Using a Cohort-Based Quality Improvement Coaching Model to Optimize Chronic Disease Management for Federally Qualified Health Center Patients.

CONTEXT: In fall 2020, Community Clinic Association of Los Angeles County, in collaboration with the Los Angeles County Department of Public Health, launched a 3-year, cohort-based quality improvement (QI) coaching program to assist Federally Qualified Health Centers (FQHCs) in improving their clinical management of hypertension, high blood cholesterol, diabetes, and chronic kidney disease. PROGRAM: The QI program utilized a cohort-based coaching model in which 5 FQHCs were each assigned a practice transformation coach who provided them with guidance and support to monitor clinical quality measures. These measures were then used to facilitate changes and improvements in clinical workflows and approaches to patient care. To encourage peer learning and promote inter-organizational collaboration, the coaching team hosted quarterly cohort check-ins and an online group messaging board where the participating FQHCs could share lessons learned. Throughout the program, the FQHCs were provided trainings and resources to advance their clinical quality measures of choice. IMPLEMENTATION: To implement the program, each FQHC selected 2 clinical quality measures to focus on, completing a minimum of 1 Plan-Do-Study-Act cycle per year for each measure. Throughout, the coaches met regularly with FQHC staff to discuss progress, strategize on how best to address challenges encountered, and identify training or resource needs for their clinic sites. EVALUATION: To drive implementation of QI interventions and monitor overall progress, the FQHCs reported quarterly on the clinical quality measures being addressed. By program's end, all 5 FQHCs reached their 10% improvement goals. DISCUSSION: This QI coaching program allowed participating FQHCs to build new competencies and achieve measurable improvements in how they managed their patients' chronic diseases. This model of practice serves as a promising approach for achieving sustainable clinical improvements in these FQHCs.

US public charge policy and Latinx immigrants' thoughts about health and healthcare utilization.

OBJECTIVES: We examined Latinx immigrants' perceptions of US policy related to restrictions on immigrants' use of public resources and their thoughts about the influence of these on immigrants' healthcare utilization. DESIGN: A series of 16 focus group discussions with Latinx immigrant men and women (documented and undocumented) (N = 130) were conducted between May and July 2017 across four US cities. RESULTS: Four central themes emerged: participants attributed the limited resources available for affordable healthcare for many uninsured US immigrants (both documented and undocumented) to the US government's view of immigrants as burdens on public resources and its subsequent unwillingness to dedicate funds for their care; participants expressed concerns, some unfounded, about negative immigration ramifications arising from diagnosis with health conditions perceived to be serious and/or expensive to treat; participants noted that some immigrants avoided using health programs and services to which they were entitled because of immigration concerns; finally, participants described how access to information on immigration laws and healthcare resources, and conversely, misinformation about these, influenced healthcare utilization. CONCLUSIONS: Participants were acutely aware of the image of immigrants as public charges or potential burdens on government resources that underlies US immigration policy. In some cases, participants came to inaccurate and potentially harmful conclusions about the substance of laws and regulations based on their beliefs about the government's rejection of immigrants who may burden public resources. This underscores the importance of ensuring that immigrants have access to information on immigration-related laws and regulations and on healthcare resources available to them. Participants noted that access to information also fostered resilience to widespread misinformation. Importantly, however, participants' beliefs had some basis in US immigration policy discourse. Law and policy makers should reconsider legislation and political commentary that frame self-reliance, the guiding principle of US immigration policy, in terms of immigrants' use of publicly funded healthcare resources.

Cine phase-contrast magnetic resonance imaging evaluation of cerebrospinal fluid flow dynamics in healthy pediatric subjects.

Objective: To evaluate cerebrospinal fluid dynamics, using cine phase-contrast magnetic resonance imaging (cine-PC MRI), in healthy pediatric subjects, determining the normal flow values in this population, as well as identifying differences related to age, sex, and body surface area. Materials and Methods: This was a descriptive cross-sectional study involving 32 healthy children and adolescents, in whom the flow of cerebrospinal fluid through the cerebral aqueduct was evaluated quantitatively with cine-PC MRI. We used specialized software to analyze the images obtained with cine-PC MRI, drawing a region of interest on the aqueduct. A flow-time curve was obtained, as were automated measurements of the various parameters. Results: The following normal (mean) values were obtained: net flow, 1.10 ± 0.99 mL/m; stroke volume, 12.2 ± 10.1 µL/cycle; mean velocity, 0.72 ± 1.00 cm/s; peak systolic velocity, 5.28 ± 2.30 cm/s; peak diastolic velocity, 4.51 ± 1.77 cm/s. These values were not affected by age or sex. In addition, body surface area was not found to correlate significantly with mean velocity or stroke volume. Conclusion: In children and adolescents, the basic cerebrospinal fluid flow parameters, as determined by cine-PC MRI, appear to be independent of age and sex.

