Insights into the transglucosylation activity of α-glucosidase from Schwanniomyces occidentalis.

The α-glucosidase from Schwanniomyces occidentalis (GAM1p) was expressed in Komagataella phaffii to about 70 mg/L, and its transferase activity studied in detail. Several isomaltooligosaccharides (IMOS) were formed using 200 g/L maltose. The major production of IMOS (81.3 g/L) was obtained when 98% maltose was hydrolysed, of which 34.8 g/L corresponded to isomaltose, 26.9 g/L to isomaltotriose, and 19.6 g/L to panose. The addition of glucose shifted the IMOS synthesis towards products containing exclusively α(1 → 6)-linkages, increasing the production of isomaltose and isomaltotriose about 2-4 fold, enabling the formation of isomaltotetraose, and inhibiting that of panose to about 12 times. In addition, the potential of this enzyme to glycosylate 12 possible hydroxylated acceptors, including eight sugars and four phenolic compounds, was evaluated. Among them, only sucrose, xylose, and piceid (a monoglucosylated derivative of resveratrol) were glucosylated, and the main synthesised products were purified and characterised by MS and NMR. Theanderose, α(1 → 4)-D-glucosyl-xylose, and a mixture of piceid mono- and diglucoside were obtained with sucrose, xylose, and piceid as acceptors, respectively. Maximum production of theanderose reached 81.7 g/L and that of the glucosyl-xylose 26.5 g/L, whereas 3.4 g/L and only 1 g/L were produced of the piceid mono- and diglucoside respectively. KEY POINTS: • Overexpression of a yeast α-glucosidase producing novel molecules. • Yeast enzyme producing the heterooligosaccharides theanderose and glucosyl-xylose. • Glycosylation of the polyphenol piceid by a yeast α-glucosidase.

Valorization of Kraft Lignins from Different Poplar Genotypes as Vegetable Oil Structuring Agents via Electrospinning for Biolubricant Applications.

This work explores the use of Kraft lignins sourced from different poplar genotypes (Populus alba L. "PO-10-10-20" and Populus × canadensis "Ballotino") isolated by selective acid precipitation (at pHs 5 and 2.5) to produce electrospun nanostructures that can be further employed for structuring vegetable oils. This approach offers a new avenue for converting these waste materials into high-value-added ingredients of eco-friendly structured lubricants. Electrospinning of poplar Kraft lignin (PKL)/cellulose acetate (CA) solutions yielded homogeneous beaded nanofiber mats that were able to generate stable dispersions when they were blended with different vegetable oils (castor, soybean, and high-oleic sunflower oils). Electrospun PKL/CA nanofiber mats with larger average fiber diameters were achieved using the lignins isolated at pH 5. Dispersions of PKL/CA nanofibers in vegetable oils presented gel-like viscoelastic characteristics and shear-thinning flow behavior, which slightly differ depending on the nanofiber morphological properties and can be tuned by selecting the poplar lignin genotype and precipitation pH. The rheological properties and tribological performance of PKL/CA nanofibers suitably dispersed in vegetable oils were found to be comparable to those obtained for conventional lubricating greases. Additionally, lignin nanofibers confer suitable oxidative stability to the ultimate formulations to different extents depending on the vegetable oil used.

Quantitative atlas of collagen hydrogels reveals mesenchymal cancer cell traction adaptation to the matrix nanoarchitecture.

