Continuing Bonds in grieving men: A comparative description of Costa Rica and Spain.

Continuing Bonds among grieving men from Costa Rica and Spain were compared, with the primary hypothesis that there would be significant differences between the two groups. A descriptive, comparative, and cross-sectional research study was conducted. Non-probability and convenience sampling was employed, involving 227 grieving men who completed an online questionnaire comprising sociodemographic data, mediators of mourning, and the Continuing Bonds Scale. The results did not reveal significant differences in Continuing Bonds expressions. However, upon controlling for the interaction between degree of kinship with the deceased person, notable differences emerged in Continuing Bonds and internalized and externalized Continuing Bonds (p < 0.05). The influence of sociocultural factors in each country on Continuing Bonds expressions is considered. The findings could support the development of strategies centered on grieving men, Continuing Bonds, and their specific needs.

Is using the Gail model to calculate the risk of breast cancer in the Venezuelan population justified?

Objective: To evaluate the accuracy of the Gail model (GM) in women who already have a diagnosis of breast cancer (BC) from the Breast Pathology Service, Hospital Oncology Department of the Venezuelan Social Security Institute (SOH-IVSS) in the period 2004-2014. To compare the accuracy of the GM in women aged above and below 40 years with a diagnosis of BC. Method: Descriptive, retrospective, cross-sectional, 830 records of patients diagnosed with BC were reviewed between 2004 and 2014. Results: The mean age for diagnosis of the disease was 46 ± 13 years; menarche age was 13 years ± 2; age at first birth 22 ± 5 years, with a history of biopsy 32 ± 11, the percentage of relatives with a primary history of BC reported (PHBC) 9.3%. Only 41% of women with a diagnosis of BC reported Gail >1.67 (positive Gail). In the dichotomous logistic regression that related positive Gail with the independent variables, it was observed: greater probability of positive Gail if menarche age <11 years (p < 0.036), PHBC (p = 0.005), previous biopsy (p = 0.007), age at first birth 25-29 years (p = 0.019). When stratifying by age, unlike the bivariate analysis, women over 40 years of age are more likely to have a positive Gail in menarche age <11 years (p = 0.008), PHBC (p = 0.001), previous biopsy (p = 0.025) when compared with younger women, the age at first birth between 25 and 29 years was statistically significant for both groups; however, the probability was higher in younger women (p = 0.008). Conclusion: There is no conclusive evidence to consider that the GM is applicable to Venezuelan women due to its low precision since it only identified 41% of the patients who had BC as high risk; however, when the factors are analysed separately, we found a higher probability of a positive Gail with statistical significance in EM <11 years, PHBC, previous biopsy and age at first birth 25-29 years; When stratifying by age, we observed that the age at first birth 25-29 years in women aged 40 or less increases the probability of a positive Gail. It is necessary to develop new risk assessment models that are adapted to our female population.

Continuidad de vínculos, hombres y mujeres en duelo por un ser querido: un análisis secundario / Continuing bonds, men, and women in bereavement: A secondary analysis

Introducción: El duelo es una respuesta compleja ante la pérdida de un ser querido que exhibe diferentes rutas para su ajuste, la continuidad de vínculos forma parte de su naturaleza. Objetivo: Analizar la experiencia de duelo por un ser querido en hombres y mujeres relacionada a percepción de cercanía con la persona fallecida, continuidad de vínculos y diagnósticos de Enfermería. Materiales y Métodos: Análisis secundario. Muestra a conveniencia de 251 dolientes, adultos, residentes de Canarias, hispanohablantes. Recolección con encuesta en línea compuesta por características sociodemográficas y de salud, y relacionadas con la pérdida, Escala de inclusión del otro en el yo, Escala de Continuidad de Vínculos y diagnósticos de Enfermería. Se utilizó análisis descriptivo, U de Mann-Whitney, coeficiente de Spearman. Nivel de significancia p<0,05. Resultados: Edad media de 45,09 años ±10,38. Un 22,70% (57) fue hombre, 77,30% (194) mujer. Se identificaron diferencias significativas entre hombres y mujeres en percepción de cercanía con el fallecido (p<0,05), y relaciones significativas entre percepción de cercanía con el fallecido, continuidad de vínculos y diagnósticos de Enfermería (p=0,001). Discusión: Al confrontar los resultados con otros estudios se presentan algunas consistencias y diferencias en el comportamiento de las variables demostrando el dinamismo del fenómeno. Conclusiones: Para este grupo de participantes, la experiencia de duelo no estaría ligada a construcciones sociales de género si no que contesta a una respuesta de afrontamiento según sus necesidades. La comprensión del proceso de duelo permite a la Enfermería de Salud Mental implementar acciones fundamentadas en el Proceso de Enfermería.

