¿Cómo detectar a los pacientes mayores no institucionalizados en riesgo de malnutrición durante su hospitalización? Comparación de 8 herramientas de cribado de malnutrición o de riesgo nutricional / How to detect non-institutionalized older patients at risk of malnutrition during their hospitalization? Comparison of 8 screening tools for malnutrition or nutritional risk

Antecedentes: La prevalencia de malnutrición es elevada entre la población mayor. El ingreso hospitalario es una ventana de oportunidad para su detección. Objetivo: Valorar la concordancia de distintas escalas nutricionales en pacientes hospitalizados.Método: Estudio prospectivo en pacientes mayores de 65años no institucionalizados ingresados en un servicio de Medicina Interna. Se compararon 5 encuestas de cribado de malnutrición (MNA, MST, MUST, NRS-2000 y CONUT) y 3 encuestas de cribado de riesgo nutricional (SCREEN3, 8 y 14). Como patrón de referencia se utilizó la definición de malnutrición de la Iniciativa Global para el Liderazgo en Malnutrición (GLIM). Resultados: Se incluyeron 85 pacientes (37% mujeres, mediana de edad 83años). El 48% (IC95%: 38-59%) de los pacientes fueron clasificados como malnutridos según criterios GLIM. La escala SCREEN3 fue la más sensible (93%; IC95%: 87-98) y MUST la más específica (91%; IC95%: 85-99). La escala más eficaz para excluir la sospecha de malnutrición fue SCREEN3 (LR− 0,17; IC95%: 0,05-0,53) y la mejor para confirmarla fue MST (LR+ 7,08; IC95%: 3,06-16,39). La concordancia entre las distintas escalas fue baja o muy baja, con índices kappa entre 0,082 y 0,465.Conclusiones: Se precisa un abordaje integral para detectar la malnutrición en adultos mayores ingresados. Las escalas más sensibles son más útiles en el cribado inicial. Las herramientas de riesgo nutricional podrían ser eficaces en esta etapa. En un segundo paso se debe confirmar la malnutrición de acuerdo con criterios establecidos como los de la GLIM.(AU)

Background: The prevalence of malnutrition is high among the elderly population. Hospital admission is a window of opportunity for its detection. Objective: To assess the concordance of different nutritional scales in hospitalized patients. Methods: Prospective study in non-institutionalized patients over 65years of age admitted to an internal medicine department. Five malnutrition screening surveys (MNA, MST, MUST, NRS-2000 and CONUT) and three nutritional risk screening surveys (SCREEN3, 8 and 14) were compared. As gold standard we use the Global Leadership Initiative for Malnutrition (GLIM) definition of malnutrition. Results: Eighty-five patients (37% female, median age 83years) were included. Forty-eight percent (95%CI: 38-59%) of patients were classified as malnourished according to GLIM criteria. The SCREEN3 scale was the most sensitive (93%; 95%CI: 87-98) and MUST the most specific (91%; 95%CI: 85-99). The most effective scale for excluding suspected malnutrition was SCREEN3 (LR− 0.17; 95%CI: 0.05-0.53) and the best for confirming it was MST (LR+ 7.08; 95%CI: 3.06-16.39). Concordance between the different scales was low or very low with kappa indices between 0.082 and 0.465. Conclusions: A comprehensive approach is needed to detect malnutrition in hospitalized patients. More sensitive scales are more useful in initial screening. Nutritional risk tools could be effective at this stage. In a second step, malnutrition should be confirmed according to established criteria such as GLIM.(AU)

Estudio de la microbiota vaginal en los resultados de la terapia de reproducción asistida / Study of the vaginal microbiota in results of assisted reproduction therapies

El microbioma del tracto genital femenino es determinante para mantener un entorno saludable. La microbiota vaginal normal se caracteriza por la abundancia de Lactobacillus, que confieren protección a la vagina huésped contra microorganismos potencialmente patógenos que pueden provocar infecciones del aparato urinario y enfermedades de transmisión sexual. Las alteraciones en la microbiota vaginal por factores intrínsecos, como la edad o el ciclo menstrual, o externos, como la actividad sexual o el embarazo, pueden conducir a un estado de disbiosis microbiana y al desarrollo de enfermedades con efecto perjudicial en la fertilidad. También se ha señalado que la microbiota vaginal puede desempeñar un papel clave en el éxito de las terapias de reproducción asistida. El objetivo de esta revisión es identificar y evaluar los estudios sobre el papel de la microbiota vaginal en la salud de la mujer y la reproducción humana.(AU)