Collagen-based hydrogels are commonly used in mechanobiology to mimic the extracellular matrix. A quantitative analysis of the influence of collagen concentration and properties on the structure and mechanics of the hydrogels is essential for tailored design adjustments for specific in vitro conditions. We combined focused ion beam scanning electron microscopy and rheology to provide a detailed quantitative atlas of the mechanical and nanoscale three-dimensional structural alterations that occur when manipulating different hydrogel's physicochemistry. Moreover, we study the effects of such alterations on the phenotype of breast cancer cells and their mechanical interactions with the extracellular matrix. Regardless of the microenvironment's pore size, porosity or mechanical properties, cancer cells are able to reach a stable mesenchymal-like morphology. Additionally, employing 3D traction force microscopy, a positive correlation between cellular tractions and ECM mechanics is observed up to a critical threshold, beyond which tractions plateau. This suggests that cancer cells in a stable mesenchymal state calibrate their mechanical interactions with the ECM to keep their migration and invasiveness capacities unaltered. STATEMENT OF SIGNIFICANCE: The paper presents a thorough study on the mechanical microenvironment in breast cancer cells during their interaction with collagen based hydrogels of different compositions. The hydrogels' microstructure were obtained using state-of-the-art 3D microscopy, namely focused ion beam-scanning electron microscope (FIB-SEM). FIB-SEM was originally applied in this work to reconstruct complex fibered collagen microstructures within the nanometer range, to obtain key microarchitectural parameters. The mechanical microenvironment of cells was recovered using Traction Force Microscopy (TFM). The obtained results suggest that cells calibrate tractions such that they depend on mechanical, microstructural and physicochemical characteristics of the hydrogels, hence revealing a steric hindrance. We hypothesize that cancer cells studied in this paper tune their mechanical state to keep their migration and invasiveness capacities unaltered.

Combined therapy for managing a clear cell renal cell carcinoma in a horseshoe kidney: A case report.

The upper urinary tract is the most common human organ system affected by congenital anomalies. A Horseshoe kidney is a fusion anomaly, it can be described as a fusion across the midline of 2 distinct functioning kidneys. The incidence of renal tumors in a Horseshoe kidney is higher than in the normal population. We present a 60-year-old male patient with a history of Horseshoe kidney and a diagnosis of clear cell renal cell carcinoma who underwent a combined therapeutic approach, guided by interventional radiology. This approach involved selective transarterial embolization and microwave ablation. Three months after surgery and with abdominal MRI follow-up, there is evidence of a non-viable tumor, indicating a favorable response to the intervention.

Characterization of NiCuOxNy Coatings Obtained via RF Sputtering: Structure, Morphology, and Optical Properties.

The rapid advancement of technology necessitates the continual development of versatile materials that can adapt to new electronic devices. Rare earth elements, which are scarce in nature, possess the set of properties required for use as semiconductors. Consequently, this research aims to achieve similar properties using materials that are abundant in nature and have a low commercial cost. To this end, nickel and copper were utilized to synthesize thin films of nickel-copper binary oxynitride via reactive RF sputtering. The influence of nitrogen flow on the structure, morphology, chemical composition, and optical properties of the films was investigated using various characterization techniques, including X-ray diffraction (XRD), scanning electron microscopy (SEM), atomic force microscopy (AFM), and X-ray photoelectron spectroscopy (XPS), as well as transmittance and absorbance measurements. The crystalline structure of the films shows that they can have preferential growth or be polycrystalline according to the nitrogen flow used during deposition and that both the oxides and oxynitrides of metals are formed. We identified unknown phases specific to this material, termed "NiCuOxNy". The morphology revealed that the grain size of the coatings was dependent on the nitrogen flow rate, with grain size decreasing as the nitrogen flow rate increased. Notably, the coatings demonstrated transparency for wavelengths exceeding 1000 nm, with an optical band gap ranging from 1.21 to 1.86 eV.

Volatile Fatty Acids Effective as Antibacterial Agents against Three Enteric Bacteria during Mesophilic Anaerobic Incubation.

The antibacterial effects of a selection of volatile fatty acids (acetic, propionic, butyric, valeric, and caproic acids) relevant to anaerobic digestion were investigated at 1, 2 and 4 g/L. The antibacterial effects were characterised by the dynamics of Enterococcus faecalis NCTC 00775, Escherichia coli JCM 1649 and Klebsiella pneumoniae A17. Mesophilic anaerobic incubation to determine the minimum bactericidal concentration (MBC) and median lethal concentration of the VFAs was carried out in Luria Bertani broth at 37 °C for 48 h. Samples collected at times 0, 3, 6, 24 and 48 h were used to monitor bacterial kinetics and pH. VFAs at 4 g/L demonstrated the highest bactericidal effect (p < 0.05), while 1 g/L supported bacterial growth. The VFA cocktail was the most effective, while propionic acid was the least effective. Enterococcus faecalis NCTC 00775 was the most resistant strain with the VFAs MBC of 4 g/L, while Klebsiella pneumoniae A17 was the least resistant with the VFAs MBC of 2 g/L. Allowing a 48 h incubation period led to more log decline in the bacterial numbers compared to earlier times. The VFA cocktail, valeric, and caproic acids at 4 g/L achieved elimination of the three bacteria strains, with over 7 log10 decrease within 48 h.