Introduction: Grief is a complex response to the loss of a loved one with different ways of adjustment, and Continuing Bonds are part of its nature. Objective: To analyze men's and women's experiences of grief in terms of perception of closeness to the deceased, Continuing Bonds, and Nursing diagnoses. Materials and Methods: Secondary analysis. A convenience sample of 251 Spanish-speaking adult mourners, residents of the Canary Islands, was used. Data was collected via an online survey consisting of socio-demographic, health, and loss-related characteristics, the Inclusion of Other in the Self scale, the Continuing Bonds Scale, and Nursing diagnoses. Descriptive analysis, Mann-Whitney U test, and Spearman's coefficient were used. Level of significance p<0.05. Results: The mean age was 45.09 years ±10.38 years; 22.70% (57) were male, and 77.30% (194) were female. Significant differences were found between men and women in the perception of closeness to the deceased (p<0.05), and significant relationships were found between the perception of closeness to the deceased, Continuing Bonds, and Nursing diagnoses (p=0.001). Discussion: A comparison of the results with other studies shows some consistencies and differences in the behavior of the variables, demonstrating the dynamism of the phenomenon. Conclusions: For this group of participants, the experience of grief would not be linked to social constructions of gender but instead respond to a coping response according to their needs. Understanding the grieving process allows Mental Health Nursing to implement interventions based on the Nursing Process.

Introdução: O luto é uma resposta complexa à perda de um ente querido que apresenta diferentes caminhos de ajustamento, a continuidade dos laços faz parte da sua natureza. Objetivo: Analisar a vivência do luto por um ente querido em homens e mulheres relacionada à percepção de proximidade com a pessoa falecida, continuidade de vínculos e diagnósticos de Enfermagem. Materiais e Métodos: Análise secundária. Amostra para conveniência de 251 enlutados, adultos, residentes nas Ilhas Canárias, falantes de espanhol. Coleção com inquérito online composto por características sociodemográficas e de saúde, e relacionadas à perda, Escala de inclusão do outro no eu, Escala de Continuidade de Vínculos e diagnósticos de Enfermagem. Foram utilizadas análise descritiva, U de Mann-Whitney, coeficiente de Spearman. Nível de significância p<0,05. Resultados: Idade média de 45,09 anos ±10,38. 22,70% (57) eram homens, 77,30% (194) eram mulheres. Foram identificadas diferenças significativas entre homens e mulheres na percepção de proximidade com o falecido (p<0,05), e relações significativas entre percepção de proximidade com o falecido, continuidade de vínculos e diagnósticos de Enfermagem (p=0,001). Discussão: Ao comparar os resultados com outros estudos, apresentam-se algumas consistências e diferenças no comportamento das variáveis, demonstrando o dinamismo do fenômeno. Conclusões: Para este grupo de participantes, a vivência do luto não estaria ligada a construções sociais de género, mas responde a uma resposta de enfrentamento de acordo com as suas necessidades. A compreensão do processo de luto permite à Enfermagem em Saúde Mental implementar ações pautadas no Processo de Enfermagem.

Do breast cancer patients have a gender preference when choosing a breast surgeon?

Introduction: There is a paucity of data on breast cancer (BC) patients' gender preferences when it comes to choosing their surgeon, unlike in other specialties like gynaecology and obstetrics, where women tend to prefer a female physician. The aim of this trial was to examine if there are any gender preferences in women with BC at the time of choosing their breast surgeon. Material and methods: A cross-sectional, observational and descriptive study with 528 patients, older than 18 years, at the Breast Department 'Servicio Oncológico Hospitalario del Instituto Venezolano de los Seguros Sociales', from January to June 2022. We applied an anonymous questionnaire to evaluate patients' gender preferences when it comes to choosing their breast surgeon. Results: The average age of the patients was 56 ± 11 years. 89.4% did not have gender preferences, whereas 6.5% and 4.1% chose to be treated by female surgeons and male surgeons, respectively. The most important characteristics chosen by the patients when they decided to choose their breast surgeon were experience (75%), knowledge (54%) and hospital-based (41%). Conclusion: Personal and professional skills are the most important factors when it comes to patients choosing their breast surgeon, gender does not have any impact on expertise or competence.

BRAF and NRAS prognostic values in conjunctival melanoma: analysis and literature review.

PURPOSE: Conjunctival melanoma is a rare and aggressive tumor with a propensity for regional and distant metastases. This study aimed to analyze BRAF/NRAS markers in conjunctival melanoma and their relationship with tumor recurrences and patient prognosis. METHODS: This retrospective, observational, single-center study included consecutive patients with an anatomopathological diagnosis of conjunctival melanoma, registered between January 1992 and December 2019. BRAF/NRAS mutations were analyzed using cobas®4800 kit (Roche®) in samples obtained by excisional or map biopsy. Additionally, the presence of other associated precancerous or tumor lesions was assessed. RESULTS: A total of 12 patients with positive histological samples for conjunctival melanoma were included (7 women, 5 men), with a mean age at diagnosis of 60 years and a mean evolution time of 6.38 ± 3.4 years. BRAF V600E mutation was observed in three biopsies (25%), similar to NRAS Q61X (25%). Recurrences occurred in all patients with positive BRAF or NRAS mutation, and five of these patients developed systemic dissemination (83.33%). Moreover, four of six patients with mutated BRAF or NRAS (66.66%) had histopathological findings of tumor or precancerous lesions. CONCLUSIONS: BRAF and NRAS mutations may be risk factors for recurrence and shorter survival in conjunctival melanoma, which would make these patients candidates for targeted therapies and comprehensive and individualized follow-up. All these data warrant standardized prospective studies.

