Unraveling sauropod diversity in the Portezuelo Formation of Patagonia through a comprehensive analysis of new and existing material.

The Portezuelo Formation preserves an outstanding record of the upper Turonian - lower Coniacian. Despite the discovery of a significant quantity of sauropod fossil material from the formation, only two species have been formally described to date: Malarguesaurus florenciae and Futalognkosaurus dukei. Here we present new sauropod material mostly composed of non-articulated caudal vertebrae (MCF-PVPH 916 and 917) that belong to two titanosauriforms on the basis of the following features: anterior caudal vertebrae with procoelous-opisthoplatyan articulations, transverse processes that reach the posterior articular face of the centrum and neural spines with a transverse width of around 50% of their anteroposterior length; anterior and middle caudal vertebrae with the neural arch restricted to the anterior half of the centrum; middle caudal centra with circular cross-section. Phylogenetic analysis recovers the new material in close relation to Malarguesaurus within a monophyletic clade at the base of Somphospondyli. This clade shares large pedicel height with a vertical anterior border on the middle caudal vertebrae, a vertical orientation of the neural spines on the distalmost middle caudal vertebrae and proximalmost posterior caudal vertebrae, and subequal relative lengths of the proximal ulnar condylar processes. The specimens presented here are distinct not only from Futalognkosaurus, but also from other indeterminate titanosaurian remains from the same formation. However, there are no significant differences between the specimen MCF-PVPH 917 and Malarguesaurus, but there are differences between the posterior caudal vertebrae of MCF-PVPH 916 and Malarguesaurus, so they could be considered different species. Whilst we err on the side of caution in not naming new taxa here, the two specimens significantly expand what we know about sauropods in the Turonian-Coniacian ecosystems of Patagonia, which will continue to do so as more material is discovered.

Specific nanoprobe design for MRI: Targeting laminin in the blood-brain barrier to follow alteration due to neuroinflammation.

Chronic neuroinflammation is characterized by increased blood-brain barrier (BBB) permeability, leading to molecular changes in the central nervous system that can be explored with biomarkers of active neuroinflammatory processes. Magnetic resonance imaging (MRI) has contributed to detecting lesions and permeability of the BBB. Ultra-small superparamagnetic particles of iron oxide (USPIO) are used as contrast agents to improve MRI observations. Therefore, we validate the interaction of peptide-88 with laminin, vectorized on USPIO, to explore BBB molecular alterations occurring during neuroinflammation as a potential tool for use in MRI. The specific labeling of NPS-P88 was verified in endothelial cells (hCMEC/D3) and astrocytes (T98G) under inflammation induced by interleukin 1ß (IL-1ß) for 3 and 24 hours. IL-1ß for 3 hours in hCMEC/D3 cells increased their co-localization with NPS-P88, compared with controls. At 24 hours, no significant differences were observed between groups. In T98G cells, NPS-P88 showed similar nonspecific labeling among treatments. These results indicate that NPS-P88 has a higher affinity towards brain endothelial cells than astrocytes under inflammation. This affinity decreases over time with reduced laminin expression. In vivo results suggest that following a 30-minute post-injection, there is an increased presence of NPS-P88 in the blood and brain, diminishing over time. Lastly, EAE animals displayed a significant accumulation of NPS-P88 in MRI, primarily in the cortex, attributed to inflammation and disruption of the BBB. Altogether, these results revealed NPS-P88 as a biomarker to evaluate changes in the BBB due to neuroinflammation by MRI in biological models targeting laminin.

Evaluación de prevalencia de pacientes con necesidades paliativas en las plantas de hospitalización de agudos de oncología y medicina interna en 2 hospitales de tercer nivel de la Comunidad de Madrid / Evaluating the prevalence of patients with palliative needs in acute oncology and internal medicine hospitalization wards at two third-level hospitals in the Community of Madrid