Exploring Cellulose Triacetate Nanofibers as Sustainable Structuring Agent for Castor Oil: Formulation Design and Rheological Insights.

Developing gelled environmentally friendly dispersions in oil media is a hot topic for many applications. This study aimed to investigate the production of electrospun cellulose triacetate (CTA) nanofibers and to explore their potential application as a thickening agent for castor oil. The key factors in the electrospinning process, including the intrinsic properties of CTA solutions in methylene chloride (DCM)/ethanol (EtOH), such us the shear viscosity, surface tension, and electrical conductivity, were systematically studied. The impact of the CTA fiber concentration and the ratio of DCM/EtOH on the rheological properties of the gel-like dispersions in castor oil was then investigated. It was found that dispersions with a non-Newtonian response and above a critical concentration (5 wt.%), corresponding to approximately 2-2.5 times the entanglement concentration, are required to produce defect-free nanofibers. The average fiber diameter increased with CTA concentration. Further, the morphology and texture of the electrospun nanofibers are influenced by the ratio of solvents used. The rheological properties of dispersions are strongly influenced by the concentration and surface properties of nanofibers, such as their smooth or porous textures, which allow their modulation. Compared to other commonly used thickeners, such as synthetic polymers and metal soaps, CTA electrospun nanofibers have a much higher oil structuring capacity. This work illustrated the potential of using CTA nanofibers as the foundation for fabricating gel-like dispersions in oil media, and thus exerting hierarchical control of rheological properties through the use of a nanoscale fabrication technique.

Effect of the Inoculum-to-Substrate Ratio on Putative Pathogens and Microbial Kinetics during the Batch Anaerobic Digestion of Simulated Food Waste.

The effects of the inoculum (anaerobic digestion effluent) to substrate (simulated food waste) ratio (ISR) 4.00 to 0.25 on putative pathogens and microbial kinetics during batch mesophilic anaerobic digestion were investigated. Red fluorescent protein labelled (RFPAKN132) Escherichia coli JM105 was introduced as a marker species, and together with the indigenous Clostridium sp., Enterococcus sp., Escherichia coli, and total coliforms were used to monitor pathogen death kinetics. Quantitative polymerase chain reaction was also used to estimate the bacterial, fungal, and methanogenic gene copies. All the ISRs eliminated E. coli and other coliforms (4 log10 CFU/mL), but ISR 0.25 achieved this within the shortest time (≤2 days), while ISR 1.00 initially supported pathogen proliferation. Up to 1.5 log10 CFU/mL of Clostridium was reduced by acidogenic conditions (ISR 0.25 and 0.50), while Enterococcus species were resistant to the digestion conditions. Fungal DNA was reduced (≥5 log10 copies/mL) and was undetectable in ISRs 4.00, 2.00, and 0.50 at the end of the incubation period. This study has demonstrated that ISR influenced the pH of the digesters during batch mesophilic anaerobic digestion, and that acidic and alkaline conditions achieved by the lower (0.50 and 0.25) and higher (4.00 and 2.00) ISRs, respectively, were critical to the sanitisation of waste.

Strategy for the Enzymatic Acylation of the Apple Flavonoid Phloretin Based on Prior α-Glucosylation.

