained was 4°, with significant differences in the survival rate (P < 0·001) and mortality (HR = 5·81, 95 % CI: 1·80, 18·67, P = 0·003). Segmental and whole-body compositions were negatively affected within one week of hospitalisation, with changes in the approach by the graphical method in both sexes. Nutritional status deteriorates within a week of hospitalisation. PhA < 4° is strongly associated with increased mortality in non-critical hospitalised patients with COVID-19.

Effect of the Addition of Fique Bagasse Cellulose Nanoparticles on the Mechanical and Structural Properties of Plastic Flexible Films from Cassava Starch.

One of the activities most representative of the agricultural sector in Colombia is the production of biodegradable fique fiber. The efficiency of the defiberization process of the fique leaves is very low since a mere 4% of the total weight of the leaf (cabuya) is used and marketed. The remaining 96%, composed of fique juice and bagasse, is considered to be waste and discarded, impacting the environment. The aim of this work was to study fique bagasse as a source of cellulose nanoparticles (CNCs). CNCs were obtained by acid hydrolysis and added at 10% to films made from cassava thermoplastic starch (TPS) by the casting method. Structural changes in the CNCs, TPS, and their mixtures were characterized by FTIR-ATR and their morphology and particle size by SEM and TEM microscopy, respectively. Thermal properties were analyzed using DSC and TGA, along with their effect on mechanical properties. Changes in the FTIR spectra indicated that the chemical method adequately removed hemicellulose and lignin from the fiber surface of fique bagasse. The CNCs showed a diameter and length of 7.5 ± 3.9 and 52.7 ± 18.1 nm, respectively, and TPS 10% CNC obtained an increase in mechanical strength of 116%. The obtainment of CNCs from lignocellulosic materials can thus be viewed as a favorable option for the subsequent reinforcement of a polymeric matrix.

n-3 Polyunsaturated Fatty Acid Supplementation Affects Oxidative Stress Marker Levels in Patients with Type II Intestinal Failure: A Randomized Double Blind Trial.

Type II intestinal failure (IF-II) is a condition in which the gastrointestinal tract is compromised. Liver complications may occur because of the pathology and/or prolonged use of parenteral nutrition (PN); oxidative stress has been implicated as one of the causes. Lipid emulsions containing n-3 polyunsaturated fatty acids (PUFAs) have been proposed for the treatment. We aimed to evaluate the effect of 7-day n-3 PUFA supplementation on oxidative stress in IF-II patients receiving PN. This was a randomized, controlled, double-blinded, pilot trial of adult patients with IF-II, receiving either conventional PN (control) or PN enriched with n-3 PUFAs (intervention). Twenty patients were included (14 men, 49 ± 16.9 years), with the ANCOVA analysis the glucose (p = 0.003), and direct bilirubin (p = 0.001) levels reduced; whereas the high-density lipoprotein cholesterol (HDL-C) increased (p = 0.017). In the random-effect linear regression analysis, a reduction (p < 0.0001) in the malondialdehyde (MDA) level was found in the intervention group when the covariables age, HDL-C level, and alanine aminotransferase activity were considered. After 1 week of PN supplementation with n-3 PUFAs, the marker levels of some oxidative stress, blood lipids, and hepatic biomarkers improved in patients with IF-II.

Simulation and Economic Analysis of the Biotechnological Potential of Biomass Production from a Microalgal Consortium.

The biomass of microalgae and the compounds that can be obtained from their processing are of great interest for various economic sectors. Chlorophyll from green microalgae has biotechnological applications of great potential in different industrial areas such as food, animal feed, pharmaceuticals, cosmetics, and agriculture. In this paper, the experimental, technical and economic performance of biomass production from a microalgal consortium (Scenedesmus sp., Chlorella sp., Schroderia sp., Spirulina sp., Pediastrum sp., and Chlamydomonas sp.) was investigated in three cultivation systems (phototrophic, heterotrophic and mixotrophic) in combination with the extraction of chlorophyll (a and b) on a large scale using simulation; 1 ha was established as the area for cultivation. In the laboratory-scale experimental stage, biomass and chlorophyll concentrations were determined for 12 days. In the simulation stage, two retention times in the photobioreactor were considered, which generated six case studies for the culture stage. Subsequently, a simulation proposal for the chlorophyll extraction process was evaluated. The highest microalgae biomass concentration was 2.06 g/L in heterotrophic culture, followed by mixotrophic (1.98 g/L). Phototrophic and mixotrophic cultures showed the highest chlorophyll concentrations of 20.5 µg/mL and 13.5 µg/mL, respectively. The simulation shows that higher biomass and chlorophyll production is attained when using the mixotrophic culture with 72 h of retention that we considered to evaluate chlorophyll production (a and b). The operating cost of the entire process is very high; the cultivation stage has the highest operating cost (78%), mainly due to the high energy consumption of the photobioreactors.