Objetivo: Avaliar a dinâmica do fluxo do líquido cerebrospinal por cine-ressonância magnética com contraste de fase em crianças saudáveis, para determinar os valores normais de fluxo nesta população, bem como a diferença entre medições distintas de acordo com idade, sexo ou área da superfície corporal. Materiais e Métodos: Convocamos 32 crianças saudáveis em uma análise descritiva de prevalência para a avaliação quantitativa do fluxo do líquido cerebrospinal pelo aqueduto de Sylvius. A análise foi realizada por meio de software especializado, desenhando uma região de interesse no aqueduto. Uma curva de fluxo-tempo e medições automáticas de diversos parâmetros foram obtidas. Resultados: Os seguintes valores normais foram obtidos: fluxo efetivo de 1,10 ± 0,99 mL/m; volume médio de 12,2 ± 10,1 µL/ciclo; velocidade média de 0,72 ± 1,00 cm/s; pico de velocidade sistólica de 5,28 ± 2,30 cm/s; pico de velocidade diastólica de 4,51 ± 1,77 cm/s. Esses valores não foram afetados pela idade ou sexo das crianças. Além disso, não foi encontrada correlação significativa entre a área corporal, a velocidade média e o volume sistólico. Conclusão: De modo geral, os parâmetros básicos do fluxo do líquido cerebrospinal independem de idade e sexo em crianças.

Cine phase-contrast magnetic resonance imaging evaluation of cerebrospinal fluid flow dynamics in healthy pediatric subjects / Avaliação da dinâmica do fluxo do líquido cerebrospinal por cine-ressonância magnética com contraste de fase em crianças saudáveis

Abstract Objective: To evaluate cerebrospinal fluid dynamics, using cine phase-contrast magnetic resonance imaging (cine-PC MRI), in healthy pediatric subjects, determining the normal flow values in this population, as well as identifying differences related to age, sex, and body surface area. Materials and Methods: This was a descriptive cross-sectional study involving 32 healthy children and adolescents, in whom the flow of cerebrospinal fluid through the cerebral aqueduct was evaluated quantitatively with cine-PC MRI. We used specialized software to analyze the images obtained with cine-PC MRI, drawing a region of interest on the aqueduct. A flow-time curve was obtained, as were automated measurements of the various parameters. Results: The following normal (mean) values were obtained: net flow, 1.10 ± 0.99 mL/m; stroke volume, 12.2 ± 10.1 μL/cycle; mean velocity, 0.72 ± 1.00 cm/s; peak systolic velocity, 5.28 ± 2.30 cm/s; peak diastolic velocity, 4.51 ± 1.77 cm/s. These values were not affected by age or sex. In addition, body surface area was not found to correlate significantly with mean velocity or stroke volume. Conclusion: In children and adolescents, the basic cerebrospinal fluid flow parameters, as determined by cine-PC MRI, appear to be independent of age and sex.

Resumo Objetivo: Avaliar a dinâmica do fluxo do líquido cerebrospinal por cine-ressonância magnética com contraste de fase em crianças saudáveis, para determinar os valores normais de fluxo nesta população, bem como a diferença entre medições distintas de acordo com idade, sexo ou área da superfície corporal. Materiais e Métodos: Convocamos 32 crianças saudáveis em uma análise descritiva de prevalência para a avaliação quantitativa do fluxo do líquido cerebrospinal pelo aqueduto de Sylvius. A análise foi realizada por meio de software especializado, desenhando uma região de interesse no aqueduto. Uma curva de fluxo-tempo e medições automáticas de diversos parâmetros foram obtidas. Resultados: Os seguintes valores normais foram obtidos: fluxo efetivo de 1,10 ± 0,99 mL/m; volume médio de 12,2 ± 10,1 μL/ciclo; velocidade média de 0,72 ± 1,00 cm/s; pico de velocidade sistólica de 5,28 ± 2,30 cm/s; pico de velocidade diastólica de 4,51 ± 1,77 cm/s. Esses valores não foram afetados pela idade ou sexo das crianças. Além disso, não foi encontrada correlação significativa entre a área corporal, a velocidade média e o volume sistólico. Conclusão: De modo geral, os parâmetros básicos do fluxo do líquido cerebrospinal independem de idade e sexo em crianças.