The microbiome of the female genital tract is essential to maintenance a healthy environment. The normal vaginal microbiota is defined by the abundance of Lactobacillus. These microbes confer the host vagina protection from potentially pathogenic microorganisms that may cause urinary tract infections and sexually transmitted diseases. Changes in the vaginal microbiota due to inherent factors, such as age or menstrual period, or external factors like sexual activity or pregnancy, can lead to microbial dysbiosis and the development of pathologies in relation of reduced rates of conception. It has also been suggested that vaginal microbiota may play a key role in the success of assisted reproductive therapies. The objective of this review is to identify and evaluate trials of the vaginal microbiota role in women's health and human reproduction.(AU)

Potential cellular targets of platinum in the freshwater microalgae Chlamydomonas reinhardtii and Nitzschia palea revealed by transcriptomics.

Platinum group element levels have increased in natural aquatic environments in the last few decades, in particular as a consequence of the use of automobile catalytic converters on a global scale. Concentrations of Pt over tens of µg L-1 have been observed in rivers and effluents. This raises questions regarding its possible impacts on aquatic ecosystems, as Pt natural background concentrations are extremely low to undetectable. Primary producers, such as microalgae, are of great ecological importance, as they are at the base of the food web. The purpose of this work was to better understand the impact of Pt on a cellular level for freshwater unicellular algae. Two species with different characteristics, a green alga C. reinhardtii and a diatom N. palea, were studied. The bioaccumulation of Pt as well as its effect on growth were quantified. Moreover, the induction or repression factors of 16 specific genes were determined and allowed for the determination of possible intracellular effects and pathways of Pt. Both species seemed to be experiencing copper deficiency as suggested by inductions of genes linked to copper transporters. This is an indication that Pt might be internalized through the Cu(I) metabolic pathway. Moreover, Pt could possibly be excreted using an efflux pump. Other highlights include a concentration-dependent negative impact of Pt on mitochondrial metabolism for C. reinhardtii which is not observed for N. palea. These findings allowed for a better understanding of some of the possible impacts of Pt on freshwater primary producers, and also lay the foundations for the investigation of pathways for Pt entry at the base of the aquatic food web.

Reducing Antibiotic Duration for Uncomplicated UTI in the Pediatric Emergency Department.

BACKGROUND: Short-duration (3-5 days) antibiotic treatment of uncomplicated urinary tract infection (uUTI) in children >24 months of age is equivalent to longer-duration antibiotic treatment, with added benefits of antibiotic stewardship. At our pediatric emergency department (ED), 13% of 5- to 18-year-old patients discharged with uUTI received ≤5 days of antibiotics. We aimed to increase short-duration prescriptions in patients with uUTI from 13% to >50% over 12 months. METHODS: This quality improvement project was conducted from January 2021 to August 2022. Complicated UTI was excluded. Interventions included education, practice feedback, and electronic health record changes. The outcome measure, the proportion of children treated with a short antibiotic duration, was studied by using p-charts. Antibiotic days saved were calculated. Revisits with UTI within 14 days of confirmed uUTI treated with short-duration antibiotics (balancing measure) were analyzed by using Fisher's exact test. RESULTS: In 1292 (n = 363 baseline, 929 post-intervention) eligible patients treated for uUTI, shorter antibiotic duration increased from 13% to 91%. We met our 50% aim within 2 months, with continued improvement leading to an additional centerline shift. Consequently, 2619 antibiotic days were saved. Two of 334 (0.6%) patients returned (P = NS) within 14 days of the index visit with a culture-positive uUTI. CONCLUSIONS: By using education, feedback, and electronic health record changes, we decreased antibiotic duration in children discharged from the ED for uUTI without a significant increase in return visits with UTI. These interventions can be expanded to wider age groups and other outpatient settings.

Analytical validation of HER2DX genomic test for early-stage HER2-positive breast cancer.

