Risk Factors and Environmental Preventive Actions for Aspergillosis in Patients with Hematological Malignancies.

(1) Background: Aspergillus spp. is a widely distributed filamentous fungus in the environment due to its high sporulation capacity. Currently, invasive aspergillosis (IA) is the most common invasive fungal infection in patients with hematologic malignancies, with high rates of mortality and morbidity. The multifactorial nature of the disease requires appropriate risk stratification to enable the most appropriate preventive measures to be adapted and implemented according to the characteristics of the patient. In this sense, the present research aims to identify recent risk factors and environmental control measures against invasive aspergillosis to establish preventive actions to reduce the incidence of invasive aspergillosis in hospitals. (2) Methods: We conducted a qualitative systematic review of the scientific literature on environmental risk factors and preventive measures for invasive aspergillosis in patients with hematologic malignancies. The Medline, Cochrane, and Scopus databases were consulted, following the PRISMA and STROBE guidelines. (3) Results: Adequate implementation of environmental control measures is presented as the most efficient intervention in terms of prevention to decrease the incidence of invasive aspergillosis in hospitals. Neutropenia, fungal contamination, insufficient environmental control measures in hospital and home settings, length of hospital stay, and anemia, are identified as independent risk factors. We show that HEPA, LAF, and Plasmair® systems are suitable methods to reduce the concentration of airborne fungal spores. Antifungal prophylaxis did not significantly influence IA reduction in our study. (4) Conclusions: Proper professional training and environmental control measures in hospitals are essential for the prevention of invasive aspergillosis. We should optimize risk stratification for patients with hematologic malignancies. Antifungal prophylaxis should be complementary to environmental control measures and should never be substituted for the latter. Studies should also be undertaken to evaluate the efficiency of environmental control measures against IA at patients' homes.

Electroacupuncture efficacy in diabetic polyneuropathy: Study protocol for a double-blinded randomized controlled multicenter clinical trial.

BACKGROUND: Diabetic peripheral neuropathy (DPN) is the most common complication of type 2 diabetes mellitus (T2DM); its diagnosis and treatment are based on symptomatic improvement. However, as pharmacological therapy causes multiple adverse effects, the implementation of acupunctural techniques, such as electroacupuncture (EA) has been suggested as an alternative treatment. Nonetheless, there is a lack of scientific evidence, and its mechanisms are still unclear. We present the design and methodology of a new clinical randomized trial, that investigates the effectiveness of EA for the treatment of DPN. METHODS: This study is a four-armed, randomized, controlled, multicenter clinical trial (20-week intervention period, plus 12 weeks of follow-up after concluding intervention). A total of 48 T2DM patients with clinical signs and symptoms of DPN; and electrophysiological signs in the Nerve Conduction Study (NCS); will be treated by acupuncture specialists in outpatient units in Mexico City. Patients will be randomized in a 1:1 ratio to one of the following four groups: (a) short fibre DPN with EA, (b) short fibre DPN with sham EA, (c) axonal DPN with EA and (d) axonal DPN with sham EA treatment. The intervention will consist of 32 sessions, 20 min each, per patient over two cycles of intervention of 8 weeks each and a mid-term rest period of 4 weeks. The primary outcome will be NCS parameters, and secondary outcomes will include DPN-related symptoms and pain by Michigan Neuropathy Screening Instrument (MNSI), Michigan Diabetic Neuropathy Score (MDNS), Dolour Neuropatique Score (DN-4), Semmes-Westein monofilament, Numerical Rating Scale (NRS) for pain assessment, and the 36-item Short Form Health Survey (SF-36). To measure quality of life and improve oxidative stress, the inflammatory response; and genetic expression; will be analysed at the beginning and at the end of treatment. DISCUSSION: This study will be conducted to compare the efficacy of EA versus sham EA combined with conventional diabetic and neuropathic treatments if needed. EA may improve NCS, neuropathic pain and symptoms, oxidative stress, inflammatory response, and genetic expression, and it could be considered a potential coadjutant treatment for the management of DPN with a possible remyelinating effect. TRIAL REGISTRATION: ClinicalTrials.gov. NCT05521737 Registered on 30 August 2022. International Clinical Trials Registry Platform (ICTRP) ISRCTN97391213 Registered on 26 September 2022 [2b].

