Photo-induced structural dynamics of o-nitrophenol by ultrafast electron diffraction.

The photo-induced dynamics of o-nitrophenol, particularly its photolysis, has garnered significant scientific interest as a potential source of nitrous acid in the atmosphere. Although the photolysis products and preceding photo-induced electronic structure dynamics have been investigated extensively, the nuclear dynamics accompanying the non-radiative relaxation of o-nitrophenol on the ultrafast timescale, which include an intramolecular proton transfer step, have not been experimentally resolved. Herein, we present a direct observation of the ultrafast nuclear motions mediating photo-relaxation using ultrafast electron diffraction. This work spatiotemporally resolves the loss of planarity which enables access to a conical intersection between the first excited state and the ground state after the proton transfer step, on the femtosecond timescale and with sub-Angstrom resolution. Our observations, supported by ab initio multiple spawning simulations, provide new insights into the proton transfer mediated relaxation mechanism in o-nitrophenol.

Rehybridization dynamics into the pericyclic minimum of an electrocyclic reaction imaged in real-time.

Electrocyclic reactions are characterized by the concerted formation and cleavage of both σ and π bonds through a cyclic structure. This structure is known as a pericyclic transition state for thermal reactions and a pericyclic minimum in the excited state for photochemical reactions. However, the structure of the pericyclic geometry has yet to be observed experimentally. We use a combination of ultrafast electron diffraction and excited state wavepacket simulations to image structural dynamics through the pericyclic minimum of a photochemical electrocyclic ring-opening reaction in the molecule α-terpinene. The structural motion into the pericyclic minimum is dominated by rehybridization of two carbon atoms, which is required for the transformation from two to three conjugated π bonds. The σ bond dissociation largely happens after internal conversion from the pericyclic minimum to the electronic ground state. These findings may be transferrable to electrocyclic reactions in general.

[Supply of sterile medical devices to an interventional technical platform via mobile RFID technology]. / Approvisionnement d'un plateau technique interventionnel en dispositifs médicaux stériles via la technologie RFID mobile.

This work presents the eight-month assessment of the mobile RFID (radio frequency identification) technology implementation for the management of sterile medical devices in an interventional cardiology department. Several indicators dedicated to stock management, organizational impact (within the pharmacy and the department) and economic impact were collected. The scope of MDS tracked by RFID was defined as well as the new supply circuit. In total, 297 (83%) references were managed by RFID. At eight months, the number of MDS units in stock has decreased by 35% and the number of overstocked references by more than 50%. The value of the inventory decreased by €30,196 (17%) in three months from an initial amount of €17,995. This decrease has been maintained at eight months. The average time spent by the pharmacy technician (PPH) was 66min/d. The paramedical team gained 180min/week. By integrating the cost of the equipment, the annual subscription and the PPH cost, the benefit is estimated at €9555 the first year (then €17,155 the following years). To conclude, RFID has allowed a significant reduction of the stock and its control over time while securing the supply circuit adjusted to the activity. The limits are the absence of interface between the dedicated software and the ordering software as well as the consequent time dedicated by the PPH to this new management mode.

Descripción de las tasas de egresos hospitalarios por psoriasis entre los años 2018 a 2021 en Chile / Psoriasis hospital discharge rates description from 2018 to 2021 in Chile

Introducción: La psoriasis es una enfermedad crónica con diversas manifestaciones cutáneas que presenta asociación con patologías cardiovasculares y reumatológicas y que puede requerir manejo hospitalizado. El objetivo de este estudio fue describir la tasa de egresos hospitalarios por psoriasis entre los años 2018-2021 en Chile. Metodología: Estudio descriptivo observacional, sobre egresos hospitalarios por psoriasis entre 2018-2021, Chile, según sexo y grupos etario (n=2463). Datos obtenidos del Departamento de estadística e información de Salud. Se calculó la Tasa de egreso hospitalario (TEH). No se requirió comité de ética. Resultados: El año 2020 y 2021 se presentó la menor TEH del periodo de estudio con 2.8 y 2.09/100.000 hab respectivamente. El sexo masculino presento la mayor TEH del periodo con 4.96, y el grupo etario de 45-64 años presento la mayor TEH con 6.97/100000 habitantes. Discusión: En el año 2020 y 2021 se evidenció una reducción de la tasa de egreso hospitalario, que coincide con la declaración de pandemia en el año 2020 producto del virus SARS-CoV-2 y esto puede deberse a una reconversión de camas, a camas respiratorias. El sexo femenino podría presentar menor TEH debido a que el estrógeno se reporta como un factor protector. La mayor TEH en el grupo etario 45-64 puede explicarse debido a que esta población presenta más comorbilidades que predisponen a la psoriasis. Conclusión: Se requieren más estudios a nivel nacional para profundizar en los resultados encontrados. Existe escasez de estadísticas nacionales de tasa de egreso de psoriasis siendo interesante aumentar el periodo de tiempo estudiado para profundizar los hallazgos reportados.