Tomografía computada en pacientes con conexión venosa pulmonar anómala, Hospital del Niño

Introducción: La conexión venosa pulmonar anómala total (CVPAT) es un defecto relativamente poco frecuente, con una prevalencia de 0.8 por cada 10 000 nacimientos vivos, mientras que la forma parcial, tiene una mayor prevalencia, que oscila entre un 0.4 y 0.7% de la población. En Panamá, la CVPAT representa un 9% de los nacimientos con defectos cardíacos. Este estudio tuvo como objetivo evaluar las características por tomografía computada de los niños con este diagnóstico que fueron atendidos entre los años 2010 y 2020 en el Hospital del Niño Dr. José Renán Esquivel. Método: Se realizó un estudio descriptivo, retrospectivo, de corte transversal en la población sometida a tomografía computarizada por cardiopatía congénita en el Hospital del Niño Dr. José Renán Esquivel de la Ciudad de Panamá, en el período comprendido entre enero de 2010 y diciembre de 2020. Se realizaron 615 tomografías computarizadas por malformación cardíaca. De estas, 51 tenían diagnóstico de conexión venosa pulmonar anómala (CVPA) Resultados: Se encontró un predominio de esta patología en el sexo masculino (57.5%). Un 76.2% de los pacientes cursaban con otra malformación cardíaca asociada, siendo la comunicación interauricular (CIA) la más frecuente (54.5%). Los tipos más frecuentes fueron el supracardíaco (50.0%) y el infracardíaco (28.5%). Conclusión: La tomografía computada con contraste endovenoso es un método útil, que permite evaluar con detalle la anatomía cardíaca y de los grandes vasos en pacientes con malformaciones cardíacas y que además brinda información valiosa sobre otras patologías asociadas. (provisto por Infomedic International)

Introduction: Total anomalous pulmonary venous anomalous connection (TAPVC) is a relatively rare defect, with a prevalence of 0.8 per 10 000 live births, while the partial form, has a higher prevalence, ranging from 0.4 to 0.7% of the population. In Panama, TAPVC accounts for 9% of births with cardiac defects. The aim of this study was to evaluate the computed tomography characteristics of children with this diagnosis who were attended between 2010 and 2020 at the Hospital del Niño Dr. José Renán Esquivel. Methods: A descriptive, retrospective, cross-sectional, retrospective study was conducted in the population undergoing computed tomography for congenital heart disease at the Hospital del Niño Dr. José Renán Esquivel in Panama City, Panama, between January 2010 and December 2020. A total of 615 CT scans were performed for cardiac malformation. Of these, 51 had a diagnosis of anomalous pulmonary venous connection (APVC). Results: A predominance of this pathology was found in the male sex (57.5%). Some 76.2% of the patients had another associated cardiac malformation, with atrial septal defect (ASD) being the most frequent (54.5%). The most frequent types were supracardiac (50.0%) and infracardiac (28.5%). Conclusion: Computed tomography with intravenous contrast is a useful method that allows detailed evaluation of cardiac and great vessels anatomy in patients with cardiac malformations and provides valuable information on other associated pathologies. (provided by Infomedic International)

Compassionate Use of Rectal Ozone (O3) in Severe COVID-19 Pneumonia: a Case-Control Study.

Objectives: To evaluate effect of rectal ozone in severe COVID-19 pneumonia and to compare it to standard of care (SOC). Material and Methods: In a case-control study, 14 patients with severe bilateral COVID-19 pneumonia (positive RT-PCR), treated with SOC and rectal ozone, were evaluated before-and-after treatment and compared with SOC (14 patients) in a 10-day follow-up period. Ozone protocol consisted of 8 sessions (1 session/day) of intra-rectal ozone (150 mL volume, 35 µg/mL concentration [5.25mg total dose]). The SOC protocol included O2 supply, antivirals (Remdesivir), corticosteroids (Dexamethasone/Metilprednisolone), monoclonal antibodies (Anakinra/Tocilizumab), antibiotics (Azytromicine), and anticoagulants (Enoxaparine). Primary outcome variables were the following: (a) clinical (O2 saturation and O2 supply); (b) biochemical (lymphocyte count, fibrinogen, D-dimer, urea, ferritin, LDH, IL-6, and CRP); (c) radiological Taylor's scale. Secondary outcome variables were the following: (a) hospitalization length of stay, (b) mortality rate. Results: At baseline, ozone/SOC groups were not different on age, comorbidities, O2 saturation, and O2 supply. Patients in the ozone group improved O2 saturation and decrease O2 supply. SOC maintained O2 saturation and required more O2 supply. Lymphocyte count improved only in the ozone group and with statistical difference (p<0.05). Biomarkers of inflammation (fibrinogen, D-dimer, urea, LDH, CRP, and IL-6) decreased in both groups, but only significantly in favor of the ozone group (p<0.05). Ferritin showed a significant decrease in the ozone group but an increase on the SOC group. Radiological pneumonitis decreased on both groups but the decrease was only significant in the ozone group (p<0.0001). Mortality and length of stay, although not significant, were inferior in the ozone group. Conclusion: Compassionate use of rectal ozone improved O2 saturation, reduced O2 supply, decreased inflammation biomarkers, and improved Taylor's radiological scale significantly when compared to the SOC group. Mortality and length of stay were inferior in the ozone group, but this difference was not significant.