Introducción: Los cuidados paliativos se demuestran útiles y eficientes en los pacientes que presentan dichas necesidades, pero es escasa aún la implementación de estos en el ars médica diaria de los médicos sin formación específica. El instrumento NECPAL (Instrumento para la Identificación de Personas en Situación de Enfermedad Crónica Avanzada y Necesidad de Atención Paliativa en Servicios de Salud y Sociales) se ha demostrado útil para identificar a estos pacientes y ayudar a la toma de decisiones. El objetivo principal de este estudio es conocer la prevalencia de pacientes con necesidades paliativas y si se produjo adecuación de medicina paliativa al alta en los pacientes NECPAL positivos. Material y métodos: Estudio observacional, retrospectivo, de cohortes, de pacientes hospitalizados en un periodo de 3 meses en las plantas de Medicina Interna y Oncología de 2 hospitales de tercer nivel, con la recogida de variables demográficas, identificación de necesidades paliativas y complejidad. Resultados: La prevalencia de pacientes con necesidades paliativas es alta (90 %) y de ellos cumplen criterios de complejidad el 32 % de los pacientes oncológicos y el 20 % de los no oncológicos. Pese a ello, el abordaje de las necesidades paliativas solo se produjo en el 18 % de los pacientes oncológicos y en el 18 % de los no oncológicos. La mortalidad de los pacientes identificados como NECPAL positivos a 12 meses fue del 96 % en los oncológicos y del 57 % en los no oncológicos. Conclusión: Pese a la alta prevalencia de pacientes con necesidades de cuidados paliativos en las plantas de hospitalización de Medicina Interna y Oncología y la alta mortalidad en el año siguiente a dicha hospitalización, la planificación de la atención es escasa. (AU)

Introduction: Palliative care has been shown to be useful and efficient in patients who present these needs, but its implementation in the daily medical practice of doctors without specific training is still scarce. The NECPAL instrument (Instrument for the Identification of People in a Situation of Advanced Chronic Illness and Need for Palliative Care in Health and Social Services) has been shown to be useful in identifying these patients and in helping decision-making. The main objective of this study was to determine the prevalence of patients with palliative needs, and whether there was adequacy of palliative measures at discharge in NECPAL-positive patients. Material and methods: An observational, retrospective, cohort study of patients hospitalized over a period of 3 months at the Internal Medicine and Oncology wards of two tertiary hospitals, with collection of demographic variables, and identification of palliative needs and complexity. Results: The prevalence of patients with palliative needs (90 %) and meeting complexity criteria is 32 % of cancer patients and 20 % of non-cancer patients. Despite this, addressing palliative needs only occurred in 18 % of cancer patients and 18 % of non-cancer patients. The mortality rate of patients identified as NECPAL-positive at 12 months was 96 % in cancer patients and 57 % in non-cancer patients. Conclusion: Despite a high prevalence of patients with palliative care needs in internal medicine and oncology hospitalization wards, and a high mortality rate in the year following said hospitalization, care planning is scarce. (AU)

Formación de grado en cuidados paliativos en las universidades de la Comunidad Autónoma de Madrid. Estudio descriptivo / Palliative care degree training at universities in the Autonomous Community of Madrid. A descriptive study

Introducción: En vista del desarrollo que se está produciendo en cuidados paliativos y las recomendaciones formativas llevadas a cabo por distintos planes estratégicos internacionales, nacionales y autonómicos, la Asociación Madrileña de Cuidados Paliativos (AMCP) realizó este estudio con el objetivo de definir la situación actual de la formación en cuidados paliativos en la Comunidad de Madrid en los grados de medicina, enfermería, psicología y trabajo social. Material y métodos: Para ello, se elaboró un cuestionario con los datos considerados relevantes según la evidencia, que fue enviado a las diferentes universidades para su cumplimentación durante el año 2021. En el caso de no obtener respuesta, la información se completó por parte del equipo investigador revisando las guías docentes oficiales.Resultados: A partir de los datos obtenidos provenientes de 46 grados universitarios analizados, encontramos que la formación específica en cuidados paliativos se encuentra en el 71,7 % de las universidades. En el 69,7 % de estas, esta formación no se imparte en una asignatura independiente; la media de ECTS (European Credit Transfer and Accumulation System) atribuidos a esta formación es de 3. En más de la mitad de estudios no hay prácticas obligatorias y los talleres o seminarios solo se encuentran en el 39,5 % de los planes formativos. El seminario más frecuente es el de “Malas noticias” en todos los estudios. Los temas más tratados son el “Abordaje emocional de paciente y familia”, seguido por el “Manejo de síntomas” y los “Aspectos éticos”. Conclusión: La formación en cuidados paliativos se hace presente cada vez más frecuentemente en las universidades madrileñas, habitualmente como parte de otras asignaturas. Los talleres, seminarios y las prácticas obligatorias son escasos. Los profesores son sobre todo titulares y sin formación específica. Hay que seguir trabajando para alcanzar los estándares marcados por las sociedades científicas respecto a formación. (AU)

