Retention of Ciprofloxacin and Carbamazepine from Aqueous Solutions Using Chitosan-Based Cryostructured Composites.

Water pollution is becoming a great concern at the global level due to highly polluted effluents, which are charged year by year with increasing amounts of organic residues, dyes, pharmaceuticals and heavy metals. For some of these pollutants, the industrial treatment of wastewater is still relevant. Yet, in some cases, such as pharmaceuticals, specific treatment schemes are urgently required. Therefore, the present study describes the synthesis and evaluation of promising cryostructured composite adsorbents based on chitosan containing native minerals and two types of reinforcement materials (functionalized kaolin and synthetic silicate microparticles). The targeted pharmaceuticals refer to the ciprofloxacin (CIP) antibiotic and the carbamazepine (CBZ) drug, for which the current water treatment process seem to be less efficient, making them appear in exceedingly high concentrations, even in tap water. The study reveals first the progress made for improving the mechanical stability and resilience to water disintegration, as a function of pH, of chitosan-based cryostructures. Further on, a retention study shows that both pharmaceuticals are retained with high efficiency (up to 85.94% CIP and 86.38% CBZ) from diluted aqueous solutions.

Ethical challenges during critical phases of the COVID-19 pandemic: An interpretive synthesis.

BACKGROUND: During the most critical phases of COVID-19 pandemic, dramatic situations were experienced in hospitals and care centers that nurses could hardly verbalize. Especially relevant were deep challenges related to terminal illness, situations of extreme sacrifice, as well as reflections on protective measures mixed with beliefs. We intend to analyze which problems had the greatest impact on professionals. AIM: The aim is to explore the ultimate basis for action when making decisions and the orientation of their behavior in the face of moral conflicts. METHOD: The methodological strategy is an interpretive synthesis. Narrative review of academic articles that analyzed ethical dilemmas during the pandemic was carried out by searching five databases (Pubmed, Scopus, Psycinfo, CINHAL, and WOS) between January 2020 and December 2022. Finally, 43 articles were selected. ETHICAL CONSIDERATIONS: Ethical requirements were respected in all study phases. RESULTS: The reading and review of the 43 articles initiated the first phase of inductive coding which resulted in 14 initial sub-themes. Based on this structure, a second phase of coding was carried out, giving rise to six categories or emerging themes. To facilitate the process of identifying the central category, the authors agreed to carry out a phase of synthesis, grouping the six themes into three meta-themes: the identification and acceptance of human vulnerability; the discovery of positive paradigms in traumatic situations in society; the prevalence of the common good over the particular interest, as the core structure of any society. CONCLUSION: The study has shown the need to consider healthcare benevolence as a new dimension of health care upon global vulnerability. Responsibility is required to ensure the well-being of a global society, prioritizing the common good over particular interests and building solutions on solid moral structures. A new ethical landscape is essential, starting with a humanistic curricular training of all healthcare professionals.

Barriers and facilitators of health professionals in adopting digital health-related tools for medication appropriateness: A systematic review.

Objective: Digital health is described as the use and development of all types of digital technologies to improve health outcomes. It could be used to prevent medication errors, a priority for health systems worldwide. However, the adoption of such tools remains slow. This study aims to identify factors (attitudes, knowledge and beliefs) acting as barriers and/or facilitators reported by healthcare professionals (HCPs) for the adoption of digital health-related tools for medication appropriateness. Methods: A systematic review was performed by searching the literature in the MEDLINE PubMed, and EMBASE scientific databases for original articles regarding qualitative and quantitative data. Results: Fifteen articles were included and a total of 125 barriers and 108 facilitators were identified, consolidated and categorized into technical (n = 48), organizational (n = 12), economical (n = 4), user-related (n = 34), and patient-related (n = 8) components. The most often reported barriers and facilitators were technical component-related ones concerning the need for additional training (n = 6), the time consumed (n = 6), and the easy way of using or learning how to use the tools (n = 9), respectively. Regarding setting analysis, agreement with clinical decision recommendations and impact on the doctor-patient relationship were more valued in primary care, while the user interface and system design were in the hospital. Conclusions: The barriers and facilitators identified in this study provide relevant information to developers and it can be used as a starting point for the designing of successful digital health-related tools, specifically related to medication appropriateness. Future research includes economic evaluation-focused studies and in-depth case studies of specific barriers and facilitators.

Evaluation of relational factor in patient satisfaction with the treatment received by dental students.