BACKGROUND: HER2DX, a multianalyte genomic test, has been clinically validated to predict breast cancer recurrence risk (relapse risk score), the probability of achieving pathological complete response post-neoadjuvant therapy (pCR likelihood score), and individual ERBB2 messenger RNA (mRNA) expression levels in patients with early-stage human epidermal growth factor receptor 2 (HER2)-positive breast cancer. This study delves into the comprehensive analysis of HER2DX's analytical performance. MATERIALS AND METHODS: Precision and reproducibility of HER2DX risk, pCR, and ERBB2 mRNA scores were assessed within and between laboratories using formalin-fixed paraffin-embedded (FFPE) tumor tissues and purified RNA. Robustness was appraised by analyzing the impact of tumor cell content and protocol variations including different instruments, reagent lots, and different RNA extraction kits. Variability was evaluated across intratumor biopsies and genomic platforms [RNA sequencing (RNAseq) versus nCounter], and according to protocol variations. RESULTS: Precision analysis of 10 FFPE tumor samples yielded a maximal standard error of 0.94 across HER2DX scores (1-99 scale). High reproducibility of HER2DX scores across 29 FFPE tumors and 20 RNAs between laboratories was evident (correlation coefficients >0.98). The probability of identifying score differences >5 units was ≤5.2%. No significant variability emerged based on platform instruments, reagent lots, RNA extraction kits, or TagSet thaw/freeze cycles. Moreover, HER2DX displayed robustness at low tumor cell content (10%). Intratumor variability across 212 biopsies (106 tumors) was <4.0%. Concordance between HER2DX scores from 30 RNAs on RNAseq and nCounter platforms exceeded 90.0% (Cohen's κ coefficients >0.80). CONCLUSIONS: The HER2DX assay is highly reproducible and robust for the quantification of recurrence risk, pCR likelihood, and ERBB2 mRNA expression in early-stage HER2-positive breast cancer.

How to detect non-institutionalized older patients at risk of malnutrition during their hospitalization? Comparison of 8 screening tools for malnutrition or nutritional risk.

BACKGROUND: The prevalence of malnutrition is high among the elderly population. Hospital admission is a window of opportunity for its detection. OBJECTIVE: To assess the concordance of different nutritional scales in hospitalized patients. METHODS: Prospective study in non-institutionalized patients over 65 years of age admitted to an internal medicine department. Five malnutrition screening surveys (MNA, MST, MUST, NRS-2000 and CONUT) and three nutritional risk screening surveys (SCREEN 3, 8 and 14) were compared. As gold standard we use the Global Malnutrition Leadership Initiative for Malnutrition (GLIM) definition of malnutrition. RESULTS: Eighty-five patients (37% female, median age 83 years) were included. Forty-eight percent (95% CI 38-59%) of patients were classified as malnourished according to GLIM criteria. The SCREEN 3 scale was the most sensitive (93%; 95% CI 87-98) and MUST the most specific (91%; CI 85-99). The most effective scale for excluding suspected malnutrition was SCREEN 3 (LR- 0.17; 95% CI 0.05-0.53) and the best for confirming it was MST (LR+ 7.08; 95% CI 3.06-16.39). Concordance between the different scales was low or very low with kappa indices between 0.082 and 0.465. CONCLUSIONS: A comprehensive approach is needed to detect malnutrition in hospitalized patients. More sensitive scales are more useful in initial screening. Nutritional risk tools could be effective at this stage. In a second step, malnutrition should be confirmed according to established criteria such as GLIM.

Ética e inteligencia artificial / Ethics and artificial intelligence

La relación entre ética e inteligencia artificial en medicina es un tema crucial y complejo y se encuadra en su contexto más amplio. Así, la ética en inteligencia artificial médica implica asegurar que las tecnologías sean seguras, justas y respeten la privacidad de los pacientes. Esto incluye preocuparse de la precisión de los diagnósticos proporcionados por la inteligencia artificial, la equidad en el tratamiento de pacientes y la protección de los datos personales de salud. Los avances en inteligencia artificial pueden mejorar significativamente la atención médica, desde diagnósticos más precisos hasta tratamientos personalizados. Sin embargo, es esencial que los desarrollos en inteligencia artificial médica se realicen con una consideración ética fuerte, involucrando a los pacientes, profesionales de la salud e inteligencia artificial y especialistas en ética para guiar y supervisar su implementación. Por último, es fundamental la transparencia en los algoritmos de inteligencia artificial y la formación continua para los profesionales médicos. (AU)

