RvE1 Promotes Axin2+ Cell Regeneration and Reduces Bacterial Invasion.

Vital pulp therapy and root canal therapy (RCT) are the dominant treatment for irreversible pulpitis. While the success rate of these procedures is favorable, they have some limitations. For instance, RCT leads to removing significant dentin in the coronal third of the tooth that increases root-fracture risk, which forces tooth removal. The ideal therapeutic goal is dental pulp regeneration, which is not achievable with RCT. Specialized proresolving mediators (SPMs) are well known for inflammatory resolution. The resolution of inflammation and tissue restoration or regeneration is a dynamic and continuous process. SPMs not only have potent immune-modulating functions but also effectively promote tissue homeostasis and regeneration. Resolvins have been shown to promote dental pulp regeneration. The purpose of this study was to explore further the cellular target of Resolvin E1 (RvE1) therapy in dental pulp regeneration and the impact of RvE1 in infected pulps. We investigated the actions of RvE1 on experimentally exposed pulps with or without microbial infection in an Axin2Cre-Dox;Ai14 genetically defined mouse model. Our results showed RvE1 promoted Axin2-tdTomato+ cell expansion and odontoblastic differentiation after direct pulp capping in the mouse, which we used to mimic reversible pulpitis cases in the clinic. In cultured mouse dental pulp stem cells (mDPSCs), RvE1 facilitated Axin2-tdTomato+ cell proliferation and odontoblastic differentiation and also rescued impaired functions after lipopolysaccharide stimulation. In infected pulps exposed to the oral environment for 24 h, RvE1 suppressed inflammatory infiltration, reduced bacterial invasion in root canals, and prevented the development of apical periodontitis, while its proregenerative impact was limited. Collectively, topical treatment with RvE1 facilitated dental pulp regenerative properties by promoting Axin2-expressing cell proliferation and differentiation. It also modulated the resolution of inflammation, reduced infection severity, and prevented apical periodontitis, presenting RvE1 as a novel therapeutic for treating endodontic diseases.

Modified Chevrel technique for abdominal closure in critically ill patients with abdominal hypertension and limited options for closure.

Abdominal compartment syndrome is a potentially life-threatening condition seen in critically ill patients, and most often caused by acute pancreatitis, postoperative abdominal vascular thrombosis or mesenteric ischemia. A decompressive laparotomy is sometimes required, often resulting in hernias, and subsequent definitive wall closure is challenging. AIM: This study aims to describe short term results after a modified Chevrel technique for midline laparotomies in patients witch abdominal hypertension. MATERIALS AND METHODS: We performed a modified Chevrel as an abdominal closure technique in 9 patients between January 2016 and January 2022. All patients presented varying degrees of abdominal hypertension. RESULTS: Nine patients were treated with new technique (6 male and 3 female), all of whom had conditions that precluded unfolding the contralateral side as a means for closure. The reasons for this were diverse, including presence of ileostomies, intraabdominal drainages, Kher tubes or an inverted T scar from previous transplant. The use of mesh was initially dismissed in 8 of the patients (88,9%) because they required subsequent abdominal surgeries or active infection. None of the patients developed a hernia, although two died 6 months after the procedure. Only one patient developed bulging. A decrease in intrabdominal pressure was achieved in all patients. CONCLUSION: The modified Chevrel technique can be used as a closure option for midline laparotomies in cases where the entire abdominal wall cannot be used.

Estudio proteomico diferencial entre liquidos pleurales secundarios a cáncer de pulmón versus mesotelioma / Differential proteomic study between pleural fluid secondary to lung cancer versus mesothelioma

Objetivo: Encontrar perfiles proteicos en líquido pleural que diferencien derrames pleurales secundarios a cáncer de pulmón (CP) versus mesotelioma pleural maligno (MPM).Metodología: Recogimos líquidos pleurales de 60 pacientes de tres grupos diferentes: MPM (N = 20), CP (N = 20) y derrames pleurales benignos (N = 20). Realizamos un análisis con proteómica diferencial con ITRAQ 4 plex (Applied Biosystem). Realizamos la identificación y cuantificación relativa de las proteínas con el programa Proteome Discoverer 1.4 (Termofisher Scientific). Construimos diagramas de Venn con las proteínas sobre/infra-expresadas en cada grupo. Realizamos una validación interna/externa mediante ELISA (Myobiosorce) añadiendo 25 muestras de CP y 14 de MPM.Resultados: Encontramos sobreexpresión de Pi3K en los derrames pleurales neoplásicos (16,86 +/- 25,83 ng/ml en CP; 20,66 +/- 17,26 ng/ml en MPM vs 5,92 +/- 0,99 ng/ml en controles). Hubo sobreexpresión de SPRM en MPM (30.702 +/- 30.310,53 ng/ml en el grupo MPM vs 10.404 +/- 10.157,72 ng/ml en el grupo CP vs 8.498 + /- 3.437,18 ng/ml en controles). Existió sobreexpresión de RhoB en CP (4,46 +/- 1,65 mg/ml en CP vs 1,65 +/- 2,65 mg/ml en MPM vs 0,92 +/- 1,6 mg/ml en controles). También encontramos sobreexpresión de PDGFR-alfa en derrames pleurales benignos (74,12 +/- 22,57 ng/ml en controles vs 43,05 +/- 23,96 ng/ml en CP vs 36,12 +/- 21,51 ng/ml en MPM).Conclusión: Existe un perfil diferencial proteico entre los derrames secundarios a CP (sobreexpresión de RhoB) y a MPM (sobrexpresión de SPRM). La sobrexpresión de Pi3K indica asociación a derrames pleurales malignos y la de PDGFR-alfa a derrames benignos. (AU)

