Elevation provenance affects photosynthesis and its acclimation to temperature in the high-Andes alpine herb Phacelia secunda.

We analysed whether Phacelia secunda populations from different elevations exhibit intrinsic traits associated with diffusive and biochemical components of photosynthesis, and if they differ in acclimation of photosynthesis to warmer temperatures. We hypothesized that P. secunda will have similar photosynthetic performance regardless of altitudinal provenance and that plants from high elevations will have a lower photosynthetic acclimation capacity to higher temperature than plants from low elevations. Plants from 1600, 2800 and 3600 m a.s.l. in the central Chilean Andes were collected and grown under two temperature regimes (20/16 °C and 30/26 °C day/night). The following photosynthetic traits were measured in each plant for the two temperature regimes: AN , gs , gm , Jmax , Vcmax , Rubisco carboxylation kcat c . Under a common growth environment, plants from the highest elevation had slightly lower CO2 assimilation rates compared to lower elevation plants. While diffusive components of photosynthesis increased with elevation provenance, the biochemical component decreased, suggesting compensation that explains the similar rates of photosynthesis among elevation provenances. Plants from high elevations had lower photosynthetic acclimation to warmer temperatures compared to plants from lower elevations, and these responses were related to elevational changes in diffusional and biochemical components of photosynthesis. Plants of P. secunda from different elevations maintain photosynthetic traits when grown in a common environment, suggesting low plasticity to respond to future climate changes. The fact that high elevation plants had lower photosynthetic acclimation to warmer temperature suggests higher susceptibility to increases in temperature associated with global warming.

«Management of nurses specialized in the aero-evacuation of highly infectious critical patients, during the COVID-19 pandemic. Systematic review¼.

INTRODUCTION: Aeromedical evacuation missions to transport highly infectious critical COVID-19 patients involve multiple factors, therefore planning is essential in their preparation. The management of specialist nurses is cross-cutting, as they participate in the planning, organisation and implementation of aero-evacuation protocols, delivery of care and operational safety procedures throughout the operation, with an integrated aeromedical crew working as a team alongside the air crew. OBJECTIVE: To study the management of nurses specialised in the aero-evacuation of highly infectious critical patients during the COVID-19 pandemic. DESIGN: Through a systematic search of the biomedical literature, this study was conducted according to the standards of the Cochrane Handbook for Systematic Reviews of Interventions and PRISMA. The literature search included articles published from 2019 to August 2020 and meta-search engines, yielding a total of 142 articles, and a triangulation of information was performed. A total of 11 articles were eventually included in the review, and the validity of each article was determined according to the guidelines of the Joanna Briggs Institute level of evidence. RESULTS AND DISCUSSION: The systematic review identified 11 studies that use different methodological considerations for conducting an aeromedical evacuation and covering key aspects for a successful operation. CONCLUSION: The management of specialist nurses has a direct impact on the aeromedical evacuation of the critical patient. It covers planning, organisation, and operational safety, applied in the instruction, training, execution and strict monitoring of the work of the aeromedical crew as a solid team. This contributes to the success of the aero-evacuation mission and the infectious patient's high likelihood of survival during the COVID-19 pandemic.

Gestión de enfermeras/os especializados en la aeroevacuación de pacientes críticos altamente infecciosos, durante la pandemia por COVID-19. Revisión Sistemática / Management of nurses specialized in the aero-evacuation of highly infectious critical patients, during the COVID-19 pandemic. Systematic review