INTRODUCTION: The study focused on the importance of the relational factor and empathy in the general satisfaction of patients for the treatment received by university dental students. To achieve this objective, a tool capable of evaluating the most humanistic dimensions (empathy, kindness, trust) in the development of dental treatment has been designed. MATERIALS AND METHODS: A review of the literature was carried out and, based on its findings, a questionnaire was designed to assess patient satisfaction with the dental student's empathy. It consisted of 20 questions and was completed by 80 patients. The questionnaire was subjected to a validation process using the Delphi method (content validity) and psychometric analysis (construct validity), through a principal components analysis (PCA). RESULTS: The results of the PCA showed the existence of four components that suggest grouping the 20 questions into three blocks with a sequential structure, in which the questions would describe the patient's satisfaction throughout their treatment: reception and explanation of the treatment; development and progress of treatment; and expectations and completion of treatment. In each of these blocks, satisfaction was determined by a specific humanistic dimension: communication, trust and benevolence. CONCLUSION: The validated questionnaire is an effective tool to analyse the relational factors that determine patient satisfaction in a treatment. Furthermore, the analysis of the questionnaire suggests that communication, trust and benevolence are elements that acquire singular importance throughout the care process. This analysis is essential for the acquisition of humanistic skills by future professionals and to optimize the dentist-patient relationship.

The Impact of Patients' Primary Language on Inpatient Gastrointestinal Bleeding Outcomes.

BACKGROUND: The impact of English proficiency on gastrointestinal bleeding (GIB) outcomes remains unclear. In this analysis, we compare inpatient GIB outcomes between patients with English as their primary language (EPL) and those with a primary language other than English (PLOE). METHODS: Using the 2019 State Inpatient Databases for New Jersey, Maryland, and Michigan, we created an analysis cohort of GIB hospitalizations using International Classification of Diseases, 10th Revision codes. Patients were stratified by primary language (EPL vs PLOE) and type of bleeding (variceal upper GI bleeding [VUGIB], nonvariceal upper GI bleeding [NVUGIB], and lower GI bleeding (LGIB)]. Regression analyses were used to compare mortality, 30-day readmissions, and length of stay. Adjusted odds ratios (aORs) and 95% confidence intervals (CIs) were reported. P < 0.05 was considered statistically significant. RESULTS: In the cohort, 5.5%-10% of the patients spoke a primary language other than English. Endoscopy utilization was lower among patients with PLOE vs EPL for NVUGIB (17.2% vs 21.2%, P < 0.001) and LGIB (26.3% vs 29.2%, P = 0.027). Patients with PLOE had higher odds of dying of VUGIB (aOR 1.45, 95% CI 1.16-2.48) and LGIB (aOR 1.71, 95% CI 1.22-2.12). Patients with PLOE were also more likely to be readmitted after NVUGIB (aOR 1.75, 95% CI 1.64-1.81). However, after controlling for the percentage of patients with PLOE discharged from each hospital, the disparities in mortality and readmissions were no longer detected. DISCUSSION: Disparities exist in GIB outcomes among patients with PLOE, but these gaps narrow at hospitals with higher percentages of patients with PLOE. Cultural and linguistic competence may improve outcomes in this vulnerable group.

Prognostic Factors and Markers in Non-Small Cell Lung Cancer: Recent Progress and Future Challenges.

Lung cancer is a highly aggressive neoplasm and, despite the development of recent therapies, tumor progression and recurrence following the initial response remains unsolved. Several questions remain unanswered about non-small cell lung cancer (NSCLC): (1) Which patients will actually benefit from therapy? (2) What are the predictive factors of response to MAbs and TKIs? (3) What are the best combination strategies with conventional treatments or new antineoplastic drugs? To answer these questions, an integrative literature review was carried out, searching articles in PUBMED, NCBI-PMC, Google Academic, and others. Here, we will examine the molecular genetics of lung cancer, emphasizing NSCLC, and delineate the primary categories of inhibitors based on their molecular targets, alongside the main treatment alternatives depending on the type of acquired resistance. We highlighted new therapies based on epigenetic information and a single-cell approach as a potential source of new biomarkers. The current and future of NSCLC management hinges upon genotyping correct prognostic markers, as well as on the evolution of precision medicine, which guarantees a tailored drug combination with precise targeting.

