The role of HR-HPV integration in the progression of premalignant lesions into different cancer types.

High-risk human papillomavirus (HR-HPV) is associated with the development of different types of cancer, such as cervical, head and neck (including oral, laryngeal, and oropharyngeal), vulvar, vaginal, penile, and anal cancers. The progression of premalignant lesions to cancer depends on factors associated with the host cell and the different epithelia infected by HPV, such as basal cells of the flat epithelium and the cells of the squamocolumnar transformation zone (STZ) found in the uterine cervix and the anal canal, which is rich in heparan sulfate proteoglycans and integrin-like receptors. On the other hand, factors associated with the viral genotype, infection with multiple viruses, viral load, viral persistence, and type of integration determine the viral breakage pattern and the sites at which the virus integrates into the host cell genome (introns, exons, intergenic regions), inducing the loss of function of tumor suppressor genes and increasing oncogene expression. This review describes the role of viral integration and the molecular mechanisms induced by HR-HPV in different types of tissues. The purpose of this review is to identify the common factors associated with the role of integration events in the progression of premalignant lesions in different types of cancer.

Effect of antihypertensive treatment on the quality of life of patients with chronic rhinosinusitis with nasal polyps.

AIM: Nasal polyposis (CRSwNP) shares type 2 inflammation biomarkers with asthma, allergy or arterial hypertension (AH), including periostin, a predictive marker of severity and post-surgical recurrence of polyposis. Antihypertensives have been shown to decrease periostin expression. We set out to evaluate the effect of antihypertensives on the quality of life of patients with CRSwNP. MATERIALS AND METHODS: Retrospective study of 43 patients with CRSwNP and ah with at least 1year of follow-up and antihypertensive treatment prescribed after the diagnosis of CRSwNP. Phenotypes were analyzed (F1: isolated CRSwNP; F2: CRSwNP with asthma and/or NERD) and aspects related to quality of life (SNOT-22), clinical severity (VAS), polypoid size (NPS), exacerbations and surgical needs after the initiation of antihypertensive treatment. RESULTS: The predominant phenotype was F1 (62.8%). The number of exacerbations was 19.2% for F1, compared to 31.3% for F2. 34.8% underwent surgery after the start of antihypertensive treatment (F1=27.9% and F2=6.97%). A significant reduction in polypoid size, SNOT22 (16.4±19.6 points), and VAS scales (p<.05) was obtained. CONCLUSIONS: polypoid size, and reduce the risk of postoperative recurrence.

Factors influencing witnesses' perception of patient safety during pre-hospital health care from emergency medical services: A multi-center cross-sectional study.

AIM: To determine the factors related with the perception of feeling safe during pre-hospital emergency care. METHODS: A multi-centred, cross-sectional study. Data collection from April 2021 to March 2022, in the Centro de Emergencias Sanitarias 061 (Andalusia, Spain). INCLUSION CRITERIA: witnesses of health care by emergency medical services. EXCLUSION CRITERIA: minors, or communication barriers. OUTCOME VARIABLE: Witness Perceived Safety Scale ESPT10. The variables studied were related with sociodemographic data, the request for health care, the patient, the hospital transfer and patient safety incidents. A multivariate linear regression model was constructed for the dependent variable. The study followed STROBE statement. RESULTS: Responses were obtained from 1400 witnesses. The linear regression model showed that the score on the scale increased as the witnesses felt more satisfied (B = 1.302; p < 0.001). On the contrary, the score was lower when the witness reported a patient safety incident (B = -2.856; p < 0.001 and B = -3.166; p < 0.001), or when the assistance took place in a public space (B = -0.722; p = 0.017). CONCLUSIONS: The level of satisfaction, the occurrence of a patient safety incident, and the place of health care are related factors with the perception of the witnesses. The Witness Perceived Safety Scale ESPT10 could be considered a valid and useful patient safety indicator.

