Molecular Environment Modulates CO2 Liberation from Carboxy-Biotin.

Carboxy-biotin serves as a coenzyme in certain carboxylases, exhibiting the remarkable capability to transfer a carboxy group to specific substrates. This process is made possible by the presence of biotin, a unique molecule that consists of a sulfur-containing tetrahydrothiophene ring fused to a ureido group. It is covalently attached to the enzyme via a flexible linker, allowing for its functionality. Biotin-dependent carboxylases consist of two distinct domains. The first domain (BC) facilitates biotin carboxylation by utilizing ATP, while the second domain (CT) transfers CO2 to the substrate. The process of ATP-dependent carboxylation using bicarbonate in the biotin carboxylase domain (BC) is well-known. However, the precise mechanism by which CO2 is released in the carboxyltransferase domain (CT) is still not fully understood. We employed advanced computational chemistry methods to investigate the decarboxylation process of carboxy-biotin in various molecular environments and different protonation states. Regardless of the polarity of the molecular surroundings, decarboxylation only occurs spontaneously in the protonated form. To determine the protonation state of biotin in different environments, we established an accurate computational chemistry method for calculating the pKa value of carboxy-biotin, reaching sub-kcal/mol accuracy. Based on our findings, nonpolar environments, such as the active site of the carboxyltransferase domain, have the ability to cause the spontaneous release of CO2 from carboxy-biotin. The CO2 release takes place spontaneously from protonated carboxy-biotin, promoting the carboxylation of substrates.

An expanded chronic care management approach to multiple chronic conditions in Hispanics using community health workers as community extenders in the Rio Grande Valley of Texas.

INTRODUCTION: The synergistic negative effects of type 2 diabetes (T2DM) and hypertension increases all-cause mortality and the medical complexity of management, which disproportionately impact Hispanics who face barriers to healthcare access. The Salud y Vida intervention was delivered to Hispanic adults living along the Texas-Mexico Border with comorbid poorly controlled T2DM and hypertension. The Salud y Vida multicomponent intervention incorporated community health workers (CHWs) into an expanded chronic care management model to deliver home-based follow-up visits and provided community-based diabetes self-management education. METHODS: We conducted multivariable longitudinal analysis to examine the longitudinal intervention effect on reducing systolic and diastolic blood pressure among 3806 participants enrolled between 2013 and 2019. Participants were compared according to their program participation as either higher (≥ 10 combined educational classes and CHW visits) or lower engagement (<10 encounters). Data was collected between 2013 and 2020. RESULTS: Baseline mean systolic and diastolic blood pressure were 138 and 81 mmHg respectively. There were overall improvements in systolic (-6.49; 95% CI = [-7.13, -5.85]; p < 0.001) and diastolic blood pressure (-3.97; 95% CI = [-4.37, -3.56]; p < 0.001). The higher engagement group had greater systolic blood pressure reduction at 3 months (adjusted mean difference = -1.8 mmHg; 95% CI = [-3.2, -0.3]; p = 0.016) and at 15 month follow-up (adjusted mean difference = -2.3 mmHg; 95% CI = [-4.2, -0.39]; p = 0.0225) compared to the lower engagement group. CONCLUSION: This intervention, tested and delivered in a real-world setting, provides an example of how CHW integration into an expanded chronic care model can improve blood pressure outcomes for individuals with co-morbidities.

Multicomponent synthesis and photophysical study of novel α,ß-unsaturated carbonyl depsipeptides and peptoids.

Multicomponent reactions were performed to develop novel α,ß-unsaturated carbonyl depsipeptides and peptoids incorporating various chromophores such as cinnamic, coumarin, and quinolines. Thus, through the Passerini and Ugi multicomponent reactions (P-3CR and U-4CR), we obtained thirteen depsipeptides and peptoids in moderate to high yield following the established protocol and fundamentally varying the electron-rich carboxylic acid as reactants. UV/Vis spectroscopy was utilized to study the photophysical properties of the newly synthesized compounds. Differences between the carbonyl-substituted chromophores cause differences in electron delocalization that can be captured in the spectra. The near UV regions of all the compounds exhibited strong absorption bands. Compounds P2, P5, U2, U5, and U7 displayed absorption bands in the range of 250-350 nm, absorbing radiation in this broad region of the electromagnetic spectrum. A photostability study for U5 showed that its molecular structure does not change after exposure to UV radiation. Fluorescence analysis showed an incipient emission of U5, while U6 showed blue fluorescence under UV radiation. The photophysical properties and electronic structure were also determined by TD-DFT theoretical study.

Comparative Study of the Removal Efficiency of Nalidixic Acid by Poly[(4-vinylbenzyl)trimethylammonium Chloride] and N-Alkylated Chitosan through the Ultrafiltration Technique and Its Approximation through Theoretical Calculations.