Barriers to Breast Cancer-Screening Adherence in Vulnerable Populations.

Breast cancer screening through periodic mammography has been effective in decreasing mortality and reducing the impact of this disease. However, adherence to screening does not meet the desired expectations from all populations. The main objective of this review is to explore the barriers that affect adherence to breast cancer-screening programs in vulnerable populations according to race and/or ethnicity in order to propose measures to reduce the lack of adherence. We conducted a search of publications in the PubMed Central and Scopus databases. The eligible criteria for the articles were as follows: original quantitative studies appearing in SJR- and/or JCR-indexed journals from 2016 to 2021 in English or Spanish. Most of them present common barriers, such as race/ethnicity (47%), low socioeconomic (35.3%) and educational levels (29.4%), no family history of cancer and being single (29.4%), medical mistrust and a health information gap (23.5%), lack of private health insurance (17.6%) and not having annual health checks (17.6%). The target populations with the lowest adherence were Black, Asian, Hispanic and foreign women. Implementing awareness campaigns focused on these populations should be promoted, as well as working on diversity, cultural acceptance and respect with healthcare workers, in order to improve breast cancer-screening adherence worldwide.

Effects of Malnutrition on the Immune System and Infection and the Role of Nutritional Strategies Regarding Improvements in Children's Health Status: A Literature Review.

Malnutrition refers to a person's status as under- or overnourished, and it is usually associated with an inflammation status, which can subsequently imply a different health status, as the risk of infection is increased, along with a deterioration of the immune system. Children's immune systems are generally more susceptible to problems than adults. In the situation of malnutrition, because malnourished children's immune systems are compromised, they are more likely to die. However, little is known about the underlying mechanism of altered immune functioning and how it relates to starvation. Nutritional interventions have been reported as cost-effective strategies to prevent or treat the development of malnourishment, considering the link between food intake and health, especially in children, and also the susceptibility of this population to diseases and how their health status during childhood might affect their long-term physiological growth. The ingestion of specific nutrients (e.g., vitamins or oligoelements) has been reported to contribute to the proper functioning of children's immune systems. In this review, we aim to describe the basis of malnutrition and how this is linked to the immune system, considering the role of nutrients in the modulation of the immune system and the risk of infection that can occur in these situations in children, as well as to identify nutritional interventions to improve their health.

Microbiota manipulation to increase macrophage IL-10 improves colitis and limits colitis-associated colorectal cancer.

Inflammatory bowel disease (IBD) is a chronic life-long inflammatory disease affecting almost 2 million Americans. Although new biologic therapies have been developed, the standard medical treatment fails to selectively control the dysregulated immune pathways involved in chronic colonic inflammation. Further, IBD patients with uncontrolled colonic inflammation are at a higher risk for developing colorectal cancer (CRC). Intestinal microbes can impact many immune functions, and here we asked if they could be used to improve intestinal inflammation. By utilizing an intestinal adherent E. coli that we find increases IL-10 producing macrophages, we were able to limit intestinal inflammation and restrict tumor formation. Macrophage IL-10 along with IL-10 signaling to the intestinal epithelium were required for protection in both inflammation and tumor development. Our work highlights that administration of immune modulating microbes can improve intestinal outcomes by altering tissue inflammation.

Epidemiological Characteristics of COVID-19 Cases in Non-Italian Nationals in Sicily: Identifying Vulnerable Groups in the Context of the COVID-19 Pandemic in Sicily, Italy.