Introduction: In view of the development that is taking place in the field of palliative care and the training recommendations given by different international, national and regional strategic plans, the Madrilenian Association of Palliative Care (AMCP) carried out this study with the aim of defining the current situation of training in palliative care within the medicine, nursing, psychology and social work degrees taught at universities in the Community of Madrid. Material and methods: To this end, a questionnaire was drawn up with the data considered relevant according to the evidence, which was sent to the different universities to be completed during the year 2021. If no response was received, the information was completed by the research team by reviewing the relevant official teaching guides. Results: From the data obtained from all 46 university degrees analysed, we found that specific training in palliative care is found in 71.7 % of universities. In 69.7 % of these, palliative care is not taught as an independent subject matter; the average number of ECTS (European Credit Transfer and Accumulation System) attributed to this training is 3. In more than 50 % of cases there are no compulsory internships, and workshops or seminars are only found in 39.5 % of the curricula. The most frequently taught seminar is “Breaking bad news”. The most frequently covered topics are “Emotional support of patients and their families”, followed by “Symptom management” and “Ethical aspects”. Conclusion: Training in palliative care is increasingly present in Madrid universities, usually as part of other subjects. Workshops, seminars, and compulsory internships are scarce. Teachers are mostly tenured, without specific training. We must continue working to achieve the standards set by scientific societies regarding training. (AU)

Evaluation of simple laboratory parameters in SARS-CoV-2 infection: the role of ratios.

BACKGROUND: The real predictive prognostic capacity of cellular indices (or ratios) is unclear in SARS-CoV-2 infection. This study aimed to assess the prognostic role of previously well-known laboratory indices and new ones in hospitalized COVID-19 patients. METHODS: A retrospective observational study from March to May 2022 evaluated laboratory indices on admission (neutrophil to lymphocyte-, derived neutrophil to lymphocyte-, platelet to lymphocyte-, CRP to lymphocyte-, CRP to albumin-, fibrinogen to lymphocyte-, d-dimer to lymphocyte-, ferritin to lymphocyte-, LDH to lymphocyte-, and IL-6 to lymphocyte ratios), in patients hospitalized due to SARS-CoV2 infection to determine the association with mortality, admission to an intensive care unit (ICU), need for non-invasive mechanical ventilation (NIMV), orotracheal intubation (OTI), or combined event at 30 days follow-up. RESULTS: A total of 1113 COVID-19 patients were evaluated with a mean age of 64.1 ± 15.9 years (58.49% male), 166 (14.91%) patients died, 58 (5.21%) required ICU admission, 73 (6.56%) needed NIMV, 46 (4.23%) needed OTI, and 247 (22.19%) presented the combined event. All the ratios evaluated in this study showed statistical significance in the univariate analysis for mortality and combined event; however, only d-dimer to lymphocyte ratio >0.6 presented an independent association in the multivariate analysis for 30-day mortality (adjusted OR 2.32; p = .047) and 30-day combined event (adjusted OR 2.62; p = .014). CONCLUSIONS: Laboratory indices might be a potential biomarker for better prognosis stratification in hospitalized COVID-19 patients. d-Dimer to lymphocyte ratio presents an independent association for 30-day mortality and 30-day adverse outcomes in hospitalized COVID-19 patients.

Development, implementation, and evaluation of a clinical decision support tool to improve naloxone coprescription within Military Health System pharmacies.