Introduction: Psoriasis is a chronic disease with a diversity of skin manifestations, whose etiology is multifactorial and associated with cardiovascular and rheumatological pathologies and that may require hospitalization. The objective of this study was to describe the rate of hospital discharges due to psoriasis between the years 2018-2021 in Chile. Methodology: Observational descriptive study on hospital discharges for psoriasis between 2018-2021 in Chile according to sex and age groups (n=2463).. The data was obtained from the Department of Statistics and Health Information (DEIS). The Hospital Discharge Rate (TEH) was calculated. No ethics committee was required. Results: The year 2020 and 2021 presented the lowest TEH of the study period with 2.8 and 2.09/100,000 habitants respectively. The male sex presented the highest TEH of the period with 4.96, and the age group of 45-64 years presented the highest TEH with 6.97/100,000 habitants. Discussion: In 2020 and 2021, there was a reduction in the hospital discharge rate, which coincides with the declaration of a pandemic in 2020 as a result of the SARS-CoV-2 virus and this may be due to a conversion of beds to respiratory beds. The female sex could present lower TEH because estrogen is reported as a protective factor. The higher TEH in the 45-64 age group can be explained by the fact that this population presents more comorbidities that predispose to psoriasis. Conclusion: More studies are required at a national level to deepen the results found. There is a scarcity of national statistics on the rate of discharge from psoriasis, and it is interesting to increase the period of time studied to deepen the reported findings.

Evaluación del conocimiento del paciente sobre fármacos para el dolor en farmacia comunitaria / Assessment of patient knowledge of pain medication in community pharmacies

JUSTIFICACIÓN: el dolor es la causa más frecuente de consulta médica. Los fármacos más utilizados por la población son analgésicos y antiinflamatorios no esteroideos (AINES). Sin embargo, también está aumentando el uso de analgésicos opioides para este fin. Es importante un buen uso de estos fármacos para conseguir una mayor efectividad y seguridad de los mismos. Desde la farmacia comunitaria en el momento de la dispensación podemos valorar el conocimiento que el paciente tiene de todos estos fármacos.OBJETIVOS: Principal: Evaluar el conocimiento que el paciente tiene del fármaco que se le dispensa en la farmacia comunitaria para reducir el dolor. Secundarios: -Conocer el correcto uso de estos fármacos-Registrar el conocimiento del paciente sobre las reacciones adversas de estos medicamentos.MATERIAL Y MÉTODO: estudio observacional transversal realizado en 8 farmacias de las provincias de Valencia y Alicante, por 11 farmacéuticos. Población diana:>18 años, durante la semana del 28 de febrero al 7 de marzo, que llegan a la farmacia comunitaria solicitando un fármaco, para sí mismo, para reducir o cese del dolor, análgésicos, AINEs, opiodes, ya sea por demanda o prescripción médica. Se elabora un cuaderno de recogida de datos mediante una encuesta de google, registrando las respuestas del paciente a las preguntas realizadas en la dispensación ¿para quién? ¿Para qué?, ¿cómo?, ¿cuándo?, ¿conoce las reacciones adversas?, tiempo de uso del fármaco y si la dispensación es con receta de prescripción. Además, se recogen las variables sociodemográficas del paciente. Análisis estadístico con MSExcel® Resultados Respondieron 164, de los cuales 105 eran mujeres, edad media 54 años. El fármaco más dispensado fue el paracetamol seguido de ibuprofeno, dexketoprofeno, metamizol y naproxeno. El 92 % de los fármacos dispensados era para la persona que lo retiraba. (AU)

Au and Pt Remain Unoxidized on a CeO2-Based Catalyst during the Water-Gas Shift Reaction.