Differential effects of high dose omega-3 fatty acids on metabolism and inflammation in patients with obesity: eicosapentaenoic and docosahexaenoic acid supplementation.

Background: Obesity is complicated by low-grade chronic inflammation characterised by increases in inflammatory proteins and cells in peripheral blood. It has been known that omega-3 fatty acids (FA) like eicosapentaenoic (EPA) and docosahexaenoic (DHA) could modulate the inflammatory process and improve metabolic markers. Objective: This study aimed to determine the effect of high-dose omega-3 FA on metabolic and inflammatory markers among patients with obesity and healthy volunteers. Methods: This prospective study included 12 women with obesity (body mass index [BMI] ≥ 35.0 kg/m2) and 12 healthy women (BMI < 24.0 kg/m2) who were supplemented with a dose of 4.8 g/day (3.2 g EPA plus 1.6 g DHA) for 3 months followed by no treatment for 1 month. Plasma metabolic and inflammatory markers and levels of mRNA transcripts of CD4+ T lymphocyte subsets were determined monthly. Results: None of the participants exhibited changes in weight or body composition after study completion. EPA and DHA supplementation improved metabolic (insulin, Homeostatic Model Assessment of Insulin Resistance [HOMA-IR], triglyceride [TG]/ high-density lipoprotein [HDL] ratio, TG, and arachidonic acid [AA]/EPA ratio) and tumor necrosis factor-alpha (TNF-α). Moreover, the levels of mRNA transcripts of T CD4+ lymphocyte subsets (TBX21, IFNG, GATA-3, interleukin [IL]-4, FOXP3, IL-10 IL-6, and TNF-α), were down-regulated during the intervention phase. After 1 month without supplementation, only insulin, HOMA-IR and the mRNA transcripts remained low, whereas all other markers returned to their levels before supplementation. Conclusion: Supplementation with high-dose omega-3 FAs could modulate metabolism and inflammation in patients with obesity without weight loss or changes in body composition. However, these modulatory effects were ephemeral and with clear differential effects: short-duration on metabolism and long-lasting on inflammation.

Oral health-related quality of life in a group of patients with rheumatoid arthritis.

BACKGROUND: Rheumatoid arthritis (RA) and periodontitis (PD) are chronic diseases that are associated with connective tissue and bone destruction, which affects the quality of life of the people suffering from these conditions. The identification of social conditions and the determinants of RA and PD would permit the elaboration of policies and strategies based on social reality. OBJECTIVES: The aim of the present study was to identify the relationship between oral health-related quality of life (OHRQoL) and the indicators of general health and oral health in patients with RA. MATERIAL AND METHODS: A cross-sectional study involving 59 patients with RA was conducted between 2019 and 2020. Demographic, general health, periodontal, and oral health parameters were collected. In addition, the Oral Health Impact Profile-14 (OHIP-14) questionnaire was administered to each patient. A description of the OHIP-14 dimensions according to different variables was performed. The relationship between OHRQoL and general/oral health indicators was analyzed with logistic and linear regression analyses. RESULTS: The highest OHIP-14 scores were found in people that were 60 years of age and over, single, had low educational achievements, a low socioeconomic status, were unemployed, and had no health affiliation. In the adjusted model, the prevalence of the impact on OHRQoL was 1.34 (1.10-5.29) times greater in those with erosive RA than in those without, and 2.22 (1.16-29.50) times greater in those who self-reported morning stiffness. Regarding the stage of PD, those with stage IV had a prevalence of the impact on the OHRQoL of 70%, an average extent of 3.4 ±4.5 and a severity score of 11.5 ±22.0, with statistically significant differences. CONCLUSIONS: The dimensions with the greatest impact on the OHRQoL of patients were physical pain, discomfort and psychological disability. The type of RA and the severity of PD are indicators of worse scores on the OHRQoL scale.