The acylation of flavonoids serves as a means to alter their physicochemical properties, enhance their stability, and improve their bioactivity. Compared with natural flavonoid glycosides, the acylation of nonglycosylated flavonoids presents greater challenges since they contain fewer reactive sites. In this work, we propose an efficient strategy to solve this problem based on a first α-glucosylation step catalyzed by a sucrose phosphorylase, followed by acylation using a lipase. The method was applied to phloretin, a bioactive dihydrochalcone mainly present in apples. Phloretin underwent initial glucosylation at the 4'-OH position, followed by subsequent (and quantitative) acylation with C8, C12, and C16 acyl chains employing an immobilized lipase from Thermomyces lanuginosus. Electrospray ionization-mass spectrometry (ESI-MS) and two-dimensional nuclear magnetic resonance spectroscopy (2D-NMR) confirmed that the acylation took place at 6-OH of glucose. The water solubility of C8 acyl glucoside closely resembled that of aglycone, but for C12 and C16 derivatives, it was approximately 3 times lower. Compared with phloretin, the radical scavenging capacity of the new derivatives slightly decreased with 2,2-diphenyl-1-picrylhydrazyl (DPPH) and was similar to 2,2-azino-bis(3-ethylbenzothiazoline-6-sulfonic acid) (ABTS•+). Interestingly, C12 acyl-α-glucoside displayed an enhanced (3-fold) transdermal absorption (using pig skin biopsies) compared to phloretin and its α-glucoside.

Caracterización de la retención de caninos maxilares en pacientes pediátricos de Ciego de Ávila

Introducción: Se reportan hallazgos que permiten observar al canino maxilar impactado como una entidad de importante prevalencia. En la provincia de Ciego de Ávila son escasas las investigaciones publicadas sobre la alteración eruptiva. Objetivos: Describir variables epidemiológicas y clínicas e identificar los factores locales presentes en pacientes pediátricos con retención de caninos maxilares del municipio Ciego de Ávila en el período comprendido entre octubre de 2019 y junio de 2020. Métodos: Se realizó una investigación observacional analítica de casos y controles donde se determinaron los factores locales asociados a la retención de caninos maxilares. La población de estudio se constituyó por 388 escolares, en las edades de 11 y 17 años, pertenecientes al área de salud de la clínica estomatológica docente Dr. Luis Páez Alfonso del municipio Ciego de Ávila, en el período de estudio. Resultados: El 56,9 % de los participantes pertenecían al sexo femenino; prevaleció el grupo de 11 a 13 años con el 70,7 % y el color de piel blanca (74,1 %). El 56,9 % de los pacientes presentaban retención bilateral y el mayor porciento (60,4 %) se ubicó por vestibular. La discrepancia hueso diente negativa, el micrognatismo transversal (OR de 6,3) y la pérdida prematura de dientes temporales (OR fue de 6,1) mostraron una importante significación estadística. Conclusiones: La retención de los caninos maxilares predominó en el sexo femenino, en el grupo etario de 11 a 13 años y en los pacientes pediátricos de piel blanca. La retención bilateral y la localización por vestibular de los caninos se presentaron con mayor frecuencia. Se constató la asociación entre la retención de caninos maxilares y los factores locales discrepancia hueso diente negativa, micrognatismo transversal y pérdida prematura de dientes temporales.

Introduction: We report findings that allow us to observe the impacted maxillary canine as an entity of important prevalence. In the province of Ciego de Avila there is little research published on this eruptive alteration. Objectives: To describe epidemiological and clinical variables and to identify the local factors present in pediatric patients with retained maxillary canines in the municipality of Ciego de Avila between October 2019 and June 2020. Methods: An analytical observational research of cases and controls was carried out to determine the local factors associated to maxillary canine retention. The study population consisted of 388 schoolchildren between the ages of 11 and 17 years old, belonging to the health area of the Dr. Luis Páez Alfonso Stomatological Teaching Clinic in the municipality of Ciego de Avila, during the study period. Results: 56.9% of the participants belonged to the female sex; the group of 11 to 13 years old prevailed with 70.7 % and the skin color was white (74.1%). A total of 56.9 % of the patients had bilateral retention and the highest percentage (60.4%) was located in the vestibular region. Negative bone-tooth discrepancy, transverse micrognathism (OR of 6.3) and premature loss of primary teeth (OR was 6.1) showed significant statistical significance. Conclusions: Maxillary canine retention predominated in the female sex, in the 11 to 13 years age group, and in white-skinned pediatric patients. Bilateral retention and vestibular location of the canines occurred more frequently. The association between maxillary canine retention and the local factors negative bone-tooth discrepancy, transverse micrognathism and premature loss of primary teeth was found.