Factores relacionados con la percepción de los pacientes de sentirse seguros en emergencias extrahospitalarias: estudio transversal multicéntrico / Factors related to patients’ perception of feeling safe in pre-hospital emergencies: a multicenter cross-sectional study

Objetivos: Conocer los factores que se relacionan con la percepción de los pacientes de sentirse seguros en emergencias extrahospitalarias. Método: Estudio observacional descriptivo, transversal, multicéntrico, en los equipos de emergencias 061 de Andalucía. Se recogieron los datos desde abril 2021 hasta marzo 2022. Criterios de inclusión fueron pacientes asistidos y trasladados por equipos de emergencias, y los criterios de exclusión fueron menores de edad, deterioro cognitivo, alteración de consciencia, o barreras comunicativas. Se calculó un tamaño muestral mínimo de 644 sujetos. La variable resultado fue la puntuación de la Escala de Seguridad Percibida (ESP16). Se estudiaron variables sociodemográficas y relacionadas con la demanda asistencial, el paciente y el traslado. Además, se recogieron notificaciones de incidentes relacionados con la seguridad del paciente (IRSP). Se construyó un modelo de regresión lineal multivariable para la variable dependiente. Se siguieron las recomendaciones STROBE. Resultados: Se obtuvieron 1.756 respuestas. La puntuación media en la ESP16 fue 77,7 (DE 5,6), con mediana de 80. El modelo de regresión lineal mostró que el nivel de satisfacción (B = 2,799; p < 0,001), la notificación de error, caída, daño o lesión (B = –6,097; p < 0,001), la notificación de cualquier otro IRSP (B = –2,742; p < 0,001), la transferencia protocolizada (B = 2,538; p = 0,001), el tipo de recurso asistencial (B = 1,157; p < 0,001), un diagnóstico final cardiológico (B = 0,726; p = 0,014) y un nivel de dolor intenso (B = 1,195; p = 0,003) influían en la escala ESP16. Conclusiones: La percepción de seguridad del paciente es muy alta, y está condicionada por el nivel de satisfacción, la notificación de IRSP, la transferencia protocolizada, el recurso asistencial, el diagnóstico final y el nivel de dolor. (AU)

Aim: To identify factors related to patients’ feeling of safety during prehospital emergencies. Methods: Descriptive, multicenter cross-sectional study in the context of “061” emergency response services of Andalusia, Spain. Data were collected from April 2021 to March 2022. Patients attended and transported by emergency responders were eligible for inclusion. Patients were excluded if they were minors or in an altered state of consciousness, or had cognitive impairment or any barrier to communication. We calculated that a minimum sample size of 644 patients would be required. The outcome variable was the score on a 16-item scale of patient-perceived safety (ESP16, as abbreviated in Spanish). Sociodemographic, emergency service response, patient, and hospital transfer variables were studied in relation to ESP16 score. We also collected patient safety incident reports.Multivariate linear regression was used to analyze associations between the independent variables and the dependent outcome variable. Guidelines for Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) were followed. Results: We received 1756 responses. The mean (SD) ESP16 score was 77.7 (5.6); the median score was 80. The b coefficients derived from the linear regression model were as follows for the variables associated with the ESP16 score: 2.799 (P < .001) for satisfaction; –6.097 (P < .001) for incident reports of errors, falls, harm, or injury; –2.742 (P < .001) for reports of any other incident during attendance; 2.538 (P = .001) for use of the transport protocol; 1.157 (P < .001) for type of emergency transport used; 0.726 (P = .014) for a cardiology diagnosis; and 1.195 (P = .003) for pain intensity. Conclusions: Patients’ perception of safety is very high, as reflected by level of satisfaction, incident reports, use of a transport protocol, means of transport used, diagnosis, and pain level. (AU)

Factors related to patients' perception of feeling safe in pre-hospital emergencies: a multicenter cross-sectional study. / Factores relacionados con la percepción de los pacientes de sentirse seguros en emergencias extrahospitalarias: estudio transversal multicéntrico.

