The growzen™ buddy smartphone app to improve adherence in patients receiving recombinant human growth hormone therapy: a retrospective observational study in Argentina.

Introduction: This study in Argentina evaluated the impact of the growzen™ buddy smartphone app on adherence to recombinant human growth hormone (r-hGH) treatment. Methods: The adherence data, invitation dates with a link to the app, app activation dates, and height measurements entered were extracted from the growzen™ digital health ecosystem. Patients with 12 months of adherence data, aged ≥2 years at treatment start, and aged <19 years were selected both before and after app implementation. Mean adherence was classified as optimal (≥85%) versus suboptimal (<85%). Adherence before and after implementation and the pre-post effect on adherence were assessed. Results: Data for 830 patients were available. Prior to app implementation, the proportion of patients with optimal adherence was 68% (n = 348/515). Following the app implementation, out of 315 patients, 302 (96%) received an invitation with a link to the app, 225 (71%) activated their account, and 127 (40%) entered height data in the first year. There was a significant early increase in the proportion of patients with optimal adherence following implementation: 82% (n = 258/315), p < 0.001. After implementation, the proportion of patients with optimal adherence included 80% (n = 78/98) of those with an active account who did not enter height measurements and 89% (n = 113/127) of those who did. There was a significant and positive pre-post app effect on adherence (p < 0.01) in patients with an active account. Discussion: Our results show that using the growzen™ buddy app has a rapid and positive impact on adherence to r-hGH treatment, and patients who were more engaged with the app demonstrated better adherence.

Unraveling habitat-driven shifts in alpha, beta, and gamma diversity of hummingbirds and their floral resource.

Background: Biodiversity, crucial for understanding ecosystems, encompasses species richness, composition, and distribution. Ecological and environmental factors, such as habitat type, resource availability, and climate conditions, play pivotal roles in shaping species diversity within and among communities, categorized into alpha (within habitat), beta (between habitats), and gamma (total regional) diversity. Hummingbird communities are influenced by habitat, elevation, and seasonality, making them an ideal system for studying these diversities, shedding light on mutualistic community dynamics and conservation strategies. Methods: Over a year-long period, monthly surveys were conducted to record hummingbird species and their visited flowering plants across four habitat types (oak forest, juniper forest, pine forest, and xerophytic shrubland) in Tlaxcala, Mexico. Three locations per habitat type were selected based on conservation status and distance from urban areas. True diversity measures were used to assess alpha, beta, and gamma diversity of hummingbirds and their floral resources. Environmental factors such as altitude and bioclimatic variables were explored for their influence on beta diversity. Results: For flowering plants, gamma diversity encompassed 34 species, with oak forests exhibiting the highest richness, while xerophytic shrublands had the highest alpha diversity. In contrast, for hummingbirds, 11 species comprised the gamma diversity, with xerophytic shrublands having the highest richness and alpha diversity. Our data reveal high heterogeneity in species abundance among habitats. Notably, certain floral resources like Loeselia mexicana and Bouvardia ternifolia emerge as key species in multiple habitats, while hummingbirds such as Basilinna leucotis, Selasphorus platycercus, and Calothorax lucifer exhibit varying levels of abundance and habitat preferences. Beta diversity analyses unveil habitat-specific patterns, with species turnover predominantly driving dissimilarity in composition. Moreover, our study explores the relationships between these diversity components and environmental factors such as altitude and climate variables. Climate variables, in particular, emerge as significant contributors to dissimilarity in floral resource and hummingbird communities, highlighting the influence of environmental conditions on species distribution. Conclusions: Our results shed light on the complex dynamics of hummingbird-flower mutualistic communities within diverse habitats and underscore the importance of understanding how habitat-driven shifts impact alpha, beta, and gamma diversity. Such insights are crucial for conservation strategies aimed at preserving the delicate ecological relationships that underpin biodiversity in these communities.

Improved biodistribution and enhanced immune response of subunit vaccine using a nanostructure formed by self-assembly of ascorbyl palmitate.

New adjuvant strategies are needed to improve protein-based subunit vaccine immunogenicity. We examined the potential to use nanostructure of 6-O-ascorbyl palmitate to formulate ovalbumin (OVA) protein and an oligodeoxynucleotide (CpG-ODN) (OCC). In mice immunized with a single dose, OCC elicited an OVA-specific immune response superior to OVA/CpG-ODN solution (OC). Rheological studies demonstrated OCC's self-assembling viscoelastic properties. Biodistribution studies indicated that OCC prolonged OVA and CpG-ODN retention at injection site and lymph nodes, reducing systemic spread. Flow-cytometry assays demonstrated that OCC promoted OVA and CpG-ODN co-uptake by Ly6ChiCD11bhiCD11c+ monocytes. OCC and OC induced early IFN-γ in lymph nodes, but OCC led to higher concentration. Conversely, mice immunized with OC showed higher serum IFN-γ concentration compared to those immunized with OCC. In mice immunized with OCC, NK1.1+ cells were the IFN-γ major producers, and IFN-γ was essential for OVA-specific IgG2c switching. These findings illustrate how this nanostructure improves vaccine's response.