Introducción: Las misiones de Evacuación Aeromédica de Paciente Crítico Altamente Infeccioso de paciente COVID-19, consideran múltiples factores, es por eso que la planificación, es la estructura fundamental de la preparación de la misión. La gestión de enfermeras/os especializados es transversal, ya que participa en gran parte en la planificación, organización y la aplicación de protocolos de aeroevacuación, ejecución de procedimientos asistenciales y de seguridad operacional durante toda la operación, con una Tripulación Aerosanitaria integrada trabajando en equipo junto a la tripulación aérea. Objetivo: Analizar la gestión de enfermeras/os especializados en la aeroevacuación de pacientes críticos altamente infecciosos, durante la pandemia por COVID-19. Diseño: Mediante una búsqueda sistemática de la literatura biomédica, este estudio se realiza según normas del manual Cochrane para las revisiones sistemáticas de las intervenciones y PRISMA (Preferred Reporting Items for Systematic reviews and Meta-Analyses). La búsqueda bibliográfica incluye artículos publicados desde el 2019 hasta agosto del 2020 y se utiliza metabuscadores, de lo cual se obtiene un total de 142 artículos, se realiza una triangulación de la información. Finalmente 11 artículos se incluyen en la revisión, y la validez de cada uno de ellos fue determinada de acuerdo con las directrices publicadas por el nivel de evidencia de Joanna Briggs. Resultados y discusión: La revisión sistemática evidencia 11 estudios que utilizan diferentes consideraciones metodológicas para la realización de una evacuación aeromédica considerando aspectos claves para una operación exitosa. Conclusión: La gestión de enfermeras/os especializados tiene un impacto directo en el proceso de Evacuación Aeromédica de Paciente Crítico Altamente Infeccioso, en diversos aspectos, como lo es la planificación, organización y seguridad operacional, aplicada en la instrucción...(AU)

Introduction: Aeromedical evacuation missions to transport highly infectious critical COVID-19 patients involve multiple factors, therefore planning is essential in their preparation. The management of specialist nurses is cross-cutting, as they participate in the planning, organisation and implementation of aero-evacuation protocols, delivery of care and operational safety procedures throughout the operation, with an integrated aeromedical crew working as a team alongside the air crew. Objective: To study the management of nurses specialised in the aero-evacuation of highly infectious critical patients during the COVID-19 pandemic. Design: Through a systematic search of the biomedical literature, this study was conducted according to the standards of the Cochrane Handbook for Systematic Reviews of Interventions and PRISMA. The literature search included articles published from 2019 to August 2020 and meta-search engines, yielding a total of 142 articles, and a triangulation of information was performed. A total of 11 articles were eventually included in the review, and the validity of each article was determined according to the guidelines of the Joanna Briggs Institute level of evidence. Results and discussion: The systematic review identified 11 studies that use different methodological considerations for conducting an aeromedical evacuation and covering key aspects for a successful operation. Conclusion: The management of specialist nurses has a direct impact on the aeromedical evacuation of the critical patient. It covers planning, organisation, and operational safety, applied in the instruction, training, execution and strict monitoring of the work of the aeromedical crew as a solid team. This contributes to the success of the aero-evacuation mission and the infectious patient's high likelihood of survival during the COVID-19 pandemic.(AU)

[«Management of nurses specialized in the aero-evacuation of highly infectious critical patients, during the COVID-19 pandemic. Systematic review¼]. / «Gestión de enfermeras/os especializados en la aeroevacuación de pacientes críticos altamente infecciosos, durante la pandemia por COVID-19. Revisión Sistemática¼.

Introduction: Aeromedical evacuation missions to transport highly infectious critical COVID-19 patients involve multiple factors, therefore planning is essential in their preparation. The management of specialist nurses is cross-cutting, as they participate in the planning, organisation and implementation of aero-evacuation protocols, delivery of care and operational safety procedures throughout the operation, with an integrated aeromedical crew working as a team alongside the air crew. Objective: To study the management of nurses specialised in the aero-evacuation of highly infectious critical patients during the COVID-19 pandemic. Design: Through a systematic search of the biomedical literature, this study was conducted according to the standards of the Cochrane Handbook for Systematic Reviews of Interventions and PRISMA. The literature search included articles published from 2019 to August 2020 and meta-search engines, yielding a total of 142 articles, and a triangulation of information was performed. A total of 11 articles were eventually included in the review, and the validity of each article was determined according to the guidelines of the Joanna Briggs Institute level of evidence. Results and discussion: The systematic review identified 11 studies that use different methodological considerations for conducting an aeromedical evacuation and covering key aspects for a successful operation. Conclusion: The management of specialist nurses has a direct impact on the aeromedical evacuation of the critical patient. It covers planning, organisation, and operational safety, applied in the instruction, training, execution and strict monitoring of the work of the aeromedical crew as a solid team. This contributes to the success of the aero-evacuation mission and the infectious patient's high likelihood of survival during the COVID-19 pandemic.

