Efficacy of radiofrequency in lumbar facet joint pain: a systematic review and meta-analysis of placebo-controlled randomized controlled trials.

BACKGROUND: Lumbar facet joint pain (LFJP) is one of the main causes of chronic low back pain (LBP) and can be treated using radiofrequency (RF) sensory denervation. The aim of this work is to analyze the efficacy of RF in LFJP through a systematic review and meta-analysis of randomized controlled trials (RCTs) with placebo control. MATERIALS AND METHODS: A systematic search was conducted in the Medline (PubMed), Scopus, Web of Science databases, and the Cochrane Central Register of Controlled Trials (CENTRAL). The variables of interest were pain, functional status, quality of life (QoL), and global perceived effect (GPE) measured at different time intervals: short (< 3 months), medium (> 3 and < 12 months), and long term (> 12 months). RESULTS: Eight RCTs with placebo control were included. RF showed significant benefits over placebo in pain relief in the short (MD - 1.01; 95% CI - 1.98 to -0.04; p = 0.04), medium (MD - 1.42; 95% CI - 2.41 to - 0.43; p = 0.005), and long term (MD - 1.12; 95% CI - 1.57 to - 0.68; p < 0.001), as well as improvement in functional disability in the short (SMD - 0.94; 95% CI - 1.73 to - 0.14; p = 0.02) and long term (SMD - 0.74; 95% CI - 1.09 to - 0.39; p < 0.001). No statistically significant differences were observed in QoL or quantitative GPE, but benefits for RF were observed in dichotomous GPE in the medium (OR 0.19; 95% CI 0.07-0.52; p = 0.001) and long term (OR 0.22; 95% CI 0.06-0.78; p = 0.02). Subgroup analyses showed more benefits for RF in LBP < 1 year in the short term and in RCTs that did not require performing an MRI for patient selection. CONCLUSIONS: RF demonstrated significant improvement in pain and functionality, but the benefits in terms of QoL and GPE are inconclusive. Future clinical trials should investigate the long-term effects of RF, its impact on quality of life, and define appropriate criteria for patient selection.

Debilidad pulmonar asociada a COVID-19 (DPAC): revisión sistemática y metaanálisis / COVID-19-associated lung weakness (CALW): Systematic review and meta-analysis

Objetivo: Evaluar la mortalidad y diversos factores clínicos derivados del desarrollo de neumotórax (NTX) y/o neumomediastino (NMD) atraumáticos en pacientes críticos como consecuencia de la debilidad pulmonar asociada a la COVID-19 (DPAC). Diseño: Revisión sistemática con metaanálisis. Ámbito: Unidad de cuidados intensivos (UCI). Participantes: Investigaciones originales en las que se evaluase a pacientes, con o sin necesidad de ventilación mecánica invasiva (VMI), con diagnóstico de COVID-19 que hubiesen desarrollado NTX o NMD atraumáticos al ingreso o durante su estancia hospitalaria. Intervenciones: Se obtuvieron los datos de interés de cada artículo que fueron analizados y evaluados por la Escala Newcastle-Ottawa. El riesgo de las variables de interés principales se evaluó por los datos derivados de los estudios que incluyeron a pacientes que desarrollaron NTX o NMD atraumáticos. Variables de interés principales: Mortalidad, estancia media en la UCI y PaO2/FiO2 media en el momento diagnóstico. Resultados: Se recogieron datos de 12 estudios longitudinales. En el metaanálisis se incluyeron datos de un total de 4.901 pacientes, entre los cuales 1.629 presentaron un episodio de NTX y 253 de NMD atraumáticos. A pesar de encontrar asociaciones significativamente fuertes, la alta heterogeneidad entre los estudios hace que la interpretación de los resultados deba hacerse con cautela. Conclusiones: La mortalidad de los pacientes con COVID-19 fue mayor en los que desarrollaron NTX y/o NMD atraumáticos con respecto a los que no lo hicieron. La media del índice PaO2/FiO2 fue menor en los pacientes que desarrollaron NTX y/o NMD atraumáticos. Proponemos agrupar bajo el término DPAC estos casos. (AU)

Objectives: To assess mortality and different clinical factors derived from the development of atraumatic pneumothorax (PNX) and/or pneumomediastinum (PNMD) in critically ill patients as a consequence of COVID-19-associated lung weakness (CALW). Design: Systematic review with meta-analysis. Setting: Intensive care unit (ICU). Participants: Original research evaluating patients, with or without the need for protective invasive mechanical ventilation (IMV), with a diagnosis of COVID-19 who had developed atraumatic PNX or PNMD on admission or during their hospital stay. Interventions: Data of interest were obtained from each article and analysed and assessed by the Newcastle-Ottawa Scale. The risk of the variables of interest was assessed by data derived from studies including patients who developed atraumatic PNX or PNMD. Main variables of interest: Mortality, mean ICU length of stay and mean PaO2/FiO2 at diagnosis. Results: Data were collected from 12 longitudinal studies. Data from a total of 4,901 patients were included in the meta-analysis. A total of 1,629 patients had an episode of atraumatic PNX and 253 patients had an episode of atraumatic PNMD. Despite finding significantly strong associations, the high heterogeneity between studies means that interpretation of the results should be made with caution. Conclusions: Mortality of COVID-19 patients was higher in those who developed atraumatic PNX and/or PNMD compared to those who did not. The mean PaO2/FiO2 index was lower in patients who developed atraumatic PNX and/or PNMD. We propose to group these cases under the term CAPD. (AU)

Osmolytes Modulate Photoactivation of Phytochrome: Probing Protein Hydration.