As in other parts of the world, undocumented migrants in Italy suffer worse health status due to their immigration enforcement situation and other vulnerabilities such as precarious illegal jobs, exploitation and abuse or barriers to higher education, with higher prevalence of chronic noncommunicable diseases. The COVID-19 pandemic, as other pandemics, has not affected everyone equally. The undocumented was one of the most affected groups with regard to hospitalization rates and mortality worldwide. Sicily is one of the gates of entrance to Europe for migrants and asylum seekers from Africa and Asia. Herein, we described the epidemiological characteristics of COVID-19 cases in Sicily to compare hospitalization rate and mortality between Italian nationals and foreigners. We extracted data from the integrated national surveillance system established by the Italian National Institute of Health (Istituto Superiore di Sanità, ISS) to collect information on all COVID-19 cases and deaths in Sicily. We found that the hospitalization rates were higher in undocumented foreigners, and they were most likely to present a more severe clinical outcome compared to Italian nationals. Inclusive public health policies should take this population group into consideration to achieve the Health for All goal.

Interleukin-1ß secretion induced by mucosa-associated gut commensal bacteria promotes intestinal barrier repair.

The gut microbiota is essential for maintenance and repair of the intestinal epithelial barrier. As shifts in both intestinal epithelial barrier function and microbiota composition are found in inflammatory bowel disease patients, it is critical to understand the role of distinct bacteria in regulating barrier repair. We identified a mouse commensal E. coli isolate, GDAR2-2, that protects mice from Citrobacter rodentium infection and dextran sulfate sodium-induced colitis. Colonization with GDAR2-2 in mice resulted in expansion of CX3CR1+ mononuclear phagocytes, including CX3CR1+ macrophages/dendritic cells and monocytes, along with IL-22-secreting type 3 innate lymphoid cells and improved epithelial barrier function. In vitro co-culture of macrophages with GDAR2-2 resulted in IL-1ß production. In vivo, protection after GDAR2-2 colonization was lost after depletion of CX3CR1+ MNPs, or blockade of IL-1ß or IL-22. We further identified human commensal E. coli isolates that similarly protect mice from C. rodentium infection through CX3CR1+ MNP and IL-1ß production. Together, these findings demonstrate an unexpected role for commensal bacteria in promoting IL-1ß secretion to support intestinal barrier repair.

Fungal and Bacterial Biodeterioration of Outdoor Canvas Paintings: The Case of the Cloisters of Quito, Ecuador.

The historic center of Quito, Ecuador, was one of the first World Cultural Heritage Sites declared by UNESCO in 1978. There are numerous religious buildings built during the Spanish colonial period reflecting the cultural heritage in this area. Between them, the cloisters of San Francisco, Santo Domingo, and Santa Clara should be highlighted. The specific problems of conservation of the outdoor canvas paintings are not well known at the moment. The objective of this paper is to achieve a conservation study of the canvas paintings exhibited in these three cloisters of the historic center of Quito in order to identify the microbial agents and the main bioclimatic parameters of deterioration. For this, a study of the state of conservation of five canvas paintings has been carried out, as well as a sampling and identification of the main microorganisms present on the obverse and reverse of the works, employing diverse techniques, traditional and biomolecular ones. An analysis of climatic conditions has also been achieved in the cloister of San Francisco. The results of the study indicate that the exhibition conditions in the cloisters are really problematic for the conservation of paintings. Important biodeteriorating agents have been isolated, including fungi and bacteria species belonging, among others, to the genera Bacillus, Penicillium, Alternaria, Mucor, and Aspergillus. We have also researched its relationship with the deterioration state of the artworks and the exhibition conditions in each case, proposing guidelines for the proper conservation of this important World Cultural Heritage.

Thymic development of gut-microbiota-specific T cells.

Humans and their microbiota have coevolved a mutually beneficial relationship in which the human host provides a hospitable environment for the microorganisms and the microbiota provides many advantages for the host, including nutritional benefits and protection from pathogen infection1. Maintaining this relationship requires a careful immune balance to contain commensal microorganisms within the lumen while limiting inflammatory anti-commensal responses1,2. Antigen-specific recognition of intestinal microorganisms by T cells has previously been described3,4. Although the local environment shapes the differentiation of effector cells3-5 it is unclear how microbiota-specific T cells are educated in the thymus. Here we show that intestinal colonization in early life leads to the trafficking of microbial antigens from the intestine to the thymus by intestinal dendritic cells, which then induce the expansion of microbiota-specific T cells. Once in the periphery, microbiota-specific T cells have pathogenic potential or can protect against related pathogens. In this way, the developing microbiota shapes and expands the thymic and peripheral T cell repertoire, allowing for enhanced recognition of intestinal microorganisms and pathogens.