OBJECTIVES: To identify factors related to patients' feeling of safety during prehospital emergencies. MATERIAL AND METHODS: Descriptive, multicenter cross-sectional study in the context of "061" emergency response services of Andalusia, Spain. Data were collected from April 2021 to March 2022. Patients attended and transported by emergency responders were eligible for inclusion. Patients were excluded if they were minors or in an altered state of consciousness, or had cognitive impairment or any barrier to communication. We calculated that a minimum sample size of 644 patients would be required. The outcome variable was the score on a 16-item scale of patient-perceived safety (ESP16, as abbreviated in Spanish). Sociodemographic, emergency service response, patient, and hospital transfer variables were studied in relation to ESP16 score. We also collected patient safety incident reports. Multivariate linear regression was used to analyze associations between the independent variables and the dependent outcome variable. Guidelines for Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) were followed. RESULTS: We received 1756 responses. The mean (SD) ESP16 score was 77.7 (5.6); the median score was 80. The ßô€€ƒ coefficients derived from the linear regression model were as follows for the variables associated with the ESP16 score: 2.799 (P .001) for satisfaction; -6.097 (P .001) for incident reports of errors, falls, harm, or injury; -2.742 (P .001) for reports of any other incident during attendance; 2.538 (P = .001) for use of the transport protocol; 1.157 (P .001) for type of emergency transport used; 0.726 (P = .014) for a cardiology diagnosis; and 1.195 (P = .003) for pain intensity. CONCLUSION: Patients' perception of safety is very high, as reflected by level of satisfaction, incident reports, use of a transport protocol, means of transport used, diagnosis, and pain level.

OBJETIVO: Conocer los factores que se relacionan con la percepción de los pacientes de sentirse seguros en emergencias extrahospitalarias. METODO: Estudio observacional descriptivo, transversal, multicéntrico, en los equipos de emergencias 061 de Andalucía. Se recogieron los datos desde abril 2021 hasta marzo 2022. Criterios de inclusión fueron pacientes asistidos y trasladados por equipos de emergencias, y los criterios de exclusión fueron menores de edad, deterioro cognitivo, alteración de consciencia, o barreras comunicativas. Se calculó un tamaño muestral mínimo de 644 sujetos. La variable resultado fue la puntuación de la Escala de Seguridad Percibida (ESP16). Se estudiaron variables sociodemográficas y relacionadas con la demanda asistencial, el paciente y el traslado. Además, se recogieron notificaciones de incidentes relacionados con la seguridad del paciente (IRSP). Se construyó un modelo de regresión lineal multivariable para la variable dependiente. Se siguieron las recomendaciones STROBE. RESULTADOS: Se obtuvieron 1.756 respuestas. La puntuación media en la ESP16 fue 77,7 (DE 5,6), con mediana de 80. El modelo de regresión lineal mostró que el nivel de satisfacción (B = 2,799; p 0,001), la notificación de error, caída, daño o lesión (B = ­6,097; p 0,001), la notificación de cualquier otro IRSP (B = ­2,742; p 0,001), la transferencia protocolizada (B = 2,538; p = 0,001), el tipo de recurso asistencial (B = 1,157; p 0,001), un diagnóstico final cardiológico (B = 0,726; p = 0,014) y un nivel de dolor intenso (B = 1,195; p = 0,003) influían en la escala ESP16. CONCLUSIONES: La percepción de seguridad del paciente es muy alta, y está condicionada por el nivel de satisfacción, la notificación de IRSP, la transferencia protocolizada, el recurso asistencial, el diagnóstico final y el nivel de dolor.

Dificultad diagnóstica en masa retroperitoneal. Reporte de un caso / Diagnostic difficulty in retroperitoneal mass: A case report

El Schwannoma se origina de la vaina perineural de Schwannoma, se detecta con frecuencia incidentalmente en estudios imagenológicos siendo el principal método diagnóstico la Tomografía Computada. El tratamiento es la resección quirúrgica con márgenes libres. Se presenta una paciente femenina de 49 años, en control por oncología por enfermedad de base, cáncer de mama izquierda, se identifica por TAC y PECT/TC imagen voluminosa en retroperitoneo situación lateroaórtica izquierda de configuración no quística e hipermetabólica, solicita biopsia percutánea, ante la falta de ventana, se decide exeresis completa de masa. Diagnóstico definitivo patológico Schwannoma. Sin indicación de tratamiento adyuvante, cursa buena evolución postoperatoria sin recidiva.

Schwannoma, a benign tumor that arises from Schwann cells of the perineural nerve sheath, is often incidentally detected in imaging tests and mainly diagnosed by CT scan. Treatment consists of surgical resection with clear margins. We present the case of a 49-year-old female patient subject to Oncology Department follow-up due to an underlying disease, left breast cancer. A large, hypermetabolic, noncystic mass in the retroperitoneal region is identified by CT and PECT/CT scan in the left lateral aortic area. A percutaneous biopsy is requested. Due to the limited acoustic window, complete resection of the mass is decided. Final histopathology diagnosis of Schwannoma. No adjuvant treatment indication; undergoing favorable postoperative progress, without recurrence

Bacillus cereus in the Artisanal Cheese Production Chain in Southwestern Mexico.