Versión en español de los criterios STOPP/START 3. Avances en la detección de la prescripción inapropiada de medicamentos en personas mayores / Spanish version of the STOPP/START 3 criteria: Advances in the detection of inappropriate prescribing medication in the older people

Los criterios STOPP/START son criterios explícitos basados en sistemas fisiológicos que resumen la evidencia sobre problemas de prescripción relevantes clínicamente relacionados con el uso de medicamentos potencialmente inapropiados (criterios STOPP) y con potenciales omisiones de prescripción (criterios START). Las dos versiones anteriores de los criterios STOPP/START se publicaron en 2008 y en 2015, y sus versiones en español, en 2009 y en 2015. En 2023 se acaba de publicar la versión3 de dichos criterios. El objetivo de este artículo es presentar la versión traducida al español, así como revisar la utilización y el impacto que ha tenido la versión2 del año 2015 en nuestro idioma. Se realizó una traducción del inglés al español por profesionales expertos y con alto nivel de inglés de la versión3 de los criterios STOPP/START, que incorporan la evidencia publicada desde abril de 2014 hasta marzo de 2022. Además, se hizo una revisión sistemática de las publicaciones que han usado la traducción española de la versión previa (versión2 de 2015) de los criterios STOPP/START. La nueva versión, presentada en este artículo, cuenta con 190 criterios STOPP/START (133 criterios STOPP y 57 criterios START), lo que supone un aumento del 40% en el número de criterios en comparación con la versión anterior. En la revisión se encontraron 37 estudios (21 observacionales, 11 de intervención y 5 de otro tipo) que han usado la versión española en lugar de la internacional. La versión3 en español de los criterios STOPP/START es una lista explícita actualizada de medicamentos potencialmente inapropiados y posibles omisiones en la prescripción que tienen el objetivo de optimizar la medicación y minimizar las reacciones adversas a los medicamentos durante la revisión de la medicación en las personas mayores, en particular aquellas con multimorbilidad y polifarmacia (AU)

The STOPP/START criteria are explicit physiologic systems-based criteria that summarize evidence on clinically relevant prescribing problems related to the use of potentially inappropriate medications (STOPP criteria) and potential prescribing omissions (START criteria). The two previous versions of the STOPP/START criteria were published in 2008 and 2015, and their Spanish versions in 2009 and 2015. Version3 of these criteria has just been published in 2023. The aim of this article is to present the Spanish translated version, and to review the use and impact that version2 of 2015 has had in our language. A translation from English to Spanish was performed by expert professionals with a high level of English of version3 of the STOPP/START criteria, which incorporates the evidence published from April 2014 to March 2022. In addition, a systematic review of publications that have used the Spanish translation of the previous version (version2 of 2015) of the STOPP/START criteria was performed. The new version, presented in this article, has 190 STOPP/START criteria (133 STOPP criteria and 57 START criteria), which is a 40% increase in the number of criteria compared to the previous version. The review found 37 studies (21 observational, 11 interventional and 5 other) that used the Spanish version instead of the international version. The Spanish version 3 of the STOPP/START criteria is an updated explicit list of potentially inappropriate medications and possible omissions in prescribing that aims to optimize medication and minimize adverse drug reactions during medication review in the elderly, particularly those with multimorbidity and polypharmacy (AU)

Antimicrobial stewardship in hospitals: Expert recommendation guidance document for activities in specific populations, syndromes and other aspects (PROA-2) from SEIMC, SEFH, SEMPSPGS, SEMICYUC and SEIP / Programas de optimización del uso de antimicrobianos en hospitales: guía de recomendaciones de expertos para actividades en poblaciones específicas, síndromes y otros aspectos (PROA-2) de la SEIMC, SEFH, SEMPSPGS y SEIP