Synthesis of Novel Triazine-Based Chalcones and 8,9-dihydro-7H-pyrimido[4,5-b][1,4]diazepines as Potential Leads in the Search of Anticancer, Antibacterial and Antifungal Agents.

This study presents the synthesis of four series of novel hybrid chalcones (20,21)a-g and (23,24)a-g and six series of 1,3,5-triazine-based pyrimido[4,5-b][1,4]diazepines (28-33)a-g and the evaluation of their anticancer, antibacterial, antifungal, and cytotoxic properties. Chalcones 20b,d, 21a,b,d, 23a,d-g, 24a-g and the pyrimido[4,5-b][1,4]diazepines 29e,g, 30g, 31a,b,e-g, 33a,b,e-g exhibited outstanding anticancer activity against a panel of 60 cancer cell lines with GI50 values between 0.01 and 100 µM and LC50 values in the range of 4.09 µM to >100 µM, several of such derivatives showing higher activity than the standard drug 5-fluorouracil (5-FU). On the other hand, among the synthesized compounds, the best antibacterial properties against N. gonorrhoeae, S. aureus (ATCC 43300), and M. tuberculosis were exhibited by the pyrimido[4,5-b][1,4]diazepines (MICs: 0.25-62.5 µg/mL). The antifungal activity studies showed that triazinylamino-chalcone 29e and triazinyloxy-chalcone 31g were the most active compounds against T. rubrum and T. mentagrophytes and A. fumigatus, respectively (MICs = 62.5 µg/mL). Hemolytic activity studies and in silico toxicity analysis demonstrated that most of the compounds are safe.

Lung transplant outcomes after acute respiratory distress syndrome requiring extracorporeal life support: Lessons from the COVID-19 pandemic.

OBJECTIVE: Lung transplant for acute respiratory distress syndrome in patients supported with extracorporeal membrane oxygenation was rare before 2020, but was rapidly adopted to rescue patients with COVID-19 with lung failure. This study aims to compare the outcomes of patients who underwent lung transplant for COVID-associated acute respiratory distress syndrome and non-COVID acute respiratory distress syndrome, and to assess the impact of type and duration of extracorporeal membrane oxygenation support on survival. METHODS: Using the United Network for Organ Sharing database, we identified 311 patients with acute respiratory distress syndrome who underwent lung transplant from 2007 to 2022 and performed a retrospective analysis of the patients who required extracorporeal membrane oxygenation preoperatively, stratified by COVID-associated acute respiratory distress syndrome and non-COVID acute respiratory distress syndrome listing diagnoses. The primary outcome was 1-year survival. Secondary outcomes included the effect of type and duration of extracorporeal membrane oxygenation on survival. RESULTS: During the study period, 236 patients with acute respiratory distress syndrome and preoperative extracorporeal membrane oxygenation underwent lung transplant; 181 patients had a listing diagnosis of COVID-associated acute respiratory distress syndrome (77%), and 55 patients had a listing diagnosis of non-COVID acute respiratory distress syndrome (23%). Patients with COVID-associated acute respiratory distress syndrome were older, were more likely to be female, had higher body mass index, and spent longer on the waitlist (all P < .02) than patients with non-COVID acute respiratory distress syndrome. The 2 groups had similar 1-year survival (85.8% vs 81.1%, P = .2) with no differences in postoperative complications. Patients with COVID-associated acute respiratory distress syndrome required longer times on extracorporeal membrane oxygenation pretransplant (P = .02), but duration of extracorporeal membrane oxygenation support was not a predictor of 1-year survival (P = .2). CONCLUSIONS: Despite prolonged periods of pretransplant extracorporeal membrane oxygenation support, selected patients with acute respiratory distress syndrome can undergo lung transplant safely with acceptable short-term outcomes. Appropriate selection criteria and long-term implications require further analysis.

Habilidades sociais na especialidade da enfermagem em oncologia: estudo qualitativo / Social skills in the nursing specialty in oncology: qualitative study / Habilidades sociales en la especialidad de enfermería en oncología: estudio cualitativo

Objetivo: compreender o significado das habilidades sociais atribuído por enfermeiros especialistas em enfermagem em oncologia. Método: estudo qualitativo, exploratório, que aplicou a Teoria Fundamentada nos Dados e o Interacionismo Simbólico. Participaram 14 enfermeiros de um dos grupos amostrais, especialistas em oncologia, de hospital oncológico. Aplicamos a entrevista semiestruturada, on-line, de maio de 2021 a dezembro de 2022. A análise seguiu a codificação aberta, axial e integração, e aplicamos o paradigma da codificação. Resultados: a categoria paradigmática 'condição do fenômeno' é apresentada face o aspecto semântico e de reconhecimento da aplicação das habilidades sociais. A categoria Percepções e significados das habilidades sociais para enfermeiros oncologistas alicerçou-se nas subcategorias: reagindo ao termo, e atribuindo significados e valores às habilidades sociais na especialidade da enfermagem em oncologia. Conclusão: os enfermeiros reconhecem as habilidades sociais e sua importância na oncologia. Desse modo, reitera-se a importância da articulação teórico-prático para qualificar a prática na oncologia(AU)