BACKGROUND: Bacillus cereus is associated with milk, dairy product, and dairy farm contamination. The aim of this study was to characterize strains of B. cereus in the small-scale artisanal cheese production chain in southwestern Mexico. METHODS: 130 samples were collected. B. cereus isolation was performed on Mannitol Egg Yolk Polymyxin (MYP) agar. Genotyping, enterotoxigenic profile, and determination of genes involved in the formation of B. cereus biofilm were performed by PCR. An antimicrobial susceptibility test was made by broth microdilution assay. The phylogenetic analysis was performed by amplification and sequencing of 16s rRNA. RESULTS: B. cereus sensu lato was isolated and molecularly identified in 16 samples and B. cereus sensu stricto (B. cereus) was the most frequently isolated and identified species (81.25%). Of all the isolated B. cereus sensu lato strains, 93.75% presented at least one gene for some diarrheagenic toxins, 87.5% formed biofilms, and 18.75% were amylolytic. All B. cereus sensu lato strains were resistant to beta-lactams and folate inhibitors. A close phylogenetic relationship between isolates was found between the cheese isolates and the air isolates. CONCLUSIONS: Strains of B. cereus sensu lato were found in small-scale artisanal cheeses on a farm in southwestern Mexico.

Factors influencing the perception of feeling safe in pre-hospital emergency care: A mixed-methods systematic review.

AIMS: To systematically describe the factors influencing the perception of feeling safe among patients receiving pre-hospital emergency care. BACKGROUND: Patient safety is a top priority worldwide. Little is known about how patients perceive safety during emergency health care and what the related factors are. DESIGN: A mixed-methods systematic review. METHODS: Six databases were searched to December 2021. Inclusion criteria were as follows: studies with patients of any age, framed in pre-hospital emergency care settings, referring to patient safety, addressing the perception of safety, and with a quantitative or qualitative research design. Exclusion criteria were as follows: conference records, abstracts, supplements, letters, editorials and reviews. The quality of the evidence was assessed with the Joanna Briggs Institute (JBI) checklists. A convergent integrated approach was followed according to the JBI methodology. The protocol was registered on PROSPERO (CRD42022306337). PRISMA 2020 guidelines were followed in reporting this review. RESULTS: Among the 5223 records identified, the whole texts of 35 articles were reviewed. Ten studies were relevant to the research question. Seven followed a qualitative methodology, with interviews or focus group. Three involved a quantitative methodology, with questionnaires or validated measures. The 74 findings were organised into 11 categories and then grouped into four dimensions: 'receiving a satisfying response from healthcare professionals when I need it', 'EMS personnel's professional competence', 'the variable and unfamiliar settings of pre-hospital emergencies', and 'patients' personal characteristics'. CONCLUSIONS: The perception of safety is influenced by many factors, which can be grouped into four independent dimensions. Quantitative and qualitative studies can provide us with complementary findings. RELEVANCE TO CLINICAL PRACTICE: Awareness of these factors enables us to act upon them. When patients feel safe their health outcomes improve, their anxiety decreases and they collaborate more actively. NO PATIENT OR PUBLIC CONTRIBUTION: Patients and caregivers shared their experiences in the articles included.

DNMT3B overexpression downregulates genes with CpG islands, common motifs, and transcription factor binding sites that interact with DNMT3B.

DNA methylation is a key epigenetic modification to regulate gene expression in mammalian cells. Abnormal DNA methylation in gene promoters is common across human cancer types. DNMT3B is the main de novo methyltransferase enhanced in several primary tumors. How de novo methylation is established in genes related to cancer is poorly understood. CpG islands (CGIs), common sequences, and transcription factors (TFs) that interact with DNMT3B have been associated with abnormal de novo methylation. We initially identified cis elements associated with DNA methylation to investigate the contribution of DNMT3B overexpression to the deregulation of its possible target genes in an epithelial cell model. In a set of downregulated genes (n = 146) from HaCaT cells with DNMT3B overexpression, we found CGI, common sequences, and TFs Binding Sites that interact with DNMT3B (we called them P-down-3B). PPL1, VAV3, IRF1, and BRAF are P-down-3B genes that are downregulated and increased their methylation in DNMT3B presence. Together these findings suggest that methylated promoters aberrantly have some cis elements that could conduce de novo methylation by DNMT3B.