In 2012, The Spanish Societies of Infectious Diseases and Clinical Microbiology (SEIMC), Hospital Pharmacy (SEFH), and Preventive Medicine, Public Health and Healthcare Management (SEMPSGS) lead a consensus document including recommendations for the implementation of antimicrobial stewardship (AMS) programs (AMSP; PROA in Spanish) in acute care hospitals in Spain. While these recommendations were critical for the development of these programs in many centres, there is a need for guidance in the development of AMS activities for specific patient populations, syndromes or other specific aspects which were not included in the previous document or have developed significantly since then. The objective of this expert recommendation guidance document is to review the available information about these activities in these patient populations or circumstances, and to provide guidance recommendations about them. With this objective the SEIMC, SEFH, SEMPSPGS, the Spanish Society of Intensive Care Medicine (SEMICYUC) and the Spanish Pediatric Infectious Disease Society (SEIP) selected a panel of experts who chose the different aspects to include in the document. Because of the lack of high-level evidence in the implementation of the activities, the panel opted to perform a narrative review of the literature for the different topics for which recommendations were agreed by consensus. The document was open to public consultation for the members of these societies for their comments and suggestions, which were reviewed and considered by the panel.(AU)

En 2012, las Sociedades Españolas de Enfermedades Infecciosas y Microbiología Clínica (SEIMC), Farmacia Hospitalaria (SEFH) y Medicina Preventiva, Salud Pública y Gestión Sanitaria (SEMPSPGS) lideraron un documento de consenso que incluía recomendaciones para la implementación de Programas de optimización del uso de antimicrobianos (PROA) en hospitales de agudos en España. Si bien estas recomendaciones fueron críticas para el desarrollo de estos programas en muchos centros, actualmente es necesario establecer unas guías para la implementación de las actividades de los PROA en determinadas poblaciones de pacientes, síndromes clínicos y otros aspectos específicos que no se incluyeron en el documento previo o que desde entonces se han desarrollado significativamente. El objetivo de esta guía de recomendaciones de expertos es revisar la información disponible acerca de esas actividades en estas poblaciones o circunstancias de pacientes y proporcionar unas recomendaciones que sirvan de guía sobre ellas. Con este objetivo, la SEIMC, la SEFH y la SEMPSPGS, así como la Sociedad Española de Medicina Intensiva, Crítica y Unidades Coronarias (SEMICYUC) y la Sociedad Española de Infectología Pediátrica (SEIP), seleccionaron un panel de expertos que eligieron los diferentes aspectos a incluir en el documento. Debido a la ausencia de evidencia de alto nivel en la implementación de las diferentes actividades, el panel optó por realizar una revisión narrativa de la literatura de los diferentes aspectos, en los que las recomendaciones se acordaron por consenso. El documento se abrió para consulta pública a los miembros de estas sociedades para sus comentarios y sugerencias, que fueron revisadas y consideradas por el panel.(AU)

Sentimientos y emociones de los pacientes en el proceso de alta de UCI / Feelings And Emotions That Emerge From The Experience Of Being Discharged From An ICU

Introducción El alta de la Unidad de Cuidados Intensivos (UCI) a la sala de hospitalización activa el sistema afectivo de los pacientes provocando la aparición de sentimientos asociados al proceso de transición. Los objetivos de este trabajo son conocer los sentimientos y emociones que emergen de la experiencia de ser dado de alta de una UCI e identificar los factores que desencadenan bienestar y malestar emocional en los pacientes. Método Estudio cualitativo y descriptivo con enfoque fenomenológico en un hospital de tercer nivel de Barcelona. Se realizaron 20 entrevistas en profundidad para la recogida de datos. Resultados Se identificaron sentimientos y emociones agradables que provocan bienestar cuando se produce la transferencia: Alegría, satisfacción y seguridad, y sentimientos desagradables que producen malestar: Ansiedad, tristeza, miedo, rabia, desprotección y ambivalencia de sentimientos. Conclusiones Es necesaria una reflexión sobre el gran número de sentimientos que evoca el alta de la UCI a la sala de hospitalización y cuáles son los desencadenantes que los provocan para poder trabajar en ellos y propiciar un alta de UCI emocionalmente saludable. (AU)