The active forms of Au and Pt in CeO2-based catalysts for the water-gas shift (WGS) reaction are an issue that remains unclear, although it has been widely studied. On one hand, ionic species might be responsible for weakening the Ce-O bonds, thus increasing the oxygen mobility and WGS activity. On the other hand, the close contact of Au or Pt atoms with CeO2 oxygen vacancies at the metal-CeO2 interface might provide the active sites for an efficient reaction. In this work, using in situ X-ray absorption spectroscopy, we demonstrate that both Au and Pt remain unoxidized during the reaction. Remarkable differences involving the dynamics established by both species under WGS atmospheres were recognized. For the prereduced Pt catalyst, the increase of the conversion coincided with a restructuration of the Pt atoms into cuboctahedrical metallic particles without significant variations on the overall particle size. Contrary to the relatively static behavior of Pt0, Au0 nanoparticles exhibited a sequence of particle splitting and agglomeration while maintaining a zero oxidation state despite not being located in a metallic environment during the process. High WGS activity was obtained when Au atoms were surrounded by oxygen. The fact that Au preserves its unoxidized state indicates that the chemical interaction between Au and oxygen must be necessarily electrostatic and that such an electrostatic interaction is fundamental for a top performance in the WGS process.

Relación entre mielitis transversa y vacunas: actualización y revisión de la literatura

La mielitis transversa (MT) es un síndrome clínico caracterizado por una inflamación y desmielinización aguda de la médula espinal. Esta entidad tomó relevancia pública en septiembre de 2020 cuando fueron suspendidos los ensayos clínicos de la vacuna ChAdOx1 para SARS-CoV-2, desarrollada por AstraZeneca y la Universidad de Oxford, por casos de MT en tres participantes. Al respecto, esta investigación se plantea recopilar la información disponible que relacione casos de MT con vacunas a nivel mundial. En este sentido, se llevó a cabo una investigación descriptiva, con diseño documental, donde se efectuó la revisión sistemática de publicaciones disponibles en las bases de datos: "PubMed", "Redalyc" y "SciELO", desde el 01/2000 al 04/2021, que presentan casos clínicos de MT post vacunación. Se estudiaron 49 casos de MT posterior a la vacunación contra diferentes virus y bacterias, 81,8 % de los mismos sucedieron en el primer mes. Se argumenta que los antígenos de las vacunas o sus adyuvantes pueden propiciar complicaciones autoinmunes que explican este fenómeno. Sin embargo, los análisis estadísticos no encuentran relación causal clara, mientras que existe evidencia que sugiere que las vacunas pueden contribuir a que se manifieste un trastorno autoinmune subyacente. El riesgo de MT pos-vacunación parece ser muy pequeño o depender del azar, mientras que el beneficio derivado de la vacunación está demostrado, incluso para disminuir los trastornos autoinmunitarios. No obstante, es importante notificar y estudiar estos casos para la realización de estimaciones certeras en el futuro, contribuyendo al desarrollo de la medicina de precisión y personalizada

Transverse myelitis (TM) is a clinical syndrome characterized by acute inflammation and demyelination of the spinal cord. This entity gained public relevance in September 2020 when clinical trials of the ChAdOx1 vaccine for SARS-CoV-2, developed by AstraZeneca and the University of Oxford, were suspended due to possible cases of MT in three participants. For this reason, this research aims to compile the available information that relates MT cases to vaccinations worldwide. In this sense, a descriptive research with documentary design was carried out through a systematic review of the publications available in the databases "PubMed", "Redalyc" y "SciELO" that presented clinical cases of post-vaccination TM from 01/2000 to 04/2021. We studied 49 cases of post-vaccination MT for different viruses and bacteria, 81.8 % of which occurred in the first month. In this sense, It's argued that vaccine antigens or their adjuvants may promote autoimmune complications that explain this phenomenon. However, statistical analyses find no certain causal relationship, while there is evidence to suggest that vaccines may contribute to the development of an underlying autoimmune disorder. The risk of postvaccination MT appears to be very small or dependent on chance, whereas the benefit derived from vaccination is certain, including in decreasing autoimmune disorders. However, it is important to report and study these cases for accurate estimates in the future, contributing to the development of precise and personalized medicine

Conformer-specific photochemistry imaged in real space and time.