Objective: to understand the meaning of social skills attributed by specialist nurses in oncology nursing. Method: a qualitative, exploratory study, which applied Grounded Theory and Symbolic Interactionism. The participants were 14 nurses from one of the sample groups, specialists in oncology, from an oncological hospital. We applied semi-structured interviews, online, from May 2021 to December 2022. The analysis followed open, axial, and integration coding, and the coding paradigm. Results: we present the paradigm condition category, given the semantic aspect and recognition of the application of social skills. The category Perceptions and meanings of social skills for oncology nurses was based on the subcategories: reacting to the term, and attributing meanings and values to social skills in the specialty of nursing in oncology. Conclusion: nurses recognize social skills and their importance in oncology. We reinforce the importance of theoretical-practical articulation to qualify the practice in oncology(AU)

Objetivo: comprender el significado de las habilidades sociales atribuido por enfermeros especialistas en enfermería oncológica. Método: estudio cualitativo, exploratorio, que aplicó la Teoría Fundamentada y el Interaccionismo Simbólico. 14 enfermeros, expertos en oncología, participaron en uno de los grupos de muestreo de un hospital oncológico. Aplicamos entrevistas semiestructuradas, en línea, de mayo de 2021 a diciembre de 2022. El análisis siguió la codificación abierta, axial y de integración, y aplicamos el paradigma de la codificación. Resultados: se presentó la categoría paradigmática 'condición del fenómeno' ante el aspecto semántico y de reconocimiento de la aplicación de habilidades sociales. La categoría 'Percepciones y significados de las habilidades sociales para enfermeros de oncología' se basó en las subcategorías: reaccionando al término y atribuyendo significados y valores a las habilidades sociales en la especialidad de enfermería en oncología. Conclusión: los enfermeros reconocen las habilidades sociales y su importancia en la oncología. Siendo así, reforzamos la importancia de la articulación teórico-práctica para cualificar la práctica en oncología(AU)

Case report: A combination of nitroglycerin and adenosine proves effective in repairing a cerebral arteriovenous malformation.

Hemorrhage secondary to rupture of a brain arteriovenous malformations (AVM) is one of the initial manifestations, and the main cause of, morbidity and mortality in patients with this condition. Current treatment strategies include endovascular embolization with the goal of AVM obliteration and neurological preservation. In the transvenous endovascular embolization procedure, adenosine is the preferred agent to induce temporary hypotension and allow adequate AVM embolization. We describe the intraoperative management of an adenosine-resistant 38 year-old male who underwent a successful intracranial AVM embolization after concomitant administration of gradually increasing doses of nitroglycerin. This report suggests that nitroglycerin infusion can be combined with adenosine boluses to create a pronounced and dose-dependent hypotension in patients partially unresponsive to adenosine alone.

The SHELTER Trial of Transplanting Hepatitis C Virus-Infected Lungs Into Uninfected Recipients.

SHELTER is a trial of transplanting lungs from deceased donors with hepatitis C virus (HCV) infection into HCV-negative candidates (sponsor: Merck; NCT03724149). Few trials have reported outcomes using thoracic organs from HCV-RNA+ donors and none have reported quality of life (QOL). Methods: This study is a single-arm trial of 10 lung transplants at a single center. Patients were included who were between 18 and 67 y of age and waitlisted for lung-only transplant. Patients were excluded who had evidence of liver disease. Primary outcome was HCV cure (sustained virologic response 12 wk after completing antiviral therapy). Recipients longitudinally reported QOL using the validated RAND-36 instrument. We also applied advanced methods to match HCV-RNA+ lung recipients to HCV-negative lung recipients in a 1:3 ratio at the same center. Results: Between November 2018 and November 2020, 18 patients were consented and opted-in for HCV-RNA+ lung offers in the allocation system. After a median of 37 d (interquartile range [IQR], 6-373) from opt-in, 10 participants received double lung transplants. The median recipient age was 57 y (IQR, 44-67), and 7 recipients (70%) had chronic obstructive pulmonary disease. The median lung allocation score at transplant was 34.3 (IQR, 32.7-86.9). Posttransplant, 5 recipients developed primary graft dysfunction grade 3 on day 2 or 3, although none required extracorporeal membrane oxygenation. Nine patients received elbasvir/grazoprevir, whereas 1 patient received sofosbuvir/velpatasvir. All 10 patients were cured of HCV and survived to 1 y (versus 83% 1-y survival among matched comparators). No serious adverse events were found to be related to HCV or treatment. RAND-36 scores showed substantial improvement in physical QOL and some improvement in mental QOL. We also examined forced expiratory volume in 1 s-the most important lung function parameter after transplantation. We detected no clinically important differences in forced expiratory volume in 1 s between the HCV-RNA+ lung recipients versus matched comparators. Conclusions: SHELTER adds important evidence regarding the safety of transplanting HCV-RNA+ lungs into uninfected recipients and suggests QOL benefits.

Evaluating the TUITEK® patient support program in supporting caregivers of children diagnosed with growth hormone deficiency in Argentina.