Un método 3D para estimar el efecto de osteotomías desrotadoras sobre alteraciones torsionales de fémur / A 3D method to estimate the effect of derotational osteotomies over femoral maltorsion

Introducción y objetivos: La medición precisa de la torsión femoral es esencial para el diagnóstico, indicación y planificación preoperatoria de las osteotomías desrotadoras femorales en pacientes con inestabilidad patelofemoral o dolor anterior de rodilla. Se han descrito múltiples métodos de medición, con valores muy diferentes entre ellos y ninguno de ellos permite establecer la magnitud de la osteotomía necesaria para devolver la torsión a valores normales. El objetivo del presente trabajo es desarrollar un método de medición que permita no solo el diagnóstico de pacientes con alteraciones torsionales, sino también establecer la magnitud de la osteotomía necesaria durante la cirugía. Material y métodos: Se seleccionaron 30 pacientes sin antecedentes de patología patelofemoral que disponían de una tomografía completa de miembros inferiores por otros motivos, siendo considerados así pacientes normales. Se calculó su torsión femoral mediante los métodos de Jeanmart y de Murphy por dos radiólogos independientes. Por otra parte, dos cirujanos ortopédicos independientes realizaron la medición de la torsión mediante el método 3D propuesto. Se evaluó el comportamiento normal de los datos y se definió la variabilidad intra- e interobservador del método 3D mediante su coeficiente de correlación intraclase y mediante el gráfico de Bland-Altman, realizando una comparación cuantitativa y cualitativa respectivamente con los métodos clásicos. Se estableció el intervalo de confianza de los valores normales con el nuevo método 3D y finalmente, se analizó al patrón de regresión lineal entre los métodos de Jeanmart y Murphy con el método de medición 3D. Resultados: La media de torsión femoral con el método 3D fue de 12,74° (DE 5,96°, IC 95%: 11,67 a 13,82°). Con el método de Jeanmart, esta fue de 12,84° (DE 8,60°, IC 95%: 11,28 a 14,39°) y de 15,87° (DE 10,68°, IC 95%: 13,94 a 17,80°) con el método de Murphy.(AU)

Introduction and objectives: Accurate measurement of femoral torsion is essential to diagnosing, correct surgical decision-making, and the preoperative planning of derotational osteotomies in a subgroup of anterior knee pain patients and patellofemoral instability. Several measurement techniques have been described with great variability in the magnitude of the values. Moreover, none of them can predict the effect of rotational osteotomy on the femoral version value. The purpose of the present work is to develop a method to reliably measure femoral torsion as well as to evaluate the effects of osteotomy on the femoral version angle. Material and methods: 30 patients without previous signs neither symptoms of patellofemoral pain or patellofemoral instability and with a lower limbs CT were selected. Their femoral torsion was measured using the classic Jeanmart and the Murphy's method by two independent radiologists. Independently, two orthopedic surgeons measured femoral torsion with the 3D method described in this study. The intraclass coefficient correlation and the Bland–Altman tests were used to analyze qualitatively and quantitatively the intraobserver and interobserver variability of the method regarding the Jeanmart's and Murphy's method. The confidence interval of the Normal values of the new method were defined and a lineal regression analysis between the 3D-Jeanmart's and 3D-Muphy's methods was performed. Results: The mean femoral version with the 3D method was 12.74° (SD 5.96°, 95% CI: 11.67° to 13.82°). With Jeanmart's method, it was 12.84° (SD 8.60°, 95% CI: 11.28° to 14.39°) and 15.87° (SD 10.68°, 95% CI: 13.94° to 17.80°) with Murphy's method, being these differences not statistically significant. Both interobserver and intraobserver agreement of the 3D method were high.(AU)

[Translated article] A 3D method to estimate the effect of derotational osteotomies over femoral maltorsion / Un método 3D para estimar el efecto de osteotomías desrotadoras sobre alteraciones torsionales de fémur