Conformational isomers (conformers) of molecules play a decisive role in biology and organic chemistry. However, experimental methods for investigating chemical reaction dynamics are typically not conformer-sensitive. We report on a gas-phase megaelectronvolt ultrafast electron diffraction investigation of α-phellandrene undergoing an electrocyclic ring-opening reaction. We directly imaged the evolution of a specific set of α-phellandrene conformers into the product isomer predicted by the Woodward-Hoffmann rules in real space and time. Our experimental results are in quantitative agreement with nonadiabatic quantum molecular dynamics simulations, which provide considerable detail of how conformation influences the time scale and quantum efficiency of photoinduced ring-opening reactions.

Efectividad y seguridad en vida real de nivolumab en el tratamiento del cáncer de pulmón no microcítico en segunda línea / Real-life efficacy and safety of nivolumab in the treatment of second-line non-small cell lung cáncer

Objetivo: Evaluar la efectividad y el perfil de seguridad de nivolumab utilizado en segunda línea en el tratamiento del cáncer de pulmón no microcítico en la práctica clínica real. Material y métodos: Estudio observacional retrospectivo en pacientes con cáncer de pulmón no microcítico en tratamiento con nivolumab en segunda línea entre diciembre-2015 y noviembre-2019. Se evaluó la respuesta mediante criterios RECIST v1.1 (Response Evaluation Criteria in Solid Tumors). Variables principales de efectividad: tasa de respuesta objetiva (TRO) y supervivencia global (SG); variables secundarias: supervivencia libre de progresión (SLP). Los posibles factores predictores de respuesta (edad, sexo, histología y ECOG-PS -Eastern Cooperative Oncology Gropup-Performance status-) se analizaron mediante un modelo de riesgos proporcionales de Cox para la SG Y SLP, y odds ratio para TRO. La seguridad se evaluó mediante la aparición de eventos adversos (EAs) y su grado según CTCEA v5.0 (Criterios Comunes de Terminología para Eventos Adversos).Resultados: Se incluyeron 48 pacientes, con una mediana de edad de 65,5 años (rango 46-83), mayoritariamente hombres (85,5%), ECOG-PS 0-1 (85%). En cuanto a la efectividad, TRO=27% (IC95% 14,04-40,12), mediana SG 13,01 meses (IC95% 7,67-18,36) y SLP 5,29 meses (IC95% 3,53-7,05). El sexo se identificó como factor predictor de mejor respuesta en términos de TRO. Un 10% de los pacientes presentaron al menos un EA G3-G4.Conclusiones: Nivolumab tuvo una efectividad ligeramente superior a la demostrada en ensayos clínicos. La seguridad del tratamiento fue aceptable, posicionando nivolumab como una alternativa válida en el tratamiento de cáncer de pulmón no microcítico en segunda línea. (AU)

Objective: To evaluate the effectiveness and safety profile of nivolumab used in second line for the treatment of non-small cell lung cancer in real clinical practice. Material and methods: Retrospective observational study was carried off in patients with non-small cell lung cancer treated with nivolumab in the second line between December 2015 and November 2019. The response was evaluated using RECIST v1.1 criteria. Main survival variables: objective response rate (ORR) and overall survival (OS); secondary variables: progression-free survival (PFS). The possible predictive response factors (age, sex, histology and ECOG-PS) were analyzed using a Cox proportional hazard model for survival, and odds ratio for the objective response rate. The safety was evaluated through the occurrence of adverse events (AD) and their degree according to CTCEA v5.Results: 48 patients were included, median age of 65.5 years (range 46-83), mostly men (85.5%), ECOG-PS 0-1 (85%). Regarding effectiveness, ORR=27% (95% CI 14.04-40.12), median SG 13.01 months (95% CI 7.67-18.36) and SLP 5.29 months (95% CI 3.53-7.05). Sex was identified as a predictor of better response in terms of ORR. EA G3-G4 appeared in 10% of patients.Conclusions: Nivolumab had a slightly higher effectiveness than demonstrated in clinical trials. The safety of the treatment was acceptable, positioning nivolumab as a valid alternative in the treatment of non-small cell lung cancer in second line. (AU)

Resultados en vida real de los antivirales de acción directa en el tratamiento de la hepatitis C crónica / Real life results of direct acting antiviral in hepatitis C treatment