Emerging antibiotic contaminants in water is a global problem because bacterial strains resistant to these antibiotics arise, risking human health. This study describes the use of poly[(4-vinylbenzyl) trimethylammonium chloride] and N-alkylated chitosan, two cationic polymers with different natures and structures to remove nalidixic acid. Both contain ammonium salt as a functional group. One of them is a synthetic polymer, and the other is a modified artificial polymer. The removal of the antibiotic was investigated under various experimental conditions (pH, ionic strength, and antibiotic concentration) using the technique of liquid-phase polymer-based retention (LPR). In addition, a stochastic algorithm provided by Fukui's functions is used. It was shown that alkylated N-chitosan presents 65.0% removal at pH 7, while poly[(4-vinylbenzyl)trimethylammonium chloride] removes 75.0% at pH 9. The interaction mechanisms that predominate the removal processes are electrostatic interactions, π-π interactions, and hydrogen bonding. The polymers reached maximum retention capacities of 1605 mg g-1 for poly[(4-vinylbenzyl) trimethylammonium chloride] and 561 mg g-1 of antibiotic per gram for alkylated poly(N-chitosan). In conclusion, the presence of aromatic groups improves the capacity and polymer-antibiotic interactions.

Repurposing of rabeprazole as an anti-Trypanosoma cruzi drug that targets cellular triosephosphate isomerase.

Trypanosoma cruzi is the causative agent of American trypanosomiasis, which mainly affects populations in Latin America. Benznidazole is used to control the disease, with severe effects in patients receiving this chemotherapy. Previous studies have demonstrated the inhibition of triosephosphate isomerase from T. cruzi, but cellular enzyme inhibition has yet to be established. This study demonstrates that rabeprazole inhibits both cell viability and triosephosphate isomerase activity in T. cruzi epimastigotes. Our results show that rabeprazole has an IC50 of 0.4 µM, which is 14.5 times more effective than benznidazole. Additionally, we observed increased levels of methyl-glyoxal and advanced glycation end products after the inhibition of cellular triosephosphate isomerase by rabeprazole. Finally, we demonstrate that the inactivation mechanisms of rabeprazole on triosephosphate isomerase of T. cruzi can be achieved through the derivatization of three of its four cysteine residues. These results indicate that rabeprazole is a promising candidate against American trypanosomiasis.

Manejo de perforaciones, fugas y fístulas del tracto gastrointestinal con clip sobre el endoscopio. Experiencia de un centro oncológico Latinoamericano / Management of perforations, leaks and fistulas of the gastrointestinal tract with over the scope clip. Experience at a Latin American cancer center

Introducción. Las fístulas derivadas de enfermedades neoplásicas del tracto digestivo, así como las fugas posteriores a procedimientos quirúrgicos, no son infrecuentes y ocasionan una morbilidad importante cuando se manejan de forma quirúrgica. También durante los procedimientos endoscópicos se pueden presentar perforaciones y, si se logra un manejo no operatorio, se alcanza una adecuada recuperación. El objetivo de este estudio fue describir las características clínicas y los resultados de los pacientes con perforaciones, fístulas y fugas del tracto gastrointestinal, manejadas endoscópicamente con clip sobre el endoscopio. Métodos. Estudio descriptivo, retrospectivo, de pacientes con perforación, fuga o fístula postoperatoria, llevados a endoscopía digestiva con colocación de clip sobre el endoscopio, en el Instituto Nacional de Cancerología en Bogotá, D.C., Colombia, entre enero de 2016 y abril de 2020. Resultados. Se incluyeron 21 pacientes, 52,4 % de ellos mujeres. La mediana de edad fue de 66 años y del diámetro del defecto fue de 9 mm. En el 95 % se logró éxito técnico. Hubo éxito clínico temprano en el 85,7 % de los casos. El 76,1 % de los pacientes permanecieron sin síntomas a los 3 meses de seguimiento. Conclusiones. El manejo de perforaciones, fugas y fístulas con clip sobre el endoscopio parece ser factible y seguro. En la mayoría de estos pacientes se logró la liberación del clip y la identificación endoscópica del cierre inmediatamente después del procedimiento; sin embargo, en el caso de las fístulas, no se alcanzó el éxito clínico tardío en todos los casos

Introduction. Fistula of the digestive tract derived from neoplastic diseases as well as leaks following surgical procedures are not uncommon and usually cause significant morbidity when are managed surgically. Diagnostic and therapeutic endoscopic procedures may present perforations during their performance; if they are managed non-operatively, an adequate recovery is obtained. The purpose of this study was to describe the clinical characteristics and the short- and long-term outcomes of patients with perforations, fistulas and leaks of the gastrointestinal tract managed endoscopically with over the scope clip (OTSC). Methods. Descriptive, retrospective study of patients brought to digestive endoscopy with OTSC placement with diagnosis of postoperative perforation, leak or fistula at the National Cancer Institute in Bogota, Colombia, between January 2016 and April 2020. Results. Twenty-one patients were taken for OTSC application for the management of perforations, leaks and fistulas of the gastrointestinal tract, 52.4% of them were women. The median age was 66 years. The median diameter of the defect was 9 mm. Technical success was achieved in 95%. Early clinical success was described in 85.7% of the cases; 76.1% of patients remained symptom-free at 3-month follow-up. Conclusions. Management of perforations, leaks and fistulas with OTSC appears to be feasible and safe. In most of these patients, clip release and endoscopic identification of closure was achieved immediately after management; however, in the case of fistulas, late clinical success was not achieved in all cases

Metformin Alleviates Diabetes-Associated Hypertension by Attenuating the Renal Epithelial Sodium Channel.