Improvement in borderline personality disorder symptomatology after repetitive transcranial magnetic stimulation of the dorsomedial prefrontal cortex: preliminary results

Objective: Current treatment for borderline personality disorder (BPD) involves psychological and pharmacological interventions. However, neuromodulation techniques such as repetitive transcranial magnetic stimulation (rTMS) may positively affect BPD symptomatology. The objective of this study was to evaluate the clinical and neuropsychological effects of rTMS on the dorsomedial prefrontal cortex (DMPFC) in BPD patients. Methods: Fourteen patients with BPD were randomized into two groups (active vs. sham) for 15 sessions of rTMS on the DMPFC. Clinical effects were measured using the Borderline Symptoms List (BSL), Clinical Global Impression Scale for BPD (CGI-BPD), Borderline Evaluation of Severity over Time (BEST), Hamilton Depression Rating Scale (HDRS), Hamilton Anxiety Rating Scale (HARS), and Barratt's Impulsiveness Scale (BIS). Neuropsychological effects were determined by a Stop-Signal Task (SST), the Wisconsin Card-Sorting Test (WCST), and the Iowa Gambling Test (IGT). Results: Within-group comparison showed significant differences (p < 0.05) in CGI-BPD (total score and six of nine psychopathologic domains), BEST, HDRS, HARS, and IGT scores for active modality. Conclusion: The 5 Hz-DMPFC rTMS technique was well tolerated and lessened the severity of BPD symptomatology, especially abandonment, affective issues, interpersonal relationships, suicidal behavior, anger, and paranoid ideation. Cognitive improvement was seen in decision-making. Additional studies are needed to fully evaluate the effects of rTMS on BPD symptomatology. Clinical Trial Registration: NCT03832777.

Improvement in borderline personality disorder symptomatology after repetitive transcranial magnetic stimulation of the dorsomedial prefrontal cortex: preliminary results.

OBJECTIVE: Current treatment for borderline personality disorder (BPD) involves psychological and pharmacological interventions. However, neuromodulation techniques such as repetitive transcranial magnetic stimulation (rTMS) may positively affect BPD symptomatology. The objective of this study was to evaluate the clinical and neuropsychological effects of rTMS on the dorsomedial prefrontal cortex (DMPFC) in BPD patients. METHODS: Fourteen patients with BPD were randomized into two groups (active vs. sham) for 15 sessions of rTMS on the DMPFC. Clinical effects were measured using the Borderline Symptoms List (BSL), Clinical Global Impression Scale for BPD (CGI-BPD), Borderline Evaluation of Severity over Time (BEST), Hamilton Depression Rating Scale (HDRS), Hamilton Anxiety Rating Scale (HARS), and Barratt's Impulsiveness Scale (BIS). Neuropsychological effects were determined by a Stop-Signal Task (SST), the Wisconsin Card-Sorting Test (WCST), and the Iowa Gambling Test (IGT). RESULTS: Within-group comparison showed significant differences (p < 0.05) in CGI-BPD (total score and six of nine psychopathologic domains), BEST, HDRS, HARS, and IGT scores for active modality. CONCLUSION: The 5 Hz-DMPFC rTMS technique was well tolerated and lessened the severity of BPD symptomatology, especially abandonment, affective issues, interpersonal relationships, suicidal behavior, anger, and paranoid ideation. Cognitive improvement was seen in decision-making. Additional studies are needed to fully evaluate the effects of rTMS on BPD symptomatology. CLINICAL TRIAL REGISTRATION: NCT03832777.

The relationship between neurosensory disturbance of the inferior alveolar nerve and the lingual split pattern after sagittal split osteotomy.

OBJECTIVE: The aim of this study was to evaluate the relationship between neurosensory disturbance (NSD) and the different types of bilateral sagittal split osteotomy (BSSO) lingual fracture created. STUDY DESIGN: The study group consisted of 45 patients with mandibular deformities (90 sides; 14 males and 31 females). Computed tomography (CT) scans were obtained preoperatively and 1 week postoperatively. All patients were divided into lingual fracture line groups on the basis of their postoperative scans. NSD was tested preoperatively and 1, 3, and 12 months postoperatively by using a sensory touch Semmes-Weinstein (SW) test and the 2-point discrimination (TPD) test. RESULTS: Patients were divided into 2 groups on the basis of their lingual fracture lines after mandibular BSSO; among the 45 patients, 39 sides (43.3%) had short-splits, and 51 sides (56.7%) had long-splits. The short-split group was less affected at all tested times, and the difference between the 2 groups was significant 1 month postoperatively on TPD test but not at other times on the both tests. CONCLUSIONS: The split type did not affect the NSD incidence at 3 and 12 months postoperatively.