Objetivo: Los antivirales de acción directa han logrado tasas de respuesta viral sostenida muy elevadas desde su comercialización. El objetivo de este trabajo fue el análisis de la efectividad y seguridad de los antivirales de acción directa en pacientes infectados por el virus de la hepatitis C crónica.Métodos: Se incluyeron pacientes infectados con el virus de la hepatitis C (VHC) y coinfectados por VHC y virus de la inmunodeficiencia humana (VIH) que iniciaron tratamiento con antivirales de acción directa entre 2015-2019. Como variable de efectividad se midió la respuesta viral sostenida.Resultados: Se incluyeron 303 pacientes, 235 (77,56%) monoinfectados y 68 (22,44%) coinfectados. El genotipo de virus más prevalente fue el 1 en ambos grupos. La proporción de cirróticos fue superior en la población monoinfectada 38,3% vs. 20,6%; p=0,047). De los 303 pacientes, a 279 se le analizó la carga viral a las 12 semanas de tratamiento; un 97,8% (273/279) alcanzaron respuesta viral sostenida, confirmándose 6 fracasos virológicos. En un análisis de subgrupos, en la mayoría de grupos según la presencia o no de cirrosis, la coinfección VIH y el genotipo, la efectividad se situó próxima o por encima del 90%. El tratamiento fue seguro, con toxicidad leve y sólo una suspensión de tratamiento. Se detectaron interacciones medicamentosas potenciales en un 20% de los pacientes.Conclusiones: Los antivirales de acción directa presentaron una efectividad elevada, igual e incluso superior a la descrita en los ensayos clínicos, e incluso en subpoblaciones difíciles de tratar. (AU)

Objetive: Direct-acting antivirals have achieved high sustained viral response rates since their commercialization. The main objective of this study was the analysis of the efficacy and safety of direct-acting antivirals in patients infected with the chronic hepatitis C virus.Methods: Patients infected with hepatitis C virus (HCV) and co-infected with HCV and human immunodeficiency virus (HIV) who started treatment with direct-acting antiviral drugs between 2015-2019 were included. The sustained viral response was measured as the effectivity variable.Results: 303 patients were included, 235 (77.56%) were monoinfected and 68 (22.44%) were co-infected. Genotype 1 virus was the most prevalent 1 in both groups. The proportion of cirrhotic was higher in the monoinfected population (38.3% vs. 20.6%; p=0.047). Of the 303 patients, 279 pacients had viral load analysis at 12 weeks of treatment, 97.8% (273/279) achieved sustained viral response and 6 virological failures were confirmed. In a subgroup analysis, the majority of the groups, regardless of the presence or not of cirrhosis, HIV coinfection or genotype, the efficacy was close to or above 90%. The treatment was safe, with mild toxicity and only one treatment suspension. Potential drug interactions were detected in 20% of patients.Conclusions: Direct-acting antivirals with a high efficacy, equal to or greater than that described in clinical trials, and even with subpopulations difficult to treat. (AU)

Sobresedación Zero como herramienta de confort, seguridad y gestión en la unidades de cuidados intensivos / Oversedation Zero as a tool for comfort, safety and intensive care unit management

La sedación es necesaria en el tratamiento de los pacientes críticos, tanto para aliviar el sufrimiento como para curar a los pacientes con enfermedades que precisan el ingreso en unidades de cuidados intensivos. Esta sedación debe ser la adecuada a las necesidades del paciente en cada momento de su evolución clínica, ni por debajo (infrasedación) ni por encima (sobresedación). Una sedación adecuada influye en la comodidad, la seguridad, la supervivencia, la calidad de vida posterior, la rotación de camas de las unidades de críticos y los costes. La infrasedación se detecta y corrige rápidamente. Sin embargo, la sobresedación es silente y difícil de prevenir sin unas pautas de actuación, una concienciación colectiva y un trabajo en equipo. El proyecto «Sobresedación Zero» del Grupo de Trabajo de Sedación, Analgesia y Delirium de la Sociedad Española de Medicina Intensiva, Crítica y Unidades Coronarias pretende ser una herramienta docente, práctica y de concienciación colectiva de comodidad, seguridad y gestión para maximizar el resultado clínico y minimizar los efectos perjudiciales de la sedación excesiva. Se basa en un paquete de medidas que se incluye monitorizar el dolor, la analgesia, la agitación, la sedación, el delirium y el bloqueo neuromuscular, mantener a los pacientes sin dolor, realizar una sedación dinámica según objetivos clínicos, consensuar el protocolo multidisciplinar a seguir y evitar la sedación profunda no indicada clínicamente