Objetivo: Find protein profiles in pleural fluid that differentiate pleural effusions secondary to lung cancer (LC) versus malignant pleural mesothelioma (MPM).Metodología: We collected pleural fluids from 60 patients from three different groups: MPM (N = 20), CP (N = 20), and benign pleural effusions (N = 20). We performed differential proteomics analysis with ITRAQ 4 plex (Applied Biosystem). We performed the identification and relative quantification of the proteins with the Proteome Discoverer 1.4 program (Termofisher Scientific). We built Venn diagrams with the over/under-expressed proteins in each group. We performed an internal/external validation using ELISA (Myobiosorce) adding 25 CP and 14 MPM samples.Resultados: We found Pi3K overexpression in neoplastic pleural effusions (16.86 +/- 25.83 ng/ml in PC; 20.66 +/- 17.26 ng/ml in MPM vs 5.92 +/- 0.99 ng/ml in controls). There was overexpression of SPRM in MPM (30,702 +/- 30,310.53 ng/ml in the MPM group vs 10,404 +/- 10,157.72 ng/ml in the CP group vs 8,498 +/- 3,437.18 ng/ml in controls). There was overexpression of RhoB in CP (4.46 +/- 1.65 mg/ml in CP vs 1.65 +/- 2.65 mg/ml in MPM vs 0.92 +/- 1.6 mg/ml in controls). We also found overexpression of PDGFR-alpha in benign pleural effusions (74.12 +/- 22.57 ng/ml in controls vs 43.05 +/- 23.96 ng/ml in PC vs 36.12 +/- 21.51 ng/ml in MPM ).Conclusión: There is a differential protein profile between effusions secondary to CP (RhoB overexpression) and MPM (SPRM overexpression). Pi3K overexpression indicates association with malignant pleural effusions and PDGFR-alpha overexpression with benign effusions. (AU)

A systematic review of relationships and sex education outcomes for students with intellectual disability reported in the international literature.

BACKGROUND: Little is known about how to evaluate relationships and sex education (RSE) delivered to students with intellectual disability and what stakeholders perceive are important outcomes. The present study aimed to systematically review existing studies on outcomes of RSE, as the first step in the development of a core outcome set (COS) for students with intellectual disability. METHOD: A systematic literature process included two stages: (1) searching for studies reporting on RSE outcomes for students with intellectual disability and (2) studies reporting on measurement properties (e.g. validity, reliability and responsiveness) of standardised instruments identified in stage 1. RESULTS: A total of 135 RSE outcomes were extracted from 42 studies: 43 outcomes for students in secondary education and 92 outcomes for students in further education. No RSE outcomes were reported for primary education. Outcomes referred to the human body, hygiene, relationships, sexuality, sex and its consequences, inappropriate and appropriate social and sexual behaviour, keeping safe, emotional vocabulary and positive self-esteem. Outcomes were predominantly knowledge-based, rather than relating to skills and attitudes development. Students with intellectual disability, parents and teachers perceive different RSE outcomes meaningful. Five instruments were used to measure the outcomes, but none have established psychometric properties with this population. CONCLUSIONS: The comprehensive list of RSE outcomes for students with intellectual disability will be used to inform the next steps of a Core Outcome Set needed for RSE evaluations in research and education settings. There is an urgent need to develop standardised instruments validated for students with intellectual disability.

Socio-economic determinants of COVID-19 in Mexico.

OBJECTIVES: This study aimed to identify and quantify the role that social and economic determinants play in the probability of dying from COVID-19, in the case of Mexico. STUDY DESIGN: This was a cross-sectional study based on secondary data. METHODS: In this study, COVID-19 contagion and mortality data were used, as well as socio-economic variables, from public databases and open access, with which an econometric model was estimated. RESULTS: It shows that the number of deaths can rise when variables related to vulnerable groups increase, such as poverty, lack of services, gender, and age. In addition, having pre-existing medical conditions or lacking access to water can be a significant factor in the increase in deaths. CONCLUSIONS: Therefore, this study suggests more policies be developed for vulnerable groups to reduce gaps in inequality, particularly given the current situation in which greater inequality can exacerbate the impact of a disease or an unforeseen situation, as is the case of COVID-19.