BRAF and NRAS prognostic values in conjunctival melanoma: analysis and literature review / Análise do valor prognóstico dos marcadores BRAF e NRAS no melanoma da conjuntiva e revisão da literatura

ABSTRACT Purpose: Conjunctival melanoma is a rare and aggressive tumor with a propensity for regional and distant metastases. This study aimed to analyze BRAF/NRAS markers in conjunctival melanoma and their relationship with tumor recurrences and patient prognosis. Methods: This retrospective, observational, single-center study included consecutive patients with an anatomopathological diagnosis of conjunctival melanoma, registered between January 1992 and December 2019. BRAF/NRAS mutations were analyzed using cobas®4800 kit (Roche®) in samples obtained by excisional or map biopsy. Additionally, the presence of other associated precancerous or tumor lesions was assessed. Results: A total of 12 patients with positive histological samples for conjunctival melanoma were included (7 women, 5 men), with a mean age at diagnosis of 60 years and a mean evolution time of 6.38 ± 3.4 years. BRAF V600E mutation was observed in three biopsies (25%), similar to NRAS Q61X (25%). Recurrences occurred in all patients with positive BRAF or NRAS mutation, and five of these patients developed systemic dissemination (83.33%). Moreover, four of six patients with mutated BRAF or NRAS (66.66%) had histopathological findings of tumor or precancerous lesions. Conclusions: BRAF and NRAS mutations may be risk factors for recurrence and shorter survival in conjunctival melanoma, which would make these patients candidates for targeted therapies and comprehensive and individualized follow-up. All these data warrant standardized prospective studies.

RESUMO Objetivo: O melanoma da conjuntiva é um tumor raro e agressivo, com propensão à disseminação metastática regional e distante. Este estudo tem como objetivo analisar os marcadores BRAF e NRAS no melanoma da conjuntiva e sua relação com recidivas tumorais e com o prognóstico do paciente. Métodos: Este foi um estudo retrospectivo, observacional e unicêntrico de pacientes consecutivos com diagnóstico anatomopatológico de melanoma da conjuntiva feito entre janeiro de 1992 e dezembro de 2019. As mutações BRAF e NRAS foram analisadas com o kit cobas® 4800 (Roche®) em amostras obtidas através de biópsia excisional ou por mapa. Além disso, foi avaliada a presença de lesões pré-cancerosas ou tumorais associadas. Resultados: Foram incluídos 12 pacientes com amostras histológicas positivas para melanoma da conjuntiva (7 mulheres e 5 homens), com idade média ao diagnóstico de 60 anos e tempo médio de evolução de 6,38 ± 3,4 anos. A mutação BRAF V600E foi encontrada em 3 biópsias (25%), bem como a NRAS Q61X (25%). Ocorreram recidivas em todos os pacientes positivos para mutações de BRAF ou NRAS e 5 desses pacientes desenvolveram disseminação sistêmica (83,33%). Além disso, 4 dos 6 pacientes com BRAF ou NRAS mutante (66,66%) apresentaram achados histopatológicos de lesões tumorais ou pré-cancerosas. Conclusões: As mutações BRAF e NRAS podem ser fatores de risco para recorrência e menor sobrevida no melanoma da conjuntiva, o que tornaria esses pacientes candidatos a terapias direcionadas e a um acompanhamento mais abrangente e individualizado. Todos esses dados justificam mais estudos prospectivos padronizados.

Production and Characterization of Nanostructured Powders of Nd2Fe14B and Fe90Al10 by Mechanical Alloying.

The objective of this work is to evaluate the applicability of exchange coupling between nanoparticles of Nd2Fe14B (hard magnetic material) and Fe90Al10 (soft magnetic material), as permanent magnets produced by surfactant-assisted mechanical alloying. The obtained powders were then mixed with 85% of the Nd2Fe14B system and 15% of the Fe90Al10 system and subsequently sintered at 300 °C, 400 °C and 500 °C for one hour. The results obtained by Mössbauer spectrometry (MS) show a ferromagnetic behavior with six magnetic sites represented by sextets (16k1, 16k2, 8j1, 8j2, 4c and 4e), characteristic of the Nd2Fe14B system. X-ray diffraction (XRD) results show a tetragonal and BCC structure for the Nd2Fe14B and FeAl systems, respectively. The results obtained by vibrating sample magnetometry (VSM), for mixtures of the Nd2Fe14B and Fe90Al10 sy stems sintered at 300 °C, 400 °C and 500 °C, allow for the conclusion that the coercive field (Hc) decreases drastically with temperature and the percentage of soft phase at values of Hc = 132 Oe compared to the coercive field values reported for Nd2Fe14B Hc = 6883 Oe, respectively. Images obtained by transmission electron microscopy (TEM), for the Fe90Al10 system, show a tendency for the nanoparticles to agglomerate.

Extrusion Improves the Antihypertensive Potential of a Kabuli Chickpea (Cicer arietinum L.) Protein Hydrolysate.