Sedation is necessary in the management of critically ill patients, both to alleviate suffering and to cure patients with diseases that require admission to the intensive care unit. Such sedation should be appropriate to the patient needs at each timepoint during clinical evolution, and neither too low (undersedation) nor too high (oversedation). Adequate sedation influences patient comfort, safety, survival, subsequent quality of life, bed rotation of critical care units and costs. Undersedation is detected and quickly corrected. In contrast, oversedation is silent and difficult to prevent in the absence of management guidelines, collective awareness and teamwork. The Zero Oversedation Project of the Sedation, Analgesia and Delirium Working Group of the Spanish Society of Intensive and Critical Care Medicine and Coronary Units aims to offer a practical teaching and collective awareness tool for ensuring patient comfort, safety and management with a view to optimizing the clinical outcomes and minimizing the deleterious effects of excessive sedation. The tool is based on a package of measures that include monitoring pain, analgesia, agitation, sedation, delirium and neuromuscular block, keeping patients pain-free, performing dynamic sedation according to clinical objectives, agreeing upon the multidisciplinary protocol to be followed, and avoiding deep sedation where not clinically indicated

Matter-wave interference of a native polypeptide.

The de Broglie wave nature of matter is a paradigmatic example of quantum physics and it has been exploited in precision measurements of forces and fundamental constants. However, matter-wave interferometry has remained an outstanding challenge for natural polypeptides, building blocks of life, which are fragile and difficult to handle. Here, we demonstrate the wave nature of gramicidin, a natural antibiotic composed of 15 amino acids. Its center of mass is delocalized over more than 20 times the molecular size in our time-domain Talbot-Lau interferometer. We compare the observed interference fringes with a model that includes both a rigorous treatment of the peptide's quantum wave nature as well as a quantum chemical assessment of its optical properties to distinguish our result from classical predictions. The realization of quantum optics with this prototypical biomolecule paves the way for quantum-assisted measurements on a large class of biologically relevant molecules.

Oversedation Zero as a tool for comfort, safety and intensive care unit management. / Sobresedación Zero como herramienta de confort, seguridad y gestión en la unidades de cuidados intensivos.

Sedation is necessary in the management of critically ill patients, both to alleviate suffering and to cure patients with diseases that require admission to the intensive care unit. Such sedation should be appropriate to the patient needs at each timepoint during clinical evolution, and neither too low (undersedation) nor too high (oversedation). Adequate sedation influences patient comfort, safety, survival, subsequent quality of life, bed rotation of critical care units and costs. Undersedation is detected and quickly corrected. In contrast, oversedation is silent and difficult to prevent in the absence of management guidelines, collective awareness and teamwork. The Zero Oversedation Project of the Sedation, Analgesia and Delirium Working Group of the Spanish Society of Intensive and Critical Care Medicine and Coronary Units aims to offer a practical teaching and collective awareness tool for ensuring patient comfort, safety and management with a view to optimizing the clinical outcomes and minimizing the deleterious effects of excessive sedation. The tool is based on a package of measures that include monitoring pain, analgesia, agitation, sedation, delirium and neuromuscular block, keeping patients pain-free, performing dynamic sedation according to clinical objectives, agreeing upon the multidisciplinary protocol to be followed, and avoiding deep sedation where not clinically indicated.

Treatment with intravenous immunoglobulins in systemic lupus erythematosus: a single-center experience with 63 patients.

BACKGROUND: Intravenous immunoglobulin (IVIG) is prepared using purified human plasma. IVIG therapy has immunomodulatory effects on autoimmune diseases, including severe systemic lupus erythematosus (SLE). However, reports of its effects on large cohorts are scarce. METHODS: This single-center retrospective study included SLE patients treated with at least one IVIG cycle for SLE complications. Demographic data, indications, cycle numbers, and clinical improvement with IVIG were evaluated. SLE Disease Activity Index 2000 (SLEDAI-2K) scores were calculated at admission and after IVIG treatment in order to measure clinical improvement. RESULTS: Sixty-three SLE patients treated with IVIG (median age: 29 years; interquartile range 21-36 years; 84.13% female) were included, who received 2 g/kg IVIG for two to five days. Main indications were immune thrombocytopenia, hypogammaglobulinemia, infection during a SLE flare, bicytopenia, and immune hemolytic anemia. Seven patients received more than one IVIG cycle without severe adverse effects. Significant differences were found in SLEDAI-2K scores when the indications were immune thrombocytopenia and hypogammaglobulinemia, with a trend for hemolytic anemia. Patients with concomitant infection, myopathy, and gastrointestinal involvement showed a considerable reduction in their last SLEDAI-2K scores. Fourteen patients died during hospitalization, mainly due to septic shock and active SLE. CONCLUSIONS: IVIG showed adequate tolerance and effectiveness in selected severe SLE manifestations, mainly hematological involvement. It was useful for concomitant infection.