Healthy Intestinal Function Relies on Coordinated Enteric Nervous System, Immune System, and Epithelium Responses.

During both health and disease, a coordinated response between the epithelium, immune system, and enteric nervous system is required for proper intestinal function. While each system responds to a number of common stimuli, their coordinated responses support digestion as well as responses and recovery following injury or pathogenic infections. In this review, we discuss how individual responses to common signals work together to support these critical functions.

Author Correction: Endothelial activation of caspase-9 promotes neurovascular injury in retinal vein occlusion.

An amendment to this paper has been published and can be accessed via a link at the top of the paper.

Endothelial activation of caspase-9 promotes neurovascular injury in retinal vein occlusion.

Central nervous system ischemic injury features neuronal dysfunction, inflammation and breakdown of vascular integrity. Here we show that activation of endothelial caspase-9 after hypoxia-ischemia is a critical event in subsequent dysfunction of the blood-retina barrier, using a panel of interrelated ophthalmic in vivo imaging measures in a mouse model of retinal vein occlusion (RVO). Rapid nonapoptotic activation of caspase-9 and its downstream effector caspase-7 in endothelial cells promotes capillary ischemia and retinal neurodegeneration. Topical eye-drop delivery of a highly selective caspase-9 inhibitor provides morphological and functional retinal protection. Inducible endothelial-specific caspase-9 deletion phenocopies this protection, with attenuated retinal edema, reduced inflammation and preserved neuroretinal morphology and function following RVO. These results reveal a non-apoptotic function of endothelial caspase-9 which regulates blood-retina barrier integrity and neuronal survival, and identify caspase-9 as a therapeutic target in neurovascular disease.

Direct Observation of Low Strain, High Rate Deformation of Cultured Brain Tissue During Primary Blast.

The Veterans Health Administration determined that over 250,000 U.S. service members were diagnosed with a traumatic brain injury (TBI) between 2008 and 2018, of which a great proportion were due to blast exposure. Although the penetrating (secondary) and inertia-driven (tertiary) phases of blast-induced TBI (bTBI) have been studied thoroughly and are known to be injurious, primary blast brain injury has been less studied. We investigated the biomechanics of primary bTBI in our previously developed in vitro shock tube model with a fluid-filled sample receiver. Using stereoscopic, high-speed cameras and digital image correlation (DIC), we mapped the deformation of organotypic hippocampal slice cultures (OHSCs) following a range of blast exposures to characterize the induced strains. As blast exposure increased, tissue strain increased, although the levels remained relatively low (maximum < 9%), with strains rates between 25 and 85 s-1. Both strain magnitude and rate were highly correlated with the in-air blast impulse and in-fluid peak pressure parameters. Comparing biomechanical parameters to previously reported blast-induced electrophysiological dysfunction, a threshold for deficits in long-term potentiation (LTP) was observed for strains between 3.7 and 6.7% and strain rates between 25 and 33 s-1. This is the first study to experimentally determine primary blast-induced strain and strain rates in hippocampal tissue.

Off-Target Effects of Clozapine-N-Oxide on the Chemosensory Reflex Are Masked by High Stress Levels.