Effects of grape pomace supplementation on the diet of lactating ewes as compared to vitamin E on the meat shelf life of suckling lambs.

Forty-eight Churra ewes and their suckling lambs were assigned to four dietary treatments: control (CTRL), VIT-E (500 mg kg-1 TMR vitamin E), GP-5 (5% grape pomace) and GP-10 (10% grape pomace). After slaughter (11.5 kg live weight), longissimus muscle of lambs was sliced, packaged under modified atmosphere (80,20%/O 2:CO 2) and stored in retail conditions. At each sampling point (0, 3, 7, 10, 14 days), microbiological, physicochemical and sensory characteristics were analysed. Vitamin E and GP-5 were found to be effective (p < 0.05) at preventing enterobacteria growth as of day 10. After day 10, vitamin E and grape pomace in the ewe's supplementation reduced metmyoglobin (p < 0.05) lipid oxidation (p < 0.05) and sensory spoilage throughout the storage period. An effect of the grape pomace dosage was observed, with the supplementation at 5% being more effective. Therefore, we can conclude that grape pomace was just as effective as vitamin E in preventing spoilage during retail storage.

El cuidar de enfermería y los derechos de la infancia: experiencia en Centros de Salud Familiar / Nursing care and children's rights: Experience in Family Health Centers / Cuidados de enfermagem e direitos da criança: experiência em Centros de Saúde da Família

RESUMEN Introducción En la última década, la política pública de salud presenta una efectiva transformación e innovación. La acción de legitimar la protección del ejercicio de los derechos de la infancia transita desde los riesgos y problemas imperantes, hasta la visualización de sus potencialidades y anhelos. Objetivo Develar el cuidado en el marco en derechos de la infancia desde la política pública de salud. Métodos Investigación cualitativa según Charmaz. Se abordó la perspectiva de 12 trabajadores de enfermería adheridos a la salud comunitaria a través de una entrevista semiestructurada. El análisis de los datos fue simultáneo, identificando las categorías fundamentales y la categoría central. La investigación cumplió con los criterios éticos de Ezekiel Emanuel; fue aprobada por el comité ético científico. Resultados Surgen las categorías: 1) negativa socialización con la construcción de identidad de género; 2) brecha entre derechos de la infancia y el rol del personal de enfermería. Discusión Estudios muestran que la enfermería ejecuta el manejo del rol en el análisis de las realidades familiares en derechos, pero frente a disparidades sanitarias se devela la influencia de sus puntos de vista sociales, sesgos y prejuicios, que pueden reflejarse en su comportamiento e influir en la forma en que los pacientes utilizan los servicios. Conclusiones Las acciones del cuidado de enfermería dirigidas a la niñez coexisten con un déficit de herramientas para el manejo del derecho infantil. Por su parte, la política pública de salud se desarrolla desde los programas con una mirada biologicista, asistencialista, racionalista, entendiendo el cuidar desde el enfoque biomédico.

ABSTRACT Introduction During the last decade, the public health policies have experienced diverse effective transformations and innovations. Now, the Lawful protection of children's rights has a broader scope and can go from considering their prevailing problems and risks to visualizing their potential and desires. Objective To explore nursing care within the children's rights frame from a public health perspective. Methods This is a qualitative research study that follows the guidelines of Charmaz. The perceptions of 12 community health nursing workers were analyzed through semi- structured interviews. The central and fundamental categories were simultaneously analyzed. The research study met Ezekiel Emanuel's ethics criteria and was approved by the scientific ethics committee. Results Two main categories arose: 1) the negative socialization towards the construction of gender identity; and 2) the gap between the children's rights and the role of the nursing personnel. Discussion Diverse studies show that nurses shape their roles in the context of family rights; however, while dealing with health disparities, they are further driven by their social points of view, their biases, and their prejudices, and these behaviors can have an influence on the way patients utilize health services. Conclusions Children's healthcare that nurses provide is not always based on tools to handle the children's rights. Moreover, there are still some public health policies that rely on biology, assistance, and reason-focused programs which consider care only from a biomedical perspective.