Lack of association between periodontitis and rheumatoid arthritis.

BACKGROUND AND OBJECTIVE: Periodontitis and rheumatoid arthritis (RA) have been associated in a bidirectional way. The objective of this study was to determine the association between clinical parameters of periodontitis and RA. MATERIALS AND METHODS: Seventy-five (75) participants distributed in 3 groups (21 patients with periodontitis without RA, 33 patients with periodontitis with RA and 21 patients with reduced periodontium with RA) were included in this cross-sectional study. A full periodontal and medical examination was performed in each patient. Additionally, subgingival plaque samples for the detection of Porphyromonas gingivalis (P. gingivalis) and blood samples for biochemical markers of RA were also taken. Logistic regression analysis adjusted for confounding variables, Spearman's rank correlation coefficient and a linear multivariate regression were used to analyze the data. RESULTS: Patients with RA presented less severity of periodontal parameters. The highest levels of anti-citrullinated protein antibodies were detected in non-periodontitis patients with RA. Covariates such as age, P. gingivalis, diabetes, smoking, osteoporosis and use of medication were not associated with RA. All periodontal variables and P. gingivalis expressed a negative correlation with biochemical markers of RA (P<0.05). CONCLUSIONS: Periodontitis was not associated with RA. Furthermore, there was no correlation between periodontal clinical parameters and biochemical markers of RA.

The Gut Microbiota-Brain Axis during Aging, Mild Cognitive Impairment and Dementia: Role of Tau Protein, ß-Amyloid and LPS in Serum and Curli Protein in Stool.

Currently, there is an increasing number of people with mild cognitive (MCI) impairment and dementia (D). In the present work we studied the role of tau protein, ß-amyloid, LPS (lipopolysaccharide), and curli protein of elderly adults with MCI or D and the contribution of gut microbiota. Four groups were studied: young subjects, healthy adults older than 60 years (A), elderly adults with MCI (MCI), and elderly adults with dementia (D). A preclinical study was conducted in old male Wistar rats to evaluate the impact of gut microbiota on curli protein abundance in feces and brain. The results showed that with increasing age, tau protein, ß-amyloid, and LPS significantly increased in serum during MCI and D, and this was associated with an increase in the abundance of E. coli that synthesize the amyloid protein curli, that may promote the aggregation of amyloid proteins. Rats showed a clear increase in the abundance of curli protein in the brain during aging. Thus, cognitive impairment and dementia are in part due to an alteration in the gut microbiota-brain axis via increase in curli protein and LPS leading to an increase in tau and ß-amyloid protein.

Evisceración vaginal espontánea en paciente con antecedente de histerectomía: reporte de caso y revisión de la literatura / Spontaneous vaginal evisceration in woman with prior pelvic surgery: case report and literature review

Reportar un caso de evisceración vaginal espontánea en paciente con antecedentes quirúrgicos de histerectomía vaginal y hacer una revisión de la literatura sobre los principales factores de riesgo asociados a la presentación de este evento. Se presenta el caso de una paciente de 74 años multípara de 12 partos vaginales con antecedente ginecológico de histerectomía vaginal en 2012, en el año 2014 una sacroespinocolpopexia con colocación de cinta transobturadora más colporrafia anterior, en 2018 presenta cuadro con asas intestinales protruyendo con signos de isquemia a través de defecto en cúpula vaginal, se realiza resección de intestino delgado y anastomosis termino-terminal, con posterior cierre de defecto por vía abdominal. Se realizó una búsqueda en las bases de datos PubMed, Scielo, Google Scholar y Science Direct para artículos publicados en inglés y español, de los últimos 22 años. Se identificaron 16 títulos que cumplieron con los criterios de selección, los resultados de la revisión muestran factores de riesgo comunes. La evisceración vaginal por dehiscencia de la cúpula vaginal es una patología poco prevalente, el abordaje mínimamente invasivo, que ha aumentado en los últimos años, ha conllevado un aumento de la incidencia, siendo la histerectomía por laparoscopia el de mayor riesgo.