The relationship between ethics and artificial intelligence in medicine is a crucial and complex topic that falls within its broader context. Ethics in medical artificial intelligence involves ensuring that technologies are safe, fair, and respect patient privacy. This includes concerns about the accuracy of diagnoses provided by artificial intelligence, fairness in patient treatment, and protection of personal health data. Advances in artificial intelligence can significantly improve healthcare, from more accurate diagnoses to personalized treatments. However, it is essential that developments in medical artificial intelligence are carried out with strong ethical consideration, involving healthcare professionals, artificial intelligence experts, patients, and ethics specialists to guide and oversee their implementation. Finally, transparency in artificial intelligence algorithms and ongoing training for medical professionals are fundamental. (AU)

Ethics and artificial intelligence.

The relationship between ethics and artificial intelligence in medicine is a crucial and complex topic that falls within its broader context. Ethics in medical artificial intelligence (AI) involves ensuring that technologies are safe, fair, and respect patient privacy. This includes concerns about the accuracy of diagnoses provided by artificial intelligence, fairness in patient treatment, and protection of personal health data. Advances in artificial intelligence can significantly improve healthcare, from more accurate diagnoses to personalized treatments. However, it is essential that developments in medical artificial intelligence are carried out with strong ethical consideration, involving healthcare professionals, artificial intelligence experts, patients, and ethics specialists to guide and oversee their implementation. Finally, transparency in artificial intelligence algorithms and ongoing training for medical professionals are fundamental.

[Translated article] A systematic review of the literature: The use of metaphyseal sleeves in revision total knee arthroplasty.

BACKGROUND AND OBJECTIVES: The purpose of this study is to analyse the indications, complications, survivorship and clinical/functional outcome of metaphyseal sleeves as a treatment option in revision total knee arthroplasty. MATERIAL AND METHOD: A systematic review was made following the PRISMA recommendations on the use of metaphyseal sleeves for revision total knee arthroplasty. We included prospective and retrospective studies published in the last 10 years looking at implant survivorship, clinical and functional outcome with a minimum follow-up of 2 years. RESULTS: The included studies showed good both functional and clinical outcomes. The overall reoperation rate was 16.2%, with an overall survival rate of 92.2% and aseptic survivorship of 98.2%. CONCLUSIONS: Metaphyseal sleeves are a good treatment option for this surgery, especially in AORI II or III type bone defects, achieving good intraoperative and primary stability of the implant, with good and rapid osseointegration.

Escabiosis en España: tendencias del interés público y consumo de ectoparasiticidas / Scabies in Spain: Trends in Public Interest and Ectoparasiticide Use

La escabiosis es una dermatosis ectoparasitaria causada por Sarcoptes scabiei var. hominis y cuyo reservorio son los humanos. En los últimos años se ha visto un incremento de los casos de escabiosis en nuestro país. El objetivo de este trabajo es complementar la evidencia existente sobre el aumento de la escabiosis en España mediante el estudio de la evolución del consumo de medicamentos ectoparasiticidas y el análisis temporal en Google Trends de las búsquedas en internet relacionadas con la infestación, así como explorar la relación entre ambos fenómenos. Nuestro estudio demuestra un incremento del interés público en la escabiosis y del consumo de ectoparasiticidas en los últimos años en España, existiendo una correlación positiva y significativa entre ambos fenómenos. Proponemos Google Trends como una herramienta complementaria a tener en cuenta a la hora de monitorizar en tiempo real el comportamiento de esta infestación en nuestro país (AU)

Scabies is an ectoparasitic dermatosis caused by the Sarcoptes scabiei var. hominis mite, which lives and reproduces in humans. Its incidence in Spain has increased in recent years. The aim of this study was to complement existing evidence on the increasing number of scabies cases in our country by analyzing changes in ectoparasiticide prescriptions and Internet searches for scabies infestations measured by Google Trends. We also examined correlations between these two variables. Our results show that public interest in scabies has increased in recent years and is positively and significantly correlated with an increasing use of ectoparasiticides. We believe that Google Trends should be considered as a complementary tool for monitoring real-time trends in scabies infestations in Spain (AU)

