Regioselective Fluoroalkylarylation of Enamides Enabled by an Iron-Catalyzed Multicomponent Radical Cross-Coupling Strategy.

Fluoroalkylated compounds are important entities in agrochemicals, pharmaceuticals, and materials. The catalytic dicarbofunctionalization of alkenes represents a powerful strategy for the rapid construction and diversification of compounds. In this vein, multicomponent cross-coupling reactions (MC-CCR) can provide an efficient synthetic route to build molecular complexity. In this work, we report the first iron-catalyzed three-component fluoroalkylarylation of enamides via selective formation and trapping of α-amide radicals under mild conditions and fast reaction times. The reaction tolerates a variety of commercially available aryl Grignard reagents and fluoroalkyl halides. Finally, the use of a removable phthalimido group provides an efficient strategy to prepare highly valuable γ-difluoroalkylated amines.

Gait Function after High-Intensity Focused Ultrasound Thalamotomy for Essential Tremor: Searching for Technique Optimization.

INTRODUCTION: Essential tremor (ET) is one of the most prevalent movement disorders in adults and may be highly disabling for some. Magnetic resonance image-guided high-intensity focused ultrasound (MRIgFUS) has been shown to control tremor efficaciously and with acceptable risk. To date, paresthesia and ataxia are the most common adverse effects (AE). Nevertheless, the impact of MRIgFUS thalamotomy on balance is not well established. METHODS: Thirty-two patients underwent MRIgFUS for ET and completed 6 months of follow-up. Tremor severity and functional disability were assessed using the Essential Tremor Rating Scale and the Quality of Life in Essential Tremor Questionnaire. The Berg Balance Scale (BBS) was applied to objectively measure balance status. RESULTS: All treatments were successful. The sonication target was 1-2 mm above the depth of the intercommissural line. Procedures lasted less the 2 h, with an average of 8 sonications per patient. Twenty-four patients were included in the tremor analysis. The hand tremor score was improved by 76% after 6 months of follow-up and 87% of patients self-reported marked improvement (≥75%). Disability scores showed marked improvement (78%), leading to a significant improvement in quality of life. At the final follow-up, 48% of the patients reported no side effects. When present, AE were generally transient and were considered mild in 96% of affected patients. Paresthesia and subjective feeling of unsteadiness were the most common persistent complaints (23% and 20%, respectively). Regarding objective ataxia, BBS scores remained stable throughout follow-up for most patients. Only 2 patients suffered a mild worsening of balance although no patients experienced moderate or severe ataxia. CONCLUSIONS: Subjective feeling of unsteadiness is one of the most frequent AE after MRIgFUS, although objective ataxia is infrequent and mild. Selecting the most appropriate lesion location and procedural parameters should increase treatment benefits while reducing side effects.

Systemic corticosteroids for management of COVID-19: Saving lives or causing harm?

The underlying cause of many complications associated with severe COVID-19 is attributed to the inflammatory cytokine storm that leads to acute respiratory distress syndrome (ARDS), which appears to be the leading cause of death in COVID-19. Systemic corticosteroids have anti-inflammatory activity through repression of pro-inflammatory genes and inhibition of inflammatory cytokines, which makes them a potential medical intervention to diminish the upregulated inflammatory response. Early in the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic, the role of corticosteroids was unclear. Corticosteroid use in other indications such as ARDS and septic shock has proven benefit while its use in other respiratory viral pneumonias is associated with reduced viral clearance and increased secondary infections. This review article evaluates the benefits and harms of systemic corticosteroids in patients with COVID-19 to assist clinicians in improving patient outcomes, including patient safety. Dexamethasone up to 10 days is the preferred regimen to reduce mortality risk in COVID-19 patients requiring oxygen support, mechanical ventilation, or extracorporeal membrane oxygenation. If dexamethasone is unavailable, other corticosteroids can be substituted at equivalent doses. Higher doses of corticosteroids may be beneficial in patients who develop ARDS. Corticosteroids should be avoided early in the disease course when patients do not require oxygen support because of potential harms.

Adherence to the 2014 American Academy of Pediatrics palivizumab prophylaxis recommendations.