To report a case of spontaneous vaginal evisceration in a patient with a surgical history of vaginal hysterectomy, and to review the literature on the main risk factors associated with the presentation of this event. We present the case of a 74-year-old multiparous patient with 12 vaginal deliveries with a gynecological history of vaginal hysterectomy in 2012, in 2014 a sacrospinocolpopexy with placement of transobturator tape plus anterior colporrhaphy, in 2018 she presented with intestinal loops protruding with signs of ischemia through a defect in the vaginal vault, resection of the small intestine and end-to-end anastomosis were performed, with subsequent closure of the defect through the abdomen. A search was made in the PubMed, Scielo, Google Scholar and Science Direct databases for articles published in English and Spanish, from the last 22 years. 16 titles that met the selection criteria were identified; the results of the review show common risk factors. Vaginal evisceration due to dehiscence of the vaginal vault is a rare pathology, the minimally invasive approach, which has increased in recent years, has led to an increase in incidence, with laparoscopic hysterectomy being of greater risk.

Circulating HMGB1 is increased in myelodysplastic syndrome but not in other bone marrow failure syndromes: proof-of-concept cross-sectional study.

Background: Myelodysplastic syndrome (MDS) is associated with persistent immune activation. High mobility group box-1 (HMGB1) is a ubiquitous, functionally diverse, non-histone intranuclear protein. During acute and chronic inflammatory states, HMGB1 is actively released by inflammatory cells, further amplifying the inflammatory response. A role in MDS and other hypoplastic bone marrow (BM) disorders is incompletely understood. Objectives: The objective of the study is to evaluate whether circulating HMGB1 is elevated in patients with MDS and other BM failure syndromes [namely, aplastic anemia (AA) and paroxysmal nocturnal hemoglobinuria (PNH)]. Design: This is a observational, cross-sectional, single-center, exploratory study. Methods: We evaluated circulating concentrations of HMGB1, interleukin (IL)-1ß, IL-6, and tumor necrosis factor (TNF)-α in patients with MDS and age-matched hematologically healthy controls as well as patients with AA and PNH. Results: We included 66 patients with MDS and 65 age-matched controls as well as 44 patients with other BM failures (AA = 27, PNH = 17). Circulating levels of HMGB1 were higher in patients with MDS [median, 4.9 ng/ml; interquartile range (IQR): 2.3-8.1] than in AA (median, 2.6 ng/ml; IQR: 1.7-3.7), PNH (median, 1.7 ng/ml; IQR: 0.9-2.5), and age-matched healthy individuals (median, 1.9 ng/ml; IQR: 0.9-2.5) (p = 0.0001). We observed higher concentrations of HMGB1 in the very low/low-risk MDS patients than in the intermediate/high/very high-risk ones (p = 0.046). Finally, in comparison with patients with AA, those with hypocellular MDS (h-MDS) had significantly higher levels of circulating HMGB1 (n = 14; median concentration, 5.6 ng/ml, IQR: 2.8-7.3; p = 0.006). We determined a circulating HMGB1 value of 4.095 ng/ml as a diagnostic cutoff differentiator between h-MDS and AA. Conclusion: These observations indicate that circulating HMGB1 is increased in patients with MDS. HMGB1 (but not IL-1ß or TNF-α) differentiated between MDS and other BM failures, suggesting that HMGB1 may be mechanistically involved in MDS and a druggable target to decrease inflammation in MDS.

Therapeutic exercise to improve motor function among children with Down Syndrome aged 0 to 3 years: a systematic literature review and meta­analysis.

The effects and the prescription parameters of therapeutic exercise are not clear. For this reason, is needed to determine the effect of therapeutic exercises on the motor function of children with Down Syndrome (DS) aged 0 to 3 years. The present study is systematic review and meta-analysis of effectiveness outcomes in this population: gait, balance, motor development, fine motor skills, and executive functions. The databases of PubMed, PEDro, EMBASE, SCIELO, Lilacs, Cochrane library were searched from January to December 2019. We recruited Randomized Controlled Trials (RCTs) which met the inclusion criteria in our study. Six studies and 151 participants were included. Two types of therapeutic exercises, aerobic and neuromuscular, were identified. Both types of exercise were effective in improving outcomes. There were no differences between the modes of application of the exercise. No differences were identified between the treadmill and the physiotherapy plan for the reduction of the time to reach independent walking, Mean Difference (MD) 46.79, 95% Confidence Interval (IC) (- 32.60, 126.19), nor for the increase in walking speed MD 0.10 IC (- 0.02, 0.21) m/s. This study suggests that aerobic exercise therapy has a potentially effective role to promote the gait and motor development of children with DS aged 0 to 3 years when it is applied using a treadmill with a frequency of 5 days, a duration of 6-8 min, and an intensity of between 0.2 and 0.5 m/s. Studies with less heterogeneity and larger sample sizes are required.