Introduction: Discharge from the Intensive Care Unit (ICU) to the hospitalization ward activates the affective system of patients, causing the appearance of feelings associated with the transition process. The objectives of this thesis are to know the feelings and emotions that emerge from the experience of being discharged from an ICU and to identify the factors that trigger well-being and emotional discomfort in patients. Methodology: Qualitative and descriptive study with a phenomenological approach in a third level hospital in Barcelona. Twenty in-depth interviews were conducted for data collection. Results: The pleasant feelings and emotions that cause wellbeing when the transfer occurs identified were: Joy, satisfaction and security. The unpleasant feelings that cause discomfort identified were: Anxiety, sadness, fear, anger, lack of protection and ambivalence of feelings. Conclusions: It is necessary to reflect on the large number of feelings that being discharged from the ICU to the hospital ward evokes and what are the triggers that provoke them in order to work on them and promote an emotionally healthy discharge from the ICU. (AU)

Nephrotic syndrome associated with primary atypical hemolytic uremic syndrome / Síndrome nefrótica associada à síndrome hemolítico-urêmica atípica primária

Abstract Primary atypical hemolytic-uremic syndrome is a rare disease characterized by non-immune microangiopathic hemolytic anemia, thrombocytopenia, and renal dysfunction; it is related to alterations in the regulation of the alternative pathway of complement due to genetic mutations. The association with nephrotic syndrome is unusual. We present here a pediatric patient diagnosed with primary atypical hemolytic-uremic syndrome associated with nephrotic syndrome who responded to eculizumab treatment.

Resumo A síndrome hemolítico-urêmica atípica primária é uma doença rara, caracterizada por anemia hemolítica microangiopática não-imune, trombocitopenia e disfunção renal; está relacionado a alterações na regulação da via alternativa do complemento devido a mutações genéticas. A associação com a síndrome nefrótica é incomum. Apresentamos aqui um paciente pediátrico com diagnóstico de síndrome hemolítico-urêmica atípica primária associada à síndrome nefrótica que respondeu ao tratamento com eculizumab.

Evaluación de la frecuencia cardiaca durante la bipedestación activa inicial en pacientes que padecen síncope vasovagal / Evaluation of the heart rate during initial active standing in patients with vasovagal syncope

Introducción: El síncope vasovagal es la causa más frecuente de pérdida breve de la conciencia, en su etiopatogenia se reporta una disfunción autonómica que puede ponerse de manifiesto en la bipedestación activa inmediata. Objetivo: Comparar la dinámica de los cambios de la frecuencia cardíaca durante la bipedestación activa inmediata, de pacientes que padecen síncope vasovagal y sujetos controles. Métodos: Se evaluaron 132 sujetos supuestamente sanos (grupo A) entre 18 y 25 años y 156 pacientes con síncopes vasovagales; fueron divididos por su respuesta ante la bipedestación prolongada, negativa 111 (grupo B) y positiva 45 (grupo C). Se registró la actividad electrocardiográfica en decúbito supino y al inicio de la bipedestación activa, se obtuvo las secuencias de intervalos RR. Se comparó la frecuencia cardíaca en los 3 grupos, con 22 indicadores (posicionales, temporales, ordinales y relacionales, promedio y de la velocidad de los cambios). Resultados: No hubo diferencias en los indicadores promedio, sin embargo, algunos que evalúan la velocidad del cambio inicial, fueron significativamente menores en el grupo A comparado con B y C (p < 0,05), mientras que los que evalúan la velocidad de recuperación, fueron significativamente menores en el grupo C comparado con A y B. Conclusión: La dinámica de los cambios de frecuencia, permitió encontrar indicadores que pueden considerarse posibles predictores de una respuesta cardiovascular inadecuada en pacientes con síncope vasovagal(AU)