Introduction: The appropriate use of recombinant human growth hormone (r-hGH) treatment provides an opportunity to improve growth outcomes among pediatric patients with growth hormone deficiency (GHD). However, a major challenge in clinical practice is to adequately recognize and address factors that negatively affect treatment adherence. TUITEK® patient support program (PSP) was designed to help caregivers of children diagnosed with GHD to personalize the care pathway, improve adherence, and achieve better outcomes. Effectiveness of TUITEK® PSP has been demonstrated previously in a smaller sample (n = 31) in Taiwanese population. Here, we present the results from Argentina. Methods: TUITEK® PSP was piloted among 76 caregivers of children with GHD administering r-hGH using easypod™ (Merck KGaA, Darmstadt, Germany) auto-injector device in Argentina. Based on TUITEK® personalization questionnaire, caregivers were assigned to high- and low-risk groups across four categories that may influence adherence, including disease and treatment coherence (DTC), self-administration (SA), treatment-related anxiety (TRA), and emotional burden (EB). The caregivers who were included in atleast one high-risk group had the provision of telephone calls with a nurse practitioner every 2 weeks for 3 months. The Wilcoxon signed-rank test was employed to assess changes in questionnaire-based scoring patterns between baseline and follow-up evaluations. Results: Statistically significant changes (p < 0.05) in questionnaire scores between baseline and follow-up evaluations were observed across the four categories. The mean/median DTC (n = 11) and SA (n = 23) scores changed from 2.45/3 and 2.17/2, respectively, to 4/4, with all the caregivers moving to low-risk group following program completion (100%) for both categories. The mean/median TRA score (n = 40) changed from 3.58/3 to 2.5/2 and 67.5% of patients (27/40) moved to low-risk group. The mean/median EB score (n = 32) changed from 3.69/3 to 3.13/3 however, none of the caregivers moved to low-risk group (0%). Conclusion: TUITEK® PSP is a simple, practical, and time-efficient interventional tool that can be used to address key adherence-related issues among caregivers of children with GHD and provide personalized adherence support. Our findings demonstrate that TUITEK® PSP has the potential to improve treatment adherence and self-management, thereby improving growth outcomes in Argentina.

Dantrolene Significantly Improves Cerebral Blood Flow in a Rat Model of Hemorrhagic Vasospasms.

INTRODUCTION: A cerebral vasospasm (CVSP) is a potent vasoconstriction of the cerebral vasculature and the primary cause of morbidity and mortality following a subarachnoid hemorrhage. The middle cerebral artery (MCA) is commonly affected by CVSPs. Concomitant administration of dantrolene and nimodipine synergistically reduces vasospasms in aortic rings from Sprague Dawley rats. To determine if the effects observed in the systemic vasculature extend to the cerebral circulation, we investigated the effect of intravenous administration of dantrolene (2.5 mg/kg) and nimodipine (1 mg/kg and 2 mg/kg) on MCA blood flow velocity (BFV) 7 days after the induction of CVSPs. METHODS: Vasospasms were induced by bathing the left common carotid artery with autologous whole blood. Age-matched sham rats were used as controls. BFV, mean arterial pressure (MAP), and heart rate (HR) were measured with a PeriFlux 5000 Laser Doppler System, and a CODA non-invasive blood pressure system, before and after administering the drugs. Morphometric evaluations were also performed to assess vascular alterations. RESULTS: BFV was reduced by 37% with dantrolene alone (n = 6, p ≤ 0.05) and by 27% with 2 mg/kg nimodipine (n = 6, p < 0.05), while it was not affected by 1 mg/kg nimodipine. The combination of 1 mg/kg nimodipine with dantrolene, however, decreased BFV by 35% (from 435.70 ± 21.53 to 284.30 ± 23.13 perfusion units, n = 7, p ≤ 0.05). A similar reduction (31%) was obtained with dantrolene and 2 mg/kg nimodipine (from 536.00 ± 32.61 to 367.80 ± 40.93 perfusion units, n = 6, p ≤ 0.05). Neither MAP nor HR was affected by dantrolene or nimodipine alone. The combination of dantrolene with 2 mg/kg nimodipine, however, decreased MAP and increased HR. Furthermore, 7 days after the induction of vasospasms, lumen area of the left common carotid artery decreased, whereas media thickness and the wall-to-lumen ratio increased when compared to contralateral controls. The latter finding suggests that vascular remodeling was present at this stage. CONCLUSION: Altogether, our results indicate that 2.5 mg/kg dantrolene significantly reduces BFV in the MCA without altering systemic hemodynamic parameters to a similar extent than the highest dose of nimodipine or the combination of dantrolene and the lowest dose of nimodipine. Therefore, dantrolene may provide a promising alternative to lower the risk, or partially revert, CVSP.