RESUMO Introdução Na última década, ases políticas públicas de saúde apresentaram uma efetiva transformação e inovação. A ação de legitimar a proteção do exercício dos direitos da criança passa pelos riscos e problemas predominantes, até a visualização de suas potencialidades e desejos. Objetivo Revelar o cuidado no marco dos direitos da criança a partir da política pública de saúde. Métodos Pesquisa qualitativa segundo Charmaz. A perspectiva de 12 trabalhadores de enfermagem vinculados à saúde comunitária foi abordada por meio de entrevista semiestruturada. A análise dos dados foi simultânea, identificando as categorias fundamentais e a categoria central. A pesquisa obedeceu aos critérios éticos de Ezekiel Emanuel; foi aprovado pelo comitê de ética científica. Resultados Emergiram as categorias: 1) socialização negativa com a construção da identidade de gênero; 2) lacuna entre os direitos da criança e o papel da equipe de enfermagem. Discussão Estudos mostram que a enfermagem desempenha papel gerencial na análise das realidades familiares em direitos, mas diante das disparidades de saúde, revela-se a influência de seus pontos de vista sociais, rumos e preconceitos, o que pode se refletir em seu comportamento e influência na forma como os pacientes utilizam os serviços. Conclusões As ações de cuidado de enfermagem voltadas à criança convivem com a falta de instrumentos para a gestão dos direitos da criança. Por sua vez, a política pública de saúde é desenvolvida a partir dos programas com uma perspectiva biologística, assistencialista, racionalista, compreendendo o cuidado a partir de uma abordagem biomédica.

Promoción de la salud a través de prácticas claves en la atención integrada a las enfermedades prevalentes de la infancia (AIEPI), en profesores de educación prebásica / Health promotion through key practices in integrated attention to prevalent childhood illnesses (IMCI), in pre-basic education teachers

Introducción: la estrategia de atención integrada a las enfermedades prevalentes de la infancia (AIEPI), avanza en el concepto de integralidad de la atención de la salud, siendo una herramienta práctica, en los servicios de salud y hogar, establece máxima validez a las preocupaciones de la comunidad y del personal de salud. Objetivo: conocer la promoción de la salud a través de prácticas claves en la atención integrada a las enfermedades prevalentes de la infancia (AIEPI), en profesores de educación prebásica. Material y métodos: investigación descriptiva en población de 59 técnicos y profesionales adscritos a jardines infantiles y salas cuna, en la ciudad de Temuco, que corresponden a 23 salas cuna, que ejercen actividades laborales con lactantes de 6-12 meses. Recolección de información, y instrumento de prácticas claves propuestas por AIEPI OMS/OPS, el análisis se trabajó con estadística descriptiva e inferencia estadística, apoyándose en el software SPSS versión 24 en español. La investigación cumplió los criterios de rigor ético de Ezequiel Emanuel y la aprobación del Comité de Ética acreditado de la Universidad Mayor. Resultados: 59 personas, de sexo femenino, personal de atención en la guardería de jardines infantiles y salas cuna. La edad promedio de 40 años, promedio de 8 años de ejercicio técnico profesional. El 78% del personal de atención en la guardería, posee una jornada laboral de 9 horas diarias. Respecto a las conductas en lactancia materna un 78 %, "siempre" realiza fomento del amamantamiento y un 72,9 % "siempre" fomenta los beneficios de la lactancia materna; no obstante, en cuanto al fomento de la técnica de acople, "a veces" fomenta la técnica un 39,8 %. De la inmunización un 64,4 % del personal parvulario, "siempre fomenta la vacunación del PNI", por otro lado, un 71 % de la muestra "siempre fomenta la administración de vacunas de campaña (influenza)". De la conducta por cuadro respiratorio, un 69,5 % de la población, "siempre reconoce los signos y síntomas que alertan de un cuadro respiratorio". Conclusión: en la comunidad educativa, el uso de la estrategia desarrolla un actuar más efectivo, identificando actitudes de promoción. El tener la posibilidad de contacto diario; permite a la comunidad de prebásica dirigir su mirada hacia los problemas más relevantes y proponer estrategias para la solución en conexión con el sector salud

Introduction: the strategy of Integrated Attention to Prevalent Childhood Diseases (IMCI), advances in the concept of comprehensive health care, being a practical tool, in health and home services, giving maximum validity to concerns of the community and health personnel. Objective: to know the promotion of health through key practices in Integrated Attention to Prevalent Childhood Illnesses (IMCI), in pre-basic education teachers. Material and Methods: Descriptive research in a population of 59 technicians and professionals assigned to Kindergartens and Nursery Rooms, in the city of Temuco, corresponding to 23 Nursery Rooms, who carry out work activities with infants aged 6-12 months. Information collection and key practices instrument proposed by IMCI WHO / PAHO. The analysis was carried out with descriptive statistics and statistical inference, relying on the SPSS software version 24 in Spanish. The research met the criteria of ethical rigor of Ezequiel Emanuel and the approval of the accredited Ethics Committee of the Universidad Mayor. Results: 59 people, female, nursery care personnel from Kindergartens and Nursery Rooms. The average age of 40 years, average of 8 years of professional technical practice. 78% of the kindergarten staff have a 9-hour workday. Regarding breastfeeding behaviors, 78% "always" promote breastfeeding and 72.9% "always" promote the benefits of breastfeeding, however, regarding the promotion of the coupling technique, "a times", 39.8% promote the technique. Of the immunization, 64.4% of the kindergarten staff "always promote the PNI vaccination", on the other hand, 71% of the sample "always promote the administration of field vaccines (Influenza)". Of the behavior due to respiratory symptoms, 69.5% of the population "always recognize the signs and symptoms that warn of a respiratory condition". Conclusion: in the educational community, the use of the strategy develops a more effective action, identifying attitudes of promotion. Having the possibility of daily contact; allows the pre-basic community to direct its gaze towards the most relevant problems and propose strategies for the solution in connection with the health sector.