Phytochromes are bistable red/far-red light-responsive photoreceptor proteins found in plants, fungi, and bacteria. Light-activation of the prototypical phytochrome Cph1 from the cyanobacterium Synechocystis sp. PCC 6803 allows photoisomerization of the bilin chromophore in the photosensory module and a subsequent series of intermediate states leading from the red absorbing Pr to the far-red-absorbing Pfr state. We show here via osmotic and hydrostatic pressure-based measurements that hydration of the photoreceptor modulates the photoconversion kinetics in a controlled manner. While small osmolytes like sucrose accelerate Pfr formation, large polymer osmolytes like PEG 4000 delay the formation of Pfr. Thus, we hypothesize that an influx of mobile water into the photosensory domain is necessary for proceeding to the Pfr state. We suggest that protein hydration changes are a molecular event that occurs during photoconversion to Pfr, in addition to light activation, ultrafast electric field changes, photoisomerization, proton release and uptake, and the major conformational change leading to signal transmission, or simultaneously with one of these events. Moreover, we discuss this finding in light of the use of Cph1-PGP as a hydration sensor, e.g., for the characterization of novel hydrogel biomaterials.

COVID-19-associated lung weakness (CALW): Systematic review and meta-analysis.

OBJECTIVES: To assess mortality and different clinical factors derived from the development of atraumatic pneumothorax (PNX) and/or pneumomediastinum (PNMD) in critically ill patients as a consequence of COVID-19-associated lung weakness (CALW). DESIGN: Systematic review with meta-analysis. SETTING: Intensive Care Unit (ICU). PARTICIPANTS: Original research evaluating patients, with or without the need for protective invasive mechanical ventilation (IMV), with a diagnosis of COVID-19, who developed atraumatic PNX or PNMD on admission or during hospital stay. INTERVENTIONS: Data of interest were obtained from each article and analyzed and assessed by the Newcastle-Ottawa Scale. The risk of the variables of interest was assessed with data derived from studies including patients who developed atraumatic PNX or PNMD. MAIN VARIABLES OF INTEREST: Mortality, mean ICU stay and mean PaO2/FiO2 at diagnosis. RESULTS: Information was collected from 12 longitudinal studies. Data from a total of 4901 patients were included in the meta-analysis. A total of 1629 patients had an episode of atraumatic PNX and 253 patients had an episode of atraumatic PNMD. Despite the finding of significantly strong associations, the great heterogeneity between studies implies that the interpretation of results should be made with caution. CONCLUSIONS: Mortality among COVID-19 patients was higher in those who developed atraumatic PNX and/or PNMD compared to those who did not. The mean PaO2/FiO2 index was lower in patients who developed atraumatic PNX and/or PNMD. We propose grouping these cases under the term COVID-19-associated lung weakness (CALW).

[COVID-19-associated lung weakness (CALW): Systematic review and meta-analysis]. / Debilidad pulmonar asociada a COVID-19 (DPAC): revisión sistemática y metaanálisis.

Objectives: To assess mortality and different clinical factors derived from the development of atraumatic pneumothorax (PNX) and/or pneumomediastinum (PNMD) in critically ill patients as a consequence of COVID-19-associated lung weakness (CALW). Design: Systematic review with meta-analysis. Setting: Intensive care unit (ICU). Participants: Original research evaluating patients, with or without the need for protective invasive mechanical ventilation (IMV), with a diagnosis of COVID-19 who had developed atraumatic PNX or PNMD on admission or during their hospital stay. Interventions: Data of interest were obtained from each article and analysed and assessed by the Newcastle-Ottawa Scale. The risk of the variables of interest was assessed by data derived from studies including patients who developed atraumatic PNX or PNMD. Main variables of interest: Mortality, mean ICU length of stay and mean PaO2/FiO2 at diagnosis. Results: Data were collected from 12 longitudinal studies. Data from a total of 4,901 patients were included in the meta-analysis. A total of 1,629 patients had an episode of atraumatic PNX and 253 patients had an episode of atraumatic PNMD. Despite finding significantly strong associations, the high heterogeneity between studies means that interpretation of the results should be made with caution. Conclusions: Mortality of COVID-19 patients was higher in those who developed atraumatic PNX and/or PNMD compared to those who did not. The mean PaO2/FiO2 index was lower in patients who developed atraumatic PNX and/or PNMD. We propose to group these cases under the term CAPD.

[Impact of the HEARTS Initiative in a second-level health institution in ColombiaImpacto da iniciativa HEARTS em um estabelecimento de atenção secundária à saúde na Colômbia]. / Impacto de la Iniciativa HEARTS en una institución de salud de segundo nivel en Colombia.

Objective: To identify the impact of the HEARTS initiative on patients with high blood pressure treated in a Colombian hospital. Methods: Quasi-experimental, retrospective study between 2017 and 2019 with hypertensive patients over 18 years of age included in the HEARTS strategy and treated at the Santa Mónica Hospital in the municipality of Dosquebradas, department of Risaralda. The unit of analysis was medical history. Blood pressure targets (defined in the HEARTS initiative as a patient with systolic blood pressure <140 mmHg and diastolic pressure <90 mmHg) were assessed at the time of admission to the HEARTS program and one year later. Sociodemographic, pharmacological, clinical, and blood pressure targets were included, as was compliance with the recommendations of the initiative. Descriptive analysis was performed, and binary logistic regression was applied (p <0.05). Results: A total of 372 patients were studied, of whom 262 were women (70.4%). The mean age was 66.3 ± 12.2 years. In the first consultation, 285 patients (76.6%) presented blood pressure figures within the target range; in the second consultation this was achieved by 84.1% of patients (n=313, mean difference: 7.5%, 95% CI: 1.8 to 13.1; p=0.005). After implementation of the HEARTS initiative, 77.4% of patients (n=288) continued with the initial treatment. Following HEARTS recommendations increases the likelihood of being in the target range (p=0.033; OR= 2,688; CI= 1.081 - 6.684). Conclusions: Implementation of the HEARTS initiative favorably impacted blood pressure figures in patients with hypertension and decreased cardiovascular risk.