Pancitopenia secundaria a intoxicación por metotrexato en paciente anciano / Pancytopenia secondary to methotrexate poisoning in an elderly patient

No disponible

Mercury in sediment cores from the southern Gulf of Mexico: Preindustrial levels and temporal enrichment trends.

Spatial and temporal variability of mercury concentrations in sediments was evaluated in 210Pb-dated sediment cores from offshore and intertidal areas in the southern Gulf of Mexico. In offshore cores, mercury concentrations were comparable (11.2-69.2 ng g-1), and intermediate between concentrations in intertidal cores from the eastern (6.0-34.4 ng g-1) and the western (34.9-137.7 ng g-1) inlets of Términos Lagoon. The enrichment factor (EF) indicated minimal contamination (EF < 2) in most offshore cores, whereas in some intertidal cores steadily increasing mercury enrichment and fluxes were observed along the past century. No evidence of oil industry related mercury contamination was found, as the minor but increasing enrichment in intertidal cores is most likely related to land-derived sources such as catchment eroded soils and waste water runoff. Results highlight the importance to control catchment erosion and untreated sewage releases to reduce mercury loadings to the coastal zone.

Electrostatic Influence on Photoisomerization in Bacteriorhodopsin and Halorhodopsin.

Bacteriorhodopsin (bR) and halorhodopsin (hR) are both membrane proteins that transport ions across the cell membrane in halobacteria. Their ion transport function is triggered by photoactivated isomerization of the retinal protonated Schiff base (RPSB) chromophore. In spite of their similar structures, bR and hR exhibit widely differing RPSB isomerization rates and quantum yields (with bR being both faster and more efficient than hR). Previous simulations of photoisomerization in bR and hR using ab initio multiple spawning (AIMS) with QM/MM have successfully reproduced the experimentally observed ordering of quantum yields and isomerization rates, but the origin of these differences remains elusive. Here we investigate the role of electrostatic interactions in the protein pocket surrounding RPSB. We probe the influence of protein electrostatics by modifying the charge of the complex counterion in bR/hR to be more/less negative than the native state. We find that such modifications lead to bR-like behavior in hR and vice versa. This demonstrates the crucial role of electrostatic interactions in controlling the outcome of RPSB photoisomerization.

Tratamiento de las fracturas subcondíleas y de cuello de cóndilo mandibular mediante abordaje intraoral endoscópicamente asistido / Treatment of subcondilar and condilar neck mandibular fractures by the intraoral endoscopically-assisted approach

INTRODUCCIÓN: El tratamiento de las fracturas de cóndilo sigue generando controversia, optándose en la mayoría de los casos por reducciones cerradas con tratamientos subóptimos. Presentamos nuestros resultados en 26 pacientes con fracturas subcondíleas o de cuello de cóndilo mandibular tratados mediante abordaje intraoral endoscópicamente asistido. MATERIAL Y MÉTODO: Seguimiento prospectivo observacional de 26 pacientes que fueron atendidos en nuestro Servicio de Cirugía Oral y Maxilofacial del Hospital Universitario Virgen del Mar de Cádiz, desde marzo de 2010 hasta enero de 2018. De estos 26 pacientes, 23 fueron hombres y 3 mujeres, con una edad media de 29 años. RESULTADOS: De los 26 casos operados, 6 fueron fracturas de cuello y 20 fueron fracturas subcondíleas. Todos los pacientes salieron de quirófano con la boca abierta, una oclusión estable y buena apertura oral. La complicación más importante fue una infección que se resolvió con antibioterapia. Discusión: Nuestro equipo ha seguido la filosofía de otros autores de abordar todas las fracturas de cóndilo, incluso aquellas con un desplazamiento menor de 10°, atendiendo a la premisa de que si no se bloquean otras fracturas no desplazadas mandibulares que previamente a la introducción de placas de osteosíntesis se bloqueaban, ¿por qué hemos de realizar esta práctica en las fracturas de cóndilo, con la consiguiente agresión a la articulación?. CONCLUSIÓN: La reducción abierta con abordaje intraoral asistido por endoscopia constituye una técnica segura, reproducible y eficaz en la mayor parte de las fracturas extracapsulares