Arbuscular Mycorrhizal Symbiosis Leads to Differential Regulation of Genes and miRNAs Associated with the Cell Wall in Tomato Leaves.

Arbuscular mycorrhizal symbiosis is an association that provides nutritional benefits to plants. Importantly, it induces a physiological state allowing plants to respond to a subsequent pathogen attack in a more rapid and intense manner. Consequently, mycorrhiza-colonized plants become less susceptible to root and shoot pathogens. This study aimed to identify some of the molecular players and potential mechanisms related to the onset of defense priming by mycorrhiza colonization, as well as miRNAs that may act as regulators of priming genes. The upregulation of cellulose synthases, pectinesterase inhibitors, and xyloglucan endotransglucosylase/hydrolase, as well as the downregulation of a pectinesterase, suggest that the modification and reinforcement of the cell wall may prime the leaves of mycorrhizal plants to react faster and stronger to subsequent pathogen attack. This was confirmed by the findings of miR164a-3p, miR164a-5p, miR171e-5p, and miR397, which target genes and are also related to the biosynthesis or modification of cell wall components. Our findings support the hypothesis that the reinforcement or remodeling of the cell wall and cuticle could participate in the priming mechanism triggered by mycorrhiza colonization, by strengthening the first physical barriers upstream of the pathogen encounter.

Possible Association between Selected Tick-Borne Pathogen Prevalence and Rhipicephalus sanguineus sensu lato Infestation in Dogs from Juarez City (Chihuahua), Northwest Mexico-US Border.

Tick-borne bacterial pathogens (TBBPs) show a worldwide distribution and represent a great impact on public health. The brown dog tick (Rhipicephalus sanguineus) is a vector of several pathogens that affect dogs and sometimes humans as well. In addition, TBBPs represent a diagnostic challenge and imply financial resources and medical treatment for long periods of time. In the present study, R. sanguineus s. l. was identified as the main tick species naturally parasitizing dogs that inhabit. Juárez City, Chihuahua, in the Paso del Norte region, Mexico-US Border, representing 99.8% of the cases. Additionally, an end-point PCR was performed to search for whether pathogens in R. sanguineus s. l. can transmit in DNA extracted from ticks and dog blood samples. This is the first molecular detection of Rickettsia rickettsi infecting domestic dogs in Mexico; however, other pathogens were also identified, such as Ehrlichia canis and Anaplasma platys in both ticks and dog blood samples, while Anaplasma phagocytophilum was identified only in dog blood samples. Moreover, co-detection in tick pools and co-infection in the analyzed dog blood samples could be found. Similarly, this research showed that dogs were found mostly parasitized by adult female ticks, increasing the possibility of transmission of E. canis.

Effect of Phentermine on Hepatic Steatosis in Bariatric Surgery: A Pilot Study.

OBJECTIVE: Hepatic steatosis is associated with increased surgical complications in bariatric surgery patients. We aimed to evaluate the effect of phentermine in reducing hepatic steatosis, adipose tissue, and surgical complications in patients undergoing bariatric surgery. METHODS: This was a two-arm, double-blind, randomized, controlled pilot trial of 64 adult subjects with BMI >35 kg/m2 selected for bariatric surgery randomized into phentermine group (15 mg once daily) or placebo group for 8 weeks. Both groups adhered to a hypocaloric diet (500 calories/day) and an individualized exercise program. The primary endpoint was reducing the frequency of hepatic steatosis measured by ultrasound and reducing adipose tissue through fat mass in total kilograms or percentage. Key secondary points were the prevalence of surgical complications. Baseline and final biochemical parameters and blood pressure too were assessments. RESULTS: In the phentermine group, the frequency of hepatic steatosis decreased by 19%, and the percentage of patients with a normal ultrasound increased from 9% to 28% (p = 0.05). Likewise, the decrease in fat mass in kilograms was more significant in the phentermine group (56.1 kg vs. 51.8 kg, p = 0.02). A significant reduction in the HOMA-IR index was observed regardless of weight loss. No differences in surgical complications were observed between groups. Phentermine was well-tolerated; no differences were observed in the frequency of adverse events between the groups. CONCLUSIONS: Phentermine decreased the proportion of individuals with hepatic steatosis by 19% and promoted a more significant fat mass loss in kilograms among candidates for bariatric surgery.