Utility of in silico-identified-peptides in spike-S1 domain and nucleocapsid of SARS-CoV-2 for antibody detection in COVID-19 patients and antibody production.

SARS-CoV-2 contains four structural proteins, two of which, the spike and nucleocapsid, are commonly used for the standardization of novel methods for antibody detection; however, some limitations in their use have been observed due to the homology of this virus with other phylogenetically-related viruses. We performed in silico analysis to search for novel immunogenic and antigenic peptides. A total of twenty-five peptides were preliminarily selected, located in the 3D structure of both proteins. Finally, eight peptides were selected: one located in the N protein and seven in the S1 domain of the spike protein. Additionally, the localization of selected peptides in 2D structures and possible changes in the sequences of these peptides in SARS-CoV-2 variants of concern were analyzed. All peptides were synthetized in MAP8 format, and recombinant S (trimer and RBD) and N proteins were used as antigens to search for antibodies in serum samples derived from COVID-19 patients, and for antibody response in New Zealand rabbits. Results showed high recognition of the serum derived from COVID-19 patients to all selected peptides; however, only the RBD3 peptide induced antibody production. In conclusion, this work provides evidence for a new strategy in peptide selection and its use for antibody detection or antibody production in animals.

In Peripheral Blood Mononuclear Cells Helicobacter pylori Induces the Secretion of Soluble and Exosomal Cytokines Related to Carcinogenesis.

Helicobacter pylori promotes the secretion of cytokines that regulate inflammation and carcinogenesis. Immune cells secrete cytokines into the extracellular medium or packaged in exosomes. The objective of this study was to analyze the profile of soluble and exosomal cytokines that were secreted by human peripheral blood mononuclear cells (PBMCs) that were infected with H. pylori and to build a network of interaction between cytokines and cellular proteins. PBMCs were obtained by density gradient centrifugation and infected with H. pylori for 24 h. The infection was verified by immunofluorescence and Western blot for CagA. The exosomes were obtained from culture supernatant by ultracentrifugation and characterized by transmission electron microscopy, particle size analysis, and Western blot for CD9 and CD81. Cytokines were quantified using a multiplex immunoassay in the culture supernatant, intact exosomes, and lysed exosomes. H. pylori adheres to lymphocytes and translocates CagA. In PBMCs, H. pylori induces an increase in the soluble and exosomal IL-1ß, IL-6, TNF-α, IL-10, IL-17A, IL-21, and IL-22. The protein-protein interaction (PPI) network shows that soluble and exosomal cytokines interact with proteins that participate in signaling pathways such as NF-κB, MAPK, PI3K-Akt, Jak-STAT, FoxO, and mTOR, that are related to carcinogenesis; moreover, TNF-α had the highest number of interactions. Cytokine-loaded exosomes represent another means of intercellular communication that is activated by H. pylori to stimulate inflammation, carcinogenesis, or cancer progression. Cytokine-loaded exosomes are likely to be associated with extragastrointestinal diseases of inflammatory origin.

Changes in the Expression of Insulin Pathway, Neutrophil Elastase and Alpha 1 Antitrypsin Genes from Leukocytes of Young Individuals with Insulin Resistance.