Chickpea hydrolysates could have antihypertensive potential, but there are no evaluations in vivo. Thus, the antihypertensive potential of a chickpea protein hydrolysate obtained before and after extrusion (a process that modifies protein digestibility) was evaluated. Protein precipitates were obtained from extruded and unextruded chickpea flours by isoelectric precipitation and hydrolyzed (α-amylase/pepsin/pancreatin). Chemical composition was determined (standard methods). ACE-I inhibition assays were carried out using a colorimetric test. For antihypertensive effect evaluations, spontaneously hypertensive rats (n = 8) received the treatments intragastrically (extruded or unextruded hydrolysate (1.2 g/kg), captopril (25 mg/kg), or water only). Fat, ash, and carbohydrate contents were lower in extruded chickpea flour (p < 0.05 versus unextruded). The protein content varied between protein precipitates (91.03%/78.66% unextruded/extruded (dry basis)) (p < 0.05). The hydrolysates' IC50 values (mg/mL) were 0.2834 (unextruded)/0.3218 (extruded) (p > 0.05). All treatments lowered the blood pressure (p < 0.05 vs. water). The extruded hydrolysate showed a more potent antihypertensive effect than the unextruded one (p < 0.05), an effect similar to captopril (p > 0.05). The results suggest that protein extrusion can be used to generate protein hydrolysates with improved health benefits. The findings have implications for the design and production of functional foods that could help to prevent hypertension or serve as an adjunct in its treatment.

Earthquake response in Chile: A case study in health emergency and disaster risk management.

Chile is one of the most seismically active nations in the world. Due to the frequency of earthquakes, the Chilean government has invested heavily in several earthquake mitigation strategies and is able to boast impressively low numbers of deaths after relatively strong earthquakes. These include earthquake-centered building codes, which help prevent collapses, early detection technologies, early warning systems, public awareness campaigns, and unified command of responding agencies. Disaster risk management is a field in need of more evidence-based recommendations, and taking cues from successful programs such as these is vital to decrease global deaths. There is still room for improvement. Individual frontline responders have sought out further training specific to earthquakes, and the frequency of earthquakes in the country has led to impressive institutional knowledge. However, there needs to be more universal, standardized response training. Additionally, although all responders are brought under one umbrella during a disaster, there is a lack of coordinated training, with most responder training occurring in silos. Further investment in preparedness, and a strong focus on mitigation and prevention of disasters is vital across a number of disasters. Fast onset disasters like earthquakes are especially amenable to mitigation strategies such as those in place in Chile.

Cutaneous Angiomyolipoma-A Distinct Entity That Should Be Separated From Classic Angiomyolipoma: Complete Review of Existing Cases and Defining Fundamental Features.

Cutaneous angiomyolipoma is a rare mesenchymal tumor that is demographically, clinically, and immunohistochemically distinct from its renal and extrarenal counterparts. We present a case of cutaneous angiomyolipoma in the right retroauricular area of a 35-year-old male patient and provide a broad systematic review of the literature and the largest compilation of cutaneous angiomyolipomas reported to date. According to the findings presented in this review, we conclude that cutaneous angiomyolipoma should be completely separated from renal and extrarenal angiomyolipomas and therefore be considered a distinct entity in the classification of skin tumors.

A decade of increases in Medicare Part B pharmaceutical spending: what are the drivers?

BACKGROUND: Medicare Part B pharmaceutical spending has increased rapidly, more than doubling in 2006-2017. Yet, it is unclear whether this increase was driven by increased utilization or increased cost per claim. OBJECTIVE: To evaluate the relative impact of changes in drug utilization and cost per claim on changes in Medicare Part B pharmaceutical spending in 2008-2016 overall, by drug type (specialty and nonspecialty) and therapeutic category. METHODS: In this retrospective descriptive study, we extracted all claims in 2008-2016 for separately payable Part B drugs from a 5% random sample of Medicare beneficiaries. Our study included 3 outcomes calculated annually for all included drugs: (1) spending, defined as the sum of total payments; (2) utilization, defined as total number of claims; and (3) cost per claim, defined as spending divided by the number of claims. Estimates of spending and utilization were expressed per beneficiary-year. Spending and cost per claim were adjusted for inflation. For each outcome, we calculated relative changes in 2008-2016. We repeated analyses stratifying by drug type (specialty and nonspecialty) and therapeutic class. RESULTS: Pharmaceutical spending in Medicare Part B increased by 34% from 2008-2016, driven by a 53% increase in the cost per claim. Utilization decreased by 12%. Spending on specialty drugs increased by 56%, driven by a 48% increase in the cost per claim and a 6% utilization increase. Spending on nonspecialty drugs decreased by 32% driven by an 18% reduction in the cost per claim and a 17% reduction in utilization. Spending on ophthalmic preparations increased by 281%, driven by a 238% utilization increase and a 13% increase in the cost per claim. Spending on antiarthritic and immunologic agents increased by 159%, driven by a 117% increase in the cost per claim and a 19% utilization increase. CONCLUSIONS: Medicare Part B pharmaceutical spending grew in recent years, despite decreased utilization, driven by an overall increase in the cost per claim. This was a product of rising drug prices and increased utilization of more expensive specialty drugs. These findings support the development of policies that aim to spur competition and control price growth of provider-administered drugs. DISCLOSURES: The authors acknowledge funding from the Myers Family Foundation. Hernandez was funded by the National Heart, Lung and Blood Institute (grant number K01HL142847). Shrank is an employee of Humana. Good is an employee of the UPMC Health Plan Insurance Services Division. There are no other potential conflicts of interest to disclose.