Objetivo: Identificar o impacto da iniciativa HEARTS nos pacientes com hipertensão arterial atendidos em um hospital colombiano. Métodos: Estudo quase-experimental, retrospectivo entre 2017 e 2019, com pacientes hipertensos maiores de 18 anos incluídos na estratégia HEARTS, atendidos no Hospital Santa Mónica do município de Dosquebradas, departamento de Risaralda. A unidade de análise foi a história clínica. As metas de pressão arterial (definidas na iniciativa HEARTS como pressão arterial sistólica <140 mmHg e pressão diastólica <90 mmHg) foram avaliadas no momento de ingresso no programa HEARTS e um ano depois. Foram incluídas variáveis sociodemográficas, farmacológicas, clínicas, metas de pressão arterial e adesão à iniciativa. Foram realizadas análises descritivas e foi aplicada a regressão logística binária (p<0,05). Resultados: Foram analisados 372 pacientes, dos quais 262 eram mulheres (70,4%). A média de idade foi de 66,3 ± 12,2 anos. Na primeira consulta de controle, 285 pacientes (76,6%) apresentaram valores de pressão arterial dentro das metas; na segunda consulta, as metas haviam sido alcançadas por 84,1% dos pacientes (n=313 diferença média: 7,5%, IC95%: 1,8 a 13,1, p=0,005). Após a implementação da iniciativa HEARTS, 77,4% dos pacientes (n=288) continuaram com o manejo inicial. O cumprimento das recomendações da HEARTS aumenta a probabilidade de estar nas metas (p=0,033; OR= 2,688; IC= 1,081 - 6,684). Conclusões: A implementação da iniciativa HEARTS teve um impacto favorável nos valores da pressão arterial em pacientes com hipertensão e diminuiu o risco cardiovascular.

Impacto de la Iniciativa HEARTS en una institución de salud de segundo nivel en Colombia

[RESUMEN]. Objetivo. Identificar el impacto de la iniciativa HEARTS en los pacientes con hipertensión arterial atendidos en un hospital colombiano. Métodos. Estudio cuasiexperimental, retrospectivo entre 2017 y 2019 con pacientes hipertensos mayores de 18 años, incluidos en la estrategia HEARTS, atendidos en el Hospital Santa Mónica del municipio de Dosquebradas, departamento de Risaralda. La unidad de análisis fue la historia clínica. Se evaluaron las metas de presión arterial (definido en la Iniciativa HEARTS como un paciente con presión arterial sistólica <140 mmHg y <90 mmHg en la presión diastólica) al momento del ingreso al programa HEARTS y un año después. Se incluyeron variables sociodemográficas, farmacológicas, clínicas, metas de presión arterial y cumplimiento de la iniciativa. Se realizaron análisis descriptivos y se aplicó regresión logística binaria (p <0.05). Resultados. Se analizaron 372 pacientes de los cuales 262 eran mujeres (70,4%). La edad media fue de 66,3 ± 12,2 años. En la primera consulta de control se reportaron 285 pacientes (76,6%) que presentaron cifras de tensión arterial en metas, en la segunda consulta este logro fue alcanzado por el 84,1% de los pacientes (n=313 diferencia media: 7,5%, IC95%: 1,8 a 13,1; p=0,005). Después de la implementación de la Iniciativa HEARTS el 77,4% en los pacientes (n=288) continuaron con el manejo inicial. Cumplir las recomendaciones HEARTS aumenta la probabilidad de estar en las metas (p=0,033; OR= 2,688; IC= 1,081 - 6,684). Conclusiones. La implementación de la Iniciativa HEARTS impactó favorablemente las cifras de tensión arterial en pacientes con hipertensión, con beneficios adicionales en variables que disminuyen el riesgo cardiovascular.

[ABSTRACT]. Objective. To identify the impact of the HEARTS initiative on patients with high blood pressure treated in a Colombian hospital. Methods. Quasi-experimental, retrospective study between 2017 and 2019 with hypertensive patients over 18 years of age included in the HEARTS strategy and treated at the Santa Mónica Hospital in the municipality of Dosquebradas, department of Risaralda. The unit of analysis was medical history. Blood pressure targets (defined in the HEARTS initiative as a patient with systolic blood pressure <140 mmHg and diastolic pressure <90 mmHg) were assessed at the time of admission to the HEARTS program and one year later. Sociodemographic, pharmacological, clinical, and blood pressure targets were included, as was compliance with the recommendations of the initiative. Descriptive analysis was performed, and binary logistic regression was applied (p <0.05). Results. A total of 372 patients were studied, of whom 262 were women (70.4%). The mean age was 66.3 ± 12.2 years. In the first consultation, 285 patients (76.6%) presented blood pressure figures within the target range; in the second consultation this was achieved by 84.1% of patients (n=313, mean difference: 7.5%, 95% CI: 1.8 to 13.1; p=0.005). After implementation of the HEARTS initiative, 77.4% of patients (n=288) continued with the initial treatment. Following HEARTS recommendations increases the likelihood of being in the target range (p=0.033; OR= 2,688; CI= 1.081 - 6.684). Conclusions. Implementation of the HEARTS initiative favorably impacted blood pressure figures in patients with hypertension and decreased cardiovascular risk.