Diabetic nephropathy is the primary cause of morbidity in type 2 diabetes mellitus (T2DM) patients. New data indicate that hypertension, a common comorbidity in T2DM, can worsen outcomes of diabetic nephropathy. While metformin is a commonly prescribed drug for treating type 2 diabetes, its blood pressure regulating ability is not well documented. The aim of this study was to investigate the effect of metformin on normalizing blood pressure in salt-loaded hypertensive diabetic db/db mice. Sixteen-week-old male and female diabetic db/db mice were individually placed in metabolic cages and then randomized to a control vehicle (saline) or metformin treatment group. We evaluated the blood pressure reducing ability of metformin in salt-induced hypertension and progression of nephropathy in db/db mice. We observed that metformin- normalized systolic blood pressure in hypertensive diabetic mice. Mechanistically, metformin treatment reduced renal cathepsin B expression. Low cathepsin B expression was associated with reduced expression and activity of the epithelial sodium channel (ENaC), sodium retention, and thus control of hypertension. In addition, we identified that urinary extracellular vesicles (EVs) from the diabetic mice are enriched in cathepsin B. Compared to treatment with urinary EVs of vehicle-treated hypertensive diabetic mice, the amiloride-sensitive transepithelial current was significantly attenuated upon exposure of renal collecting duct cells to urinary EVs isolated from metformin-treated db/db mice or cathepsin B knockout mice. Collectively, our study identifies a novel blood pressure reducing role of metformin in diabetic nephropathy by regulating the cathepsin B-ENaC axis.

Enhancing the importance of value-based urology and uro-oncology / Realzar la importancia de la urología y la uro-oncología basadas en valores

With the ongoing advances and evolution in healthcare, we have witnessed new breakpoints in patient management. As a result, there have been tireless efforts to identify and eradicate barriers to care and minimize their impact on patients.

Con los continuos avances y la evolución de la asistencia sanitaria, hemos sido testigos de nuevos puntos de inflexión en la gestión de los pacientes. Como resultado, se han realizado incansables esfuerzos para identificar y erradicar las barreras a la atención y minimizar su impacto en los pacientes.

Lipid Profiles of Urinary Extracellular Vesicles Released during the Inactive and Active Phases of Aged Male Mice with Spontaneous Hypertension.

Hypertension remains a major problem, especially in the elderly, as it increases the risk for cardiovascular, coronary artery, cerebrovascular, and kidney diseases. Extracellular vesicles (EVs) play a role in the aging process and contribute to pathophysiology. Our goal was to examine differences in lipid profiles of urinary EVs (uEVs) collected during the inactive and active phases of aged mice and investigate whether these EVs regulate the density of lipid rafts in mouse cortical collecting duct (mpkCCD) principal cells. Here, we demonstrate the epithelial sodium channel (ENaC) inhibitor benzyl amiloride reduced systolic blood pressure in aged male mice during the inactive and active phases. Lipidomics data demonstrate differential enrichment of lipids between the two groups. For example, there are more phosphatidylethanolamine plasmalogens, particularly in the form of alkyl phosphatidylethanolamines, that are enriched in active phase uEVs compared to inactive phase uEVs from the same mice. Amiloride-sensitive transepithelial current increased more in mpkCCD cells challenged with uEVs from the active phase group. Moreover, more ENaC alpha protein was distributed to lipid raft fractions of mpkCCD cells challenged with active phase uEVs. Taken together, the identification of bioactive lipids associated with lipid rafts that are enriched in EVs released during the active phase of aged mice may offer clues to help understand lipid raft organization in recipient principal cells after EV uptake and increased renal ENaC activity, leading to a time-of-day dependent regulation of blood pressure in an aging model.

Formation and evolution of C-C, C-O, C[double bond, length as m-dash]O and C-N bonds in chemical reactions of prebiotic interest.