Influence of oestrogen deficiency and excessive mechanical stress on condylar head of mandible.

OBJECTIVE: We assessed the aetiology of idiopathic condylar resorption by examining the effects of oestrogen and compressive mechanical stress under a low systemic oestrogen condition in temporomandibular joints (TMJ) caused by an ovariectomy. MATERIALS AND METHODS: Female rabbits were divided into non-ovariectomy (non-OVX) and ovariectomy (OVX) groups. A cortical osteotomy was performed with a custom device that was increased in length by 0.25 mm every 12 hr for 1 week after the operation, during which the TMJs in the rabbits received compressive mechanical stress. Samples from both groups were examined with micro-computed tomography and histological staining. RESULTS: Area and depth of bone resorption were both greater in the OVX group. Furthermore, a significantly earlier and greater prevalence of sub-condylar bone resorption was noted in that group, while cells positive for tartrate-resistant acid phosphatase were increased in the OVX group. CONCLUSIONS: The present findings suggest that oestrogen induced a much greater amount of bone resorption on the anterior surface of the condylar head at an earlier stage in the TMJs of the present model rabbits. Thereafter, restoration of TMJ function appeared to occur in a normal manner.

Arsenic in Peruvian rice cultivated in the major rice growing region of Tumbes river basin.

Arsenic (As) exposure from surface and groundwater in Peru is being recognised as a potential threat but there are limited studies on As in the food-chain and none on As in Peruvian rice. In this study, we have determined the As content in rice cultivated in the Tumbes river basin located in the northern province of Peru, an area known for extensive rice cultivation. We collected rice and soil samples from agricultural fields, soil was collected using grid sampling technique while rice was collected from the heaps of harvested crop placed across the fields. The average total As concentration in rice was 167.94 ±â€¯71 µg kg-1 (n = 29; range 68.39-345.31 µg kg-1). While the rice As levels were not highly elevated, the As content of few samples (n = 7) greater than 200 µg kg-1 could contribute negatively to human health upon chronic exposure. Average concentration of As in soil was 8.63 ±â€¯7.8 mg kg-1 (n = 30) and soil to grain transfer factor was 0.025 ±â€¯0.018 for 12 matched samples. Compared to our previous pilot study in 2006 (samples collected from the same agricultural fields but not from exact locations) there was a 41% decrease in As soil concentration in this study. Rice samples collected in 2006 (n = 5) had a mean concentration of 420 ±â€¯109 µg kg-1. Our data provides a baseline of rice grain As concentrations in Peruvian province of Tumbes and warrants further studies on factors affecting uptake of As by the rice varieties cultivated in Peru and any potential human health risks.

Histologic and histomorphometric evaluation of the bone regeneration following cortical bone repositioning in a rabbit mandible.

BACKGROUND: Although bone graft (BG) is the gold standard for bone augmentation, its use is hampered by donor site morbidity and limited quantity. PURPOSE: To evaluate the capabilities of bone formation by cortical bone repositioning (CBR) as the healing response following grafting of autogenous bone block without filling biomaterial at the gap between gap and recipient. MATERIALS AND METHODS: Twelve Japanese White rabbits were divided into three groups (postoperative 2, 5, and 8 weeks). A cortical block was freed from the mandibular body, half of the block was positioned and fixed overlapped the original bone surface beside the defect and the other half remained only elevated above the defect. Three areas were decided for the evaluation; BG, CBR, and defect (D) area. Areas were evaluated by micro-CT, histology, and histomorphometric analysis. RESULTS: There is no statistical difference between BG and CBR by evaluating distance and area in histomorphometrical analysis (P < .05). D area showed statistical decrease compared with BG and CBR at week 2. Histologically, new bone was evident at week 2, mature bone was observed in all three areas at week 8, D area disappeared and fused completely with the elevated bone block. CONCLUSION: CBR has potential for bone augmentation as BG induced from its own regenerative ability of healing process.

Coping strategies and quality of life in Mexican multiple sclerosis patients: Physical, psychological and social factors relationship.