Colorimetric detection of residual quaternary ammonium compounds on dry surfaces and prediction of antimicrobial activity using bromophenol blue.

Controlling and monitoring the residual activity of quaternary ammonium compounds (QACs) are critical for maintaining safe yet effective levels of these agents in the environment. This study investigates the utility of bromophenol blue (BPB) as a safe, rapid and user-friendly indicator to detect in situ residual QACs dried on hard, non-porous surfaces, as well a means to assess their antimicrobial efficacy. At pH 7, BPB has a purple colour which turns blue upon its complexation with QACs such as didecyldimethylammonium chloride (DDAC). BPB itself has no antimicrobial properties up to 400 ppm. Within the range of 0-400 ppm, BPB colour change was tied to specific DDAC antimicrobial performances with a detection threshold of 100 ppm. BPB concentration and application volume could be adjusted such that a colour shift from purple to blue correlated with a set percent reduction (>99·9%) in test bacteria (Staphylococcus aureus and Klebsiella aerogenes). The BPB solutions developed in this study yielded similar colour shifts on polycarbonate and stainless steel surfaces and did not cross-react with chemical ingredients commonly found in sanitizers and disinfectant products. Overall, this study suggests that BPB provides a simple solution to safely monitor the post-application level and biocidal activity of residual dried QACs on surfaces.

Prevalence of Spasticity and Postural Patterns in the Upper Extremity Post Stroke.

INTRODUCTION: A high number of patients with stroke develop upper extremity spasticity, causing abnormal postures and patterns. These alterations limit the use of arm in functional activities and affect social participation. AIM: To determine the prevalence of spasticity and postural patterns of the upper extremity post stroke. MATERIALS AND METHODS: A cross-sectional descriptive design was used with a prospective follow-up. The sample included 136 patients. The study included 3 measuring times; at 10 days (T1), applying a record with sociodemographic-clinical data, the evaluation of muscle tone in the elbow and wrist and the postural patterns of the UE, and at 3 months (T2) and 12 months (T3) post stroke, re-evaluating tone and patterns. Prevalence was calculated through the one-sample chi-squared (χ2) test followed by inspection of the standardized residuals (z) in each cell. The Kappa coefficient evaluated the degree of agreement in elbow and wrist tone. RESULTS: The prevalence of spasticity in the elbow was 37.5% at T1, 57.4% at T2, and 57.4% at T3. At each time there was a high degree of agreement between elbow and wrist tone. Patients developed increased elbow tone between T1 and T2, with maintained tone between T2 and T3. Postural pattern III was the most prevalent according to Hefter's classification. CONCLUSION: The prevalence of spasticity in the elbow and wrist increases between 10 days and 3 months post stroke, and is maintained between 3 and 12 months. The onset of spasticity occurs in almost half of patients during the first 10 days post stroke. Postural pattern III according to Hefter's classification presented the greatest prevalence in the spastic UE.

Reducing risk of Type 2 diabetes in HIV: a mixed-methods investigation of the STOP-Diabetes diet and physical activity intervention.

AIM: To conduct a mixed-methods feasibility study of the effectiveness and acceptability of an individualized diet and physical activity intervention designed to reduce the risk of Type 2 diabetes experienced by people living with HIV. METHODS: Participants with impaired fasting glucose and HIV were invited to take part in a 6-month diet and physical activity intervention. Individualized advice to achieve 10 lifestyle goals was delivered monthly. Diabetes risk was assessed pre- and post-intervention by measurement of the glucose and insulin response to a 3-h meal tolerance test. Six-month change was analysed using paired t-tests. Research interviews exploring the acceptability of the intervention and factors influencing behaviour change were conducted with those who participated in the intervention, and those who declined participation. RESULTS: The intervention (n=28) significantly reduced the following: glucose and insulin, both fasting and postprandial incremental area under the curve (glucose 7.9% and 17.6%; insulin 22.7% and 31.4%, respectively); weight (4.6%); waist circumference (6.2%); systolic blood pressure (7.4%); and triglycerides (36.7%). Interview data demonstrated the acceptability of the intervention. However, participants expressed concern that deliberate weight loss might lead to disclosure of HIV status or association with AIDS-related illness. The belief that antiretroviral medications drove diabetes risk was associated with declining study participation or achieving fewer goals. CONCLUSIONS: We have demonstrated the beneficial effects of a lifestyle intervention in mitigating the increased risk of Type 2 diabetes associated with HIV. Future interventions should be designed to further reduce the unique barriers that prevent successful outcomes in this cohort.