[RESUMO]. Objetivo. Identificar o impacto da iniciativa HEARTS nos pacientes com hipertensão arterial atendidos em um hospital colombiano. Métodos. Estudo quase-experimental, retrospectivo entre 2017 e 2019, com pacientes hipertensos maiores de 18 anos incluídos na estratégia HEARTS, atendidos no Hospital Santa Mónica do município de Dosquebradas, departamento de Risaralda. A unidade de análise foi a história clínica. As metas de pressão arterial (definidas na iniciativa HEARTS como pressão arterial sistólica <140 mmHg e pressão diastólica <90 mmHg) foram avaliadas no momento de ingresso no programa HEARTS e um ano depois. Foram incluídas variáveis sociodemográficas, farmacológicas, clínicas, metas de pressão arterial e adesão à iniciativa. Foram realizadas análises descritivas e foi aplicada a regressão logística binária (p<0,05). Resultados. Foram analisados 372 pacientes, dos quais 262 eram mulheres (70,4%). A média de idade foi de 66,3 ± 12,2 anos. Na primeira consulta de controle, 285 pacientes (76,6%) apresentaram valores de pressão arterial dentro das metas; na segunda consulta, as metas haviam sido alcançadas por 84,1% dos pacientes (n=313 diferença média: 7,5%, IC95%: 1,8 a 13,1, p=0,005). Após a implementação da iniciativa HEARTS, 77,4% dos pacientes (n=288) continuaram com o manejo inicial. O cumprimento das recomendações da HEARTS aumenta a probabilidade de estar nas metas (p=0,033; OR= 2,688; IC= 1,081 - 6,684). Conclusões. A implementação da iniciativa HEARTS teve um impacto favorável nos valores da pressão arterial em pacientes com hipertensão e diminuiu o risco cardiovascular.

Escala de movilidad ProMover. Un lenguaje unificado para la evaluación de pacientes hospitalizados / ProMover mobility scale. A unified language for the evaluation of hospitalized patients

Resumen La Clasificación Internacional del Funcionamiento (CIF) define la movilidad como la posibilidad de "moverse cambiando la posición o ubicación del cuerpo o moviéndose de un lugar a otro, trans portando, moviendo o manipulando objetos, caminando, corriendo o trepando, y utilizando diversas formas de transporte". La fisioterapia se centra en la evaluación y el tratamiento de los problemas de movimiento. La deter minación del estado de movilidad es un componente central de la evaluación de la salud de los adultos mayores, ya que es un marcador importante de las capacidades físicas y la independencia, y un predictor de morbilidad y mortalidad. Sin embargo, a la fecha no disponemos de escalas que representen el grado de movilidad del paciente con algún tipo de imagen visual que facilite su documentación de forma rápida y fiable por parte de cualquier profesional sanitario que trabaje en el ámbito de la hospitalización. Por estas razones, desarrollamos una escala de movilidad intuitiva basada en iconos que es fácil de administrar en pacientes hospitalizados en diferentes entornos. La escala de movilidad ProMover proporciona a los profesionales de la salud una herramienta unificada para evaluar la movilidad de los pacientes hospitalizados, con el fin de unificar un lenguaje común. Se trata de una herramienta sencilla, práctica, fiable y objetiva y de uso común por todos los profesionales sanitarios.

Abstract. The International Classification of Functionality (CIF) defines mobility as the possibility of "moving by changing the position or location of the body or moving from one place to another, transporting, moving or manipulating objects, walking, running or climbing, and using various forms of transport ". Physical therapy focuses on the assessment and management of movement problems. Determining mobility status is a central component of the health assessment of older adults since it is an important marker of physical abilities and independence, and a predictor of morbidity and mortality. However, to date we did not have scales that represent the degree of mobility of the patient with some type of visual image that facilitates its documentation quickly and reliably by any health professional who works in the field of hospitalization. For these reasons, we developed an intuitive, icon-based mobility scale that is easy to administer in hospitalized patients in different settings. The ProMover mobility scale provides health professionals with a unified tool for evaluating the mobility of hospitalized patients, in order to unify a common language. This is a simple, practical, reliable and objective tool and commonly used by all health professionals.

[ProMover mobility scale. A unified language for the evaluation of hospitalized patients]. / Escala de movilidad ProMover. Un lenguaje unificado para la evaluación de pacientes hospitalizados.

The International Classification of Functionality (CIF) defines mobility as the possibility of "moving by changing the position or location of the body or moving from one place to another, transporting, moving or manipulating objects, walking, running or climbing, and using various forms of transport". Physical therapy focuses on the assessment and management of movement problems. Determining mobility status is a central component of the health assessment of older adults since it is an important marker of physical abilities and independence, and a predictor of morbidity and mortality. However, to date we did not have scales that represent the degree of mobility of the patient with some type of visual image that facilitates its documentation quickly and reliably by any health professional who works in the field of hospitalization. For these reasons, we developed an intuitive, icon-based mobility scale that is easy to administer in hospitalized patients in different settings. The ProMover mobility scale provides health professionals with a unified tool for evaluating the mobility of hospitalized patients, in order to unify a common language. This is a simple, practical, reliable and objective tool and commonly used by all health professionals.

La Clasificación Internacional del Funcionamiento (CIF) define la movilidad como la posibilidad de "moverse cambiando la posición o ubicación del cuerpo o moviéndose de un lugar a otro, transportando, moviendo o manipulando objetos, caminando, corriendo o trepando, y utilizando diversas formas de transporte". La fisioterapia se centra en la evaluación y el tratamiento de los problemas de movimiento. La determinación del estado de movilidad es un componente central de la evaluación de la salud de los adultos mayores, ya que es un marcador importante de las capacidades físicas y la independencia, y un predictor de morbilidad y mortalidad. Sin embargo, a la fecha no disponemos de escalas que representen el grado de movilidad del paciente con algún tipo de imagen visual que facilite su documentación de forma rápida y fiable por parte de cualquier profesional sanitario que trabaje en el ámbito de la hospitalización. Por estas razones, desarrollamos una escala de movilidad intuitiva basada en iconos que es fácil de administrar en pacientes hospitalizados en diferentes entornos. La escala de movilidad ProMover proporciona a los profesionales de la salud una herramienta unificada para evaluar la movilidad de los pacientes hospitalizados, con el fin de unificar un lenguaje común. Se trata de una herramienta sencilla, práctica, fiable y objetiva y de uso común por todos los profesionales sanitarios.