Calidad de vida en pacientes con esclerosis sistémica en confinamiento por pandemia de COVID-19 en Argentina / Quality of life in patients with systemic sclerosis in confinement due to the COVID-19 pandemic in Argentina

Introducción: los pacientes con enfermedades reumáticas tienen una calidad de vida significativamente deteriorada. La pandemia por COVID-19 tuvo un notable impacto sobre la población y los sistemas de salud de todo el mundo. Objetivos: en este trabajo nos proponemos conocer el impacto de la pandemia en la calidad de vida de los pacientes con esclerosis sistémica (ES) y cómo fue el acceso a la atención médica. Materiales y métodos: mediante encuestas anónimas y digitales a pacientes durante julio y agosto de 2020 se evaluó la calidad de vida utilizando el cuestionario de calidad de vida de la esclerosis sistémica (SScQoL). Además, se realizaron preguntas para evaluar el acceso al sistema de salud durante ese período. Resultados: se encuestaron 300 pacientes con ES. La mediana de afectación de la calidad de vida según el cuestionario utilizado fue de 17 (9,25-22) y el dolor fue el dominio más afectado. El 29,33% no hizo los controles médicos. El 74,33% refirió haber tenido estudios médicos pendientes al inicio de la cuarentena y solo el 25% pudo realizarlos. Conclusiones: los pacientes con ES presentaron compromiso de la calidad de vida durante la pandemia y mostraron dificultades en el acceso al sistema de salud.

Introduction: patients with rheumatic diseases have a significantly impaired quality of life. The COVID-19 pandemic has had a significant impact on the population and health systems around the world. Objectives: to analyze the impact of the pandemic on the quality of life and access to medical care of patients with systemic sclerosis (SS). Materials and methods: through anonymous and digital surveys of patients during July and August 2020, quality of life was assessed using the Systemic Sclerosis Quality of Life Questionnaire (SScQoL). In addition, questions were asked to assess access to the health system during that period. Results: 300 patients with SS were surveyed. The median quality of life affectation according to the questionnaire used was 17 (9.25-22), with pain being the most affected domain. Twenty-nine percent did not attend their medical appointments, 74.33% reported having pending medical studies at the beginning of the quarantine, and only 25% could carry them out. Conclusions: patients with SS presented compromised quality of life during the pandemic and showed difficulties in accessing the health system.

TLR9 activation is required for cytotoxic response elicited by baculovirus capsid display.

Although the baculovirus Autographa californica multiple nuclear polyhedrosis virus (AcMNPV) infects lepidopteran invertebrates as natural hosts, represents an efficient vector for vaccine development. Baculovirus surface display induces strong humoral responses against viruses and parasites. A novel strategy based on capsid display carrying foreign antigens in the AcMNPV particle further improved the immune response by eliciting CD8+ T cell activation. In this study, we analyze the intracellular mechanisms and signalling pathways involved in CD8+ T cell activation by capsid display. Our results show that baculovirus can attach to the cell surface, enter dendritic cells (DCs), transit within endocytic vesicles and escape to the cytosol for further degradation by the proteasome. We found that the availability of viral proteins, endosomal acidification, and proteasome activity are needed for efficient Major Histocompatibility Complex class-I presentation by baculovirus carrying Ovalbumin in the viral capsid. Importantly, we demonstrated with this strategy that the induction of cytotoxic T cells and IL-12 production by DCs are TLR9-dependent and STING-independent. Finally, our study shows differential intracellular processing for capsid and surface baculovirus proteins in DCs and highlights the role of different danger receptors during cytotoxic T cell priming through the capsid display delivery system, which could lead to improved baculovirus-based vaccines development.

Cost-Effectiveness Analysis of Pertuzumab Plus Trastuzumab and Docetaxel Compared With Trastuzumab and Docetaxel in the Adjuvant Treatment of Human Epidermal Growth Factor Receptor 2-Positive Metastatic Breast Cancer in Colombia.

OBJECTIVES: The addition of pertuzumab to the scheme of docetaxel plus trastuzumab (TH) in patients with metastatic breast cancer with overexpression of human epidermal growth factor receptor 2 increases survival. Nevertheless, this addition could represent a high cost for the health system of a middle-income country such as Colombia. Therefore, it is necessary to evaluate the efficiency of the pertuzumab plus TH (PTH) scheme in comparison with TH. METHODS: A partitioned survival model-based cost-utility analysis was performed. Progression-free survival and overall survival curves for each scheme were obtained from the CLEOPATRA study. The time horizon was 30 years with a discount rate of 5% for costs and quality-adjusted life-years. Total direct costs were calculated using national tariffs. Utilities were obtained from external sources. Model uncertainty was evaluated by deterministic and probabilistic sensitivity analysis. A willingness to pay value of 5180 US dollars was used. RESULTS: The discounted total average costs of TH and PTH were $24 109 and $60 846, respectively. These regimens' average life-years were 5.78 and 8.38, and their quality-adjusted life-years were 3.28 and 4.51, respectively. The incremental cost-effectiveness ratio was $29 867. One-way sensitivity analysis showed that the cost of pertuzumab was the variable that explained the uncertainty in the model. The probability that PTH is cost-effective in the probabilistic sensitivity analysis is 0.0724. CONCLUSIONS: The addition of pertuzumab to the TH regimen in patients with human epidermal growth factor receptor 2-positive metastatic breast cancer has a low probability of being cost-effective from the payer's perspective in the Colombian health system.