Gravedad de infecciones respiratorias agudas bajas por adenovirus en los años 2015 y 2016 en el hospital de niños Roberto del Rio / Severity of acute lower respiratory infections due to adenovirus in the years 2015 and 2016 at the Roberto del Rio children's hospital

OBJETIVO. Comparar la gravedad de las infecciones respiratorias agudas bajas (IRAb) producidas por Adenovirus (ADV) entre los años 2015 y 2016, en el Hospital de Niños Roberto del Río. MÉTODOS. Se identificó a pacientes hospitalizados por IRAb por ADV, y se registró edad, sexo, días de hospitalización, ingreso a unidad de paciente crítico (UPC), necesidad de ventilación mecánica (VM), entre otros. Se comparó la evolución de los pacientes, y se analizó la relación entre gravedad y presencia de infecciones asociadas a atención de salud (IAAS). RESULTADOS. Se identificó 158 pacientes hospitalizados por IRAb por ADV. La relación hombre: mujer fue 6:4, con una edad promedio de 17.4 meses. La media de días de hospitalización fue de 9.88 el 2015 y 16.06 el 2016 (p=0.01). El promedio de días de oxigenoterapia fue de 5.86 el 2015 y 8.76 el 2016. Un 22.8% (n:36) de los pacientes ingresó a UPC, y el 20.25% (n:32) requirió VM. Un 41.8% de los casos (n:66) correspondió a IAAS. 3 pacientes fallecieron. CONCLUSIONES. Durante el 2016 hubo hospitalizaciones más prolongadas en comparación al 2015, sin diferencias estadísticamente significativas en relación a requerimientos de oxigenoterapia, VM y fallecimiento. La prolongación de la hospitalización se podría asociar a mayor presencia de IAAS.

OBJETIVE. To compare the severity of lower respiratory infections produced by Adenovirus between 2015 and 2016 at the Hospital de Niños Roberto del Río. METHODS. We identified patients hospitalized for lower respiratory tract infection for ADV and we recorded age, sex, days of hospitalization, admission to Intensive Care Unit (ICU), need for mechanical ventilation (MV), among others. The evolution of the patients between the two years were compared. The relationship between severity and the presence of nosocomial infections was also analyzed. RESULTS. We identified 158 hospitalized patients for ADV. The male:female ratio was 6:4, with an average age of 17.4 months. The mean of hospitalization days was 9.88 days in 2015 and 16.06 days in 2016 (p = 0.01). The average number of oxygen therapy days was 5.86 in 2015 and 8.76 in 2016. The 22.8% (n: 36) of cases required admission in the ICU, and 20.25% (n: 32) required MV. The 41.8% (n: 66) of cases corresponded to nosocomial infections. 3 patients died. CONCLUSIONS. During 2016, there were longer hospitalizations for adenovirus infections compared to 2015, without significant differences in relation to oxygen therapy, MV requirements and death. The prolongation of the hospitalization could be associated by the greater presence of nosocomial infections.

Trends in list prices, net prices, and discounts of self-administered injectable tumor necrosis factor inhibitors.

BACKGROUND: List prices of tumor necrosis factor (TNF) inhibitors drastically increased during the last decade, but previous research has shown that half of these increases were offset by rising manufacturer discounts. It remains unclear to what extent manufacturers' discounts have offset increases in list prices of each self-administered injectable TNF inhibitor. Evaluating trends in net prices and discounts at the product level will be paramount in understanding the role of competition in the biologic market. OBJECTIVES: To (a) describe product-level changes in net prices of each self-administered injectable TNF inhibitor available in 2007-2019 and (b) quantify to what extent manufacturer discounts have offset increases in list prices. METHODS: We obtained 2007-2019 pricing data for etanercept, adalimumab, certolizumab, and golimumab from the investment firm SSR Health, which uses company-reported sales to estimate net prices and discounts for brand products manufactured by publicly traded companies. For each drug and year, we calculated annual costs of treatment for patients with rheumatoid arthritis based on list and net prices and discounts in Medicaid and other payers. RESULTS: From 2007-2019, list prices of etanercept and adalimumab increased by 293% and 295%, respectively; however, discounts offset 47% and 45% of these increases, leading to net price increases of 171% and 203%. List prices of golimumab and certolizumab increased by 183% and 182%, respectively, but with discounts offsetting 58% and 59% of these increases, net prices increased by 103% and 109%. Net prices of golimumab started to decrease after 2016, while net prices of adalimumab and certolizumab experienced their first drop in 2019. Across the study period, discounts in Medicaid and in other payers increased, respectively, from 21% to 85% and 6% to 32% for etanercept; from 26% to 88% and 19% to 35% for adalimumab; from 28% to 63% and 22% to 46% for golimumab; and from 29% to 83% and 27% to 47% for certolizumab. CONCLUSIONS: Despite growing manufacturer discounts, net prices of self-administered injectable TNF inhibitors still increased at a mean annual rate of 9.6% in 2007-2019. This led to net prices tripling for adalimumab and more than doubling for etanercept, golimumab, and certolizumab. DISCLOSURES: This study was funded by the Myers Family Foundation. Hernandez is funded by the National Heart, Lung and Blood Institute (grant number K01HL142847). Funding sources had no role in design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; or decision to submit the manuscript for publication. Hernandez has served on Pfizer's scientific advisory board. The other authors have nothing to disclose.