Background: Chronic hyperinsulinemia is a hallmark of insulin resistance that affects a diversity of cells, including leukocytes modifying the expression of some genes involved in insulin signaling. Purpose: The aim of this study was to evaluate how hyperinsulinemia affects the expression of genes involved in the proximal insulin signaling pathway in leukocytes from 45 young individuals grouped: normal weight with not insulin resistance (NIR), with insulin resistance (IR) and with obesity (OB-IR). Methods: qPCR was performed to analyze the expression of insulin receptor (INSR), insulin receptor substrate 1 and 2 (IRS-1 and IRS-2), neutrophil elastase (NE), alpha 1 antitrypsin (A1AT), glucose transporters 1, 3 and 4 (GLUT-1, GLUT-3 and GLUT-4) by the 2-ΔCt method, and the correlation between the genes was determined by Spearman's test. Results: The mRNA expression analysis of all genes between NIR and IR individuals revealed no differences. However, when comparing NIR and IR individuals with OB-IR, an increase in NE and A1AT expression and a clear trend towards a decrease in IRS-2 expression was observed, whereas the comparison of IR and OB-IR showed a decrease in GLUT-3 expression. Overall, the correlation analysis showed that in the IR group there was a positive correlation only between NE with IRS-1 (r = 0.72, p = 0.003), while in the OB-IR group, there was a positive correlation between the NE and A1AT with INSR (r = 0.62, p = 0.01 and r = 0.74, p = 0.002, respectively) and with IRS-2 (r = 0.74, p = 0.002 and r = 0.76, p = 0.001, respectively). Conclusion: These results suggest that hyperinsulinemia and obesity are associated with changes in the expression of genes in leukocytes involved in the insulin pathway that are related to NE and A1AT.

Correlation between dental enamel chemical composition and bracket debonding, comparing adhesive systems through a scanning electron microscope.

Literature reports indicate that during bracket removal there can be enamel damage. We compare the shear bond strength (SBS) and tooth enamel loss of four adhesive systems and identify the Ca/P ratio. Then a total of 20 premolars were divided into four groups of five each. After prophylaxis, photographs were taken at 35× with a scanning electron microscope (SEM) and analyzed with X-ray spectroscopy (EDS) at 250×. Brackets were bonded with Transbond™ MIP(G1), Transbond™ PLUS SEP(G2), Enlight(G3) and Stylus®(G4) adhesives, 24 h after were debonded with a Instron universal testing machine at 1 mm/min. All the brackets were photographed with the SEM. The amount of lost enamel was measured with AutoCad. All the results were measured with a significance level p < .05. The SBS general average at debonding was 7.94 ± 2.26 MPa, meanwhile the SBS for G1, G2, G3 and G4 was 9.38 ± 1.46, 6.28 ± 0.69, 9.08 ± 2.45 and 7.04 ± 2.64 MPa respectively. 90% of the samples had no enamel loss, 10% had enamel loss. Only two samples in G1 presented an enamel loss area of 0.34mm2 and 0.80mm2 respectively. From EDS analysis, the Ca/P ratio was 1.6 ± 0.05, 1.61 ± 0.03, 1.64 ± 0.83 and 1.59 ± 0.07 for G1, G2, G3 and G4 respectively; no statistically significant differences were found. We conclude that no association was found between the Ca/P ratio and enamel damage when brackets are removed. HIGHLIGHTS: Where enamel is lost, we observe fractures, steps, horizontal and vertical enamel loss. There is a loss of tooth enamel from 0.34 to 0.80 mm2 with Transbond PLUS SEP. Structural loss of enamel is almost inevitable during the separation of the bracket.

The regulatory role of insulin in energy metabolism and leukocyte functions.

Insulin is the hormone responsible for maintaining glucose homeostasis in the body, in addition to participating in lipid metabolism, protein synthesis, and the inhibition of gluconeogenesis. These functions are well characterized in the classic organ target cells that are responsible for general energy regulation: the liver, skeletal muscle, and adipose tissue. However, these actions are not restricted to these tissues because insulin has been shown to affect most cells in the body. This review describes the role of insulin in leukocyte signaling pathways, metabolism and functions, and how insulin resistance could affect this signaling and deteriorate leukocyte metabolism and function, in addition to showing evidence that suggests leukocytes may substantially contribute to the development of systemic insulin resistance.

Masa vesicular hallazgo ecográfico / Vesicular mass ecographic find

Objetivos: Presentar una resección quirúrgica R0, con fines curativos de un cáncer de vesícula biliar estadio 1B. Caso Clínico: Femenina de 60 años de edad, sin antecedentes de relevancia, que presenta por estudios complementarios alta sospecha de cáncer de vesícula biliar (T2N0Mx), se realiza laparotomía exploradora con colecistectomía convencional, bisegmentectomía 4 b y 5 del hígado y vaciamiento ganglionar. Sin complicaciones con alta sanatorial al 4 día post operatorio. Conclusión: El diagnostico precoz y una cirugía temprana en el cáncer de vesicula biliar puede ser una herramienta fundamental para poder ofrecer al paciente una cirugía curativa en este tipo de patología