A series of prebiotic chemical reactions yielding the precursor building blocks of amino acids, proteins and carbohydrates, starting solely from HCN and water is studied here. We closely follow the formation and evolution of the pivotal C-C, C-O, C[double bond, length as m-dash]O, and C-N bonds, which dictate the chemistry of the molecules of life. In many cases, formation of these bonds is set in motion by proton transfers in which individual water molecules act as catalysts so that water atoms end up in the products. Our results indicate that the prebiotic formation of carbon dioxide, formaldehyde, formic acid, formaldimine, glycolaldehyde, glycine, glycolonitrile, and oxazole derivatives, among others, are best described as highly nonsynchronous concerted single step processes. Nonetheless, for all reactions involving double proton transfer, the formation and breaking of O-H bonds around a particular O atom occur in a synchronous fashion, apparently independently from other primitive processes. For the most part, the first process to initiate seems to be the double proton transfer in the reactions where they are present, then bond breaking/formation around the reactive carbon in the carbonyl group and finally rupture of the C-N bonds in the appropriate cases, which are the most reluctant to break. Remarkably, within the limitations of our non-dynamical computational model, the wide ranges of temperature and pressure in which these reactions occur, downplay the problematic determination of the exact constraints on the early Earth.

Participant engagement in a community health worker-delivered intervention and type 2 diabetes clinical outcomes: a quasiexperimental study in MexicanAmericans.

OBJECTIVES: This study helps to fill the existing research gap related to participant engagement in behavioural interventions and diabetes management. We examined type 2 diabetes control over time among Mexican Americans by level of engagement in a chronic care management (CCM) program that included community health worker (CHW)-delivered multilevel interventions. The programme complemented clinical care and promoted behaviour changes to improve diabetes self-management. DESIGN: Quasiexperimental study. SETTING: The study was implemented in the Rio Grande Valley region in the USA. Recruitment was conducted in clinics and community events. All other visits were provided in participant homes and community locations. PARTICIPANTS: 5649 adults (aged ≥18 years) with poorly controlled type 2 diabetes who enrolled in a community-delivered CCM programme between September 2013 and 2018. INTERVENTIONS: The intervention comprised two components: CHW home visits conducted every 3 months and diabetes self-management education (DSME) classes provided in community locations. PRIMARY OUTCOME MEASURES: The primary outcome was haemoglobin A1c (HbA1c) measured at baseline every 3 months for up to 24 months. We first examined changes in HbA1c levels over time. The number of completed CHW and DSME encounters was used to classify participants into engagement groups-high engagement defined as ≥10 encounters (n=2952); low engagement defined as 1-9 encounters (n=2697). We used univariable and multivariable longitudinal linear regression models with a generalised estimating equation method. We tested interactions between engagement groups and time. RESULTS: Participants' mean HbA1c decreased from 10.20% at baseline to 8.93% (p<0.0001) at 3 months, remaining stable thereafter. Changes in HbA1c were statistically different between the engagement groups. High engagement participants had lower HbA1c levels over the first 15 months of the follow-up period compared with low engagement participants, as compared at 3 months (-0.44%, 95% CI -0.57% to -0.31%; p<0.0001), 6 months (-0.31%, 95% CI -0.43% to -0.14%; p<0.0001), 9 months (-0.27%, 95% CI -0.42% to -0.13%; p=0.0001), 12 months (-0.23%, 95% CI -0.37% to -0.08%; p=0.0025) and 15 months (-0.32%, 95% CI -0.54% to -0.10%; p=0.0040). At months 18, 21 and 24, the HbA1c differences were not statistically significant (18 months: -0.34%, 95% CI -0.77% to 0.08%; p=0.1086; 21 months: -0.22%, 95% CI -1.00% to 0.56%; p=0.5721; 24 months: -0.42%, 95% CI -1.38% to 0.55%; p=0.3966). CONCLUSIONS: Higher engagement in the CCM programme delivered by CHWs and coordinated with clinical care was associated with beneficial improvements in type 2 diabetes control, but both engagement groups showed strong improvements.

Respuestas psicológicas a la cuarentena por pandemia de COVID-19 en población colombiana / Psychological responses to the COVID-19 pandemic quarantine in Colombian population

Resumen Introducción: el presente estudio analiza el estrés percibido, las estrategias de afrontamiento, su regulación emocional, impacto y malestar psicológico, durante la cuarentena por la pandemia de COVID-19 en la población colombiana. Método: muestra no probabilística de 356 adultos que respondieron un cuestionario en línea. Resultados: se encontraron puntuaciones medias y altas en estrategias de afrontamiento y regulación emocional activas y puntuaciones bajas en estrés, malestar psicológico e impacto de la cuarentena. El 38.76 % presentó puntuaciones que indican riesgo de trastorno por estrés postraumático. Las mujeres, los menores de 35 años, los bachilleres, los estudiantes y las personas que viven solas presentan mayores afectaciones. Se encontraron relaciones estadísticamente significativas de estrés con todas las variables, excepto con apoyo social y convivientes durante la cuarentena. Por último, se encontró asociación positiva del estrés con desahogo, supresión expresiva, impacto de la cuarentena y malestar psicológico; y asociación negativa con planificación, aceptación, revaluación cognitiva y edad mayor de 25 años. Conclusiones: los resultados contribuyen a comprender las respuestas ante la cuarentena e identificar factores de vulnerabilidad para diseñar programas de prevención e intervención.