Recommendations for the diagnosis and management of persons with suspected vaccine-induced immune thrombotic thrombocytopenia (VITT) / Recomendaciones para diagnostico y manejo de personas con trombocitopenia trombotica inmune inducida por vacunas (VITT)

Abstract In recent months, rare cases of thrombosis at unusual sites associated with thrombocytopenia, occurring within a typical risk window (i.e., 4-28 days) after receiving SARS CoV2 vaccines, have been reported. Healthcare professionals should be prepared to detect these cases on time. The Expert Panel of the Knowledge Management and Transfer Network conducted a free search of the related literature. With the available information and the clinical expertise of the working group, we formulated, reviewed, and endorsed recommendations for the timely suspicion, diagnosis (case definitions, the use of initial laboratory and imaging tests, specific tests), and management of these thrombotic conditions. This document is considered a living document that will be updated as new evidence emerges, and recommendations may change over time.

Resumen En meses recientes se han reportado casos raros de trombocitopenia y trombosis en sitios inusuales, que ocurren dentro de una ventana de riesgo típica ( por ejemplo de 4 a 28 días) luego de recibir vacunas de SARS CoV 2. Los profesionales de la salud deben estar preparados para detectar estos casos a tiempo. Un panel de expertos y una red de transferencia de conocimiento realizó una búsqueda libre de literatura seleccionada. Con la información disponible y la experticia clínica del grupo de trabajo revisamos y dimos recomendaciones para la sospecha temprana, el diagnostico (definición de caso, el uso de pruebas de laboratorio especificas y de imágenes diagnósticas) para le manejo de estas condiciones tromboticas. Este documento es considerado un documento vivo que debe ser actualizado a medida que surja nueva evidencia y las recomendaciones vayan cambiando con el tiempo

Preclinical investigation of ß-caryophyllene as a therapeutic agent in an experimental murine model of Dravet syndrome.

Dravet Syndrome (DS) is caused by mutations in the Scn1a gene encoding the α1 subunit of the sodium channel Nav1.1, which results in febrile seizures that progress to severe tonic-clonic seizures and associated comorbidities. Treatment with cannabidiol has been approved for the management of seizures in DS patients, but it appears to be also active against associated comorbidities. In this new study, we have investigated ß-caryophyllene (BCP), a cannabinoid with terpene structure that appears to also have a broad-spectrum profile, as a useful therapy against both seizuring activity and progression of associated comorbidities. This has been studied in heterozygous conditional knock-in mice carrying a missense mutation (A1783V) in Scn1a gene expressed exclusively in neurons of the Central Nervous System (Syn-Cre/Scn1aWT/A1783V), using two experimental approaches. In the first approach, an acute treatment with BCP was effective against seizuring activity induced by pentylenetetrazole (PTZ) in wildtype (Scn1aWT/WT) and also in Syn-Cre/Scn1aWT/A1783V mice, with these last animals having a greater susceptibility to PTZ. Such benefits were paralleled by a BCP-induced reduction in PTZ-induced reactive astrogliosis (labelled with GFAP) and microgliosis (labelled with Iba-1) in the prefrontal cortex and the hippocampal dentate gyrus, which were visible in both wildtype (Scn1aWT/WT) and Syn-Cre/Scn1aWT/A1783V mice. In the second approach, both genotypes were treated repeatedly with BCP to investigate its effects on several DS comorbidities. Thus, BCP corrected important behavioural abnormalities of Syn-Cre/Scn1aWT/A1783V mice (e.g. delayed appearance of hindlimb grasp reflex, induction of clasping response, motor hyperactivity, altered social interaction and memory impairment), attenuated weight loss, and slightly delayed premature mortality. Again, these benefits were paralleled by a BCP-induced reduction in reactive astrogliosis and microgliosis in the prefrontal cortex and the hippocampal dentate gyrus typical of Syn-Cre/Scn1aWT/A1783V mice. In conclusion, BCP was active in Syn-Cre/Scn1aWT/A1783V mice against seizuring activity (acute treatment) and against several comorbidities (repeated treatment), in both cases in association with its capability to reduce glial reactivity in areas related to these behavioural abnormalities. This situates BCP in a promising position for further preclinical evaluation towards a close translation to DS patients.

Impacto de la Iniciativa HEARTS en una institución de salud de segundo nivel en Colombia / Impact of the HEARTS Initiative in a second-level health institution in Colombia / Impacto da iniciativa HEARTS em um estabelecimento de atenção secundária à saúde na Colômbia

RESUMEN Objetivo. Identificar el impacto de la iniciativa HEARTS en los pacientes con hipertensión arterial atendidos en un hospital colombiano. Métodos. Estudio cuasiexperimental, retrospectivo entre 2017 y 2019 con pacientes hipertensos mayores de 18 años, incluidos en la estrategia HEARTS, atendidos en el Hospital Santa Mónica del municipio de Dosquebradas, departamento de Risaralda. La unidad de análisis fue la historia clínica. Se evaluaron las metas de presión arterial (definido en la Iniciativa HEARTS como un paciente con presión arterial sistólica <140 mmHg y <90 mmHg en la presión diastólica) al momento del ingreso al programa HEARTS y un año después. Se incluyeron variables sociodemográficas, farmacológicas, clínicas, metas de presión arterial y cumplimiento de la iniciativa. Se realizaron análisis descriptivos y se aplicó regresión logística binaria (p <0.05). Resultados. Se analizaron 372 pacientes de los cuales 262 eran mujeres (70,4%). La edad media fue de 66,3 ± 12,2 años. En la primera consulta de control se reportaron 285 pacientes (76,6%) que presentaron cifras de tensión arterial en metas, en la segunda consulta este logro fue alcanzado por el 84,1% de los pacientes (n=313 diferencia media: 7,5%, IC95%: 1,8 a 13,1; p=0,005). Después de la implementación de la Iniciativa HEARTS el 77,4% en los pacientes (n=288) continuaron con el manejo inicial. Cumplir las recomendaciones HEARTS aumenta la probabilidad de estar en las metas (p=0,033; OR= 2,688; IC= 1,081 - 6,684). Conclusiones. La implementación de la Iniciativa HEARTS impactó favorablemente las cifras de tensión arterial en pacientes con hipertensión, con beneficios adicionales en variables que disminuyen el riesgo cardiovascular.