BACKGROUND: Multiple sclerosis (MS) is one of the principal causes of non-traumatic neurological disability among young adults. The unpredictable and progressive evolution of multiple sclerosis is associated with a decline in physical and psychological health, affecting quality of life, which may be influenced by additional physical and psycho-social factors. OBJECTIVE: The present investigation aims to evaluate the quality of life (QoL), use of coping strategies and their relationship with other physical and psycho-social factors among 26 Mexican persons with MS. METHODS: Eight questionnaires were administrated for evaluation of the additional psycho-social and physical factors, including quality of life, coping strategies, social support system, family functionality, depression and anxiety prevalence. RESULTS: Results showed that the use of positive coping strategies (84.6% of our population) improve QoL perception (r = 0.396, p = 0.045) and the following domains: physical health (r = 0.514, p = 0.009), psychological health (r = 0.516, p = 0.008), social relationships (r = 0.654, p = 0.000) and environment (r = 0.600, p = 0.002). Negative correlations were observed between QoL and the presence of symptoms of both depression (r = -0.557, p = 0.003) and anxiety (r = -0.517, p = 0.007). A multiple linear regression model showed that QoL can be explained by physical and psycho-social factor in 54.6% of the cases that were evaluated. CONCLUSION: The use of positive coping strategies in conjunction with a suitable psycho-social environment and good physical health result in a better perception of QoL in Mexican patients living with MS. Still, the negative factors are ineffectively diagnosed and hence generally under treated in medical MS monitoring. An interdisciplinary evaluation will provide the adequate tools to confront the diagnosis and the uncertainty of multiple sclerosis evolution, benefiting the QoL of Mexican patients with MS.

Data of the effects of acetone fraction from Sechium edule (Jacq.) S.w. edible roots in the kidney of endothelial dysfunction induced mice.

Endothelial dysfunction induced by Angiotensin II (AG II) plays an important role in the pathogenesis of hypertension and is accompanied by a prooxidative condition, which in turn induces an inflammatory state, vascular remodeling, and tissue damage including the kidney (Schmitt and Dirsch, 2009) [1]. New drugs that can control several of these pathologies are required. Sechium edule has been reported to possess antioxidant, anti-inflammatory and antihypertensive activity (Ibarra-Alvarado et al., 2010) [2]. This paper contains data complementary to those published in Journal of Ethnopharmacology (Moreno et al., 2018) [3], evaluating the effect in kidney of hypertensive mice of the acetone fraction from S. edule to control de pro-oxidative state, reduction of the inflammatory adhesion molecule (ICAM) and recruitment of inflammatory cells.

Acetone fraction from Sechium edule (Jacq.) S.w. edible roots exhibits anti-endothelial dysfunction activity.

ETHNOPHARMACOLOGICAL RELEVANCE: A recent ethnomedical survey on medicinal plants grown in Mexico revealed that Sechium edule (Jacq.) Sw. (Cucurbitaceae) is one of the most valued plant species to treat cardiovascular diseases, including hypertension. Fruits, young leaves, buds, stems, and tuberous roots of the plant are edible. Considering that endothelial dysfunction induced by Angiotensin II plays an important role in the pathogenesis of hypertension and is accompanied by a prooxidative condition, which in turn induces an inflammatory state, vascular remodeling, and tissue damage, and that S. edule has been reported to possess antioxidant, anti-inflammatory and antihypertensive activity, its capability to control endothelial dysfunction was also assessed. AIM OF THE STUDY: To assess in vivo the anti-endothelial dysfunction activity of the acetone fraction (rSe-ACE) of the hydroalcoholic extract from S. edule roots. MATERIALS AND METHODS: Endothelial dysfunction was induced in female C57BL/6 J mice by a daily intraperitoneal injection of angiotensin II for 10 weeks. Either rSe-ACE or losartan (as a control) were co-administered with angiotensin II for the same period. Blood pressure was measured at weeks 0, 5, and 10. Kidney extracts were prepared to determine IL1ß, IL4, IL6, IL10, IL17, IFNγ, TNFα, and TGFß levels by ELISA, along with the prooxidative status as assessed by the activity of antioxidant enzymes. The expression of ICAM-1 was evaluated by immunohistochemistry in kidney histological sections. Kidney and hepatic damage, as well as vascular tissue remodeling, were studied. RESULTS: The rSe-ACE fraction administered at a dose of 10 mg/kg was able to control hypertension, as well as the prooxidative and proinflammatory status in kidney as efficiently as losartan, returning mice to normotensive levels. Additionally, the fraction was more efficient than losartan to prevent liver and kidney damage. Phytochemical characterization identified cinnamic acid as a major compound, and linoleic, palmitic, and myristic acids as the most abundant non-polar components in the mixture, previously reported to aid in the control of hypertension, inflammation, and oxidative stress, three important components of endothelial dysfunction. IN CONCLUSION: this study demonstrated that rSe-ACE has anti-endothelial dysfunction activity in an experimental model and highlights the role of cinnamic acid and fatty acids in the observed effects.