Introducción y objetivos: La medición precisa de la torsión femoral es esencial para el diagnóstico, indicación y planificación preoperatoria de las osteotomías desrotadoras femorales en pacientes con inestabilidad patelofemoral o dolor anterior de rodilla. Se han descrito múltiples métodos de medición, con valores muy diferentes entre ellos y ninguno de ellos permite establecer la magnitud de la osteotomía necesaria para devolver la torsión a valores normales. El objetivo del presente trabajo es desarrollar un método de medición que permita no solo el diagnóstico de pacientes con alteraciones torsionales, sino también establecer la magnitud de la osteotomía necesaria durante la cirugía. Material y métodos: Se seleccionaron 30 pacientes sin antecedentes de patología patelofemoral que disponían de una tomografía completa de miembros inferiores por otros motivos, siendo considerados así pacientes normales. Se calculó su torsión femoral mediante los métodos de Jeanmart y de Murphy por dos radiólogos independientes. Por otra parte, dos cirujanos ortopédicos independientes realizaron la medición de la torsión mediante el método 3D propuesto. Se evaluó el comportamiento normal de los datos y se definió la variabilidad intra- e interobservador del método 3D mediante su coeficiente de correlación intraclase y mediante el gráfico de Bland-Altman, realizando una comparación cuantitativa y cualitativa respectivamente con los métodos clásicos. Se estableció el intervalo de confianza de los valores normales con el nuevo método 3D y finalmente, se analizó al patrón de regresión lineal entre los métodos de Jeanmart y Murphy con el método de medición 3D. Resultados: La media de torsión femoral con el método 3D fue de 12,74° (DE 5,96°, IC 95%: 11,67 a 13,82°). Con el método de Jeanmart, esta fue de 12,84° (DE 8,60°, IC 95%: 11,28 a 14,39°) y de 15,87° (DE 10,68°, IC 95%: 13,94 a 17,80°) con el método de Murphy.(AU)

Introduction and objectives: Accurate measurement of femoral torsion is essential to diagnosing, correct surgical decision-making, and the preoperative planning of derotational osteotomies in a subgroup of anterior knee pain patients and patellofemoral instability. Several measurement techniques have been described with great variability in the magnitude of the values. Moreover, none of them can predict the effect of rotational osteotomy on the femoral version value. The purpose of the present work is to develop a method to reliably measure femoral torsion as well as to evaluate the effects of osteotomy on the femoral version angle. Material and methods: 30 patients without previous signs neither symptoms of patellofemoral pain or patellofemoral instability and with a lower limbs CT were selected. Their femoral torsion was measured using the classic Jeanmart and the Murphy's method by two independent radiologists. Independently, two orthopedic surgeons measured femoral torsion with the 3D method described in this study. The intraclass coefficient correlation and the Bland–Altman tests were used to analyze qualitatively and quantitatively the intraobserver and interobserver variability of the method regarding the Jeanmart's and Murphy's method. The confidence interval of the Normal values of the new method were defined and a lineal regression analysis between the 3D-Jeanmart's and 3D-Muphy's methods was performed. Results: The mean femoral version with the 3D method was 12.74° (SD 5.96°, 95% CI: 11.67° to 13.82°). With Jeanmart's method, it was 12.84° (SD 8.60°, 95% CI: 11.28° to 14.39°) and 15.87° (SD 10.68°, 95% CI: 13.94° to 17.80°) with Murphy's method, being these differences not statistically significant. Both interobserver and intraobserver agreement of the 3D method were high.(AU)

Clinical, environmental, and molecular factors associated to the occurrence and persistence of posttraumatic stress disorder after an earthquake.