PURPOSE: To describe the development, implementation, and evaluation of a pharmacy clinical decision support tool designed to increase naloxone coprescription among people at risk for opioid overdose in a large healthcare system. SUMMARY: The Military Health System Opioid Registry and underlying presentation layer were used to develop a clinical decision support capability to improve naloxone coprescription at the pharmacy point of care. Pharmacy personnel use a patient identification card barcode scanner or manually enter a patient's identification number to quickly visualize information on a patient's risk for opioid overdose and medical history related to pain and, when appropriate, receive a recommendation to coprescribe naloxone. The tool was made available to military treatment facility pharmacy locations. An interactive dashboard was developed to support monitoring, utilization, and impact on naloxone coprescription to patients at risk for opioid overdose. CONCLUSION: Initial implementation of the naloxone tool was slow from a lack of end-user awareness. Efforts to increase utilization were, in part, successful owing to a number of enterprise-wide educational initiatives. In early 2020, the naloxone tool was used in 15% of all opioid prescriptions dispensed at a military pharmacy. Data indicate that the frequency of naloxone coprescription to patients at risk for opioid overdose was significantly higher when the naloxone tool was used than when the tool was not used.

Influence of Breastfeeding Time on Levels of Organochlorine Pesticides in Human Milk of a Mexican Population.

This study was conducted with the objective of determining whether there is a depuration of organochlorine pesticides in breast milk according to breastfeeding time. In total, 171 samples from mothers that lived in the State of Guerrero, Mexico were analyzed. There was a weak negative relationship between pp'DDE (r = -0.216) and Σ-DDT (r = -0.222) concentrations with the days of lactation. In a comparison analysis, a statistically significant decrease of pp'DDT and pp'DDE levels was observed, as well as the Σ-DDT from the first to the fifth week of lactation. A reduction of 0.188 mg/kg lipid of pp'DDE and 0.181 mg/kg lipid of Σ-DDT per week was obtained. HCB, ß-HCH and op'DDT concentrations were low and had no major fluctuations between subgroups. The low levels found and the observed reduction in time involve less exposure to the infant to these pollutants. Through this methodology changes in levels of certain organochlorine pesticides in various stages of human milk production may be shown.

Valores y factores sociodemográficos en estudiantes universitarios: un estudio comparativo / Values and socio demographic- factors in university students: a comparative study / Valores e fatores sócio-demográficos nos estudantes universitários: um estudo comparativo

El objetivo de este trabajo fue comparar los valores de los estudiantes de una institución universitaria en función de las variables socio demográficas género, procedencia (colegio: privado - público y religioso - no religioso), religión (católica - no católica) y edad. Para la investigación se diseñó una escala autoaplicada de 55 valores, que se administró mediante una selección intencional a 3.384 estudiantes. De la escala de valores se derivaron cinco dimensiones: Cosmopolitas, Sociales, Instrumentales, Morales y Conservadores. Los resultados indicaron que las mujeres presentaron mayor valoración de las dimensiones valores Morales, Sociales y Conservadores, mientras que los hombres valoraron más la dimensión Cosmopolitas. Los estudiantes provenientes de colegios religiosos valoraron más la dimensión valores Conservadores. La variable socio demográfica de mayor influencia en las preferencias axiológicas fue el género y la dimensión de valores diferenciada por mayor cantidad de los factores socio demográficos evaluados fue aquella representada por valores conservadores.

The purpose of this study was to compare the values of university students as a function of socio-demographic variables such as: gender, kind of school (religious vs. non-religious; private vs. public), religion (Catholic - Non Catholic) and age. A self-administered scale of 55 values was designed for this research and it was used with a sample of 3.384 students selected intentionally. The values scale showed five dimensions: Cosmopolitan, Social, Instrumental, Moral and Conservative. Results indicated that women presented a higher appreciation of Moral, Social and Conservative values, whereas men valued more the Cosmopolitan values. The students that attended religious schools valued more the Conservative dimension. The socio demographic variable of major influence in the axiological preferences was gender and the value dimension differentiated by most socio-demographic factors was the Conservative.

Neste artigo comparam-se os valores dos estudantes de uma instituição universitária em função das variáveis sócio-demográficas género, procedência (colégio, privado, público; religioso, no religioso) e idade. Desenhou-se uma escala auto-aplicada de 55 valores, administrada a uma seleção intencional de 3.384 estudantes. Da escala de valores, determinaram-se cinco valores: Cosmopolitas, Sociais, Instrumentais, Morais e Conservadores. Os resultados revelaram que as mulheres mostraram maiores valorações nas dimensões Morais, Sociais e Conservadores, em quanto os homens valoraram mais a dimensão Cosmopolitas. Os estudantes provenientes de colégios religiosos valoraram mais a dimensão Conservadores. A variável sócio-demográfica de maior influencia nas preferências axiológicas foi o gênero; a dimensão de valores diferenciada por maior quantidade dos fatores sócio-demográficos avaliados foi Conservadores.

