Ocimum gratissimum essential oil in the transport water of Brycon hilarii: implications at water quality, blood parameters and residues in tissue and plasma.

Transporting live fish is a common practice in fish farming, and is certainly one of the main problems that affect fish homeostasis. In this scenario, the use of natural additives has shown promise in improving fish resistance to adverse situations. This study aimed to assess the impact of Ocimum gratissimum L. essential oil (OGEO) on water quality, hematological parameters, and residue levels in the plasma, fillet, and liver of juvenile piraputanga (Brycon hilarii) during a two-hour transportation period. The fish were divided into plastic bags (4 L) and exposed to three different OGEO concentrations (10, 20, and 30 mg L-1), while a control group received no OGEO (three repetitions each). After the two-hour transportation, blood samples were collected, as well as portions of the fillet and liver for quantifying essential oil compounds, which were also measured in the plasma. Oxygen levels remained high throughout the transportation period, in all groups, while the pH decreased. Hemoglobin, MCHC, and MCH increased in fish exposed to OGEO concentrations of 20 and 30 mg L-1, compared to the control group. However, lymphocyte counts and the concentrations of essential oil compounds in plasma, fillet, and liver increased with higher OGEO concentrations. The use of 10 mg L-1 OGEO in the two-hour transport water is promising to ensure the survival and well-being of Brycon hilarii juveniles (weighing 16 g), showing to be safe and effective. The residual concentration of eugenol the major compound of OGEO in the fillet remains below the maximum limit of the recommended daily intake.

Photocatalytic degradation of acid yellow 36 with calcined titania-hydroxyapatite-cuo xerogels.

Advanced oxidation processes (AOP), using semiconductor (SC) and hydroxyapatite (HA) composites, are promising due to the synergy of photocatalytic and adsorption properties. Still, dye removal efficiency of composites based on HA-SC remains low, because most of the research reported consider single SC materials. In this work, nanocrystalline xerogels of titanium oxide (TiO2) with copper oxide (CuO) and HA were synthesized by the sol-gel process. HA was obtained by the precipitation method without heat treatment and calcined in the range of 200-1000 °C. TiO2 and copper precursors were added to a sol containing HA in a 12:1 mol ratio, obtaining HA-TiO2 and HA-CuO-TiO2 nanomaterials. The xerogels were characterized by X-ray diffraction, scanning electron microscopy, emission field scanning electron microscopy and photoresponse. Their performance in the photocatalytic discoloration of an aqueous solution acid yellow dye 36 (AY36) was evaluated, using visible and UV light. The best discoloration was achieved with HA-CuO-TiO2 xerogels with HA calcined at 600 °C, showing a degradation kinetic constant of 0.24 min-1. In contrast, HA-TiO2 materials showed little or no photocatalytic activity, but strong dye adsorption/desorption. The thermal treatment of HA determines the filament-like morphology and degree of compaction of the nanomaterials, which are relevant in the crystallite size and sensitization of the SC matrix. Further studies must address the surface chemistry and rectifying properties of the best SC composite to have a more complete understanding of the mechanisms involved.

Brycon hilarii produced in hapas: effects in allometric growth.

Biometric evaluations are essential to determine the growth characteristics related to the weight and length of fish. This study aimed to determine the growth patterns of juvenile piraputangas (Brycon hilarii) produced in hapas within an excavated pond. The piraputangas were anesthetized and micro-chipped and their biometric characteristics were measured. Subsequently, the fish were distributed in six hapas of eight m3 at the density of 20 fish/hapa, totaling 120 animals. During the experimental period six months, the fish were fed twice (5% of the biomass) a day. Every 30 days, all fish were sampled to measure the biometric characteristics of body weight (g); standard length; total length; head height; head length; body height and body width (cm). The calculations of the weight ratio with the biometric characteristics were determined using allometric equation and estimated by linear regression according to the equation log Y = log a + b log X. All tested relationships were significant by the Student t-test (p < 0.05). Allometric growth was positive for: weight x total length; standard weight x length; weight x head height; weight x head length and weight x body height. The relative condition factor of piraputangas observed in this study was 1.00. The study provided information on the allometric parameters of juvenile Brycon hilarii produced in hapas, and the relative condition factor indicated good growth conditions for piraputangas with positive allometric growth.

Smell loss associated with SARS-CoV-2 is not clinically different from other viruses: a multicenter cohort study.