Experiencia sobre el proceso de salud-enfermedad-atención en pacientes con artritis reumatoidea pertenecientes a la comunidad Wichí de Misión Chaqueña "El Algarrobal", Salta / Experience on the health-disease-care process in patients with rheumatoid arthritis belonging to the Wichí community of Mission Chaqueña "El Algarrobal", Salta

Introducción: se ha reportado que la prevalencia de artritis reumatoidea (AR) en la comunidad Wichí representa la más alta informada por el Grupo Latinoamericano para el Estudio de las Enfermedades Reumáticas en los Pueblos Originarios (GLADERPO). El objetivo de este estudio fue describir la experiencia sobre el proceso de salud-enfermedad-atención de pacientes con AR de la comunidad Wichí de Misión Chaqueña "El Algarrobal", Salta. Materiales y métodos: estudio narrativo. Diseño de corte etnográfico. Se realizaron entrevistas semi-estructuradas y observaciones registradas. Se utilizaron guías de entrevistas y observación. Los aspectos incluidos fueron: concepción del proceso salud-enfermedad, percepción de la AR en la vida diaria, el acceso al sistema de salud, utilización de recursos tradicionales y de medicina tradicional. Resultados: se realizaron 10 entrevistas. Los aspectos más relevantes fueron la concepción del proceso salud-enfermedad asociado al trauma social pasado y al concepto de voluntad Wichí. Se evidenció la combinación de estrategias para mejorar el dolor (biomedicina, medicina tradicional y acompañamiento religioso). Además, se observó una relación unidireccional con el sistema de salud. Conclusiones: la AR es una enfermedad con un impacto negativo en la comunidad Wichí. Se requieren otras actividades, desde otras disciplinas, para mejorar el acceso al sistema de salud y la continuidad de los tratamientos.

Introduction: the prevalence of rheumatoid arthritis (RA) in the Wichí community has already been published, representing the highest reported by the Grupo Latinoamericano para el Estudio de las Enfermedades Reumáticas en los Pueblos Originarios (GLADERPO). The objective was to describe the experience of the health-disease-care process of patients with RA from the Wichí community of Misión Chaqueña "El Algarrobal", Salta. Materials and methods: study with ethnographic design. Semi-structured interviews and recorded observations were conducted. Interview and observation guides were used. The aspects included were: conception of the health-disease process; perception of RA in daily life, access to the health system, use of traditional resources and traditional medicine. Results: ten interviews were conducted. The most relevant aspects were the conception of the health-disease process, associated with past social trauma and the concept of "Wichí good will". The combination of strategies to improve pain (biomedicine, traditional medicine and religious accompaniment) was evidenced. In addition, a unidirectional relationship with the health system was observed. Conclusions: RA is a disease with a negative impact on the Wichí community. Other activities from other disciplines are necessary to improve access to the health system and continuity of treatment.

Decision-making Among Hepatitis C Virus-negative Transplant Candidates Offered Organs from Donors with HCV Infection.

Background: Historically, many organs from deceased donors with hepatitis C virus (HCV) were discarded. The advent of highly curative direct-acting antiviral (DAA) therapies motivated transplant centers to conduct trials of transplanting HCV-viremic organs (nucleic acid amplification test positive) into HCV-negative recipients, followed by DAA treatment. However, the factors that influence candidates' decisions regarding acceptance of transplant with HCV-viremic organs are not well understood. Methods: To explore patient-level perceptions, influences, and experiences that inform candidate decision-making regarding transplant with organs from HCV-viremic donors, we conducted a qualitative semistructured interview study embedded within 3 clinical trials investigating the safety and efficacy of transplanting lungs and kidneys from HCV-viremic donors into HCV-negative recipients. The study was conducted from June 2019 to March 2021. Results: Among 44 HCV-negative patients listed for organ transplant who were approached for enrollment in the applicable clinical trial, 3 approaches to decision-making emerged: positivist, risk analyses, and instinctual response. Perceptions of risk contributed to conceptualizations of factors influencing decisions. Moreover, most participants relied on multiple decision-making approaches, either simultaneously or sequentially. Conclusions: Understanding how different decisional models influence patients' choices regarding transplant with organs from HCV-viremic donors may promote shared decision-making among transplant patients and providers.

Review of suicidal ideation during pregnancy: risk factors, prevalence, assessment instruments and consequences.