How Is Colonialism a Sociostructural Determinant of Health in Puerto Rico?

Puerto Rico is experiencing a public health crisis driven by effects and processes of US colonialism in the archipelago, such as the exclusionary application of federal health policy, an exodus of health care professionals, and the long-term effects of unequal distribution of health care funding in the unincorporated territories. Compound effects of multiple disasters, including Hurricane María, repeated earthquakes, and the COVID-19 pandemic, as well as relentless privatization and fragmentation of the health care system, have led to very poor health outcomes. Puerto Rico's case clearly shows the negative effects of colonialism on public health. This article specifies what decolonization requires from a public health standpoint to promote health equity.

Puerto Rico atraviesa una crisis de salud pública debido a los efectos y procesos del colonialismo estadounidense en el archipiélago, como la aplicación excluyente de la política sanitaria federal, el éxodo de los profesionales de la salud y los efectos a largo plazo de la distribución desigual de la financiación sanitaria en los territorios no incorporados. Los efectos combinados de múltiples catástrofes, como el huracán María, los repetidos terremotos y la pandemia del COVID-19, así como la constante privatización y fragmentación del sistema de atención médica, han propiciado resultados de salud muy deficientes. El caso de Puerto Rico muestra claramente los efectos negativos del colonialismo en la salud pública. Este artículo especifica lo que requiere la descolonización desde el punto de vista de la salud pública para promover la equidad sanitaria.

The Effect of Periodontal Treatment on Clinical and Biological Indicators, Quality of Life, and Oral Health in Rheumatoid Arthritis Patients: A Quasi-Experimental Study.

Non-surgical periodontal therapy (NSPT) has been shown to have systemic effects. It has been suggested that, similar to rheumatoid arthritis (RA), periodontitis (PD) has an impact on general health, in terms of psychological, physical, and social aspects. This study determines the effect of periodontal treatment in RA activity, health-related quality of life, and oral health self-perception before and after periodontal treatment in RA patients. A quasi-experimental, prospective, non-randomized study was conducted, and 52 patients were included in the study. Periodontal parameters and the instruments disease activity score-28 (DAS-28), SF-36, and OHIP-14 were measured at baseline and at 3 months after NSPT. All differences were statistically assessed. The study protocol was registered in Clinical Trials (NCT04658615). No statistically significant differences were found in the scores of DAS-28 before and after the intervention in the group with PD and reduced periodontium. When the effect of periodontal treatment was analyzed in the group of 29 patients who were followed up, it was found that there were statistically significant differences before and after in variables such as psychological distress, emotional role, and mental health, which indicates an improvement in the scores of these variables. NSPT influenced the health-related quality of life measured with SF-36 and OHIP-14 in patients with RA. In conclusion, NSPT has an effect on self-reported quality of life and health indicators more than the RA activity as measured with DAS-28. However, the clinical effect of periodontal treatment in RA patients provides important data to support periodontal care in patients.

Phase angle and overhydration are associated with post-extubating dysphagia in patients with COVID-19 discharged from the ICU.