Post-traumatic stress disorder (PTSD) is a common and disabling condition with high incidence after an earthquake. The objective of the present study was to identify risk factors associated with the occurrence and persistence of PTSD. Individuals (18-65 years old) who experienced the earthquake of September 19th, 2017, attended the National Institute of Psychiatry (INPRFM) between October and November 2017 (baseline n = 68). Participants were followed 4-6 (first follow-up, n = 40) and 7-9 (second follow-up n = 41) months after the earthquake. Delay returning to normal activities, a negative emotional valence to a previous earthquake, comorbidity with depression, history of childhood maltreatment, and low expression of Glucocorticoid Receptor (GR) were associated with PTSD in the basal assessment. The earthquake-related variable associated with the persistence of PTSD at the second follow-up was that the earthquake had directly affected the participants, either because they were evicted, had damage to their homes, or suffered some injury. Comorbidity with dysthymia, history of childhood maltreatment, and higher severity of PTSD in the basal assessment were associated with persistent PTSD in the second follow-up. The lower expression of the FK506 binding protein 5 (FKBP5) in participants with persistent PTSD in the second follow-up was better explained by childhood physical abuse than with PTSD severity. These findings suggest that acute exposure to earthquake-related stressful situations is relevant for the initial risk of PTSD, while potential long-term stressful conditions are associated with its persistence. Likewise, molecular markers associated with hypothalamus-pituitary-adrenal-axis dysregulation were differentially associated with PTSD diagnosis at the different assessment times.

The inverse square law: A basic principle in brachytherapy.

The purpose of this article is to remind the importance of the inverse square law in radiotherapy and especially in brachytherapy. Indeed, beyond the impact in radiation therapy with high energy beam, there is the use of radionuclides and low energy photons with short FSD where it is still more important. Comparisons between Iridium Brachytherapy and low energy X-rays brachytherapy show equivalent dose distributions in the first few centimeters. If the inverse square law is not the only element influencing the dose distributions calculations, it must not be forgotten. And it is playing a major role in brachytherapy with short FSD (<6cm).

[Translated article] A 3D method to estimate the effect of derotational osteotomies over femoral maltorsion.

INTRODUCTION AND OBJECTIVES: Accurate measurement of femoral torsion is essential to diagnosing, correct surgical decision-making, and the preoperative planning of derotational osteotomies in a subgroup of anterior knee pain patients and patellofemoral instability. Several measurement techniques have been described with great variability in the magnitude of the values. Moreover, none of them can predict the effect of rotational osteotomy on the femoral version value. The purpose of the present work is to develop a method to reliably measure femoral torsion as well as to evaluate the effects of osteotomy on the femoral version angle. MATERIAL AND METHODS: 30 patients without previous signs neither symptoms of patellofemoral pain or patellofemoral instability and with a lower limbs CT were selected. Their femoral torsion was measured using the classic Jeanmart and the Murphy's method by two independent radiologists. Independently, two orthopedic surgeons measured femoral torsion with the 3D method described in this study. The intraclass coefficient correlation and the Bland-Altman tests were used to analyze qualitatively and quantitatively the intraobserver and interobserver variability of the method regarding the Jeanmart's and Murphy's method. The confidence interval of the Normal values of the new method were defined and a lineal regression analysis between the 3D-Jeanmart's and 3D-Muphy's methods was performed. RESULTS: The mean femoral version with the 3D method was 12.74° (SD 5.96°, 95% CI: 11.67°-13.82°). With Jeanmart's method, it was 12.84° (SD 8.60°, 95% CI: 11.28°-14.39°) and 15.87° (SD 10.68°, 95% CI: 13.94°-17.80°) with Murphy's method, being these differences not statistically significant. Both interobserver and intraobserver agreement of the 3D method were high. CONCLUSION: The method presented in this study allows for the reliable quantification of femoral torsion in a reproducible way. This method can be applied in several open access 3D image programmes what makes its implementation in the healthcare centres possible from now on.