Abstract Introduction: The aim of this study was to analyze the perceived stress, coping strategies, emotional regulation, impact of the event, and psychological distress during quarantine due to COVID-19 pandemic in the Colombian population. Method: Non-probabilistic sample made up of 356 adults who answered an online questionnaire. Results: It was found medium and high scores in active coping strategies and emotional regulation, and low scores in stress, psychological distress and impact of quarantine. The 38.76 % presented scores that indicate risk of post-traumatic stress disorder. Women, people under 35 years of age, high school graduates, students, and living alone during the quarantine showed higher affectation. Statistically significant correlations of stress with all variables except with social support and cohabitants during quarantine were found. Finally, it was found a positive association of stress with venting, expressive suppression, the impact of quarantine, and psychological distress, and negative association with planning, acceptance, cognitive reappraisal, and age over 25 years. Conclusions: These results contribute to understanding responses to quarantine and to identify vulnerability factors to design prevention and intervention programs.

Exploring In Vitro Biological Cellular Responses of Pegylated ß-Cyclodextrins.

ßCDPEG5 and ßCDPEG2 are two derivatives comprising seven PEG linear chains of 5 and 2 kDa, respectively, conjugated to ßCD. As ßCDPEGs display different physicochemical properties than their precursors, they could also trigger distinct cellular responses. To investigate the biological behavior of ßCDPEGs in comparison to their parent compounds, we performed broad toxicological assays on RAW 264.7 macrophages, MC3T3-E1 osteoblasts, and MDCK cells. By analyzing ROS and NO2- overproduction in macrophages, we found that ßCDPEGs induced a moderate stress response without affecting cell viability. Although MC3T3-E1 osteoblasts were more sensitive than MDCK cells to ßCDPEGs and the parent compounds, a similar pattern was observed: the effect of ßCDPEG5 on cell viability and cell cycle progression was larger than that of ßCDPEG2; PEG2 affected cell viability and cell cycle more than ßCDPEG2; cell post-treatment recovery was favorable in all cases, and the compounds had similar behaviors regarding ROS generation. The effect on MDCK cell migration followed a similar pattern. In contrast, for osteoblasts, the interference of ßCDPEG5 with cell migration was smaller than that of ßCDPEG2; likewise, the effect of PEG2 was shorter than its conjugate. Overall, the covalent conjugation of ßCD and PEGs, particularly to yield ßCDPEG2, improved the biocompatibility profile, evidencing that a favorable biological response can be tuned through a thoughtful combination of materials. Moreover, this is the first time that an in vitro evaluation of ßCD and PEG has been presented for MC3T3-E1 and MDCK cells, thus providing valuable knowledge for designing biocompatible nanomaterials constructed from ßCD and PEGs.

Políticas sanitarias en América Latina y el Caribe, un problema político en escenarios de Pandemia

Reflexionar sobre los efectos evidentes en la mayoría de sistemas de salud que tenemos en América Latina, a partir de las relaciones entre diferentes regímenes políticos de sus Estados y su incidencia en las políticas públicas sanitarias, inmersas y moduladas en escenarios de Mercado privado de seguros sanitarios, es una tarea urgente. Nos preguntamos ¿es posible modificar las políticas públicas sanitarias en estados democráticos o socialdemócratas de AL? Y si es posible incidir en este escenario estructural, afectarían positivamente el sector sanitario, ¿Como crear o reformular sistemas de salud considerados instituciones encargadas de operar la prestación y atención sanitaria? Reconocer efectos de la pandemia en la dinámica de nuestros sistemas de salud nos muestra que debemos recomponer la estructura de pensamiento social de nuestros Estados para construir políticas sociales y políticas públicas sanitarias orientadas a fortalecer el derecho humano fundamental a la salud de forma sostenible, configurando la participación de la sociedad con incidencia política en la toma de decisiones justas que incrementará la intensidad de la acción pública de la gobernanza.

Reflect on the evident effects in the majority of health systems that we have in Latin America, based on the relationships between different political regimes in their States and their impact on public health policies, immersed and modulated in private health insurance market scenarios, it is an urgent task. We ask ourselves, ¿is it possible to modify public health policies in democratic or social democratic states of LA? And if it is possible to influence this structural scenario, they would positively affect the health sector. ¿How to create or reformulate health systems considered institutions in charge of operating the provision and health care? Recognizing the effects of the pandemic on the dynamics of our health systems shows us that we must rebuild the structure of social thought in our states to build social policies and public health policies aimed at strengthening the fundamental human right to health in a sustainable way, configuring the participation of society with political influence in making fair decisions that will increase the intensity of public action of governance.

A Chronic Care Management Framework Bridging Clinic, Home, and Community Care in a Mexican American Population.