Effects of ascending buprenorphine doses on measures of experimental pain: A pilot study.

BACKGROUND: Buprenorphine is widely used in the treatment of opioid use disorder and pain management. Little is known about the analgesic effects of high-dose sublingual buprenorphine, particularly in doses of >8 mg. The aim of this study was to examine the effect of ascending doses of buprenorphine upon acute pain measures in patients stabilized on buprenorphine as treatment for opioid dependence. METHODS: The pilot study (n = 7) was a randomised, controlled, double-blind, double-dummy, within-subject crossover study examining cold-pressor threshold and tolerance testing under different buprenorphine dose conditions. Each participant attended three sessions to test the analgesic effect of buprenorphine in their usual dose (100%), 150% and 200% of their usual daily dose. RESULTS: No significant effects of increased dose were seen on experimental pain measures. Expected physiological effects on pupil size and pulse were observed with increasing dose. No effect of buprenorphine condition was seen on subjective ratings of drug strength, or self-reported sedation, though lower ratings drug liking were seen with 150% and 200% conditions, and lower ratings of 'bad effects' and intoxication were reported with the 200% buprenorphine dose condition. No safety concerns with the 150 and 200% buprenorphine dose condition were observed. DISCUSSION: This pilot study suggests that a ceiling effect on analgesia may be observed in people maintained on buprenorphine, though larger studies may confirm this finding. Clinical Trial Number: ACTRN12614001038684.

Grape pomace in ewes diet: Effects on meat quality and the fatty acid profile of their suckling lambs.

Grape pomace (GP) is an inexpensive natural antioxidant promising as animal feed supplement due to its high content of phenolic compounds. In order to evaluate its effect in lactating ewe rations on meat quality and fat composition of their suckling lambs, 48 Churra ewes were divided into 4 treatments. All animals were fed a ration containing linseed oil (Control) supplemented with Vitamin E or two levels of GP. Lambs were nourished exclusively by suckling until they were slaughtered. Dietary GP did not generate adverse effects on carcasses or lambs meat quality when compared with Control or Vit-E diets. GP improved the water holding capacity of the meat. In addition, lambs meat FA profile was not nutritionally affected with the diets assayed. Hence, the use of GP as a dietary supplement in ewe rations would not have negative effects on meat from suckling lambs.

A qualitative metasynthesis exploring the impact of prostate cancer and its management on younger, unpartnered and gay men.

Prostate cancer (PCa) can negatively impact on men's sexual, urinary and emotional functioning, affecting quality of life. Most men with PCa are older (≥65 years), married and heterosexual and little is known about the impact on men who are younger, unpartnered or gay. We aimed to synthesise existing qualitative research on these three groups of men. A systematic metasynthesis was undertaken that included data on the unique impacts of PCa on younger (<65 years) (n = 7 papers), unpartnered (n = 17 papers) or gay or bisexual men (n = 11 papers) using a modified meta-ethnographic approach. The three overarching constructs illustrated the magnified disruption to men's biographies, that included: marginalisation, isolation and stigma-relating to men's sense of being "out of sync"; the burden of emotional and embodied vulnerabilities and the assault on identity-illustrating the multiple threats to men's work, sexual and social identities; shifting into different communities of practice-such as the shift from being part of a sexually active community to celibacy. These findings suggest that PCa can have a particular impact on the quality of life of younger, unpartnered and gay men. This has implications for the provision of tailored support and information to these potentially marginalised groups.

Cognition and adaptive functioning in older people attending drug and alcohol services.

BACKGROUND: Substance use disorders in older adults are expected to increase dramatically in the coming years. Given the increased susceptibility to cognitive deficits in older substance users (defined here as aged 50+ years due to the accelerated health decline observed in this population), it is important to consider the functional correlates of cognitive impairment in these older adults. This study details the cognitive status of older individuals attending outpatient drug and alcohol (D&A) treatment services and seeks to determine of the association of cognitive impairment to self-reported daily functioning. METHODS: Ninety nine clients aged 50 years or over attending outpatient D&A treatment services in Sydney, Australia participated. Cognition was assessed using the Addenbrooke's Cognitive Examination - Revised (ACE-R). Recent substance use (Australian Treatment Outcome Profile), physical and mental health (SF12, Geriatric Depression Scale), social isolation (Lubben Social Network Scale), and activities of daily living (Bayer ADL Scale) were also assessed. RESULTS: Nearly two-thirds of participants screened positive for cognitive impairment on the ACE-R; 41% and 65% of clients met the cut-off scores for mild cognitive impairment (MCI) and more severe cognitive impairment, respectively. Self-reported seizure history was a predictor of cognitive impairment. CONCLUSIONS: The results suggest that cognitive impairment in this group is common. The assessment of cognitive status for this older group of patients should not only include the identification of cognitive impairment but also encompass mental health and social functioning. A greater understanding of the needs of this cohort will also enable better co-ordination with other health and welfare services tailored to this population.