BACKGROUND: Although the COVID-19 pandemic has increased the prevalence of cases with olfactory loss, other respiratory viruses can also cause this condition. We aimed to compare the prevalence of acute SARS-CoV-2 infection and other respiratory viruses in patients with sudden smell loss, and to assess the impact of SARS-CoV-2 viral load and co-infection on olfactory symptoms. METHODS: Patients with sudden smell loss were recruited in a multicenter prospective cohort study in 15 hospitals in Brazil. Clinical questionnaire, Connecticut Chemosensory Clinical Research Center (CCCRC) olfactory test and nasopharyngeal swab to perform a PCR-based respiratory viral panel were collected at first visit (day 0) and 30 and 60 days after recruitment. RESULTS: 188 of 213 patients presented positive test result for SARS-CoV-2, among which 65 were co-infected with other respiratory viruses (e.g., rhinovirus, enterovirus, and parainfluenza). 25 had negative test results for SARS-CoV-2. Patients in both SARSCoV-2 and non-SARS-CoV-2 groups had objective anosmia (less than 2 points according to the psychophysical olfactory CCCRC) at day 0, with no significant difference between them. Both groups had significant smell scores improvement after 30 and 60 days, with no difference between them. Co-infection with other respiratory viruses, and SARS-CoV-2 viral load did not impact olfactory scores. CONCLUSION: Patients with sudden smell loss associated with SARS-CoV-2 and other respiratory viruses had similar presentation, with most participants initiating with anosmia, and total or near total recovery after 60 days. SARS-CoV-2 viral load and co-infections with other respiratory viruses were not associated with poorer olfactory outcomes.

Induced reproduction of yellow-tailed lambari (Astyanax lacustris) with Ovopel® and buserelin acetate as alternatives to the protocol with carp pituitary extract.

The objective of this study was to evaluate reproductive traits in adults of Astyanax lacustris subjected to different spawning inducers. The study involved 240 females (12.54 g ± 2.33 and 7.66 cm ± 0.63 cm) and 240 males (5.83 g ± 0.39 g and 6.14 cm ± 0.64 cm), all at reproductive age. Three different inducers were evaluated: (i) 0.4 pellets of Ovopel®/kg of body weight; (ii) 0.5 ml of buserelin acetate/kg of body weight; and (iii) carp pituitary extract (CPE) (5.5 mg CPE/kg body weight for females and 2.5 mg CPE/kg body weight for males), as well as saline solution (without hormone). The degree-hours for spawning were greater (P<0.05) for the Ovopel® treatment (with 204.93) than in the treatment with CPE (183.2). Ovary weight and gonadosomatic index were higher (P<0.05) in CPE and Ovopel® treatments when compared to buserelin acetate. The number of oocytes per female, absolute and relative fecundity were greater (P<0.05) for Ovopel® and CPE treatments. Fertilization rate was higher (P<0.05) in treatment with buserelin acetate (82.3%) in relation to Ovopel® (72.33%) and CPE (62.40%) treatments, and the highest (P<0.05) hatching rates were achieved with buserelin acetate and Ovopel®. The number of larvae per female body weight was greater (P<0.05) when Ovopel® was used. In conclusion, Ovopel® proves to be a more effective reproductive inducer for induced reproduction of A. lacustris when compared to CPE and buserelin acetate.

Efectos de la pandemia en una consulta de tabaquismo / Effects of the pandemic on a smoking consultation

Objetivo. Análisis de las diferencias entre pacientes atendidos en la unidad hospitalaria de tabaquismo del H. Doctor Peset de Valencia, antes de la pandemia y con posterioridad, para valorar resultados obtenidos en cuanto a abstinencia tabáquica. Material y método. Estudio retrospectivo observacional analizando las mismas variables en dos periodos temporales: pacientes atendidos por primera vez durante el año previo a la pandemia (enero-diciembre 2019) y entre junio de 2021 y junio de 2022 (postpandemia). Se valoran datos demográficos, comorbilidades, dependencia, tratamiento farmacológico prescrito y éxitos obtenidos. Resultados. Diferencias en el número de pacientes atendidos con una reducción de 645 a 115. Incremento de trastornos psiquiátricos de 16,1% a 30,4%. Entre los tratamientos prescritos hay variación en vareniclina (46% a 13,9%) y en citisina (0 a 27,8%). La tasa de abstinencia a los 12 meses disminuye de 37,6% a 8,7% y el porcentaje de abstinencia entre los que completan el seguimiento pasa de 72% a 15,62%. No hay variación significativa en el resto de las variables estudiadas. Conclusión. El impacto de la pandemia en esta consulta se ha reflejado no solo en el drástico descenso del número de pacientes atendidos, sino también en un notable aumento de la comorbilidad psiquiátrica. Además, preocupa la reducción del porcentaje de pacientes que consiguen deshabituación. (AU)