ABSTRACT Objective. To identify the impact of the HEARTS initiative on patients with high blood pressure treated in a Colombian hospital. Methods. Quasi-experimental, retrospective study between 2017 and 2019 with hypertensive patients over 18 years of age included in the HEARTS strategy and treated at the Santa Mónica Hospital in the municipality of Dosquebradas, department of Risaralda. The unit of analysis was medical history. Blood pressure targets (defined in the HEARTS initiative as a patient with systolic blood pressure <140 mmHg and diastolic pressure <90 mmHg) were assessed at the time of admission to the HEARTS program and one year later. Sociodemographic, pharmacological, clinical, and blood pressure targets were included, as was compliance with the recommendations of the initiative. Descriptive analysis was performed, and binary logistic regression was applied (p <0.05). Results. A total of 372 patients were studied, of whom 262 were women (70.4%). The mean age was 66.3 ± 12.2 years. In the first consultation, 285 patients (76.6%) presented blood pressure figures within the target range; in the second consultation this was achieved by 84.1% of patients (n=313, mean difference: 7.5%, 95% CI: 1.8 to 13.1; p=0.005). After implementation of the HEARTS initiative, 77.4% of patients (n=288) continued with the initial treatment. Following HEARTS recommendations increases the likelihood of being in the target range (p=0.033; OR= 2,688; CI= 1.081 - 6.684). Conclusions. Implementation of the HEARTS initiative favorably impacted blood pressure figures in patients with hypertension and decreased cardiovascular risk.

RESUMO Objetivo. Identificar o impacto da iniciativa HEARTS nos pacientes com hipertensão arterial atendidos em um hospital colombiano. Métodos. Estudo quase-experimental, retrospectivo entre 2017 e 2019, com pacientes hipertensos maiores de 18 anos incluídos na estratégia HEARTS, atendidos no Hospital Santa Mónica do município de Dosquebradas, departamento de Risaralda. A unidade de análise foi a história clínica. As metas de pressão arterial (definidas na iniciativa HEARTS como pressão arterial sistólica <140 mmHg e pressão diastólica <90 mmHg) foram avaliadas no momento de ingresso no programa HEARTS e um ano depois. Foram incluídas variáveis sociodemográficas, farmacológicas, clínicas, metas de pressão arterial e adesão à iniciativa. Foram realizadas análises descritivas e foi aplicada a regressão logística binária (p<0,05). Resultados. Foram analisados 372 pacientes, dos quais 262 eram mulheres (70,4%). A média de idade foi de 66,3 ± 12,2 anos. Na primeira consulta de controle, 285 pacientes (76,6%) apresentaram valores de pressão arterial dentro das metas; na segunda consulta, as metas haviam sido alcançadas por 84,1% dos pacientes (n=313 diferença média: 7,5%, IC95%: 1,8 a 13,1, p=0,005). Após a implementação da iniciativa HEARTS, 77,4% dos pacientes (n=288) continuaram com o manejo inicial. O cumprimento das recomendações da HEARTS aumenta a probabilidade de estar nas metas (p=0,033; OR= 2,688; IC= 1,081 - 6,684). Conclusões. A implementação da iniciativa HEARTS teve um impacto favorável nos valores da pressão arterial em pacientes com hipertensão e diminuiu o risco cardiovascular.

Trends of vasopressor use in intensive care units in Colombia / Tendencias de consumo de vasopresores en unidades de cuidados intensivos de Colombia

Abstract Introduction Vasopressors are essential in the management of various types of shock. Objective To establish the trend of vasopressors use in the intensive care units (ICU) in a population of patients affiliated with the Colombian Health System, 2010-2017. Methods Observational trial using a population database of patients hospitalized in eleven ICUs in various cities in Colombia. The drugs dispensed to hospitalized patients over 18 years old, from January 2010 until December 2017 were considered. A review and analysis of the vasopressors dispensed per month was conducted, taking into account sociodemographic and pharmacological variables (vasopressor used and daily doses defined per 100/beds/day (DBD). Results 81,348 dispensations of vasopressors, equivalent to 26,414 treatments in 19,186 patients receiving care in 11 hospitals from 7 cities were reviewed. The mean age of patients was 66.3±18.1 years and 52.6 % were males. Of the total number of treatments recorded, 17,658 (66.8 %) were with just one vasopressor. Norepinephrine was the most frequently prescribed drug (75.9 % of the prescriptions dispensed; 60.5 DBD), followed by adrenaline (26.6 %; 41.6 DBD), dopamine (19.4%), dobutamine (16.0 %), vasopressin (8.5 %) and phenylephrine (0.9 %). The use of norepinephrine increased from 2010 to 2017 (+6.19 DBD), whilst the use of other drugs decreased, particularly the use of adrenaline (-60.6 DBD) and dopamine (-10.8 DBD). Conclusions Norepinephrine is the most widely used vasopressor showing a growing trend in terms of its use during the study period, which is supported by evidence in favor of its effectiveness and safety in patients with shock.