BACKGROUND: Pregnancy is a period when women are particularly vulnerable to suicidal ideation and a great opportunity for suicide risk prevention. AIMS: This study aimed to establish a comprehensive understanding of suicidal ideation prevalence, risk factors, screening tools, consequences and management during pregnancy. METHOD: A literature search was performed in MEDLINE and PsycInfo databases from 2016 to 2021. A narrative synthesis of the literature and a critical overview of the current issues/questions to be addressed within the topic of suicidal ideation during pregnancy was performed. RESULTS: The prevalence of suicidal ideation during pregnancy was between 2.73 and 18% internationally. The risk factors identified were major depressive disorder, anxiety disorder, difficulties with sleep, previous suicide attempts, high rumination, low incomes, being black, being young, low educational level, partner violence, having poor support, food insecurity, history of child abuse, high obstetric risk, multiparity, previous induced abortion and exposure to tobacco or human immunodeficiency virus diagnosis. The screening tools used for suicidal ideation during pregnancy were item 10 of the Edinburgh Postpartum Depression Scale and item 9 of the Patient Health Questionnaire. Results showed that suicidal ideation during pregnancy is associated with poor cognitive development in children and low birth weight. No case management studies on suicidal ideation were found. LIMITATIONS: The main limitation of the available studies was the lack of articles with a high degree of methodological rigour on this subject. CONCLUSIONS: This narrative review is a state-of-the-art paper about suicidal ideation during pregnancy. Further research is needed, and researchers should carry out systematic reviews and meta-analyses, leading to Clinical Practice Guidelines in this area. This effort would improve our evidence-based practice in Perinatal Psychology and prevent associated suicidal behaviour.

Protocolo de profilaxis antibiótica para pacientes dentales en riesgo de infección / Antibiotic prophylaxis protocol for dental patients at risk of infection

La profilaxis antibiótica involucra el uso de fármacos en una etapa preoperatoria de atención odontológica, con la finalidad específica de contribuir a la prevención de infecciones sistémicas como la endocarditis infecciosa (EI) asociada a bacteriemias transitorias por procedimientos odontológicos que implican sangrado en pacientes con alto riesgo de complicación por su condición sistémica cardiaca o no cardiaca. Esta complicación potencial inflama el revestimiento interno de las válvulas cardiacas, por proliferación de microorganismos específicos, y aunque es infrecuente es responsable de una elevada tasa de morbilidad y mortalidad. En el año 2007, la Asociación Estadounidense del Corazón (AHA), publica la última actualización vigente en la literatura sobre las recomendaciones y directrices aplicadas para el uso de profilaxis antibiótica. El objetivo de esta revisión pretende desarrollar una síntesis de evidencia existente seguida de un balance honesto de los riesgos y beneficios de forma individual sobre el uso de este protocolo. Se realizó una búsqueda digital integral en idioma español e inglés sobre los protocolos de profilaxis antibiótica en pacientes con riesgo de infección. Se incluyeron bases de datos como: MEDLINE, PUBMED y SciELO, adicionalmente se tomaron como referentes de partida las recomendaciones de la AHA. Se concluye con gran énfasis y soporte de la literatura actual, que los beneficios del uso de profilaxis antibiótica en un momento preoperatorio superan los posibles riesgos de resistencia bacteriana y anafilaxia, por lo que son totalmente justificables y requeridos para los pacientes adultos y niños inmunológicamente comprometidos.

Antibiotic prophylaxis involves the use of drugs at a preoperative stage of dental care, with a specific aim of contributing to the prevention of systemic infections such as infectious endocarditis (IE) associated with transient bacteremia due to dental procedures that involve bleeding in patients at high risk of complication due to their non-cardiac or cardiac systemic condition. This potential complication inflames the inner lining of the heart valves, due to the proliferation of specific microorganisms, and although it is uncommon, it is responsible for a high rate of morbidity and mortality. In 2007, the American Heart Association (AHA) published the last current update in the literature on the recommendations and guidelines applied for the use of antibiotic prophylaxis. The aim of this review is to develop a synthesis of existing evidence followed by an honest assessment of the risks and benefits individually on the use of this protocol. A comprehensive digital search was conducted in both Spanish and English on antibiotic prophylaxis protocols in patients at risk of infection. Databases such as MEDLINE, PUBMED, and SciELO were included, in addition the AHA recommendations were taken as baseline references. It is concluded with great emphasis and support from the current literature, that the benefits of the use of antibiotic prophylaxis in a preoperative moment overcome the possible risks of bacterial resistance and anaphylaxis, so they are fully justifiable and required for immunologically compromised adult and children patients.

Diferencias entre ginecólogos y residentes en habilidades motoras básicas de un módulo de ejercicios de un sistema virtual de simulación / Differences between gynecologists and medical residents in basic motor skills of an exercise module of a virtual simulation system

Resumen OBJETIVO: Evaluar las diferencias en los desenlaces de los ejercicios del módulo de habilidades motoras básicas del simulador Simbionix LAP Mentor entre un grupo de residentes de Ginecología y otro de especialistas en cirugía laparoscópica. MATERIALES Y MÉTODOS: Estudio observacional, prospectivo, longitudinal y comparativo efectuado de diciembre de 2019 a enero de 2020 en el Hospital Español de México. Se seleccionaron médicos residentes de Ginecología y especialistas en la misma rama con experiencia diversa en cirugía laparoscópica. Se evaluaron, con un programa de adiestramiento mediante simulación de alta fidelidad, los ejercicios del módulo de habilidades motoras básicas de un sistema de realidad virtual. Para las variables con distribución normal se aplicó la prueba de t de Student y la de U de Mann-Whitney para las variables que no cumplieron el criterio de normalidad. RESULTADOS: Se incluyeron 31 participantes: el grupo de especialistas (n = 19) y el de residentes (n = 12). Se encontraron diferencias significativas entre residentes y especialistas en el ejercicio 3-coordinación ojo-mano (4.45 seg, IC95%: 0.167-8.73; p < 0.05) y en el ejercicio 5-tracción y engrapado de mangueras con fugas (29.58 seg, IC95%: -42.99 -14.00; p < 0.001), a favor del grupo de especialistas. En los ejercicios 7-corte y ejercicio 8-fulguración no hubo diferencias significativas entre uno y otro grupo. CONCLUSIONES: El simulador de realidad virtual Simbionix LAP Mentor detecta diferencias entre grupos de ginecoobstetras con diferente experiencia en cirugía ginecológica de mínima invasión y residentes de la especialidad.