[Translated article] Scabies in Spain: Trends in Public Interest and Ectoparasiticide Use / Escabiosis en España: tendencias del interés público y consumo de ectoparasiticidas

Scabies is an ectoparasitic dermatosis caused by the Sarcoptes scabiei var. hominis mite, which lives and reproduces in humans. Its incidence in Spain has increased in recent years. The aim of this study was to complement existing evidence on the increasing number of scabies cases in our country by analyzing changes in ectoparasiticide prescriptions and Internet searches for scabies infestations measured by Google Trends. We also examined correlations between these two variables. Our results show that public interest in scabies has increased in recent years and is positively and significantly correlated with an increasing use of ectoparasiticides. We believe that Google Trends should be considered as a complementary tool for monitoring real-time trends in scabies infestations in Spain (AU)

La escabiosis es una dermatosis ectoparasitaria causada por Sarcoptes scabiei var. hominis y cuyo reservorio son los humanos. En los últimos años se ha visto un incremento de los casos de escabiosis en nuestro país. El objetivo de este trabajo es complementar la evidencia existente sobre el aumento de la escabiosis en España mediante el estudio de la evolución del consumo de medicamentos ectoparasiticidas y el análisis temporal en Google Trends de las búsquedas en internet relacionadas con la infestación, así como explorar la relación entre ambos fenómenos. Nuestro estudio demuestra un incremento del interés público en la escabiosis y del consumo de ectoparasiticidas en los últimos años en España, existiendo una correlación positiva y significativa entre ambos fenómenos. Proponemos Google Trends como una herramienta complementaria a tener en cuenta a la hora de monitorizar en tiempo real el comportamiento de esta infestación en nuestro país (AU)

Scabies in Spain: Trends in Public Interest and Ectoparasiticide Use. / Escabiosis en España: tendencias del interés público y consumo de ectoparasiticidas.

Scabies is an ectoparasitic dermatosis caused by the Sarcoptes scabiei var. hominis mite, which lives and reproduces in humans. Its incidence in Spain has increased in recent years. The aim of this study was to complement existing evidence on the increasing number of scabies cases in our country by analyzing changes in ectoparasiticide prescriptions and Internet searches for scabies infestations measured by Google Trends. We also examined correlations between these two variables. Our results show that public interest in scabies has increased in recent years and is positively and significantly correlated with an increasing use of ectoparasiticides. We believe that Google Trends should be considered as a complementary tool for monitoring real-time trends in scabies infestations in Spain.

[Translated article] Scabies in Spain: Trends in Public Interest and Ectoparasiticide Use.

Scabies is an ectoparasitic dermatosis caused by the Sarcoptes scabiei var. hominis mite, which lives and reproduces in humans. Its incidence in Spain has increased in recent years. The aim of this study was to complement existing evidence on the increasing number of scabies cases in our country by analyzing changes in ectoparasiticide prescriptions and Internet searches for scabies infestations measured by Google Trends. We also examined correlations between these two variables. Our results show that public interest in scabies has increased in recent years and is positively and significantly correlated with an increasing use of ectoparasiticides. We believe that Google Trends should be considered as a complementary tool for monitoring real-time trends in scabies infestations in Spain.

Genotoxic and cytotoxic evaluation of venlafaxine in an acute and a subchronic assay in mouse / Avaliação genotóxica e citotóxica da venlafaxina em ensaio agudo e subcrônico em camundongos

Abstract The present research was made to determine the micronuclei and cytotoxic capacity of the antidepressant venlafaxine in an in vivo acute and subchronic assays in mouse. In the first study, we administered once 5, 50, and 250 mg/kg of the drug, and included a negative and a daunorubicin treated group. Observations were daily made during four days. The subchronic assay lasted 5 weeks with daily administration of venlafaxine (1, 5, and 10 mg/kg) plus a negative and an imipramine administered groups. Observations were made each week. In the first assay results showed no micronucleated polychromatic erythrocytes (MNPE) increase, except with the high dose at 72 h. The strongest cytotoxic effect was found with 250 mg/kg at 72 h (a 51% cytotoxic effect in comparison with the mean control level). In the subchronic assay no MNPE increase was found; however, with the highest dose a significant increase of micronucleated normochromatic erythrocytes was observed in the last three weeks (a mean of 51% respect to the mean control value). A cytotoxic effect with the two high doses in the last two weeks was observed (a polychromatic erythrocyte mean decrease of 52% respect to the mean control value). Results suggest caution with venlafaxine.