Gamification for health promotion: systematic review of behaviour change techniques in smartphone apps.

OBJECTIVE: Smartphone games that aim to alter health behaviours are common, but there is uncertainty about how to achieve this. We systematically reviewed health apps containing gaming elements analysing their embedded behaviour change techniques. METHODS: Two trained researchers independently coded apps for behaviour change techniques using a standard taxonomy. We explored associations with user ratings and price. DATA SOURCES: We screened the National Health Service (NHS) Health Apps Library and all top-rated medical, health and wellness and health and fitness apps (defined by Apple and Google Play stores based on revenue and downloads). We included free and paid English language apps using 'gamification' (rewards, prizes, avatars, badges, leaderboards, competitions, levelling-up or health-related challenges). We excluded apps targeting health professionals. RESULTS: 64 of 1680 (4%) health apps included gamification and met inclusion criteria; only 3 of these were in the NHS Library. Behaviour change categories used were: feedback and monitoring (n=60, 94% of apps), reward and threat (n=52, 81%), and goals and planning (n=52, 81%). Individual techniques were: self-monitoring of behaviour (n=55, 86%), non-specific reward (n=49, 82%), social support unspecified (n=48, 75%), non-specific incentive (n=49, 82%) and focus on past success (n=47, 73%). Median number of techniques per app was 14 (range: 5-22). Common combinations were: goal setting, self-monitoring, non-specific reward and non-specific incentive (n=35, 55%); goal setting, self-monitoring and focus on past success (n=33, 52%). There was no correlation between number of techniques and user ratings (p=0.07; rs=0.23) or price (p=0.45; rs=0.10). CONCLUSIONS: Few health apps currently employ gamification and there is a wide variation in the use of behaviour change techniques, which may limit potential to improve health outcomes. We found no correlation between user rating (a possible proxy for health benefits) and game content or price. Further research is required to evaluate effective behaviour change techniques and to assess clinical outcomes. TRIAL REGISTRATION NUMBER: CRD42015029841.

Antimicrobial Sensitivity of Avibacterium paragallinarum Isolates from Four Latin American Countries.

The antimicrobial sensitivity of 11 reference strains and 66 Avibacterium paragallinarum isolates from four Latin American countries was investigated. All 11 reference strains were sensitive to amoxicillin-clavulanic acid, ampicillin, fosfomycin, gentamicin, kanamycin, neomycin, penicillin, tetracycline, and trimethoprim-sulfamethoxazole. The 11 reference strains were all resistant to lincomycin. All isolates (100%) from Mexico, Panama, and Peru were sensitive to amoxicillin-clavulanic acid, ampicillin, and fosfomycin. The Ecuadorian isolates showed some level of resistance to all 16 agents tested. The Ecuadorian isolates were significantly more sensitive to erythromycin, lincomycin, and streptomycin, and significantly more resistant to gentamicin, kanamycin, penicillin, and tetracycline, than the Mexican isolates. A total of 57.5% (38/66) of tested isolates were multi-drug resistant (MDR), with 16 MDR patterns detected in 88.4% (23/26) of the antimicrobial-resistant isolates from Ecuador, and 8 MDR patterns detected in 42.8% (15/35) of the antimicrobial-resistant isolates from Mexico. In conclusion, the variation in antimicrobial sensitivity patterns between isolates from Ecuador and Mexico emphasizes the importance of active, ongoing monitoring of A. paragallinarum isolates.