Objective. Analysis of the differences between patients seen in a hospital smoking cessation unit of the H. Doctor Peset de Valencia before and after the pandemic to evaluate the results obtained regarding smoking abstinence. Material and methods. A retrospective observational study analyzing the same variables in two time periods: patients seen for the first time during the year prior to the pandemic (January-December 2019) and between June 2021 and June 2022 (post-pandemic). Demographic data, comorbidities, dependency, drug treatment prescribed and successes obtained are evaluated. Results. Differences were found in the number of patients seen, with a reduction from 645 to 115 and an increase of psychiatric disorders from 16.1% to 30.45. Among the treatments prescribed, there were variations in varenicline (46% to 13.9%) and in cytisine (0 to 27.8%). Abstinence rate at 12 months decreased from 37.6% to 8.7% and the abstinence percentage among those who completed the follow-up from 72% to 15.62%. There are no significant variations in the rest of the variables studied. Conclusion. The impact of the pandemic in this consultation has not only been reflected in the drastic decrease in the number of patients seen but also on a notable increase in psychiatric comorbidity. In addition, the reduction in the percentage of patients who achieved cessation is of concern. (AU)

Superiority of manual disinfection using pre-soaked wipes over automatic UV-C radiation without prior cleaning.

BACKGROUND: The efficacy of ultraviolet C (UV-C) radiation against a broad spectrum of micro-organisms has been demonstrated in several studies, but differences in the specific doses and the extent of microbial reduction were found. Furthermore, the conditions of laboratory tests differ greatly from reality, such that efficacy achieved in tests may not necessarily be assumed in reality. Consequently, it is important to investigate the effectiveness of UV-C in representative field trials. The aim was therefore to develop and establish a field test to evaluate automatic UV-C in comparison to manual disinfection. METHODS: Before and after disinfection, samples were repeatedly collected from naturally highly contaminated surfaces using the swab technique to obtain representative data sets for disinfected and non-disinfected surfaces. Subsequently, the log reduction values (LRV) and the disinfection success were evaluated for UV-C radiation and full compliant manual disinfection using alcohol-based wipes. RESULTS: Surfaces that are naturally contaminated with bacteria on a regular and nearly uniform basis have been identified as particularly suitable for field testing. Mean contamination was reduced from 23.3 to 1.98 cfu/cm2 (LRV 0.9) and 29.7 to 0.26 cfu/cm2 (LRV 1.2) for UV-C and manual disinfection, respectively. UV-C disinfection achieved 75.5% successful disinfected surfaces, whereas manual disinfection showed 98.1%. CONCLUSIONS: Full compliant manual disinfection showed slightly higher LRVs and disinfection success than automatic UV-C disinfection. Successful, operator-independent UV-C disinfection still has the potential to improve disinfection performance in addition to manual disinfection.

Tolerance of clinical vancomycin-resistant Enterococcus faecium isolates against UV-C light from a mobile source.