Abstract OBJECTIVE: To evaluate the differences in the outcomes of the exercises of the basic motor skills module of the Simbionix LAP Mentor simulator between a group of gynecology residents and another group of already graduated specialists. MATERIALS AND METHODS: Observational, prospective, longitudinal and comparative study carried out from December 2019 to January 2020 at the Hospital Español de México. Gynecology residents and specialists in the same branch with diverse experience in laparoscopic surgery were selected. The exercises of the basic motor skills module of a virtual reality system were evaluated with a high-fidelity simulation training program. The Student's t test was applied for variables with normal distribution and the Mann-Whitney U test for variables that did not meet the normality criterion. RESULTS: Thirty-one participants were included: the specialist group (n = 19) and the resident group (n = 12). Significant differences between residents and specialists were found in exercise 3-eye-hand coordination (4.45 sec, 95%CI: 0.167-8.73; p < 0.05) and in exercise 5-pulling and stapling of leaking hoses (29.58 sec, 95%CI: -42.99 -14.00; p < 0.001), in favor of the specialist group. In exercise 7-cutting and exercise 8-fulguration there were no significant differences between one group and the other. CONCLUSIONS: The Simbionix LAP Mentor virtual reality simulator detects differences between groups of obstetrician-gynecologists with different experience in minimally invasive gynecologic surgery and residents of the specialty.

Methodological path to reach the degree of saturation in qualitative research: grounded theory / Marco metodológico para alcance del grado de saturación en la investigación cualitativa: teoría fundamentada / Percurso metodológico para alcance do grau de saturação na pesquisa qualitativa: teoria fundamentada

ABSTRACT Objectives: to achieve the degree of saturation in study that applied the grounded theory. Methods: qualitative research, carried out in four Family Health Units, between June 2018 and May 2019. The data from the interviews with 30 health professionals and non-participant observation were coded in the stages: open, axial and integration. Results: the degree of saturation was achieved by two conceptual models - theoretical saturation and inductive thematic. Theoretical saturation was considered: the development of conceptual codes and observation, in the collection and analysis of data, when they generated new categories/subcategories or only indicated increasing instances. For thematic inductive saturation, the use of new codes based on each interview stood out. Final Considerations: the visual layout for the number of codes, the theoretical scope of the concepts and the delimitation of the sample groups guided the identification of the degree of saturation for the development of the conceptual body that supported the substantive theory.

RESUMEN Objetivos: alcanzar grado de saturación en estudio que aplicó la teoría fundamentada. Métodos: investigación cualitativa, realizada en cuatro Unidades Salud de la Familia, entre junio de 2018 y mayo de 2019. Datos de entrevistas con 30 profesionales de salud y observación no participante fueron codificados en las etapas: abierta, axial e integración. Resultados: grado de saturación fue alcanzado por dos modelos conceptuales - saturación teórica y temática inductiva. Fueron considerados para la saturación teórica: el desarrollo de códigos conceptuales y observación, en la recolecta y análisis de los datos, cuando generaban nuevas categorías/subcategorías o apenas indicaban instancias crecientes. Para la saturación temática inductiva, destacó la utilización de nuevos códigos basados en cada entrevista. Consideraciones Finales: la esquematización visual para la cantidad de códigos, inclusión teórica de los conceptos y delimitación de los grupos muestrales orientó la identificación del grado de saturación al desarrollo del cuerpo conceptual que sustentó la teoría sustantiva.

RESUMO Objetivos: alcançar o grau de saturação em estudo que aplicou a teoria fundamentada. Métodos: pesquisa qualitativa, realizada em quatro Unidades Saúde da Família, entre junho de 2018 e maio de 2019. Os dados das entrevistas com 30 profissionais de saúde e observação não participante foram codificados nas etapas: aberta, axial e integração. Resultados: o grau de saturação foi alcançado por dois modelos conceituais - saturação teórica e temática indutiva. Foram considerados para a saturação teórica: o desenvolvimento dos códigos conceituais e a observação, na coleta e análise dos dados, quando geravam novas categorias/subcategorias ou apenas indicavam instâncias crescentes. Para a saturação temática indutiva, destacou-se a utilização de novos códigos baseados em cada entrevista. Considerações Finais: a esquematização visual para a quantidade de códigos, abrangência teórica dos conceitos e delimitação dos grupos amostrais orientou a identificação do grau de saturação para o desenvolvimento do corpo conceitual que sustentou a teoria substantiva.