Despite evidence that chronic care management improves outcomes, a framework designed for low income, uninsured populations is still needed to improve health disparities and guide further replication. We describe the Innovative Care for Chronic Conditions framework implemented by a coalition of clinics and agencies to address chronic care management for Mexican Americans with Type 2 diabetes mellitus who have low income and primarily uninsured. The core elements of the framework are described by clinic, home and community settings with community health workers playing an essential role in the delivery of community-based services that address the social determinants of health. Promising results are described. This framework expands the understanding of chronic care management approaches and contributes to further replication of the framework in diverse settings.

Evaluación de adherencia a la guía de práctica clínica para el manejo de faringoamigdalitis aguda en la atención de urgencias del Hospital Universitario San Ignacio, Bogotá, Colombia / Evaluation of adherence to the clinical practice guideline for the management of acute pharyngotonsillitis in the emergency care of the University Hospital San Ignacio, Bogota, Colombia

Introducción: la faringoamigdalitis aguda, independientemente de su origen, es de los diagnósticos más frecuentes en los servicios de urgencias. Aunque se ha establecido que en la mayoría de casos su origen es viral, ante la dificultad de identificar su agente etiológico con hallazgos clínicos se ha aumentado la formulación indiscriminada de antibióticos, principalmente en los servicios de urgencias, lo que contribuye con la emergencia de resistencias bacterianas y la aparición de efectos secundarios. Se propone evaluar la adherencia a la guía de práctica clínica para el manejo de faringoamigdalitis aguda en urgencias en el Hospital Universitario San Ignacio en Bogotá, Colombia. Materiales y métodos: se realizó un estudio de tipo descriptivo retrospectivo. Se revisaron 7762 historias clínicas de pacientes que consultaron por urgencias entre 2016 y 2019 por dolor de garganta. Se analizaron los datos de formulación de analgésicos, antibióticos, solicitud de la prueba rápida de detección de Estreptococo betahemolítico del grupo A (SBHGA) y el registro de la presencia de exudados al examen físico. Resultados: se incluyeron 7762 pacientes. Del total, 74,2 % recibieron antibiótico y 98 % analgesia. Se solicitó la prueba rápida de detección de SBHGA al 11,53 % de los pacientes. La presencia de exudados es el principal factor asociado a la formulación de antibióticos, y la solicitud de una prueba rápida de detección disminuye significativamente su formulación, dado que 21 % de dichos estudios fueron positivos

Objective: Sore throat is one of the most frequent complaints in the ER, both in children and adults. Although it has been established that most cases of acute tonsillitis are caused by viruses, given the difficulty in identifying its etiology based exclusively upon clinical signs, the indiscriminate prescription of antibiotics in the emergency setting has become very frequent. This practice may lead to the emergence of antibiotic resistance and secondary effects. We evaluated the adherence of ER physicians to clinical practice guidelines for the management of acute tonsillitis at Hospital Universitario San Ignacio in Bogotá, Colombia. Methods: A retrospective descriptive study was carried out. Clinical records for emergency visits between the years of 2016 and 2019 were reviewed. Data regarding rapid antigen detection test for GABHS (RAD), antibiotic and analgesic prescription and tonsillar exudates on physical exam, were recorded. Results: 7.762 patients with acute tonsillitis were included in the study. 74,2% were prescribed antibiotics and 98% received pain medication. For 11,53% of cases the rapid antigen test for GABHS was requested. Although tonsillar exudates are the main factor associated with the formulation of antibiotics, only 21% of rapid antigen detection tests were positive. As such, the systemic use of rapid diagnostic tests may help reduce unnecessary antibiotic prescription, bacterial resistance and drug side effects

Structure and roles of rapid response teams for adult care in high complexity hospitals: Scoping review / Estructura y función de los equipos de respuesta rápida para la atención de adultos en contextos hospitalarios de alta complejidad: Revisión sistemática de alcance

Objective: A significant proportion of hospitalized patients experience severe clinical deterioration that may result in adverse events, unexpected cardiac arrest, or death. Rapid response teams (RRTs) have been created to reduce the frequency and prevent the consequences of these events. The objective of this scoping review is to describe the structure, role and results of the implementation of RRTs in the hospital context, with a focus on gynecological surgery and obstetric care. Materials and methods: A search was conducted in the Medline via Pubmed, Embase via OVID, LILACS, Cochrane Library and Open Gray medical databases. The search included descriptive and analytical observational studies, experimental studies and qualitative studies that included RRTs in high complexity healthcare institutions or teaching hospitals. Two researchers selected the studies and extracted data pertaining to the structure, roles and team activation criteria, response times or tools to assess their performance. No date or publication status restrictions were applied. Studies in English, Spanish and Portuguese were included. A narrative synthesis of the findings is made. Results: Overall, 15,833 titles were retrieved, of which 15 studies met the inclusion criteria. Only one study mentions the use of RRTs in obstetric services. RRTs have a multidisciplinary structure and they must be available at least 12 hours a day. The roles of RRTs include identification of patients who are deteriorating, especially outside the intensive care setting, and of patients with underlying conditions or triggering events that increase the risk of cardiac arrest. In addition, they implement rapid multifaceted interventions that include pharmacological treatments, cardiopulmonary procedures, and they develop communication and training activities. Tools for team activation and care process assessment are available. Conclusion: The structure and roles of RRTs are clearly described, making it possible to assemble them in high complexity hospitals. Further research is required to explore risks and benefits of using RRTs to mitigate harm in patients with adverse events and to compare effectiveness and safety between code activation and RRT strategies in obstetrics services.