BACKGROUND: Admission to a room previously occupied by patients carrying environmentally robust pathogens implies an increased risk of acquiring those pathogens. Therefore, 'No-touch' automated room disinfection systems, including devices based on UV-C irradiation, are discussed to improve terminal cleaning. It is still unclear if clinical isolates of relevant pathogens behave differently under UV-C irradiation compared to laboratory strains used in the approval process of disinfection procedures. In this study we analysed the susceptibility of well characterized clonally divergent vancomycin-resistant enterococci (VRE) strains, including a linezolid-resistant isolate, against UV-C radiation. METHODS: Susceptibility against UV-C of ten clonally divergent clinical isolates of VRE was determined in comparison to the commonly used test organism Enterococcus hirae ATCC 10541. Ceramic tiles contaminated with 105 to 106 colony forming units/25 cm² of the different enterococci were positioned at a distance of 1.0 and 1.5 m and irradiated for 20 s, resulting in a UV-C dose of 50 and 22 mJ/cm², respectively. Reduction factors were calculated after quantitative culture of the bacteria recovered from treated and untreated surfaces. RESULTS: Susceptibility to UV-C varied considerably among the strains studied, with the mean value of the most robust strain being up to a power of ten lower compared to the most sensitive strain at both UV-C doses. The two most tolerant strains belonged to MLST sequence types ST80 and ST1283. The susceptibility of the laboratory strain E. hirae ATCC 10541 ranged between the most sensitive and most tolerant isolates for both irradiation doses. However, for UV-C dose of 22 mJ/cm², the reduction of the most tolerant isolate of ST1283 was statistically significantly lower compared to E. hirae ATCC 10541. The most susceptible strains belonged to the MLST sequence types ST117 and ST203. CONCLUSIONS: These results indicate that UV-C doses reported in the literature are sufficient for the reduction of commonly used reference strains of enterococci but could be insufficient for the reduction of tolerant patient VRE-isolates in a hospital setting. Therefore, for future studies, the most tolerant clinical isolates should be used to validate automated UV-C devices or longer exposure times should be expected to ensure efficacy in the real world.

Production of mycelial biomass, proteases and protease inhibitors by Ganoderma lucidum under different submerged fermentation conditions.

Ganoderma lucidum is a medicinal mushroom widely recognized as a source of biomolecules with pharmacological properties, however, little is known about the factors that influence the synthesis of bioactive proteins by this fungus when cultivated under submerged fermentation. The objective of this work was to evaluate the production of mycelial biomass and intracellular proteases and protease inhibitors by G. lucidum cultivated under different submerged fermentation conditions. The cultivation was carried out in a medium composed of glucose (10 or 20 g.L-1), soy peptone (2.5 or 5 g.L-1) and yeast extract (5 g.L-1), with incubation under agitation (120 rpm) and non-agitation, totaling 8 experimental conditions. Biomass production was determined from the dry weight, while glucose consumption was estimated by quantification of reducing sugars. The proteins were extracted in NaCl (0.15 M), and the protein extracts were submitted to protein quantification by the Bradford method, total proteolytic activity using azocasein, caseinolytic and fibrinolytic activity in Petri dishes, activity of serine (trypsin and chymotrypsin) and cysteine (papain) protease inhibitors. Cultivation in agitated condition showed higher biomass production with a maximum value of 7 g.L-1, in addition to higher activities of trypsin, chymotrypsin and papain inhibitors, with 154 IU.mg-1, 153 IU.mg-1 e 343 IU.mg-1 of protein, respectively. The non-agitated condition showed a greater potential for obtaining proteins, total proteases, caseinolytic and fibrinolytic enzymes, with maximum values of 433 mg.g-1 of extract, 71 U.mL-1 of extract, 63.62 mm2 and 50.27 mm2, respectively. Thus, a medium composed of soy peptone, yest extract and glucose in a 1:2:4 proportion is recommended, under agitation to produce protease inhibitors, and the non-agitated condition when the target is, mainly caseinolytic and fibrinolytic enzymes.

Prediction of Radiation-induced Lymphopenia following Exposure of the Thoracic Region and Associated Risk of Infections and Mortality.

AIMS: Large blood volumes are irradiated when the heart is exposed to radiation. The mean heart dose (MHD) may be a good surrogate for circulating lymphocytes exposure. We investigated the association between MHD and radiation-induced lymphopenia and explored the impact of the end-of-radiation-therapy (EoRT) lymphocyte count on clinical outcomes. MATERIALS AND METHODS: In total, 915 patients were analysed: 303 patients with breast cancer and 612 with intrathoracic tumours: oesophageal cancer (291), non-small cell lung cancer (265) and small cell lung cancer (56). Heart contours were generated using an interactive deep learning delineation process and an individual dose volume histogram for each heart was obtained. A dose volume histogram for the body was extracted from the clinical systems. We compared different models analysing the effect of heart dosimetry on the EoRT lymphocyte count using multivariable linear regression and assessed goodness of fit. We published interactive nomograms for the best models. The association of the degree of EoRT lymphopenia with clinical outcomes (overall survival, cancer treatment failure and infection) was investigated. RESULTS: An increasing low dose bath to the body and MHD were associated with a low EoRT lymphocyte count. The best models for intrathoracic tumours included dosimetric parameters, age, gender, number of fractions, concomitant chemotherapy and pre-treatment lymphocyte count. Models for patients with breast cancer showed no improvement when adding dosimetric variables to the clinical predictors. EoRT lymphopenia grade ≥3 was associated with decreased survival and increased risk of infections among patients with intrathoracic tumours. CONCLUSION: Among patients with intrathoracic tumours, radiation exposure to the heart contributes to lymphopenia and low levels of peripheral lymphocytes after radiotherapy are associated with worse clinical outcomes.