Objects: This paper introduces an R0 surgical resection in the treatment of stage 1B gallbladder cancer. Discussion: 60-year female patient without medical history with highly suspect gallbladder cancer (T2N0Mx), revealed by clinical exams. The patient underwent an exploratory laparotomy, a conventional cholecystectomy, a double segmentectomy for 4b-5 liver, and the lymph node was removed. Complications were not reported, and the patient was discharged four days after surgery. Conclusion: Early diagnosis and early surgery on gallbladder cancer patients may prove essential to cure such pathology

Development and Validation of a Safety Scale Perceived by the Witness of Prehospital Emergency Care.

OBJECTIVE: The aim of the study was to design and validate a new tool to measure the security perceived by witnesses of patient care and hospital transfers, after requesting urgent assistance via the "061" phone number. METHODS: This is a descriptive observational, cross-sectional, design, and validation study of a scale conducted by telephone interview. Witnesses of urgent assistance and transfers by prehospital emergency medical services in the province of Cadiz, in the south of Spain, were the subjects of study. A questionnaire was designed after focus groups with patients, witnesses, and professionals. It consisted of 10 items, with Likert-type answers, and a range of 0 to 50 points. In addition to basic criteria (frequency of endorsement and ability to discriminate between groups), their validity (content and construct) and reliability (stability and homogeneity) were evaluated. Stability was evaluated by test-retest and homogeneity by means of two properties: internal consistency of items (corrected item-scale correlation coefficient) and internal consistency of the scale (Cronbach α coefficient). RESULTS: A total of 849 questionnaires were obtained, with scores between 0 and 50 points, with an average of 47.31 (median of 50). The exploratory factor analysis detected a component that explained 61.1% of the total variance. The intraclass correlation coefficient was 0.933 with 95% confidence interval between 0.900 and 0.954. The corrected item-scale correlation coefficient was greater than 0.596, and the Cronbach α coefficient was 0.927 (95% confidence interval, 0.919-0.934). CONCLUSIONS: The ESPT10 Witness Perceived Safety Scale is valid and reliable for quantifying the safety perception of witnesses of emergency assistance and transfers.

Evaluation of enamel loss by scanning electron microscopy after debonding brackets place with four different adhesives.

The clinically adequate shear bond strengths (SBS) should be from 2.8 to 10 MPa. The aim of this research is to observe tooth enamel loss through a scanning electron microscope (SEM) during the debonding of braces of four adhesive systems. Then, 100 premolars were used in 4 groups of 25 specimens each, for Transbond MIP (G1), Enlight (G2), Stylus (G3), and Transbond Plus SEP (G4). The research was done under the NOM ISO/TS 11405:2015. Gemini 3M were placed under the manufacturer's recommendations. The SBS test was done at 24 hr in an Instron electromechanical universal testing machine at 1 mm/1 min. Adhesive remnant index (ARI) was measured, all of the brackets where examined in the SEM. For the shear bonding strength G1 = 10.09 ± 2.73 MPa, G2 = 9.27 ± 3.99 MPa, G3 = 7.83 ± 4.46 MPa, and G4 = 6.40 ± 2.85 MPa statistically significant differences were found when comparing the four groups (p = .002). In the Tukey post hoc test, G1 versus G4 and G2 versus G4, statistically significant differences were found. For the ARI a value of 1 in 46%, followed by a value of 2 in 38%, a value of 3 in 13% and a value of 0 in 3% of the total samples, finding statistically significant differences (p < .001). In relation to the tooth enamel loss due to SBS, statistically significant differences were found (p = .326). G1 and G4 had not statistically significant differences. Even though our results concur with the appropriate clinical values, we observed tooth enamel loss with Transbond Plus SEP and Stylus.

Reflexiones sobre la ética de la investigación en Colombia / Reflections on Ethics of Research in Colombia

Resumen Se reflexiona en torno al diseño normativo que regula la investigación en Colombia y las prácticas de los investigadores desde un enfoque ético, abordando asuntos pro blemáticos en las ciencias de la salud, las ciencias sociales y las disciplinas ambien tales, para concluir que se necesita fortalecer el control del Estado en estos temas, la actualización de la normatividad y una mayor formación de los investigadores y miembros de Comités de Ética en investigación, especialmente en: la protección de los participantes, el cuidado de los animales, los conflictos de interés, el manejo de comunidades y de grupos vulnerables, los protocolos comunitarios, el consentimien to informado, la consulta previa, el cuidado de la biodiversidad y el acceso a recursos genéticos.