Resumo A presente pesquisa foi feita para determinar a capacidade micronuclei e citotóxica do antidepressivo venlafaxina em ensaios agudos e subcrônicos in vivo em camundongos. No primeiro estudo, administramos uma vez 5, 50 e 250 mg/kg do medicamento e incluímos um grupo negativo e um grupo tratado com daunorubicina. As observações foram feitas diariamente durante quatro dias. O ensaio subcrônico durou cinco semanas com administração diária de venlafaxina (1, 5, e 10 mg/kg) mais um grupo negativo e um grupo administrado de imipramina. As observações foram feitas a cada semana. No primeiro ensaio, os resultados não mostraram aumento de eritrócitos policromáticos micronucleados (MNPE), exceto com a dose elevada a 72 h. O efeito citotóxico mais forte foi encontrado com 250 mg/kg a 72 h (um efeito citotóxico de 51% em comparação com o nível médio de controle). No ensaio subcrônico não foi encontrado aumento de MNPE; entretanto, com a dose mais alta, um aumento significativo de eritrócitos normocromáticos micronucleados foi observado nas últimas três semanas (média de 51% em relação ao valor médio de controle). Foi observado um efeito citotóxico com as duas altas doses nas últimas duas semanas (uma diminuição média de 52% em relação ao valor médio de controle dos eritrócitos policromáticos). Os resultados sugerem cautela com a venlafaxina.

Genotoxic and cytotoxic evaluation of venlafaxine in an acute and a subchronic assay in mouse

Abstract The present research was made to determine the micronuclei and cytotoxic capacity of the antidepressant venlafaxine in an in vivo acute and subchronic assays in mouse. In the first study, we administered once 5, 50, and 250 mg/kg of the drug, and included a negative and a daunorubicin treated group. Observations were daily made during four days. The subchronic assay lasted 5 weeks with daily administration of venlafaxine (1, 5, and 10 mg/kg) plus a negative and an imipramine administered groups. Observations were made each week. In the first assay results showed no micronucleated polychromatic erythrocytes (MNPE) increase, except with the high dose at 72 h. The strongest cytotoxic effect was found with 250 mg/kg at 72 h (a 51% cytotoxic effect in comparison with the mean control level). In the subchronic assay no MNPE increase was found; however, with the highest dose a significant increase of micronucleated normochromatic erythrocytes was observed in the last three weeks (a mean of 51% respect to the mean control value). A cytotoxic effect with the two high doses in the last two weeks was observed (a polychromatic erythrocyte mean decrease of 52% respect to the mean control value). Results suggest caution with venlafaxine.

Resumo A presente pesquisa foi feita para determinar a capacidade micronuclei e citotóxica do antidepressivo venlafaxina em ensaios agudos e subcrônicos in vivo em camundongos. No primeiro estudo, administramos uma vez 5, 50 e 250 mg/kg do medicamento e incluímos um grupo negativo e um grupo tratado com daunorubicina. As observações foram feitas diariamente durante quatro dias. O ensaio subcrônico durou cinco semanas com administração diária de venlafaxina (1, 5, e 10 mg/kg) mais um grupo negativo e um grupo administrado de imipramina. As observações foram feitas a cada semana. No primeiro ensaio, os resultados não mostraram aumento de eritrócitos policromáticos micronucleados (MNPE), exceto com a dose elevada a 72 h. O efeito citotóxico mais forte foi encontrado com 250 mg/kg a 72 h (um efeito citotóxico de 51% em comparação com o nível médio de controle). No ensaio subcrônico não foi encontrado aumento de MNPE; entretanto, com a dose mais alta, um aumento significativo de eritrócitos normocromáticos micronucleados foi observado nas últimas três semanas (média de 51% em relação ao valor médio de controle). Foi observado um efeito citotóxico com as duas altas doses nas últimas duas semanas (uma diminuição média de 52% em relação ao valor médio de controle dos eritrócitos policromáticos). Os resultados sugerem cautela com a venlafaxina.