Ocular trauma by kinetic impact projectiles during civil unrest in Chile.

BACKGROUND: The use of kinetic impact projectiles (KIPs) for crowd-control has increased worldwide. Despite having been created as non-lethal weapons, significant damage to several organs, including the eye, has been reported. In this study, we investigated cases of ocular trauma from KIPs during the civil unrest in Chile. To our knowledge, this is the largest case series recorded in international literature. METHODS: We included all patients who sought care or were referred to the Eye Trauma Unit, a national referral centre in Santiago, Chile, during the civil unrest from October 18 to November 30, 2019. We reviewed paper medical records and extracted data on suspected cause of trauma, type of trauma, visual acuity and sociodemographic data. RESULTS: We included 259 patients, out of which in 182 cases (70.5%) KIPs were the suspected cause. Cases by KIPs were predominantly male (86.6%), young (median age 26.3, interquartile range 22.0-31.4) and living in the Metropolitan Region. Eighty-nine patients (48.9%) had severe visual impairment or were blind at the first examination. The trauma was an open-globe injury in 20.3% of cases and 13 cases required evisceration of the ocular content. Compared to other causes of ocular trauma, KIPs were related to a more severe loss of visual acuity and a higher frequency of open-globe injuries. CONCLUSIONS: The use of KIPs during a period of civil unrest in Chile resulted in severe ocular trauma, visual impairment and permanent disability. KIPs should be avoided as a method of crowd-control.

Aneurisma de arteria pulmonar: una revisión y dos casos ilustrativos / Pulmonary artery aneurysm: a review and two illustrative cases

El aneurisma de la arteria pulmonar (AAP) es una patología poco frecuente, con una prevalencia estimada en 0,06 %; si bien sus mecanismos fisiopatológicos aún se encuentran en estudio, se cree que la principal causa es el incremento de la presión y/o del flujo a través de la arteria pulmonar (AP), como sucede en la hipertensión pulmonar y el síndrome de Eisenmenger. Con frecuencia el AAP tiene un curso asintomático o desencadena síntomas inespecíficos, pero sus complicaciones pueden presentarse con independencia de los síntomas y llegar a tener un desenlace fatal. En el presente artículo se realiza una revisión de la literatura y se presentan dos casos de AAP.

Pulmonary artery aneurysm (PAA) is a rare disease with an estimated prevalence of 0.06%. Although its pathophysiological mechanisms are still under study, the main cause is believed to be an increased pressure and/or flow through the pulmonary artery (PA), as occurs in pulmonary hypertension and Eisenmenger syndrome. PAA often has an asymptomatic course or triggers nonspecific symptoms, but its complications can occur regardless of the symptoms and be fatal. In this article, a literature review is carried out and two cases of PAA are reported.

Cytotoxic activity of the chloroform fraction of Piper aduncum and its effect on the cell cycle in gastric cancer cell lines. / Actividad citotóxica de la fracción clorofórmica de Piper aduncum y su efecto en el ciclo celular en líneas celulares de cáncer gástrico.

OBJECTIVES: To evaluate the cytotoxic activity of the chloroform fraction of the Piper aduncum methanolic extract (PAMoCl) and its effect on the cell cycle in two gastric cancer cell lines: AGS and KATO III. MATERIALS AND METHODS: The cytotoxic effect of PAMoCl was evaluated in cell lines AGS and KATO III. The following PAMoCl concentrations were tested, 1.25, 2.5, 5, 10, 20, 40, 80 and 160 µg/mL. Resazurine was used to evaluate cell viability. In the cell cycle assay, the cells were treated with 19.62 µg/mL and 39.23 µg/mL of PAMoCl for AGS as well as 87.49 µg/mL and 160 µg/mL for KATO III. After 24 hours both cell lines were analyzed by flow cytometry. RESULTS: PAMoCl showed cytotoxic activity, inhibiting cell growth by 50%. It presented a (IC50) of 39.23 µg/mL and 87.49 µg/mL at 24 hours and a (IC50) of 49.47 µg/mL and 64.68 µg/mL at 48 hours against AGS and KATO III cell lines, respectively. In addition, it was observed that PAMoCl has an effect on the cell cycle, it causes an accumulation of cells in the G2/M phase. CONCLUSIONS: PAMoCl contains secondary metabolites with cytotoxic activity that have an effect on the G2/M phase of the cell cycle, in two gastric cancer cell lines, both primary and metastatic. The results of this study will allow us to deepen the search for more effective active ingredients found in PAMoCl for eliminating gastric cancer cells, but with less toxicity for healthy cells.