Abstract This paper reflects on the normative design, which regulates research in Colombia and the practices of researchers from an ethical approach, by addressing critical issues in the health sciences, social sciences, and environmental disciplines, to conclude that it is necessary to strengthen state control in these issues, the updating of the regulations and greater training of researchers and members of Ethics Committees in research , especially in the protection of participants, animal care, conflicts of interest, the management of communities, and vulnerable groups, community pro tocols, informed consent, prior consultation, biodiversity care, and access to genetic resources.

Concordancia interevaluador en la elección de tratamiento profiláctico para la migraña vestibular y papel de un algoritmo asistido para la elección de dicho tratamiento / Inter-rater agreement in the choice of prophylactic treatment for vestibular migraine and role of an assisted algorithm for this choice

ANTECEDENTES Y OBJETIVO: La migraña vestibular (MV) es una de las causas de síndrome vestibular episódico. Existen muchos fármacos disponibles para su profilaxis y actualmente su elección se realiza mayoritariamente según las comorbilidades del paciente. El objetivo de este artículo es medir la concordancia de un grupo de otorrinolaringólogos en la elección de profilaxis y evaluar el papel que ejerce sobre esta un algoritmo asistido para la elección de profilaxis. MATERIAL Y MÉTODO: Las historias clínicas de 10 pacientes con MV fueron ofrecidas a 10 otorrinolaringólogos, a los que se les pidió que seleccionasen para cada paciente el fármaco que considerasen más adecuado entre 5 opciones posibles. Se calcularon los índices κ de Fleiss entre los 10 otorrinolaringólogos solos y se recalcularon incluyendo al algoritmo como undécimoevaluador, y la κ de Cohen entre cada otorrinolaringólogo y el algoritmo. Se ofreció a los otorrinolaringólogos la opción de cambiar su respuesta tras conocer la respuesta del algoritmo, y ambos índices fueron calculados nuevamente. RESULTADOS: El índice κ de Fleiss fue de 0,302. Dicho índice se elevó a 0,343 tras introducir al algoritmo como evaluador. Tras ofrecer las soluciones propuestas por el algoritmo, se mejoró la κ de Cohen en 9 de los 10 evaluadores y la κ de Fleiss subió a 0,711. CONCLUSIONES: La concordancia entre otorrinolaringólogos para elegir profilaxis para la MV se define como «justa». Las respuestas del algoritmo para la elección de profilaxis se situaron próximas a la opinión media de los otorrinolaringólogos, elevando la concordancia entre ellos a «sustancial»

BACKGROUND AND OBJECTIVE: Vestibular migraine (VM) is a cause of episodic vestibular syndrome. There are many drugs available for its prophylaxis and currently the choice is mainly made according to the patient's comorbidities. The aim of this article was to measure the agreement of a group of otorhinolaryngologists in the choice of a prophylactic treatment and to evaluate the role of an assisted algorithm in the choice of this prophylaxis. MATERIAL AND METHOD: The medical records of 10 patients with VM were offered to 10 otolaryngologists who were asked to select for each patient the drug they considered most appropriate among five possible options. The Fleiss' κ index was calculated among the 10 otolaryngologists alone, recalculating it including the algorithm as the eleventh evaluator, and Cohen's κ index was calculated between each otolaryngologist and the answers of the algorithm. The otolaryngologists were offered the option to change their responses after knowing the responses of the algorithm and then both indexes were calculated again. RESULTS: The Fleiss' κ index was .302. This index was raised to .343 after introducing the algorithm as an evaluator. After offering the responses proposed by the algorithm, Cohen's κ was improved in 9 of the 10 evaluators, and Fleiss' κ rose to .711. CONCLUSIONS: The agreement between otorhinolaryngologists in choosing prophylaxis for MV can be defined as "fair". The responses of the algorithm for the choice of prophylaxis were close to the average opinion of the otolaryngologists, raising the agreement between them to "substantial"