Objetivo: una importante proporción de pacientes hospitalizados presenta deterioro clínico severo que puede terminar en eventos adversos, paro cardíaco no esperado, o muerte; para reducir su frecuencia y prevenir sus consecuencias se han creado los equipos de respuesta rápida (ERR). El objetivo de esta revisión de alcance es describir la conformación, funcionamiento y resultados de la implementación de los ERR en el contexto hospitalario, con énfasis en los servicios de cirugía ginecológica y atención obstetricia. Materiales y métodos: se llevó a cabo una búsqueda en las bases de datos de literatura médica Medline vía Pubmed, Embase vía OVID, LILACS, Cochrane Library y Open Gray. Se incluyeron estudios observacionales descriptivos y analíticos, estudios experimentales y estudios cualitativos que incluyeron ERR en instituciones de salud de alta complejidad u hospitales universitarios. Dos investigadores seleccionaron los estudios y extrajeron los datos respecto a la conformación, funcionamiento, los criterios de activación del equipo, los tiempos de respuesta o las herramientas de evaluación de su desempeño. No se hicieron restricciones de fecha o estado de publicación. Se incluyeron estudios en inglés, español y portugués. Se hace síntesis narrativa de los hallazgos. Resultados: la búsqueda arrojó 15,833 títulos, un total de 15 estudios cumplieron con los criterios de inclusión. Solo un estudio menciona el uso de los ERR en servicios de obstetricia. La conformación de los ERR es multidisciplinaria y están disponibles al menos 12 horas cada día. Sus funciones son la identificación temprana de pacientes con deterioro de la condición, especialmente en áreas por fuera de la unidad de cuidados intensivos y de pacientes con condiciones subyacentes o eventos desencadenantes que aumentan el riesgo de paro cardíaco. Además, implementan intervenciones rápidas multifacéticas que incluyen tratamientos farmacológicos, procedimientos cardiopulmonares, y desarrollan actividades de comunicación y formación. Se dispone de herramientas para la activación y evaluación de los procesos asistenciales. Conclusión: la estructura y las funciones del ERR están claramente descritas, lo que permite que sean ensamblados en hospitales de alta complejidad. Se deben realizar más investigaciones sobre los beneficios y riesgos del uso de los ERR para mitigar los daños en pacientes con EREND y comparar la efectividad y seguridad entre la activación de códigos y las estrategias de ERR en los servicios de obstetricia.

When Cyclodextrins Met Data Science: Unveiling Their Pharmaceutical Applications through Network Science and Text-Mining.

We present a data-driven approach to unveil the pharmaceutical technologies of cyclodextrins (CDs) by analyzing a dataset of CD pharmaceutical patents. First, we implemented network science techniques to represent CD patents as a single structure and provide a framework for unsupervised detection of keywords in the patent dataset. Guided by those keywords, we further mined the dataset to examine the patenting trends according to CD-based dosage forms. CD patents formed complex networks, evidencing the supremacy of CDs for solubility enhancement and how this has triggered cutting-edge applications based on or beyond the solubility improvement. The networks exposed the significance of CDs to formulate aqueous solutions, tablets, and powders. Additionally, they highlighted the role of CDs in formulations of anti-inflammatory drugs, cancer therapies, and antiviral strategies. Text-mining showed that the trends in CDs for aqueous solutions, tablets, and powders are going upward. Gels seem to be promising, while patches and fibers are emerging. Cyclodextrins' potential in suspensions and emulsions is yet to be recognized and can become an opportunity area. This is the first unsupervised/supervised data-mining approach aimed at depicting a landscape of CDs to identify trending and emerging technologies and uncover opportunity areas in CD pharmaceutical research.