Predicting the effect of intravenous calcitriol on parathyroid gland activity using double-phase technetium Tc 99m-sestamibi scintigraphy.

BACKGROUND: Although intravenous calcitriol is useful for decreasing intact parathyroid hormone (iPTH) blood levels in patients with secondary hyperparathyroidism (SHP) undergoing hemodialysis, approximately half these patients remain refractory to this treatment. The current study measures the diagnostic utility of double-phase technetium Tc 99m-sestamibi (MIBI) scintigraphy in predicting the response to calcitriol treatment. METHODS: Sixty hemodialysis patients with SHP with iPTH blood levels between 240 and 600 pg/mL (ng/L) were selected. Initial intravenous calcitriol pulse therapy was 6 microg/wk (for iPTH levels of 400 to 600 pg/mL [ng/L]) or 3 microg/wk (for iPTH levels of 240 to 400 pg/mL [ng/L]). MIBI scintigraphy was performed before the onset of calcitriol therapy and repeated 1 year later. Patients were injected intravenously with 740 MBq of MIBI. Images were obtained at 15 minutes (thyroid phase) and 2 hours (parathyroid phase) after radiotracer administration. Focal areas of increased MIBI uptake were considered pathological parathyroid glands. RESULTS: Forty-eight patients completed the study. After 1 year, iPTH levels had decreased significantly in 95.2% (47 patients), whereas good control (iPTH < 240 pg/mL [ng/L]) was reached in 70.8% (34 patients) and only 4 patients had iPTH levels greater than 400 pg/mL (ng/L; all were patients with 3 MIBI-positive areas at baseline determination). At baseline, there were 30 patients (62.5%) with MIBI positive areas (1, 2, or 3 areas), which decreased to 14 patients (29%) at the end of the study period. No patient showed 4 positive areas at any time. The 18 patients (37.5%) with no MIBI-positive area at baseline remained unchanged. CONCLUSION: MIBI scintigraphy is a reliable exploratory tool in predicting the response to treatment with intravenous calcitriol in hemodialysis patients with SHP.

Usefulness of pamidronate in severe secondary hyperparathyroidism in patients undergoing hemodialysis.

BACKGROUND: Although bisphosphonates have been widely used to treat bone diseases characterized by increased bone resorption, there are limited data showing their possible usefulness in patients on hemodialysis (HD) with secondary hyperparathyroidism. METHODS: The aim of this study was to evaluate the efficacy and safety of pamidronate in HD patients affected by severe secondary hyperparathyroidism and moderate hypercalcemia who were receiving intravenous calcitriol (Calcijex). RESULTS: In this prospective one-year, open-labeled study, 13 patients (9 women/4 men) with a mean age of 64 +/- 9 years and a mean time on dialysis of 94 +/- 61 months were evaluated. The inclusion criteria were: iPTH>500 pg/mL, Ca>11 mg/dL, P <6 mg/dL, and osteopenia (T-score <-1 SD). Blood levels of Ca, P, alkaline phosphatase (AP), and iPTH were assessed at the beginning of the study and every month. Radiographs of the vertebral spine and bone mineral density (BMD) (lumbar spine and femoral neck) were assessed basal and every 6 months. All patients received 60 mg of pamidronate intravenously every two months throughout the study period. Calcitriol and phosphate binders were adjusted according to iPTH, Ca, and P blood levels. BMD increased in both the lumbar and femoral neck scans (mean increase of 33%) at 6 and 12 months. iPTH increased at 3 months in all patients, and decreased more than 50% in 10 patients after increasing the calcitriol doses. Three patients had no response. A slight decrease in Ca and P was observed in all patients with no significant changes in AP. There were no adverse events. CONCLUSION: Pamidronate is effective in controlling hypercalcemia in patients on HD with secondary hyperparathyroidism and allows for a more aggressive use of intravenous calcitriol.