INTRODUCTION: The treatment of condylar fractures continues to generate controversy, opting in most cases for closed reductions with suboptimal treatment. We present our results in 26 patients treated by endoscopically assisted intraoral approach as treatment for subcondylar and neck condyle fractures. MATERIAL AND METHOD: Prospective observational follow-up of 26 patients who were treated at our Oral and Maxillofacial Surgery Service at the Virgen del Mar University Hospital of Cádiz from March 2010 to January 2018. Of these 26 patients, 23 were men and 3 women, with an age average of 29 years. RESULTS: Of the 26 operated cases, 6 were neck fractures and 20 were subcondylar. All the patients came out of the operating room with their mouths open, a stable occlusion and good oral opening. The most important complication was an infection that resolved with antibiotic therapy. Discussion: Our team has followed the philosophy of other authors to address all condylar fractures, even those with a displacement of less than 10°, following the premise that, if other non-displaced mandibular fractures are not blocked prior to the introduction of osteosynthesis plates were blocked, why should we perform this practice in the fractures of condyle with the consequent aggression to the joint?. CONCLUSION: Open reduction with endoscopic assisted intraoral approach is a safe, reproducible and effective technique in most extracapsular fractures

Prácticas de analgosedación y delirium en Unidades de Cuidados Intensivos españolas: Encuesta 2013-2014 / Management of analgesia, sedation and delirium in Spanish Intensive Care Units: A national two-part survey

Objetivo: Conocer la práctica clínica real de las UCI españolas en relación con la analgosedación y delirium, y valorar cómo se ajusta a las recomendaciones actuales. Diseño: Estudio transversal descriptivo elaborado mediante encuesta nacional sobre prácticas de analgosedación y delirium de los pacientes ingresados en UCI los días 16 de noviembre de 2013 y 16 de octubre de 2014. Se envió un cuestionario a través de Internet con el aval de la SEMICYUC. Ámbito: UCI tanto públicas como privadas de todo el territorio nacional. Resultados: Se incluyeron un total de 166 UCI y a 1.567 pacientes. El 61,4% de las UCI contaban con un protocolo de sedación. El 75% de las UCI monitorizaban la sedación y agitación, con RASS como la escala empleada con mayor frecuencia. El dolor se monitorizaba en algo más de la mitad de las UCI, pero las escalas conductuales eran de muy baja implantación. El delirium también presentaba un bajo nivel diagnóstico. Entre los pacientes en ventilación mecánica el midazolam continuaba siendo un sedante de muy amplio uso. Conclusiones: Esta encuesta es la primera realizada en España sobre analgosedación y delirium y nos muestra una fotografía sobre estas prácticas, señala algunos aspectos como los relacionados con la monitorización y usos de escalas, junto con el manejo del delirium, en los que los resultados del estudio animan a desarrollar proyectos docentes que acerquen la práctica clínica real a las recomendaciones nacionales e internacionales

Objective: To know the real clinical practice of Spanish ICUs in relation to analgesia, sedation and delirium, with a view to assessing adherence to current recommendations. Design: A descriptive cross-sectional study was carried out based on a national survey on analgesia, sedation and delirium practices in patients admitted to intensive care on 16 November, 2013 and 16 October, 2014. An on-line questionnaire was sent with the endorsement of the SEMICYUC. Setting: Spanish ICUs in public and private hospitals. Results: A total of 166 ICUs participated, with the inclusion of 1567 patients. The results showed that 61.4% of the ICUs had a sedation protocol, and 75% regularly monitored sedation and agitation - the RASS being the most frequently used scale. Pain was monitored in about half of the ICUs, but the behavioral scales were very little used. Delirium monitoring was implemented in few ICUs. Among the patients on mechanical ventilation, midazolam remained a very commonly used agent. Conclusions: This survey is the first conducted in Spain on the practices of analgesia, sedation and delirium. We identified specific targets for quality improvement, particularly concerning the management of sedation and the assessment of delirium