Caracterización de filtros comerciales para agua a base de carbón activado para el tratamiento de agua del río Tumbes - Perú / Characterization of water commercial filters based on activated carbon for water treatment of the Tumbes river - Peru / Caracterização de carvão ativado de filtros comerciais para tratamento da água do rio Tumbes -Perú

Resumen Se caracterizaron y se evaluaron carbones activados comerciales (A, B, C y D) utilizados en filtros para el tratamiento de agua en la descontaminación de metales pesados presentes en agua de río y en la eliminacion de microorganismos coliformes; los carbones comerciales resultaron tener estructuras microporosas y mesoporosas. Se determinaron areas superficiales entre 705 y 906 m2/g. Los carbones fueron amorfos y se detectó la presencia de agentes antibacterianos, tales como Ag, Cl, Cu y Si. Se determinó que para el As y Pb, cuyas concentraciones iniciales en el agua contaminada (agua del Río Tumbes-Perú) fueron 56,7 y 224,0 μg/L, respectivamente, el porcentaje de adsorción fue cercano al 100%. También se encontró que la relación entre el pH de carga cero de los carbones y pH del agua del río durante los experimentos juega un rol determinante en la adsorción de los elementos analizados. Por otro lado, la capacidad antibacteriana fue evaluada satisfactoriamente frente a las siguientes cepas de bacterias gram negativas fecales: Escherichia coli (ATCC® 25922™), Salmonella typhimurium (ATCC® 14028™) y Shigella flexneri (ATCC® 12022™). Esta capacidad se basa en la presencia superficial en los carbones de los agentes antibacterianos mencionados.

Abstract Comercial activated carbon samples (A, B, C, and D) used in filters for the treatment of water were characterized and evaluated in the decontamination of heavy metals present in river water and in the elimination of coliform microorganisms. The carbon samples had microporous and mesoporous structures. Surface areas of between 705 and 906 m2/g were found. The carbon samples were amorphous and the presence of antibacterial agents such as Ag, Cl, Cu, and Si was detected. It was determined that for As and Pb, whose initial concentrations in contaminated water (water of the Tumbes river-Peru) were 56.7 and 224.0 μg/L, respectively, the percentage of adsorption was close to 100%. The relationship between point of zero charge pH of the activated carbons and pH of the river water during the experiments plays a determinant role in the adsorption of the analyzed elements. The antibacterial capacity was evaluated satisfactorily against the following strains of fecal gram negative bacteria: Escherichia coli (ATCC® 25922™), Salmonella typhimurium (ATCC® 14028™), and Shigella flexneri (ATCC® 12022™). This ability is based on the surface presence in the carbons ofthe mentioned antibacterial agents.

Resumo Carvões ativados comerciais (A, B, C e D) usado em filtros para o tratamento de água foram caracterizados e avaliados na descontaminação de metais pesados da água do rio e para a remoção de microrganismos coliformes. Os carvões comerciais mostraram estruturas microporosas e mesoporosas. Foram determinadas as áreas superficiais entre 705 e 906 m2/g. As amostras de carvão foram amorfas e foi detectada a presença de agentes antibacterianos, tais como Ag, Cl, Cu e Si. Determinou-se que, no caso de As e Pb, cujas concentrações iniciais na água contaminada (água do rio Tumbes-Peru) foram de 56,7 e 224,0 μg/L respectivamente, a taxa de adsorção foi de quase 100%. Também foi econtrado que e a relação entre o pH de carga zero dos carvões e o pH da água do rio durante as experiências desempenha um papel decisivo na adsorção dos elementos analisados. Além disso, a capacidade antibacteriana foi avaliada com sucesso contra as seguintes variedades de bactérias gram negativas de origem fecal: Escherichia coli (ATCC® 25922™), Salmonella typhimurium (ATCC® 14028™) e Shigella flexneri (ATCC® 12022™). Esta capacidade esta baseada na presença de agentes bacterianos na superfície dos carvões.

Timed-release system for periosteal expansion osteogenesis using NiTi mesh and absorbable material in the rabbit calvaria.