Respiratory chemosensory circuits are implicated in several physiological and behavioral disorders ranging from sudden infant death syndrome to panic disorder. Thus, a comprehensive map of the chemosensory network would be of significant value. To delineate chemosensory neuronal populations, we have utilized pharmacogenetic Designer Receptors Exclusively Activated by Designer Drugs (DREADD) perturbations for acute neuronal perturbations in respiratory circuit mapping. Recent studies show that the biologically inert DREADD ligand clozapine-N-oxide (CNO) is back-metabolized into the bioactive compound clozapine in rodents, emphasizing the need for CNO-only DREADD-free controls, which have been carried out in several studies. However, we show that high CNO doses used in several chemosensory circuit mapping studies nonetheless affect the chemosensory ventilatory reflexes in control mice, which is unmasked by extensive habituation. Here, unhabituated control animals showed no differences in respiratory parameters after CNO administration, whereas habituated animals receiving the commonly used dose of 10 mg/kg of CNO show a deficit in the hypercapnic (high CO2) chemosensory reflex, which is not present in 1 mg/kg CNO treated or saline control groups. Our findings indicate that even in appropriately controlled studies, additional masked CNO off-target effects may exist and underscore the importance of using minimal doses of activating ligand in combination with high levels of habituation.

Efecto del microhábitat sobre la abundancia y riqueza específica de los macroinvertebrados bentónicos en dos ríos tropicales de montaña, Guatemala / Effect of microhabitat on the abundance and specific richness of benthic macroinvertebrates in two tropical mountain streams, Guatemala

Los macroinvertebrados bentónicos cumplen funciones ecológicas importantes en los sistemas lóticos, como el traspaso de energía a través de las redes tróficas, la descomposición de la materia orgánica, el reciclaje de nutrientes y la mezcla de sedimentos. Uno de los principales factores que definen la composición del ensamble de macroinvertebrados es la disponibilidad de microhábitats. Debido a ello, se evaluó el efecto de ocho microhábitats (hojarasca, grava, piedras, roca, musgo, vegetación acuática, pozas y cataratas), así como de la velocidad y profundidad, sobre la abundancia y riqueza específica de los macroinvertebrados en los ríos La Labor y Tzununá en la cuenca del lago Atitlán en el altiplano de Guatemala. Se colectaron 19,529 organismos correspondientes a 91 taxa, 49 familias y 65 géneros. El microhábitat que presentó mayor abundancia fue hojarasca (7,723 organismos) y pozas presentó la menor (652 organismos). En cuanto a riqueza, piedras presentó la mayor riqueza (41 taxa) y musgo tuvo la menor (28 taxa). Se evidenció que el microhábitat tuvo un efecto significativo sobre la abundancia y la riqueza (p < .05), ésta última también se vio influenciada por la profundidad (p = .030). Se concluyó que el microhábitat es un factor importante, para determinar la composición de la comunidad de macroinvertebrados; ya que la presencia y dominancia de elementos de heterogeneidad en los ríos, contribuye a incrementar la diversidad del hábitat físico, así como las opciones de alimento y refugio, promoviendo la abundancia y riqueza de macroinvertebrados en los sistemas lóticos.

Benthic macroinvertebrates serve important ecological functions in lotic systems, such as the transfer of energy through trophic networks, decomposition of organic matter, nutrient recycling and sediment mixing. One of the main factors that define the composition of the macroinvertebrate assemblage is the availability of microhabitats. The survey evaluated the effect of eight microhabitats (leaf litter, gravel, stones or pebbles, rock, moss, aquatic vegetation, pools and waterfalls), as well as speed and depth, on the abundance and specific richness due to rarefaction of the macroinvertebrates in La Labor and Tzununá rivers, which are part of the Lake Atitlán basin in the Guatemalan highlands. In this area 19,529 organisms corresponding to 91 taxa, 49 families and 65 genera were collected. The highest abundance was in leaf litter microhabitat (7,723 organisms), while stones showed the highest richness (41 taxa). Pools had the lowest abundance (652 organisms) and moss had the lowest richness (28 taxa). The microhabitat has a significant effect on abundance and richness (p < .05), also depth has a significant effect on richness (p = .030). The microhabitat is an important factor, to determine the composition of the macroinvertebrate community, because the presence and dominance of elements of heterogeneity in the rivers contributes to increase the diversity of the physical habitat, which provides refuge and food that satisfy the requirements of organisms promoting the abundance and richness of macroinvertebrates in lotic systems.