Mortality in a swiftly repurposed hospital in northeast Brazil during the first and second COVID-19 waves: A retrospective cohort study.

Background: The first months of the coronavirus disease 2019 (COVID-19) pandemic demanded rapid re-organization of available local resources. This study evaluated the performance of a private hospital in the Brazilian state of Ceará that was swiftly repurposed into a public tertiary COVID-19 centre during the first wave of the COVID-19 pandemic, and how it improved in the second wave. Methods: This retrospective cohort study included 2492 patients with COVID-19 at Hospital Estadual Leonardo da Vinci (HELV) during the first and second waves. Demographic, clinical and laboratory data were collected using a dedicated web platform (ResCOVID). A Poisson regression model was used to estimate factors associated with in-hospital mortality. Results: Differences in demographics and clinical features were found between the two waves. There was reduced in-hospital mortality during the second wave (36.2%) in comparison with the first wave (48.8%). Invasive mechanical ventilation showed the strongest association with increased risk of death in both waves {first wave: relative risk (RR) 4.28 [95% confidence interval (CI) 2.86-6.41], P<0.001; second wave: RR 12.94 (95% CI 3.4-49.12), P<0.001}. Conclusions: HELV was a pillar in the strategic public health plan to respond to COVID-19 in Ceará, helping to assist a group of moderate-to-severe cases and reduce the pressure on emergency and primary care facilities. Although mortality in intubated individuals remained high, there was an overall decrease in the in-hospital mortality rate in the second wave.

Benefits in quality of life following an obstructive sleep apnea screening and treatment program in patients with acute ischemic stroke. / Beneficios en la calidad de vida de un programa de cribado y tratamiento de apnea obstructiva del sueño en pacientes con ictus isquémico agudo.

INTRODUCTION: Obstructive sleep apnea (OSA) has been proposed as a factor that worsens stroke prognosis. Our aim was to determine if an OSA intervention could improve quality of life (QOL, first objective) and modified Rankin score (mRS, second objective). PATIENTS AND METHODS: The intervention group of this quasi-experimental study included patients with acute ischemic stroke <72 hours who underwent polygraphy and Continuous Positive Airway Pressure (CPAP) and hygienic-dietary measures if required. The control group followed routine clinical practice. The Short Form 36 Health Survey (SF-36) and mRS were applied at the sixth month after stroke in both groups. RESULTS: Fifty-five vs. sixty-two patients were included in the intervention and control group respectively. In the intervention group, 64.71% of patients accepted the proposed CPAP (16 cases with a good adherence). An improvement in SF-36 items was detected in the intervention group: physical functioning (p = 0.008), role physical (p = 0.002), bodily pain (p = 0.008), general health (p <0.001), vitality (p = 0.001) and role emotional (p = 0.015). In a per-protocol analysis, all these improvements were verified in the group of patients treated with good CPAP adherence (p < 0.05 in all the same SF-36 items). The percentage of patients with physical component summatory = 50 was higher in the intervention group (p = 0.003). There were no differences in the median of mRS (p = 0.262). CONCLUSIONS: Although more evidence is needed, a significant improvement in QOL was suggested after our OSA intervention, particularly in patients with good CPAP adherence.