OBJETIVOS: Evaluar la actividad citotóxica de la fracción clorofórmica del extracto metanólico de Piper aduncum (PAMoCl) y su efecto en el ciclo celular en dos líneas celulares de cáncer gástrico: AGS y KATO III. MATERIALES Y MÉTODOS: El efecto citotóxico de PAMoCl se evaluó en las líneas celulares: AGS y KATO III. Se probaron concentraciones de PAMoCl: 1,25; 2,5; 5; 10; 20; 40; 80 y 160 µg/mL. Para evaluar la viabilidad celular se usó el reactivo resazurina. En el ensayo de ciclo celular las células fueron tratadas con 19,62 µg/mL y 39,23 µg/mL de PAMoCl para AGS, así como 87,49 µg/mL y 160 µg/mL para KATO III. Después de 24 horas ambas líneas celulares fueron analizadas por citometría de flujo. RESULTADOS: PAMoCl mostró actividad citotóxica con una inhibición del crecimiento celular en un 50% (IC50) de 39,23 µg/mL y 87,49 µg/mL a las 24 horas y un IC50 de 49,47 µg/mL y 64,68 µg/mL a las 48 horas frente a las líneas celulares AGS y KATO III, respectivamente. Además, se observó que PAMoCl tiene efecto a nivel del ciclo celular: provoca una acumulación de células en la fase G2/M. CONCLUSIONES: PAMoCl contiene metabolitos secundarios con actividad citotóxica que tienen efecto en la fase G2/M del ciclo celular, en dos líneas celulares de cáncer gástrico tanto primario como metastásico. Los resultados de este estudio permitirán profundizar en la búsqueda de principios activos presentes en PAMoCl que tengan mayor eficacia en la eliminación de células de cáncer gástrico, pero con menor toxicidad en células sanas.

Enfermedad cerebrovascular en pacientes ingresados en cuidados intensivos / Cerebrovascular disease in patients admitted to intensive care

RESUMEN Introducción: las enfermedades cerebrovasculares son un problema de salud mundial y representan la tercera causa de muerte, la primera de discapacidad y segunda de demencia. Objetivo: caracterizar clínica y epidemiológicamente la enfermedad cerebrovascular en pacientes ingresados con cuidados intensivos. Métodos: estudio observacional, descriptivo y transversal, efectuado en el Hospital General Docente "Comandante Pinares"", de la provincia de Artemisa, entre 2016 y 2018. De forma probabilística, aleatoria simple, fue seleccionada una muestra de 200 pacientes con enfermedad cerebrovascular. El estudio de las historias clínicas permitió la obtención de información que dio salida a las variables estudiadas, se emplearon para su presentación, métodos de estadística descriptiva. Se respetó la ética médica. Resultados: predominaron los pacientes con 80 años y más (26 %), del sexo masculino (56 %). Fueron frecuentes los accidentes cerebrovasculares isquémicos (83 %) de tipo trombótico (33 %), donde la hipertensión arterial (93,5 %) y el tabaquismo (82 %) fueron los principales factores de riesgo; se tuvo la ventana terapéutica de tres a seis horas (73,5 %) como la más común, predominaron los pacientes vivos, con secuelas al egreso hospitalario (48,5 %). Conclusiones: los pacientes mayores de 80 años y masculinos con factores de riesgos como la hipertensión arterial y tabaquismo, fueron los más propensos al accidente cerebrovascular; los isquémicos y de tipo trombóticos los más comunes, con ventana terapéutica de tres a seis horas en la mayoría de los casos. El mayor número llegó obnubilado y fueron egresados vivos con secuelas.

ABSTRACT Introduction: cerebrovascular diseases are a global health problem and represent the third cause of death, the first cause of disability and the second cause of dementia. Objective: to characterize clinical and epidemiologically cerebrovascular disease in patients admitted to intensive care. Methods: observational, descriptive and cross-sectional study was conducted at "Comandante Pinares" General Hospital, Artemisa province, for the period of 2016-2018. A probabilistic and at simple random sample of 200 patients suffering from cerebrovascular disease was chosen. The study of the clinical histories allowed the collection of output information to the studied variables, using for its presentation methods of descriptive statistics. Medical ethics was respected. Results: patients from 80 years and older predominated (26 %), male sex (56 %). Ischemic cerebrovascular strokes (83 %), thrombotic type (33 %) were frequent, where hypertension (93,5 %) and smoking (82 %) stated as the main risk factors, having the therapeutic window of 3-6 hours (73,5 %) as the most common, alive patients with sequelae at hospital discharged predominated (48,5 %). Conclusions: patients older than 80 years and male, with hypertension and smoking addiction were prone to cerebrovascular stroke, where ischemic and thrombotic types were the most common, with a therapeutic window of three to six hours in the ajority of the cases. The greatest number of patients was admitted with obnubilation and they were discharged alive with sequelae.