Relación del síndrome de ojo seco y consumo de fármacos que lo incluyen como reacción adversa / Relationship between dry eye syndrome and the use of drugs that include it as an adverse reaction

INTRODUCCIÓN: el síndrome de ojo seco (SOS) es una enfermedad multifactorial de las lágrimas y la superficie ocular, diversos factores de riesgo predisponen a padecerlo, entre ellos el consumo de ciertos medicamentos. El test OSDI (Ocular Surface Disease Index) validado al castellano, ha demostrado ser una herramienta fiable y sencilla para el diagnóstico del SOS.OBJETIVO: determinar si existe relación entre el SOS y el consumo de fármacos cuya RAM incluyen SOS.Establecer cuál es la influencia de los FR para el SOS en los pacientes estudiados y el SOS.MATERIAL Y MÉTODO: se realizó un estudio observacional descriptivo transversal en dos farmacias comunitarias de Salamanca entre octubre-2020 a enero-2021, utilizando un muestreo consecutivo simple que incluyo a 75 pacientes mayores de edad que acudan a las FC participantes a retirar medicación, sin dificultad de comprensión y que acepten participar firmando el consentimiento informado. Se recogieron los siguientes datos: edad, sexo, situación laboral, tiempo visión de pantallas consumo de alcohol y tabaco, enfermedad ocular, patologías, tratamiento farmacológico, además se realizó el test OSDI. Para las variables cuantitativas se realizó un estudio de tendencia central, media y desviación estándar, análisis de frecuencias para las cualitativas. Un análisis bivariante para comparar los grupos de ojo seco normal-leve, moderado y severo respecto del resto de variables. Se utilizó el test chi-cuadrado, Pearson para variables cualitativas y t-Student para la cuantitativas. Se realizó un análisis de regresión logística multinomial cuando se trataron los resultados del OSDI como variable continua. (AU)

Medicamentos con potencial farmacogenético dispensados en la farmacia comunitaria / Medicinal products with pharmacogenetic potential dispensed in community pharmacies

JUSTIFICACIÓN: los servicios de farmacogenética (PGx) permiten la identificación temprana de pacientes cuya terapia puede ser optimizada según su genotipo. Entidades como el Clinical Pharmacogenetics Consortium (CPIC) y la FDA (Food and Drug Administration) cuentan con guías y recomendaciones de PGx para más de 50 fármacos. En España, la integración de los servicios de PGx en el ámbito hospitalario es una realidad, pero su inserción a nivel primario/comunitario permanece como una posibilidad a futuro. Estimar el porcentaje de pacientes a los que se les dispensan medicamentos con potencial farmacogenético (PAPGx) en la farmacia comunitaria es un paso preliminar para evaluar la factibilidad de implementar un servicio de PGx en este nivel.OBJETIVOS: determinar la prevalencia de medicamentos con potencial acción farmacogenética (PAPGx) dispensados a pacientes en el periodo de un año en una farmacia comunitaria de Salamanca, España.MATERIAL Y MÉTODOS: estudio observacional retrospectivo. ¬Se revisaron los registros de dispensación en el periodo de 1 año natural (2019). Se registró el total de pacientes atendidos y los medicamentos dispensados por paciente. Se identificaron los fármacos con PAPGx por prescripción y se estimó el porcentaje de pacientes que serían candidatos a la prestación de servicios de PGx en la farmacia comunitaria. Se clasificó como medicamento "farmacogenéticamente accionable" a todo fármaco que contara con recomendaciones posológicas del CPIC o que formaran parte de la sección 1 de la tabla de asociaciones farmacogenéticas de la FDA. (AU)

Derivación desde el Servicio de Indicación Farmacéutica a la revisión del uso de medicamentos: un caso de isoapariencia / Referral from the Pharmaceutical Indication Service to medicines use review: a case of isoappearance