TITLE: Beneficios en la calidad de vida de un programa de cribado y tratamiento de apnea obstructiva del sueño en pacientes con ictus isquémico agudo.Introducción. La apnea obstructiva del sueño (AOS) se ha propuesto como un factor de mal pronóstico en el ictus. Pretendemos determinar si una intervención sobre la AOS puede mejorar las escalas de calidad de vida (primer objetivo) y de discapacidad (segundo objetivo). Pacientes y métodos. El grupo de intervención de este estudio cuasi experimental incluye a pacientes con ictus isquémico agudo menor de 72 horas de evolución a quienes se les realizó poligrafía, así como presión positiva continua en las vías aéreas (CPAP) y medidas higienicodietéticas si se requerían. En el grupo de control se siguió la práctica clínica habitual. Se aplicaron las escalas Short Form 36 Health Survey (SF-36) y modified Rankin Score (mRS) en el sexto mes del ictus en ambos grupos. Resultados. Se incluyó a 55 y a 62 pacientes en el grupo de intervención y en el de control, respectivamente. En el grupo de intervención, el 64,71% de los pacientes aceptó la CPAP indicada (16 casos con buena adhesión). Se detectó una mejoría en los ítems de la escala SF-36 en el grupo de intervención: funcionamiento físico (p = 0,008), rol físico (p = 0,002), dolor corporal (p = 0,008), salud general (p menor de 0,001), vitalidad (p = 0,001) y rol emocional (p = 0,015). En un análisis por protocolo, todas estas mejorías se comprobaron en el grupo de pacientes tratados con CPAP con buena adhesión (p menor de 0,05 en todos los ítems de la SF-36). El porcentaje de pacientes con el sumatorio del componente físico = 50 fue más alto en el grupo de intervención (p = 0,003). No había diferencias en la mediana de la mRS (p = 0,262). Conclusiones. Aunque se necesitan más evidencias, nuestro estudio sugiere una mejoría significativa de la calidad de vida tras nuestra intervención en la AOS, especialmente en pacientes con buena adhesión a la CPAP.

Systemic Corticosteroids in Patients With Bronchial Asthma: A Real-Life Study

Objective: The objective of the present study was to determine the use of systemic corticosteroids (SCs) in patients with bronchial asthma using big data analysis. Methods: We performed an observational, retrospective, noninterventional study based on secondary data captured from free text in the electronic health records. This study was performed based on data from the regional health service of Castille-La Mancha (SESCAM), Spain. We performed the analysis using big data and artificial intelligence via Savana® Manager version 3.0. Results: During the study period, 103 667 patients were diagnosed with and treated for asthma at different care levels. The search was restricted to patients aged 10 to 90 years (mean age, 43.5 [95%CI, 43.4-43.7] years). Of these, 59.8% were women. SCs were taken for treatment of asthma by 58 745 patients t some point during the study period. These patients were older, with a higher prevalence of hypertension, dyslipidemia, diabetes, obesity, depression, and hiatus hernia. SCs are used frequently in the general population with asthma (31.4% in 2015 and 39.6% in 2019). SCs were prescribed mainly in primary care (59%), allergy (13%), and pulmonology (20%). The frequency of prescription of SCs had a direct impact on the main associated adverse effects. Conclusion: In clinical practice, SCs are frequently prescribed to patients with asthma, especially in primary care. Use of SCs is associated with a greater number of adverse events. It is necessary to implement measures to reduce prescription of SCs to patients with asthma, especially in primary care (AU)

Objetivo: El objetivo del presente estudio fue determinar el uso de corticoides sistémicos (CS) en pacientes con asma bronquial mediante el análisis de big data. Métodos: Se realizó un estudio observacional, retrospectivo y no intervencionista basado en datos secundarios capturados a partir de texto libre en las historias clínicas electrónicas. Este estudio se realizó a partir de los datos del Servicio Regional de Salud de Castilla-La Mancha (SESCAM), España. Se realizó el análisis mediante big data e inteligencia artificial a través de Savana® Manager versión 3.0. Resultados: Durante el periodo de estudio, 103 667 pacientes fueron diagnosticados y tratados de asma en los diferentes niveles asistenciales. La búsqueda se restringió a pacientes de entre 10 y 90 años (edad media, 43,5 [IC 95%, 43,4-43,7] años). De ellos, el 59,8% eran mujeres. 58 745 pacientes tomaron SC para el tratamiento del asma en algún momento del periodo de estudio. Estos pacientes eran de mayor edad, con una mayor prevalencia de hipertensión, dislipidemia, diabetes, obesidad, depresión y hernia de hiato. Los SC se utilizan con frecuencia en la población general con asma (31,4% en 2015 y 39,6% en 2019). Los SC se prescribieron principalmente en Atención Primaria (59%), Alergia (13%) y Neumología (20%). La frecuencia de prescripción de SCs tuvo un impacto directo en los principales efectos adversos asociados. Conclusiones: En la práctica clínica, los CS se prescriben con frecuencia a los pacientes con asma, especialmente en Atención Primaria. El uso de los CS se asocia a un mayor número de efectos adversos. Es necesario implementar medidas para reducir la prescripción de CS a los pacientes con asma, especialmente en Atención Primaria (AU)

[Recurring genital bleeding in an extreme premature infant]. / Sangrado genital recurrente en una lactante prematura extrema.