Estructura y función de los equipos de respuesta rápida para la atención de adultos en contextos hospitalarios de alta complejidad: Revisión sistemática de alcance / Structure and roles of rapid response teams for adult care in high complexity hospitals: Scoping review

Resumen Introducción y objetivo: Una importante proporción de pacientes hospitalizados presenta deterioro clínico severo que puede terminar en eventos adversos, paro cardíaco no esperado, o muerte; para reducir su frecuencia y prevenir sus consecuencias se han creado los equipos de respuesta rápida (ERR). El objetivo de esta revisión de alcance es describir la conformación, funcionamiento y resultados de la implementación de los ERR en el contexto hospitalario, con énfasis en los servicios de cirugía ginecológica y atención obstetricia. Materiales y métodos: Se llevó a cabo una búsqueda en las bases de datos de literatura médica Medline vía Pubmed, Embase vía OVID, LILACS, Cochrane Library y Open Gray. Se incluyeron estudios observacionales descriptivos y analíticos, estudios experimentales y estudios cualitativos que incluyeron ERR en instituciones de salud de alta complejidad u hospitales universitarios. Dos investigadores seleccionaron los estudios y extrajeron los datos respecto a la conformación, funcionamiento, los criterios de activación del equipo, los tiempos de respuesta o las herramientas de evaluación de su desempeño. No se hicieron restricciones de fecha o estado de publicación. Se incluyeron estudios en inglés, español y portugués. Se hace síntesis narrativa de los hallazgos. Resultados: La búsqueda arrojó 15,833 títulos, un total de 15 estudios cumplieron con los criterios de inclusión. Solo un estudio menciona el uso de los ERR en servicios de obstetricia. La conformación de los ERR es multidisciplinaria y están disponibles al menos 12 horas cada día. Sus funciones son la identificación temprana de pacientes con deterioro de la condición, especialmente en áreas por fuera de la unidad de cuidados intensivos y de pacientes con condiciones subyacentes o eventos desencadenantes que aumentan el riesgo de paro cardíaco. Además, implementan intervenciones rápidas multifacéticas que incluyen tratamientos farmacológicos, procedimientos cardiopulmonares, y desarrollan actividades de comunicación y formación. Se dispone de herramientas para la activación y evaluación de los procesos asistenciales. Conclusión: La estructura y las funciones del ERR están claramente descritas, lo que permite que sean ensamblados en hospitales de alta complejidad. Se deben realizar más investigaciones sobre los beneficios y riesgos del uso de los ERR para mitigar los daños en pacientes con EREND y comparar la efectividad y seguridad entre la activación de códigos y las estrategias de ERR en los servicios de obstetricia.

Abstract Introduction and Objective: A significant proportion of hospitalized patients experience severe clinical deterioration that may result in adverse events, unexpected cardiac arrest, or death. Rapid response teams (RRTs) have been created to reduce the frequency and prevent the consequences of these events. The objective of this scoping review is to describe the structure, role and results of the implementation of RRTs in the hospital context, with a focus on gynecological surgery and obstetric care. Materials and methods: A search was conducted in the Medline via Pubmed, Embase via OVID, LILACS, Cochrane Library and Open Gray medical databases. The search included descriptive and analytical observational studies, experimental studies and qualitative studies that included RRTs in high complexity healthcare institutions or teaching hospitals. Two researchers selected the studies and extracted data pertaining to the structure, roles and team activation criteria, response times or tools to assess their performance. No date or publication status restrictions were applied. Studies in English, Spanish and Portuguese were included. A narrative synthesis of the findings is made. Results: Overall, 15,833 titles were retrieved, of which 15 studies met the inclusion criteria. Only one study mentions the use of RRTs in obstetric services. RRTs have a multidisciplinary structure and they must be available at least 12 hours a day. The roles of RRTs include identification of patients who are deteriorating, especially outside the intensive care setting, and of patients with underlying conditions or triggering events that increase the risk of cardiac arrest. In addition, they implement rapid multifaceted interventions that include pharmacological treatments, cardiopulmonary procedures, and they develop communication and training activities. Tools for team activation and care process assessment are available. Conclusion: The structure and roles of RRTs are clearly described, making it possible to assemble them in high complexity hospitals. Further research is required to explore risks and benefits of using RRTs to mitigate harm in patients with adverse events and to compare effectiveness and safety between code activation and RRT strategies in obstetrics services.

Technological evolution of cyclodextrins in the pharmaceutical field.

We herein disclose how global cyclodextrin-based pharmaceutical technologies have evolved since the early 80s through a 1998 patents dataset retrieved from Derwent Innovation Index. We used text-mining techniques based on the patents semantic content to extract the knowledge contained therein, to analyze technologies related to the principal attributes of CDs: solubility, stability, and taste-masking enhancement. The majority of CDs pharmaceutical technologies are directed toward parenteral aqueous solutions. The development of oral and ocular formulations is rapidly growing, while technologies for nasal and pulmonary routes are emerging and seem to be promising. Formulations for topical, transdermal, vaginal, and rectal routes do not account for a high number of patents, but they may be hiding a great potential, representing opportunity research areas. Certainly, the progress in materials sciences, supramolecular chemistry, and nanotechnology, will influence the trend of that, apparently neglected, research. The bottom line, CDs pharmaceutical technologies are still increasing, and this trend is expected to continue in the coming years. Patent monitoring allows the identification of relevant technologies and trends to prioritize research, development, and investment in both, academia and industry. We expect the scope of this approach to be applied in the pharmaceutical field beyond CDs technological applications.