ANTECEDENTES: mujer de 54 años acude a la farmacia comunitaria por un trastorno del sueño, solicitando tratamiento. Realizamos el Servicio Profesional Farmacéutico Asistencial (SPFA) de Indicación Farmacéutica y se incluye en el proyecto INDICA+Pro a través del software SEFAC e_XPERT. Detectamos dificultad para conciliar el sueño, despertares nocturnos y somnolencia diurna las últimas 3 semanas. La paciente valora su estado de salud en 70 sobre 100. Se automedicó con Zolpidem 5mg recomendado por un familiar durante 4 días, aun así, no está conforme debido a que el medicamento le produce sopor. Sus prescripciones son: Paracetamol 650mg (a demanda); Diclofenaco tópico (0-1-0); Metformina 850mg (1-0-1); Enalapril 20mg (1-0-0).Como actuación del servicio se indica un tratamiento con melatonina. Se hace hincapié en cesar el Zolpidem y se instruye en hábitos para la higiene del sueño y medidas higiénico-dietéticas. EVALUACIÓN: tras 12 días, se realiza la evaluación del servicio, presenta una mejoría de 7 sobre 10 en el síntoma menor y un incremento de 5 puntos en su estado de salud subjetivo.SEGUIMIENTO: tras dos meses la paciente acude a la farmacia y se aprovecha para preguntar por su problema de insomnio. Indica que es mucho peor y ha cesado voluntariamente el tratamiento porque “cuando lo toma duerme menos”. Revisando su ficha se observa que no ha retirado de nuevo el medicamento de indicación. Tampoco lo ha retirado en otra farmacia según refiere. Asegura que le quedan suficientes dosis y que las sigue tomando, autorreporta buena adherencia. Por recuento de medicación es algo imposible, teniendo que haber agotado todas las dosis del primer envase.INTERVENCIÓN: se deriva al SPFA de Revisión de Uso de los Medicamentos (RUM) de la farmacia comunitaria. (AU)

Comprensión de pictogramas farmacéuticos: una revisión sistemática / Understanding pharmaceutical pictograms: a systematic review

JUSTIFICACIÓN: la comprensión lectora del prospecto es crucial, pues contiene todas las informaciones indispensables para su correcto empleo, así como una invitación expresa a ser leído. Es necesario identificar oportunidades para que el material educativo que recibe el paciente sea lo más comprensible posible para garantizar la administración segura. Los pictogramas farmacéuticos pretenden comunicar mensajes complejos, independientemente del nivel educativo.OBJETIVOS: revisar la evidencia disponible sobre la eficacia comunicativa de los pictogramas farmacéuticos.MATERIAL Y MÉTODOS: se realizó una búsqueda sistemática en paralelo de la literatura publicada en los últimos 20 años. Las bases de datos consultadas fueron Scopus, PubMed y Web of Science. Las palabras clave empleadas fueron: adherence, compliance, “consumer health information”, “health literacy”, “health education”, pictograms, “illustrated leaflet” y “visual aid”. Solo se incluyeron artículos en inglés que consistieran en estudios controlados aleatorizados como estándar oro para la evidencia. La búsqueda arrojó 207 resultados. Tras la eliminación de duplicados y lectura de títulos y resúmenes se seleccionaron 13 artículos que se ajustaban a nuestro objetivo.RESULTADOS: Sudáfrica, con 5, es el país que más estudios controlados aleatorizados realizó según nuestros criterios de búsqueda. Sus autores remarcaron la importancia de asegurar la comprensión de instrucciones escritas sobre medicamentos en un entorno con tasas de analfabetismo elevadas. Solo 2 estudios realizaron tests de Alfabetización en Salud complementarios. 4 estudios no hallaron diferencias significativas en la comprensión entre grupo control y el de intervención, pero la aceptación del pictograma por el paciente fue generalizada en todos los estudios identificados. (AU)

Impact of layered non-pharmacological interventions on COVID-19 transmission dynamics in Yucatan, Mexico.

Background: The pandemic propagation of SARS-CoV-2 led to the adoption of a myriad of non-pharmacological interventions (NPIs, e.g., social distancing, mobility restrictions, gathering restrictions) in the Americas. Using national epidemiological data, here we report the impact of the layered adoption of multiple NPIs aimed at curving SARS-CoV-2 transmission in Yucatan State, Mexico. Methods: Data from suspected and laboratory confirmed COVID-19 cases during 2020 were analyzed by age groups and sex, clinical signs, and symptoms as well as outcome. The impact of NPIs was quantified using time-varying reproduction numbers (R t) estimated as a time-series and by sectors of the city. Findings: A total of 69,602 suspected cases were reported, 39.3% were laboratory-confirmed. Men were hospitalized (60.2%), more severely ill (3% vs 1.9%) and more likely to die (62%) than women. Early in the outbreak, all sectors in Merida had R t estimates above unity. Once all NPÍs were in place, R t values were dramatically reduced below one, and in the last interval transmission estimates of R t remained below one in all sectors. Interpretation: In the absence of a COVID-19 vaccination program, the combination and wide adherence of NPÍs led to a low and stable trend in SARS-CoV-2 transmission that did not overwhelm the health sector. Our study reflects that a controlled and planned ease of restrictions to balance health, social and economic recovery resulted in a single wave of transmission that prolonged at low and stable levels. Funding: GVP received funding from Emory University via the MP3 Initiative.