Resumen Introducción Los fármacos vasopresores son fundamentales en el manejo de los diferentes tipos de choque. Objetivo Determinar la tendencia de utilización de fármacos vasopresores en unidades de cuidados intensivos (UCI) en una población de pacientes afiliados al Sistema de Salud de Colombia, 2010-2017. Métodos Estudio observacional, a partir de una base de datos poblacional con pacientes hospitalizados en once UCI de diferentes ciudades de Colombia. Se obtuvieron las dispensaciones de pacientes mayores de 18 años hospitalizados desde enero de 2010 hasta diciembre de 2017. Se hizo revisión y análisis de la dispensación mensual de vasopresores. Se consideraron variables sociodemográficas y farmacológicas (medicamento vasopresor usado y dosis diarias definidas por 100 camas/día [DCD]). Resultados Se revisaron 81.348 dispensaciones de vasopresores, equivalentes a 26.414 terapias en 19.186 pacientes atendidos en 11 hospitales de 7 ciudades, cuya edad promedio fue 66,3±18,1 años y el 52,6 % eran hombres. Del total de terapias registradas, 17.658 (66,8 %) fueron con un solo vasopresor. La norepinefrina fue el más comúnmente prescrito (75,9 % de las dispensaciones; 60,5 DCD), seguido por adrenalina (26,6 %; 41,6 DCD), dopamina (19,4 %), dobutamina (16,0 %), vasopresina (8,5 %) y fenilefrina (0,9 %). El uso de norepinefrina se incrementó de 2010 a 2017 (+6,19 DCD), mientras que el de otros fármacos disminuyó, especialmente adrenalina (-60,6 DCD) y dopamina (-10,8 DCD). Conclusiones La norepinefrina es el fármaco vasopresor más utilizado y el que ha demostrado una tendencia de uso incremental durante el periodo de estudio, lo cual está respaldado por evidencia a favor de su efectividad y seguridad en pacientes con choque.

Calcifediol is superior to cholecalciferol in improving vitamin D status in postmenopausal women: a randomized trial.

Vitamin D has shown to play a role in multiple diseases due to its skeletal and extraskeletal actions. Furthermore, vitamin D deficiency has become a worldwide health issue. Few supplementation guidelines mention calcifediol treatment, despite being the direct precursor of calcitriol and the biomarker of vitamin D status. This 1-year, phase III-IV, double-blind, randomized, controlled, multicenter clinical trial assessed the efficacy and safety of calcifediol 0.266 mg soft capsules in vitamin D-deficient postmenopausal women, compared to cholecalciferol. Results reported here are from a prespecified interim analysis, for the evaluation of the study's primary endpoint: the percentage of patients with serum 25-hydroxyvitamin D (25(OH)D) levels above 30 ng/ml after 4 months. A total of 303 patients were enrolled, of whom 298 were included in the intention-to-treat (ITT) population. Patients with baseline levels of serum 25(OH)D <20 ng/ml were randomized 1:1:1 to calcifediol 0.266 mg/month for 12 months, calcifediol 0.266 mg/month for 4 months followed by placebo for 8 months, and cholecalciferol 25,000 IU/month for 12 months. At month 4, 35.0% of postmenopausal women treated with calcifediol and 8.2% of those treated with cholecalciferol reached serum 25(OH)D levels above 30 ng/ml (p < 0.0001). The most remarkable difference between both drugs in terms of mean change in serum 25(OH)D levels was observed after the first month of treatment (mean ± standard deviation change = 9.7 ± 6.7 and 5.1 ± 3.5 ng/ml in patients treated with calcifediol and cholecalciferol, respectively). No relevant treatment-related safety issues were reported in any of the groups studied. These results thus confirm that calcifediol is effective, faster, and more potent than cholecalciferol in raising serum 25(OH)D levels and is a valuable option for the treatment of vitamin D deficiency. © 2021 The Authors. Journal of Bone and Mineral Research published by Wiley Periodicals LLC on behalf of American Society for Bone and Mineral Research (ASBMR).

Estado nutricional y preferencia del sabor dulce en adultos chilenos / Nutritional status and sweet taste preference in Chilean adults

El dramático aumento de la prevalencia e incidencia de la obesidad sugiere que factores ambientales y cambios en el estilo de vida contribuyen de forma importante a su tendencia epidémica. En humanos, se han reportado diferencias interindividuales en los umbrales de detección y preferencia del sabor dulce, lo que podría afectar la ingesta habitual de azúcares, y por ende al estado nutricional. Objetivo: El presente estudio busca determinar la relación entre el estado nutricional y la preferencia al sabor dulce en la comunidad de un establecimiento de educación superior. Método: Muestra fue constituida por estudiantes, funcionarios y docentes, entre 18 y 60 años, pertenecientes a la Universidad Mayor, Sede Temuco. Para determinar preferencia al sabor dulce se empleó prueba organoléptica que mide grado de satisfacción frente a solución dulce, junto a ello se realizaron mediciones de peso y talla para determinar el Índice de Masa Corporal. Resultados: Muestra final comprendió de 319 personas, de las cuales un 30,1% fueron hombres y 69,9% mujeres. No se observaron diferencias significativas en la preferencia hacia las soluciones con mayor concentración de sacarosa según el estado nutricional. Sin embargo, el modelo predictivo desarrollado arrojó que hombres prefieren las soluciones con mayor concentración de azúcar independiente de la edad y estado nutricional. Conclusiones: Es necesario desarrollar nuevos estudios que permitan aclarar si la preferencia al sabor dulce favorece el desarrollo de obesidad y sobrepeso, o si es la composición nutricional de los alimentos procesados o ultraprocesados, lo que está teniendo un mayor impacto negativo en el estado nutricional de la población(AU)