Actividad citotóxica de la fracción clorofórmica de Piper aduncum y su efecto en el ciclo celular en líneas celulares de cáncer gástrico / Cytotoxic activity of the chloroform fraction of Piper aduncum and its effect on the cell cycle in gastric cancer cell lines

RESUMEN Objetivos: Evaluar la actividad citotóxica de la fracción clorofórmica del extracto metanólico de Piper aduncum (PAMoCl) y su efecto en el ciclo celular en dos líneas celulares de cáncer gástrico: AGS y KATO III. Materiales y métodos: El efecto citotóxico de PAMoCl se evaluó en las líneas celulares: AGS y KATO III. Se probaron concentraciones de PAMoCl: 1,25; 2,5; 5; 10; 20; 40; 80 y 160 µg/mL. Para evaluar la viabilidad celular se usó el reactivo resazurina. En el ensayo de ciclo celular las células fueron tratadas con 19,62 µg/mL y 39,23 µg/mL de PAMoCl para AGS, así como 87,49 µg/mL y 160 µg/mL para KATO III. Después de 24 horas ambas líneas celulares fueron analizadas por citometría de flujo. Resultados: PAMoCl mostró actividad citotóxica con una inhibición del crecimiento celular en un 50% (IC50) de 39,23 µg/mL y 87,49 µg/mL a las 24 horas y un IC50 de 49,47 µg/mL y 64,68 µg/mL a las 48 horas frente a las líneas celulares AGS y KATO III, respectivamente. Además, se observó que PAMoCl tiene efecto a nivel del ciclo celular: provoca una acumulación de células en la fase G2/M. Conclusiones: PAMoCl contiene metabolitos secundarios con actividad citotóxica que tienen efecto en la fase G2/M del ciclo celular, en dos líneas celulares de cáncer gástrico tanto primario como metastásico. Los resultados de este estudio permitirán profundizar en la búsqueda de principios activos presentes en PAMoCl que tengan mayor eficacia en la eliminación de células de cáncer gástrico, pero con menor toxicidad en células sanas.

ABSTRACT Objectives: To evaluate the cytotoxic activity of the chloroform fraction of the Piper aduncum methanolic extract (PAMoCl) and its effect on the cell cycle in two gastric cancer cell lines: AGS and KATO III. Materials and methods: The cytotoxic effect of PAMoCl was evaluated in cell lines AGS and KATO III. The following PAMoCl concentrations were tested, 1.25, 2.5, 5, 10, 20, 40, 80 and 160 μg/mL. Resazurine was used to evaluate cell viability. In the cell cycle assay, the cells were treated with 19.62 μg/mL and 39.23 μg/mL of PAMoCl for AGS as well as 87.49 μg/mL and 160 μg/mL for KATO III. After 24 hours both cell lines were analyzed by flow cytometry. Results: PAMoCl showed cytotoxic activity, inhibiting cell growth by 50%. It presented a (IC50) of 39.23 μg/mL and 87.49 μg/mL at 24 hours and a (IC50) of 49.47 μg/mL and 64.68 μg/mL at 48 hours against AGS and KATO III cell lines, respectively. In addition, it was observed that PAMoCl has an effect on the cell cycle, it causes an accumulation of cells in the G2/M phase. Conclusions: PAMoCl contains secondary metabolites with cytotoxic activity that have an effect on the G2/M phase of the cell cycle, in two gastric cancer cell lines, both primary and metastatic. The results of this study will allow us to deepen the search for more effective active ingredients found in PAMoCl for eliminating gastric cancer cells, but with less toxicity for healthy cells.

Male-to-Female Gender-Affirming Surgery Using Nile Tilapia Fish Skin as a Biocompatible Graft.

STUDY OBJECTIVE: Insufficient penile skin is common during vaginoplasty for male-to-female transition. This issue may be compensated by a scrotal skin flap, with the drawback of hair growth [1]. In recent studies, Nile tilapia skin was successfully used for the surgical management of Mayer-Rokitansky-Küster-Hauser syndrome [2,3] and vaginal stenosis [4,5]. This study aims to describe a novel technique for primary vaginoplasty in male-to-female gender-affirming surgery using Nile tilapia skin as a biocompatible graft to ensure adequate vaginal depth. DESIGN: Stepwise demonstration of the procedure with narrated video footage. SETTING: Transgender health clinic. INTERVENTIONS: A 29-year-old patient with gender dysphoria was referred to our office because of a desire for gender-affirming surgery. A physical examination revealed normal male genitalia with a 14-cm-long penis. Before surgery, approval from the institutional review board and written permission from the patient were obtained. After orchiectomy, penile disassembly, perineal dissection, and urethroplasty were performed, and a hollow Nile tilapia skin mold was prepared and sutured to the distal edge of the remaining penile skin. This structure was inverted, covering the newly created canal. The neocavity was then filled with a handmade inflatable vaginal mold, held in place by sutures in the labia majora. Finally, labiaplasty and clitoroplasty were conducted. After 7 days, the inflatable mold was removed, and the use of progressively larger dilators was initiated. After 3 weeks, a neovagina that was 16 cm long and able to accommodate the width of 2 fingers was detected. At that time, the Nile tilapia skin was completely reabsorbed into the neovaginal mucosa. There were no complications in the early postsurgical period. CONCLUSION: Nile tilapia skin, a safe, low-cost, and easy-to-use biocompatible material, may be an alternative option to scrotal skin grafts for neovaginal augmentation in primary vaginoplasty for male-to-female gender transition. However, further studies are needed to confirm this assertive.