A 3D method to estimate the effect of derotational osteotomies over femoral maltorsion. / Un método 3D para estimar el efecto de osteotomías desrotadoras sobre alteraciones torsionales de fémur.

INTRODUCTION AND OBJECTIVES: Accurate measurement of femoral torsion is essential to diagnosing, correct surgical decision-making, and the preoperative planning of derotational osteotomies in a subgroup of anterior knee pain patients and patellofemoral instability. Several measurement techniques have been described with great variability in the magnitude of the values. Moreover, none of them can predict the effect of rotational osteotomy on the femoral version value. The purpose of the present work is to develop a method to reliably measure femoral torsion as well as to evaluate the effects of osteotomy on the femoral version angle. MATERIAL AND METHODS: 30 patients without previous signs neither symptoms of patellofemoral pain or patellofemoral instability and with a lower limbs CT were selected. Their femoral torsion was measured using the classic Jeanmart and the Murphy's method by two independent radiologists. Independently, two orthopedic surgeons measured femoral torsion with the 3D method described in this study. The intraclass coefficient correlation and the Bland-Altman tests were used to analyze qualitatively and quantitatively the intraobserver and interobserver variability of the method regarding the Jeanmart's and Murphy's method. The confidence interval of the Normal values of the new method were defined and a lineal regression analysis between the 3D-Jeanmart's and 3D-Muphy's methods was performed. RESULTS: The mean femoral version with the 3D method was 12.74° (SD 5.96°, 95% CI: 11.67° to 13.82°). With Jeanmart's method, it was 12.84° (SD 8.60°, 95% CI: 11.28° to 14.39°) and 15.87° (SD 10.68°, 95% CI: 13.94° to 17.80°) with Murphy's method, being these differences not statistically significant. Both interobserver and intraobserver agreement of the 3D method were high. CONCLUSION: The method presented in this study allows for the reliable quantification of femoral torsion in a reproducible way. This method can be applied in several open access 3D image programs what makes its implementation in the healthcare centers possible from now on.

Pouteria sapota (Red Mamey Fruit): Chemistry and Biological Activity of Carotenoids.

BACKGROUND: Red mamey is the fruit of P. sapota, a tree found in Mesoamerica and Asia. This fruit is considered a nutraceutical due to its multiple beneficial health including antiamyloidogenic activity and potential anti-tumorigenic property. Red mamey contain a variety of carotenoids including novel ketocarotenoids such as sapotexanthin and cryptocapsin. A ketocarotenoid is a chemical compound with a carbonyl group present in the ß-ring or in the double bond chain of a carotenoid. In red mamey, the 3'-deoxy-k-end group in sapotexanthin has proven to be an important pro-vitamin A source, which is essential for maintaining a healthy vision and cognitive processes. OBJECTIVE: This work reviews the current knowledge about the chemistry and biological activities of carotenoids in red mamey. METHOD: An exhaustive extraction is the most usual methodology to isolate and thoroughly characterize the carotenoids present in this fruit. High performance liquid chromatography is used to determine the profile of total carotenoids and its purity, while atmospheric pressure chemical ionization was used to determine their molecular weight and nuclear magnetic resonance determined their structure. RESULT: For each 100 g of fresh weight, 0.12 mg of total carotenoid from this fruit can be obtained. Out of the more than 47 reported carotenoids in red mamey, only 34 have a detailed characterization. CONCLUSION: It is important to continue studying the chemical composition and biological activity of this unique tropical fruit with commercial and nutritional value.