The dramatic increase in the prevalence and incidence of obesity seems to suggest that environmental factors and lifestyle changes are contributing significantly to the epidemic trend of this pathology. In humans, inter-individual differences in the thresholds of preference of sweet taste have been reported, which could affect habitual sugar intake, and therefore the nutritional status. Objective: The present study seeks to determine the relationship between nutritional status and the preference of sweet taste in the population of a higher education establishment. Method: Sample was constituted by students, officials and teachers between 18 and 60 years, belonging to the Universidad Mayor, Temuco. To determine the perception of the sweet taste, an organoleptic test was used that measures the degree of satisfaction with the sweet solution, along with this, weight and height measurements were made to determine the Body Mass Index. Results: Final sample comprised 319 people, of which 30.1% were men and 69.9% women. No significant differences were observed in the preference for solutions with a higher concentration of sucrose according to nutritional status. However, a predictive model developed showed that men prefer the solutions with the highest concentration of sugar regardless of age and nutritional status. Conclusions: It is necessary to develop new studies to clarify whether the preference for sweet taste favors the development of obesity and overweight, or if it is the nutritional composition of processed or ultraprocessed foods, which is having a greater negative impact on the nutritional status of the population.(AU)

Vulvar lesion mimicking vitiligo: A case report.

BACKGROUND: Post-inflammatory hypopigmentation (PIH) is an acquired partial or total loss of pigment that occurs as a result of cutaneous inflammation. Clinically, post-inflammatory hypopigmentation is recognized by a discoloration of the skin; however, proper diagnosis requires a skin biopsy. Although post-inflammatory hypopigmentation is similar in appearance to vitiligo, histopathological evaluation highlights the key differences in the presence of melanocytes and melanophages. CASE PRESENTATION: A 28-year-old woman presented with discoloration in the vulvovaginal area. Physical examination was within normal limits; however, a genital exam revealed a large, intensely white discoloration in an hourglass pattern involving the clitoris, labia majora, and perianal area. Pigmentation was observed at the base of the hair follicles, which is not consistent with vitiligo. The patient consented to a skin biopsy, which was performed without complication. The biopsy showed mild chronic vulvitis and pigment incontinence due to post-inflammatory hypopigmentation. The patient was prescribed a high-potency topical steroid and a significant reduction in lesion area was observed at 3-month follow-up. DISCUSSION: Proper diagnosis via clinical examination and skin biopsy is essential in the treatment of pigment deficiencies. In cases of post-inflammatory hypopigmentation, the initial cause of inflammation must first be identified in order to provide an effective treatment regimen. When facing uncommon dermatological conditions such as post-inflammatory hypopigmentation, proper histopathological diagnosis, course of treatment, and follow-up are important in order to achieve patient satisfaction.

[Recommendations for the use of thromboprophylaxis in hospitalized patients with COVID-19 in Argentina]. / Recomendaciones para el uso de tromboprofilaxis en pacientes hospitalizados por COVID-19 en la Argentina.

Although the incidence is uncertain, some case reports suggest that COVID 19 infection is associated with an increased risk of venous thromboembolism. We suggest starting prophylactic anticoagulant therapy for all patients hospitalized with a symptomatic infection with COVID-19, unless contraindicated, with enoxaparin 40 mg SC daily if creatinine clearance is greater than 30 ml/min.

Si bien la incidencia es incierta, algunos reportes de caso sugieren que la infección por COVID 19 se asocia con un aumento del riesgo de tromboembolismo venoso. Sugerimos iniciar tromboprofilaxis a todos los pacientes hospitalizados por síntomas asociados con una infección por COVID-19, a menos que esté contraindicado, con enoxaparina 40 mg SC diariamente si el clearance de creatinina es mayor a 30 ml/min.

Carbon dioxide (CO2) laser ablation treatment of a peri-urethral genital wart: A case report.

BACKGROUND: Visible genital warts are caused by the nearly 100 recognized strains of human papillomavirus (HPV). HPV infections caused by high-risk strains are associated with significant morbidity and mortality rates. Genital warts are diagnosed by visual inspection and treated by three major methods: topical agents, systemic agents, and surgical therapies. CO2 laser ablation is the best treatment option for warts that present as refractory, thick, extensive lesions. CO2 ablation offers benefits such as a painless procedure, increased clearance rate, lesser side-effects and decreased pain. CASE PRESENTATION: An 18-year old patient was referred to the obstetric/gynecology clinic and presented with severe urinary complications. She complained of dysuria, frequency, vaginal irritation, and spraying while voiding. Physical exam was within normal limits; however, genital examination revealed a 3 cm fungating mass corresponding to a large genital wart at the urethral meatus and peri-urethral area. Due to her progressing symptomatology, CO2 laser ablation therapy was advised. DISCUSSION: HPV directly impacts the public health system, affecting 1% of the US population with an estimated 10-20% prevalence rate. Treatment options such as CO2 laser ablation offers complete removal for most patients with limited side-effects. Accurate follow-up is necessary to monitor proper recovery. CONCLUSION: CO2 laser ablation is considered an effective form of therapy in cases where immediate removal is desired and surgical excision is not recommended. CO2 laser ablation provides high clearance rates and minimal instances of recurrence, as well as superior aesthetic outcome.

Recomendaciones para el uso de tromboprofilaxis en pacientes hospitalizados por COVID-19 en la Argentina / Recommendations for the use of thromboprophylaxis in hospitalized patients with COVID-19 in Argentina

Si bien la incidencia es incierta, algunos reportes de caso sugieren que la infección por COVID 19 se asocia con un aumento del riesgo de tromboembolismo venoso. Sugerimos iniciar tromboprofilaxis a todos los pacientes hospitalizados por síntomas asociados con una infección por COVID-19, a menos que esté contraindicado, con enoxaparina 40 mg SC diariamente si el clearance de creatinina es mayor a 30 ml/min.

Although the incidence is uncertain, some case reports suggest that COVID 19 infection is associated with an increased risk of venous thromboembolism. We suggest starting prophylactic anticoagulant therapy for all patients hospitalized with a symptomatic infection with COVID-19, unless contraindicated, with enoxaparin 40 mg SC daily if creatinine clearance is greater than 30 ml/min.