Batimetría y análisis morfométrico del lago de Atitlán (Guatemala) / Bathymetry and morphometric analysis of Atitlán Lake

La cuenca del lago de Atitlán es de tipo endorreica y cuenta con el cuerpo de agua más profundo de Centroamérica, sin embargo, desde el año 1975 no se tiene información actualizada de su batimetría ni de su morfometría. El objetivo de desarrollar un estudio batimétrico en el lago de Atitlán, fue determinar su morfometría, y así poder comprender en el futuro algunos procesos físicos, químicos y biológicos. Para el levantamiento batimétrico del lago de Atitlán, durante 2014 se tomaron datos de profundidad a lo largo y ancho de todo el espejo de agua con una ecosonda de multi-frecuencia. Posteriormente la información fue procesada y se obtuvieron 16 parámetros morfométricos, tales como volumen, área, perímetro, profundidad máxima, fetch efectivo, longitud y ancho máximo, entre otros. El área superficial del lago obtenida fue de 125.77 km2, el perímetro de 101.67 km y un volumen de 25.46 km3. El lago de Atitlán es un sistema tropical profundo y de forma cóncava, según la curva hipsográfica, tiene una profundidad máxima de 327.56 m, una media de 203.21m. El mapa batimétrico del 2014, presenta pocas diferencias morfométricas y morfológicas encomparación con el que se realizó en el año 1975

The lake Atitlan basin is endorheic and is the deepest body of water in Central America. Information regarding its bathymetry and morphometry has not been updated since 1975.The objective of a bathymetric study in lake Atitlán was to determine its morphometry and in the future, understand some physical, chemical and biological processes. For the bathymetric survey of lake Atitlán, during 2014, depth data were taken along the lake with a multi-frecuency echo sounder. Later the information was processed and 16 morphometric parameters were obtained, such as volume, area, perimeter, maximum depth, effective fetch, length and maximum width, among others. The surface area of the lake obtained was 125.77 km2, perimeter of 101.67 km and a volume of 25.46km3. Lake Atitlan is a deep tropical system with a maximum depth of 327.56 m, an average depth of 203.21 m and concave; according to the hypsographic curve. The bathymetric map of the year 2014, presents few morphometric and morphological differences compare with the one that was realized in 1975

Physiology of biodeterioration on canvas paintings.

The study of the physiological action of microorganisms in artistic materials is one of the most interesting topics in biodeterioration nowadays. Pathologies and illnesses of organic and inorganic materials provoked by microorganisms can be treated by experts by a variety of preventive interventions. Artistic medicine encompasses the monitoring of the exhibition and storage of art, as well as proper environmental conditions and the regular cleaning of museums. Biodeterioration control is essential in order to prevent fungal and bacterial contamination in artwork. Biodeterioration of canvas paintings is a complex phenomenon, not well-known at the moment. Canvas paintings are created by several artistic techniques on textile supports that are not always kept in the best conditions, and the best parameters of preventive conservation are often not applied. Therefore, we need to research the agents and the main causes that provoke canvas painting biodeterioration. By applying new methodologies, we can identify the alterations and the treatments needed in order to manage the diverse materials employed in artwork correctly. Herein, we review the causes of biodeterioration that affect artwork, especially art created on textile supports. We also study the alterations of the natural filmogenic materials employed in traditional pictorial techniques, such as agglutinants and protection layers, and the biodeterioration agents that impact them. Additionally, we review current scientific methods employed for the identification of microbial species, and the types of alterations of the materials where the organisms grow. Finally, we summarize the different biocides and preventive conservation treatments that are currently employed.

CDK9: A key player in cancer and other diseases.

Cyclin-Dependent Kinase 9 (CDK9) is part of a functional diverse group of enzymes responsible for cell cycle control and progression. It associates mainly with Cyclin T1 and forms the Positive Transcription Elongation Factor b (p-TEFb) complex responsible for regulation of transcription elongation and mRNA maturation. Recent studies have highlighted the importance of CDK9 in many relevant pathologic processes, like cancer, cardiovascular diseases, and viral replication. Herein we provide an overview of the different pathways in which CDK9 is directly and indirectly involved.