BACKGROUND: Few studies have evaluated the prevalence of post-extubation dysphagia and associated factors in patients with coronavirus disease 2019 (COVID-19) . Our study assessed the prevalence of post-extubation dysphagia and body composition in patients with COVID-19 discharged from an intensive care unit (ICU). METHODS: A prospective cohort study was performed in post-ICU extubated patients with acute respiratory distress syndrome related to COVID-19 in two referral hospitals. A total of 112 patients were evaluated and included; swallowing assessment and bioelectrical impedance analysis (BIA) were performed after extubation and discharge from the ICU. To identify associations between dysphagia, lower phase angle (PhA) (<4.8°) and hydration (extracellular water/total body water < 0.390) logistic and linear regression analyses were conducted. RESULTS: The incidence of post-extubation dysphagia was 41% (n = 46). From these, 65% (n = 30) had severe swallowing impairment. Overhydration and PhA were significantly different in patients with dysphagia, and segmental hydration in the trunk and legs was higher than in arms. PhA <4.8° (odds ratio [OR], 12.2; 95% CI, 4.3-34.1; P < .05) and overhydration measured by BIA (OR, 9.1; 95% CI, 3.4-24.5; P < .05) were associated with post-extubation dysphagia in multivariate analysis. PhA (<4.8°) was associated with a lower rate of swallowing recovery at hospital discharge (log-rank test = 0.007). CONCLUSIONS: A high incidence of post-extubation dysphagia was found in patients with COVID-19. Low PhA and overhydration were associated with the presence of dysphagia. Lower PhA was an independent factor for swallowing recovery at discharge.

Lifespan of peripheral intravenous short catheters in hospitalized children: A prospective study.

OBJECTIVE: To estimate the recommended lifespan of 223 peripheral intravenous accesses in pediatric services. METHOD: In this cohort study, we monitored the time of intravenous catheter between insertion and removal in children aged up to 15 years old in a Hospital from Bogotá-Colombia. The routine catheter observations was registered in questionnaires during nursing shifts. Survival analyses were performed to analyze the lifespan of the catheter free of complications. RESULTS: The median lifespan of peripheral intravenous catheters without complications was 129 h (IQR 73.6-393.4 h). This median time free from complications was much lower for children ⩽1 year 98.3 h (IQR 63-141 h), than for participants aged >1 year 207.4 h (IQR 100-393 h). Catheters of 24 G (gauge) caliber had a median complication free time of 128 h (IQR 69-207 h) and 22 G calibers 144 h (IQR 103-393 h). CONCLUSIONS: In this study, 75% of peripheral indwell catheters remained free from complications for 74 h, the other extreme 25% of these patients could remain up to 393 h.

The Influence of Sevelamer Hydrochloride and Calcium Carbonate on Markers of Inflammation and Oxidative Stress in Hemodialysis at Six Months of Follow-Up.

Patients with end-stage renal disease (ESRD) present alterations in mineral and bone metabolism. Hyperphosphatemia in ESRD is considered an independent risk factor for cardiovascular disease (CVD), increasing morbidity, and mortality. Sevelamer hydrochloride is a calcium-free, non-absorbable phosphate-chelating polymer. Calcium carbonate chelator is helpful in controlling serum phosphate levels. There is insufficient information on the influence of sevelamer hydrochloride and calcium carbonate on the behavior of oxidative stress (OS) markers and inflammation in patients on hemodialysis (HD). A randomized open clinical trial was carried out on patients to evaluate sevelamer hydrochloride and calcium carbonate influence at 6 months of study follow-up. Levels of oxidants (LPO, NO, and 8-isoprostanes), antioxidants (SOD and TAC), oxidative DNA damage (8-OHdG and hOGG1), pro-inflammatory cytokines (IL-6 and TNF-α), and inflammation markers (ferritin and C-reactive protein) were measured with colorimetric and ELISA methods. We found a significant increase in oxidants LPO and NO, and antioxidants SOD and TAC, and downregulation of IL-6 and TNF-α. Ferritin decrease at 6 months follow-up in the sevelamer hydrochloride group. Increase in C-reactive protein was found in the group of patients treated with calcium carbonate. In conclusion, we found an oxidative state imbalance with increase in LPO and NO oxidants. The activity of the antioxidant enzymes (SOD and TAC) was also found to increase, suggesting a compensatory effect in the face of increase in oxidants. The same phenomenon was observed with increase in the oxidative damage marker to DNA and the increase in the DNA repair enzyme, suggesting a compensatory effect. Pro-inflammatory cytokines were predominantly downregulated by TNF-α in the group that ingested sevelamer hydrochloride in the final determination at 6 months of follow-up. Serum ferritin levels decreased significantly at the end of follow-up in patients on HD in the sevelamer hydrochloride group. The management of hyperphosphatemia with sevelamer hydrochloride appears to have obvious anti-inflammatory and antioxidant benefits.