UNLABELLED: This study aimed to improve bone regeneration using a timed-release system for periosteal expansion osteogenesis (TIME-PEO) using a shape memory alloy (SMA) mesh device and absorbable thread in a rabbit model. MATERIALS AND METHODS: Twelve rabbits were used in this study. The device was inserted under the periosteum at the forehead, then pushed, bent, and attached to the bone surface and fixed with an absorbable thread. Rabbits were divided into groups C1 (5 weeks postoperatively without dynamic elevation), C2 (8 weeks postoperatively without dynamic elevation), T1 (5 weeks postoperatively from TIME-PEO), and T2 (8 weeks postoperatively from TIME-PEO). Newly formed bone was evaluated histologically and radiographically. RESULTS: The newly formed bone volume to elevated bone volume ratio was 6.1% in C1, 21.9% in T1 15.5% in C2 and 36.0% in T2. These quantitative data indicate that TIME-PEO group had a significantly higher volume than that of the control group (P < 0.05). Histologically, multiple dome-shaped bones, outlined by thin and scattered trabeculae, over the original bone surface were evident in the T group. CONCLUSION: This technique appears to be a promising clinical alternative for alveolar bone augmentation and introduces the new concept of "dynamic guided bone regeneration" for atrophic alveolar bone.

The combined-disk boronic acid test as an accurate strategy for the detection of KPC carbapenemase in Central America.

INTRODUCTION: Carbapenemase-producing Klebsiella pneumoniae (KPC) outbreaks may cause a huge economical burden on developing countries. Furthermore, KPC can be challenging to detect. We describe the laboratory strategy for the detection of KPC from 2011 to 2013 in a tertiary care hospital in Central America with approximately 1,000 beds. METHODOLOGY: A retrospective analysis of a clinical laboratory database was done to determine the pragmatic application of the combined-disk boronic acid test during a KPC outbreak in Panama. A total of 1,026 Klebsiella pneumoniae isolates were found, of which 133 were positive for KPC. The strategy during two phases was described according to the test employed as a confirmatory test for KPC. After the K. pneumoniae isolates were detected by the VITEK 2 system, blaKPC polymerase chain reaction (PCR) and the combined-disk boronic acid test were employed as a confirmatory test during phase one. The combined-disk boronic acid test was employed as a confirmatory test for KPC during phase two. RESULTS: The sensitivity, specificity, positive predictive value, and negative predictive value of the boronic acid test were 100%, 97%, 91%, and 100%, respectively, when blaKPC PCR was employed as a confirmatory test during the start of the outbreak. Afterwards, modified VITEK 2 system parameters resulted in 116 suspicious KPC samples and the boronic acid test confirmed 102 isolates. CONCLUSIONS: The use of an automated bacterial identification system and the boronic acid test for the detection of KPC was an effective and low-cost strategy for a clinical laboratory in Panama during an outbreak.

Synthesis, characterization and biocompatibility of cadmium sulfide nanoparticles capped with dextrin for in vivo and in vitro imaging application.

BACKGROUND: The safe use in biomedicine of semiconductor nanoparticles, also known as quantum dots (QDs), requires a detailed understanding of the biocompatibility and toxicity of QDs in human beings. The biological characteristics and physicochemical properties of QDs entail new challenges regarding the management of potential adverse health effects following exposure. At certain concentrations, the synthesis of semiconductor nanoparticles of CdS using dextrin as capping agent, at certain concentration, to reduce their toxicity and improves their biocompatibility. RESULTS: This study successfully synthesized and characterized biocompatible dextrin-coated cadmium sulfide nanoparticles (CdS-Dx/QDs). The results show that CdS-Dx/QDs are cytotoxic at high concentrations (>2 µg/mL) in HepG2 and HEK293 cells. At low concentrations (<1 µg/mL), CdS-Dx/QDs were not toxic to HepG2 or HeLa cells. CdS-Dx nanoparticles only induced cell death by apoptosis in HEK293 cells at 1 µg/mL concentrations. The in vitro results showed that the cells efficiently took up the CdS-Dx/QDs and this resulted in strong fluorescence. The subcellular localization of CdS-Dx/QDs were usually small and apparently unique in the cytoplasm in HeLa cells but, in the case of HEK293 cells it were more abundant and found in cytoplasm and the nucleus. Animals treated with 100 µg/kg of CdS-Dx/QDs and sacrificed at 3, 7 and 18 h showed a differential distribution in their organs. Intense fluorescence was detected in lung and kidney, with moderate fluorescence detected in liver, spleen and brain. The biocompatibility and toxicity of CdS-Dx/QDs in animals treated daily with 100 µg/kg for 1 week showed the highest level of fluorescence in kidney, liver and brain. Less fluorescence was detected in lung and spleen. There was also evident presence of fluorescence in testis. The histopathological and biochemical analyses showed that CdS-Dx/QDs were non-toxic for rodents. CONCLUSIONS: The in vitro and in vivo studies confirmed the effective cellular uptake and even distribution pattern of CdS-Dx/QDs in tissues. CdS-Dx/QDs were biocompatible with tissues from rodents. The CdS-Dx/QDs used in this study can be potentially used in bio-imaging applications.