INTRODUCTION: This study aims to describe adherence rates to the 2014 American Academy of Pediatrics (AAP) Committee on Infectious Disease guidance document recommending which patients should receive palivizumab for prophylaxis against respiratory syncytial virus (RSV). METHODS: A retrospective, single-center analysis of patients who received at least one dose of palivizumab between October 1, 2012, and March 1, 2017 was conducted. Data collected included demographics, medical history, palivizumab administration regimens, and incidence of RSV infection. RESULTS: Data were collected on 457 patients who received palivizumab over five RSV seasons. Approximately half of the patients (45% and 55%, respectively) received palivizumab according to the AAP recommendations in place at the time (2012 or 2014 recommendations, respectively). One percent of patients had a breakthrough RSV infection after receiving at least one dose of palivizumab. There was no significant difference in the number of breakthrough infections before and after the 2014 recommendations were released (3 vs. 2). CONCLUSIONS: Approximately half of the patients received prophylaxis in accordance with the 2014 AAP recommendations and infrequently suffered from a breakthrough RSV infection.

Conocimientos, actitudes y prácticas en salud sexual y reproductiva en los y las adolescentes de tercer año que estudian en la escuela normal mixta Pedro Nufio de Tegucigalpa, Honduras durante el mes de abril 2,016

El presente estudio sobre Conocimientos, Actitudes y Practicas (CAP) en Salud Sexualy Reproductiva en los y las Adolescentes de Tercer Año que Estudian en la Escuela Normal Mixta Pedro Nufio de Tegucigalpa, Honduras durante el Mes de abril 2,016.Objetivo general: relacionar los CAP en salud sexual y reproductiva (SSR) de los y las adolescentes de tercer año de Escuela Normal Mixta Pedro Nufio. Los objetivos específicos fueron: Describir las características socios demográficos, identificar conocimientos, conocer las actitudes e identificar las prácticas en SSR. Metodología: Es un estudio descriptivo de corte transversal Resultados: Se encuestaron 191 adolescentes, 38 del sexo masculino y 153 femenino, todos provenían del área urbana, el 81% tenían edades comprendidas entre 17-18 años, seguido un 11% entre 15 y 16 años, el 43% viven con ambos padres, 23% viven solo con la mamá. El internet es el medio de comunicación que más conocen y utilizan los adolescentes, eltipo de persona a quien solicitan información es personal de salud 42.41%, 65 adolescentes manifestaron haber tenido relaciones sexuales, la mayoría inició entre los 14 – 16 años, el 84.61% refirió utilizar métodos anticonceptivos, la mayoría expresó que el uso correcto y consistente del condón previene ITS, VIH y embarazo. Del total deadolescentes femeninas que han tenido relaciones sexuales 7 han estado embarazadas alguna vez.

Diferentes caras de la distonía sensible a la levodopa / No disponible

No disponible

Incidencia de cepas de bacterias gram negativas productoras de betalactamasas de espectro extendido en las Unidades de Cuidados Intensivos, hospital regional Doctor Teodoro Maldonado Carbo, 2004 – 2005 / Incidence of Gram negative bacteria strains extended spectrum beta-lactamases producing in the Intensive Care Units, Doctor Teodoro Maldonado Carbo regional hospital, 2004-2005

La producción de enzimas betalactamasas es el principal problema en las bacterias gram negativas y son la principal causa de infección nosocomial en unidades de cuidados intensivos. Tipo de estudio: transversal y prospectivo. Objetivos: con el fin de describir la importancia de estas bacterias en las unidades de cuidados intensivos del hospital “Dr. Teodoro Maldonado Carbo” de la ciudad de Guayaquil, se realizó un estudio para estimar la incidencia de este tipo de enzimas entre bacterias gram negativas resistentes. Método: la susceptibilidad de las muestras se analizó mediante concentración inhibitoria mínima en un microscan autoscan 4 de Dade Behring y con lectura visible según las recomendaciones del National Committee for Clinical Laboratory Standars. Para el análisis estadístico se empleó cálculo de estadígrafos y porcentajes. Resultados: 107 muestras fueron identificadas como bacterias gram negativas productoras de betalactamasas de espectro extendido constituyendo una prevalencia del 13.20 del total de muestras (n = 810), incidencia de 5.18 de todas las muestras solicitadas para cultivo y antibiograma (n=2.062). Las unidades de cuidados intensivos del hospital contribuyó con el 22.4 de las muestras que resultaron bacterias gram negativas productoras de betalactamasas de espectro extendido positivas y al 33.36 de las muestras enviadas desde hospitalización. La unidad de cuidados intensivos de neurología contribuyó con el 66.6 de las muestras de todas las unidades de cuidados intensivos y al 14 de todos los departamentos del hospital, la unidad de cuidados intensivos generales contribuyó con el 16. Conclusiones: la presencia de bacterias gram negativas productoras de betalactamasas de espectro extendido es un problema en la unidad de cuidados intensivos de neurología del hospital que se debe atender con efectividad y pertinencia.