Traqueotomías abiertas a pie de cama / No disponible

Introducción: La traqueotomía como procedimiento para asegurar la vía aérea, se puede realizar de dos formas; mediante cirugía abierta, llamada también traqueotomía estándar. Y de forma percutánea, con el método de Seldinger, popularizado por Ciaglia. Se plantea un análisis descriptivo de una serie de pacientes a los que se les realizó traqueotomía abierta a pie de cama por un servicio de cirugía torácica, en los que se desestimó la técnica percutánea por el equipo medico de cuidados intensivos. Metodología: Se trata de un estudio descriptivo y retrospectivo, de todas las traqueotomías abiertas a pie de cama realizadas por el servicio de Cirugía torácica en las diferentes unidades de cuidados intensivos de un Hospital de tercer nivel, entre junio de 2009 y diciembre de 2013. Los criterios de inclusión para este estudio, fueron todos los pacientes que requerían una traqueotomía en la unidad de reanimación (en esta unidad no se realizan traqueotomías percutáneas) y todos aquellos pacientes que por cualquier tipo de anormalidades; anatómicas y/o funcionales, fueron desestimados para la realización de la traqueotomía percutánea por parte del personal medico de la UCI. Resultados: En total se realizaron 166 traqueotomías abiertas durante el periodo de estudio, de ellas se excluyeron 10 por ser realizadas en quirófano o de forma percutánea. Se realizaron 156 traqueotomías a pie de cama, a 94 varones y 62 mujeres con una edad media de 60,15 años (rango 16-84). La principal indicación para el procedimiento fue la intubación orotraqueal prolongada por dificultad para el destete en pacientes con cirugía cardiaca y pulmonar, seguido del distrés respiratorio en 29 casos. La contraindicación más frecuente para realizar el procedimiento por la vía percutánea fueron las alteraciones de la coagulación en 60 casos, seguida de la dificultad para extender el cuello en 26 casos. No existía contraindicación para realizar el procedimiento de manera percutánea en 26 casos. La principal complicación del procedimiento fue el sangrado en 8 casos, que se solucionó durante el procedimiento y que no requirieron transfusiones. Conclusión: La traqueotomía abierta a pie de cama puede ser realizada de forma segura en todos los pacientes, independientemente de las desventajas anatómicas o funcionales del paciente

Introduction: As an airway stabilizing surgical procedure, tracheotomy can be performed in two ways, by an open surgery as a standard tracheotomy, and by a percutaneous method using the Seldinger technique, popularized by Ciaglia. This paper expose a descriptive analysis of a patient series dismissed for a percutaneous tracheotomy by Intensive Care Unit (ICU) specialists, and then operated by thoracic surgeons with a bedside open tracheotomy. Methods: Descriptive retrospective study of all bedside open tracheotomy performed by the Thoracic Surgery Department in a tertiary Hospital, between June 2009 and December 2013. Inclusion criteria were: 1) patients with a bedside open tracheotomy done in the Post Anesthesia Care Unit (PACU), where no percutaneous tracheotomies are usually performed in this Hospital, and 2) patients who for any anatomic or functional reasons were dismissed for a percutaneous procedure by ICU specialists, and in consequence a bedside open tracheotomy was performed by thoracic surgeons. Results: In the period of the study, a total number of 166 open tracheotomies were performed, and 10 of these were done in a operating room (OR) or percutaneously; these were excluded. A total of 156 bedside open tracheotomies were performed, 94 patients were male and 62 female, with a media age of 60.15 years (range 16-84 years old). Principal indication for the procedure was a prolonged orotracheal intubation due to a difficult weaning, 29 of them due to respiratory distress syndrome. Principal contraindication of the percutaneous procedure were coagulopathies in 60 cases, followed by difficulties in spine extensión in 26 cases. There were no absolute contraindications for the percutaneous tracheotomy in 26 cases. The most frequent complication of the open bedside tracheotomy was bleeding in 8 cases, but it was resolved during the procedure and did not required blood transfusion in any case. Conclusion: Open bedside tracheotomy can be a safe and secure procedure in all patients, nevertheless the tracheal and spine anatomic or functional characteristics of the patient

First case of Mycobacterium heckeshornense cavitary lung disease in the Latin America and Caribbean region.

A case of cavitary pulmonary disease caused by Mycobacterium heckeshornense in Uruguay is described. This is the first case reported in the Latin America and Caribbean region, showing that this species is a worldwide opportunistic human pathogen.

Effects of grape pomace in growing lamb diets compared with vitamin E and grape seed extract on meat shelf life.

The effect of dietary treatment (CTRL, control; VIT-E, 500 mg kg(-1) vitamin E; GSE, 50 mg grape seed extract kg(-1); GP-5, 5% dried red grape pomace kg(-1)) on shelf life of lamb meat was studied. After slaughter (27 kg LBW), m. longissimus thoracis et lumborum was sliced, packaged under modified atmosphere (80:20%/O2:CO2) and stored in retail conditions for 14 days. At each sampling day (0, 4, 7, 11, 14), microbiological, physico-chemical and sensory characteristics were analysed. Meat from VIT-E presented lower microbial counts than CTRL, GSE and GP-5, without differences between polyphenol treatments (GSE and GP-5) and CTRL. Vitamin E reduced meat discoloration and lipid oxidation (TBARS values) from day 7 with respect to the other treatments. Although not significant, an improvement in TBARS values of about 20% was observed for GSE and GP-5, compared with CTRL, from day 7 of storage. VIT-E dietary treatment was more effective in preventing sensory spoilage than the other treatments.