Grado de seguridad clínica percibida por pacientes adultos hospitaliza dos en un servicio de medicina interna / Degree of clinical safety perceived by adult patients hospitalized in an internal medicine service

Resumen

Introducción: la seguridad del paciente es el proceso por el cual una organización proporciona atención y cuidados seguros. Implica efectuar una gestión adecuada de riesgos, dotarse de la capacidad para conocer y analizar los posibles incidentes que se produzcan, aprender de ellos y aplicar soluciones que minimicen el riesgo de su ocurrencia.

Objetivo: valorar la percepción del paciente acerca del grado de seguridad clínica durante su proceso de hospitalización.

Metodología: estudio transversal con 123 pacientes adultos hospitalizados. Se utilizó un cuestionario diseñado y validado para medir la percepción del paciente sobre seguridad en la atención de salud en el ámbito hospitalario. Asimismo, se hizo un análisis descriptivo correlacional.

Resultados: de 123 pacientes, 31% refirió haber tenido un incidente durante la estancia hospitalaria, de los cuales 21% fue confundido con otro paciente, 21% presentó reacción alérgica a los medicamentos o alimentos, 18% presentó infección y 15% fue sometido a intervención quirúrgica de forma imprevista. En general, la valoración de los pacientes sobre la seguridad de los servicios sanitarios fue percibida en grado de seguridad alto por el 71%.

Conclusiones: se debe garantizar que los profesionales de la salud sean competentes para otorgar cuidados seguros y que se mantenga la seguridad en la estructura física y los equipos.

Abstract

Introduction: Patient safety is the process by which an organization provides assistance and safe care. It implies adequate risk management, the ability to know and analyze possible incidents, learn from them and apply solutions that minimize the risk of their occurrence.

Objective: To assess the patient's perception of the degree of clinical safety during their hospitalization.

Methods: We conducted a cross-sectional study with 123 hospitalized adult patients. We used a questionnaire designed and validated to measure the patient's perception about safety in health care in the hospital setting. We also carried out a descriptive correlational analysis.

Results: Out of 123 patients, 31% reported having had an incident during the hospital stay, of which 21% were confused with another patient, 21% had an allergic reaction to drugs or foods, 18% had an infection, and 15% underwent surgery unexpectedly. In general, the assessment of patients on the safety of health services was perceived in a high degree of security by 71%.

Conclusions: It should be ensured that health professionals are competent to provide safe care and that safety in the physical structure and equipment is maintained.

Phosphodiesterase-4 inhibition restored hippocampal long term potentiation after primary blast.

Due to recent military conflicts and terrorist attacks, blast-induced traumatic brain injury (bTBI) presents a health concern for military and civilian personnel alike. Although secondary blast (penetrating injury) and tertiary blast (inertia-driven brain deformation) are known to be injurious, the effects of primary blast caused by the supersonic shock wave interacting with the skull and brain remain debated. Our group previously reported that in vitro primary blast exposure reduced long-term potentiation (LTP), the electrophysiological correlate of learning and memory, in rat organotypic hippocampal slice cultures (OHSCs) and that primary blast affects key proteins governing LTP. Recent studies have investigated phosphodiesterase-4 (PDE4) inhibition as a therapeutic strategy for reducing LTP deficits following inertia-driven TBI. We investigated the therapeutic potential of PDE4 inhibitors, specifically roflumilast, to ameliorate primary blast-induced deficits in LTP. We found that roflumilast at concentrations of 1nM or greater prevented deficits in neuronal plasticity measured 24h post-injury. We also observed a therapeutic window of at least 6h, but <23h. Additionally, we investigated molecular mechanisms that could elucidate this therapeutic effect. Roflumilast treatment (1nM delivered 6h post-injury) significantly increased total AMPA glutamate receptor 1 (GluR1) subunit expression, phosphorylation of the GluR1 subunit at the serine-831 site, and phosphorylation of stargazin at the serine-239/240 site upon LTP induction, measured 24h following injury. Roflumilast treatment significantly increased PSD-95 regardless of LTP induction. These findings indicate that further investigation into the translation of PDE4 inhibition as a therapy following bTBI is warranted.