Production of betalactamases enzymes is the main problema with Gram negative bacteria and the main cause of nosocomial infection in Intensive Care Units. Study type: Transversal and prospective. Objectives: in order to describe the importance of these bacteria in the “Dr. Teodoro Maldonado Carbo” Hospital (Guayaquil) intensive care units, a study has been made to appraise the incidence of this type of enzyme among resistant Gram negative bacteria. Method: susceptibility of the samples was analyzed through minimal inhibitory concentration in a Dade Behring microscan autoscan 4, and with visible reading according to the National Committee for Clinical Laboratory Standars advise. For statistical analysis calculation of statistic and percentages were used. Results: 107 samples were identified as Gram negative bacteria extended spectrum betalactamases producing, with a prevalence of 13.20 of all samples (n=810),an incidence of 5.18 of al samples required for culture and antibiogram (n=2062). The hospital intensive care units delivered the 22.4 of samples that turned out Gram negative bacteria positive extended spectrum betalactamases producing and 33.36 were samples sent from hospitalization. Neurology intensive care unit delivered 66.6 of the samples of all intensive care units, and 14 were sent from all hospital departments. General intensive care unit delivered 16. Conclusions: the presence of Gram negative bacteria extended spectrum betalactamases producing is a problem of the hospital Neurology intensive care unit that must be solved with effectiveness and appropriateness.

[Physical abuse of women]. / Maltrato físico en mujeres.

OBJECTIVE: Our aim was determine prevalence of intrafamily violence of the type physical-abuse, toward female claimants aged 18 years and older at the HGZ MF No. 1 in Colima. MATERIAL AND METHOD: A transversal study was conducted in 288 females aged 18 years and older who were seen at the Family Medicine Unit for external consultation. RESULTS: Average age was 33.86 years (+/- 11.6), the highest level of schooling was primary for 33% of subjects and secondary for 26%, 75% of our female claimants were divorced, 53.5% of monthly family incomes in each household was between 1,000 and 3,000 thousand Mexican pesos, and 27.8% of physical abuse consisted of shoving. CONCLUSIONS: Our research revealed that there is indeed physical violence toward 63.45% of female claimants at our hospital, especially toward those with low level of schooling, low socioeconomic status, and monthly income below minimum wage. These conditions only contribute toward making women fall prey to physical violence. Our study is only a first step for better understanding of domestic violence. Risk factors associated with physical abuse need to be controlled to decrease rate of interfamily violence against our claimants.

Maltrato físico en mujeres / Physical Abuse of Women

Objetivo: determinar la prevalencia de la violencia intrafamiliar en mujeres derechohabientes mayores de 18 años del HGZMF No. 1 Colima. Material y métodos: se realizó un estudio transversal en 288 mujeres mayores de 18 años que acudieron a la consulta externa de Medicina Familiar. Resultados: se estudiaron 288 mujeres, la edad media fue de 33 años (± 11.6), la escolaridad que predominó fue primaria en 33%; secundaria en 26%. El estado civil más frecuente fue separación en 75%. El ingreso mensual en 53% de las mujeres fue de mil a 3 mil pesos. En 27.8% de ellas, el maltrato físico más frecuente consistió en ser aventadas. Conclusiones: nuestro estudio identificó que la violencia física es frecuente en nuestro hospital y se presenta en 63.54% de las mujeres derechohabientes; con escolaridad y nivel socio-económico bajos, y con un salario mensual menor del mínimo; condiciones todas ellas que favorecen que la mujer sea presa fácil del maltrato físico. Este trabajo es un paso inicial dentro del estudio de violencia familiar, necesitamos modificar estos factores de riesgo para lograr reducir la violencia familiar de nuestros derechohabiente.

Objective: Our aim was determine prevalence of intrafamily violence of the type physical-abuse, toward female claimants aged 18 years and older at the HGZ MF No. 1 in Colima. Material and Method: A transversal study was conducted in 288 females aged 18 years and older who were seen at the Family Medicine Unit for external consultation. Results: Average age was 33.86 years (+/- 11.6), the highest level of schooling was primary for 33% of subjects and secondary for 26%, 75% of our female claimants were divorced, 53.5% of monthly family in comes in each household was between $1,000 and $3,000 thousand Mexican pesos, and 27.8% of physical abuse consisted of shoving. Conclusions: Our research revealed that there is indeed physical violence toward 63.45% of female claimants at our hospital, especially toward those with low level of schooling, low socioeconomic status, and monthly income below minimum wage. These conditions only contribute toward making women fall prey to physical violence. Our study is only a first step for better understanding of domestic violence. Risk factors associated with physical abuse need to be controlled to decrease rate of interfamily violence against our claimants.