Mini-puberty refers to the transient activation of the hypothalamic-pituitary-gonadal axis during the first months of life. This activation in preterm infants could be more exaggerated and prolonged. Ob jective: To present a case of exaggerated mini-puberty in an extremely preterm infant, with recurrent genital bleeding. Clinical Case: A 25-week preterm newborn presented at 5 months old with breast buds, areolar pigmentation, and estrogenic effects on the vaginal mucosa, with recurrent genital blee ding in three consecutive months. Her laboratory evaluation showed elevated values of luteinizing hormone (LH), follicle-stimulating hormone (FSH), and estradiol (E2). An exaggerated mini-puber ty due to extreme prematurity was suspected, therefore a conservative approach was taken. During follow-up, the patient showed partial regression of breast buds and cessation of genital bleeding, and decreasing levels of gonadotropin and estradiol. Conclusion: Mini-puberty in preterm newborns can present exaggeratedly, simulating precocious puberty and even presenting, exceptionally, recurrent genital bleeding. Considering the increasing survival of extremely premature infants, it is important to know the spectrum of clinical and laboratory manifestations of this phenomenon, in order to carry out adequate management.

Systemic Corticosteroids in Patients with Bronchial Asthma: A Real-Life Study.

OBJECTIVES: The objective of the present study was to determine the use of systemic corti-costeroids (SCs) in patients with bronchial asthma using big data analysis. METHODS: We performed an observational, retrospective, noninterventional study based on secondary data captured from free text in the electronic health records. This study was per-formed based on data from the regional health service of Castille-La Mancha (SESCAM), Spain. We performed the analysis using big data and artificial intelligence via Savana® Manager version 3.0. RESULTS: During the study period, 103 667 patients were diagnosed with and treated for asthma at different care levels. The search was restricted to patients aged 10 to 90 years (mean age, 43.5 [95%CI, 43.4-43.7] years). Of these, 59.8% were women. SCs were taken for treatment of asthma by 58 745 patients at some point during the study period. These patients were older, with a higher prevalence of hypertension, dyslipidemia, diabetes, ob-esity, depression, and hiatus hernia. SCs are used frequently in the general population with asthma (31.4% in 2015 and 39.6% in 2019). SCs were prescribed mainly in primary care (59%), allergy (13%) and pulmonology (20%). The frequency of prescription of SCs had a direct impact on the main associated adverse effects. CONCLUSION: In clinical practice, SCs are frequently prescribed to patients with asthma, especially in primary care. Use of SCs is associated with a greater number of adverse events. It is necessary to implement measures to reduce prescription of SCs to patients with asthma, especially in primary care.

Future Tail Tales: A Forward-Looking, Integrative Perspective on Tail Research.

Synopsis Tails are a defining characteristic of chordates and show enormous diversity in function and shape. Although chordate tails share a common evolutionary and genetic-developmental origin, tails are extremely versatile in morphology and function. For example, tails can be short or long, thin or thick, and feathered or spiked, and they can be used for propulsion, communication, or balancing, and they mediate in predator-prey outcomes. Depending on the species of animal the tail is attached to, it can have extraordinarily multi-functional purposes. Despite its morphological diversity and broad functional roles, tails have not received similar scientific attention as, for example, the paired appendages such as legs or fins. This forward-looking review article is a first step toward interdisciplinary scientific synthesis in tail research. We discuss the importance of tail research in relation to five topics: (1) evolution and development, (2) regeneration, (3) functional morphology, (4) sensorimotor control, and (5) computational and physical models. Within each of these areas, we highlight areas of research and combinations of long-standing and new experimental approaches to move the field of tail research forward. To best advance a holistic understanding of tail evolution and function, it is imperative to embrace an interdisciplinary approach, re-integrating traditionally siloed fields around discussions on tail-related research.