Introduction: Vasovagal syncope is the most frequent cause of brief loss of consciousness, in its etiopathogenesis an autonomic dysfunction is reported that can be manifested in immediate active standing. Objective: To compare the dynamics of heart rate changes during immediate active standing of patients suffering from vasovagal syncope with control subjects. Methods: 132 supposedly healthy subjects (group A) between 18 and 25 years old and 156 patients with vasovagal syncope were evaluated, which were divided by their response to prolonged standing, negative 111 (group B) and positive 45 (group C). Electrocardiographic activity was recorded in the supine position and at the beginning of active standing, the sequences of RR intervals were obtained. The heart rate was compared in the 3 groups, using 22 indicators (positional, temporal, ordinal and relational, average and of the speed of changes). Results: Differences were not found in the average indicators in the analyzed period, however, some that evaluate the speed of the initial change were significantly lower in group A compared to B and C (p < 0.05), while others that evaluate the speed recovery rates were significantly lower in group C compared to A and B. This allows to characterize, compare and differentiate the groups studied during the complex and rapid interactions that occur in the change of position. Conclusion: The dynamic of frequency changes, allowed to find indicators, which can be considered as possible predictors of an inadequate cardiovascular response in patients with vasovagal syncope(AU)

Relación entre el funcionamiento familiar, ansiedad y depresión en adultos mayores / Relationship between Family Functioning, Anxiety and Depression in Older Adults

Introducción: El envejecimiento poblacional constituye en la actualidad un serio problema de salud de carácter universal. Objetivo: Relacionar el funcionamiento familiar con ansiedad y depresión en adultos mayores. Métodos: Se realizó un estudio descriptivo correlacional de serie de casos en el Área de Salud II de Cienfuegos, en el período de enero a mayo de 2019. El universo de estudio fue conformado por 12 774 adultos mayores del Área 2 de Cienfuegos. Se utilizó un muestreo aleatorio simple (n = 50). Los instrumentos en la recogida de la información fueron: Entrevista al paciente, Autoescala de Depresión de Zung y Conde, Prueba de Ansiedad Rasgo y Estado y Cuestionario de Funcionabilidad Familiar (FF-SIL).El análisis estadístico de la información se realizó a través del paquete estadístico SPSS (Statistical Package for the Social Sciences). Se utilizó de la estadística descriptiva la frecuencia absoluta y el por ciento. Resultados: Prevalecieron las familias unigeneracionales (36 por ciento), pequeñas (62 por ciento) y nucleares (64 por ciento). Predominaron las familias moderadamente funcionales (60 por ciento). Los adultos mayores presentaron ansiedad en niveles medios y alto (70 y 30 por ciento respectivamente); además, 76 por ciento presentó depresión moderada. En cuanto a la relación entre el funcionamiento familiar con la ansiedad y la depresión se obtuvieron valores menores al nivel de significación 0,05. Conclusiones: En los adultos mayores del estudio no hubo relación entre el funcionamiento familiar con la ansiedad y la depresión(AU)

Introduction: Population aging is currently a serious universal health concern. Objective: To relate family functioning with anxiety and depression in older adults. Methods: A correlational and descriptive study of case series was carried out in the health area II of Cienfuegos, in the period from January to May 2019. The study universe was made up of 12 774 older adults from the health area II of Cienfuegos. Simple random sampling (n=50) was used. The instruments used to collect the information were patient interview, the Zung and Conde's Autoscale for Depression, the State-Trait Anxiety Test, and the Family Functioning Perception Test (FF-SIL). The statistical analysis of the information was carried out using the statistical package SPSS (Statistical Package for the Social Sciences). As descriptive statistics, absolute frequency and the percentage were used. Results: Unigenerational (36 percent), small (62 percent) and nuclear (64 percent) families prevailed. Moderately functional families predominated (60 percent). Older adults presented anxiety at medium and high levels (70 percent and 30 percent, respectively). In addition, 76 percent presented moderate depression. Regarding the relationship between family functioning with anxiety and depression, values lower than the 0.05 level of significance were obtained. Conclusions: Among the older adults included in the study, there was no relationship of family functioning with anxiety and depression(AU)

Síndrome serotoninérgico inducido por polifarmacia / Serotoninergic syndrome induced by multiple medications

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