Plantas medicinales que se expende en mercado de Barranca para aliviar las afecciones respiratorias

Muchos años han pasado hasta hoy, donde las plantas medicinales juegan un papel importante en tratamiento de muchas enfermedades y aún falta investigar más sobre sus propiedades. Objetivo. Determinar la relación que hay entre consumo de plantas medicinales y alivio de enfermedades respiratorias de trabajadores del mercado el Milagro. Materiales y métodos. Se basó en estudio descriptivo con enfoque cuantitativo, prospectivo y observacional, se enfocó en edades de 20 a 60 años, ambos sexos quienes participaron voluntariamente. Se tomó datos desde junio hasta setiembre del 2021 de muestra de 60 trabajadores. Se recolectaron datos de dimensiones del consumo de plantas medicinales y relación entre plantas y alivio de enfermedades respiratorias por semana, luego se promedió por mes de allí se procesaron mediante estadísticas básicas y correlación. Resultados. Se pudo determinar que consumieron plantas medicinales como eucalipto, escorzonera y huamanripa para afecciones respiratorias en agosto con 3% y setiembre con 5% eucalipto para COVID-19; consumieron hierbas medicinales como eucalipto, escorzonera y huamanripa como infusiones destacó agosto con 7%; consumieron hierbas medicinales para enfermedades respiratorias destacó julio con 25% y setiembre con 64 % para COVID-19; consumieron hierbas para aliviar síntomas del coronavirus sobresalió setiembre con 80% y correlación entre consumo de hierbas y alivio de síntomas de COVID-19 obtuvo r = 0.8946. Conclusiones. Se pudo establecer que existe una alta relación entre consumo de plantas medicinales y alivio de síntomas este virus y afecciones respiratorias; por lo tanto, los consumos de hierbas en muchos casos conjuntamente con terapia médica mejoraron las dolencias de estas enfermedades.

Many years have passed until today, where medicinal plants play an important role in the treatment of many diseases and there is still a lack of research on their properties. Objective. To determine the relationship between the consumption of medicinal plants and the relief of respiratory diseases in workers of the El Milagro market. Materials and methods. It was based on a descriptive study with a quantitative, prospective and observational approach, focused on ages from 20 to 60 years, both sexes, who participated voluntarily. Data were collected from June to September 2021 from a sample of 60 workers. Data were collected on the dimensions of consumption of medicinal plants and the relationship between plants and relief of respiratory diseases per week, then averaged by month and processed by basic statistics and correlation. Results. It was determined that they consumed medicinal plants such as eucalyptus, scorzonera and huamanripa for respiratory diseases in August with 3% and September with 5 % eucalyptus for COVID-19; they consumed medicinal herbs such as eucalyptus, scorzonera and huamanripa as infusions in August with 7%; consumed medicinal herbs for respiratory diseases, July stood out with 25% and September with 64% for COVID-19; consumed herbs to alleviate symptoms of coronavirus, September stood out with 80% and correlation between consumption of herbs and relief of COVID-19 symptoms obtained r = 0. 8946. Conclusions. It was possible to establish that there is a high relationship between consumption of medicinal plants and relief of symptoms of this virus and respiratory diseases; therefore, the consumption of herbs in many cases together with medical therapy improved the ailments of these diseases.

Muitos anos se passaram até hoje, onde as plantas medicinais desempenham um papel importante no tratamento de muitas doenças e ainda são necessárias mais pesquisas sobre suas propriedades. Objetivo. Determinar a relação entre o consumo de plantas medicinais e o alívio de doenças respiratórias em trabalhadores do mercado El Milagro. Materiais e métodos. Este foi um estudo descritivo com uma abordagem quantitativa, prospectiva e observacional, com foco em trabalhadores com idade entre 20 e 60 anos, de ambos os sexos, que participaram voluntariamente. Os dados foram coletados de junho a setembro de 2021 de uma amostra de 60 trabalhadores. Os dados foram coletados sobre as dimensões do consumo de plantas medicinais e a relação entre as plantas e o alívio de doenças respiratórias por semana, depois calculados em média por mês e processados usando estatísticas básicas e correlação. Resultados. Foi determinado que eles consumiram plantas medicinais como eucalipto, scorzonera e huamanripa para doenças respiratórias em agosto com 3% e setembro com 5%, eucalipto para COVID-19; eles consumiram ervas medicinais como eucalipto, scorzonera e huamanripa como infusões em agosto com 7%; consumiram ervas medicinais para doenças respiratórias em julho com 25% e setembro com 64% para COVID-19; consumiram ervas para aliviar os sintomas do coronavírus, setembro se destacou com 80% e a correlação entre o consumo de ervas e o alívio dos sintomas da COVID-19 obteve r = 0. 8946. Conclusões. Foi possível estabelecer que existe uma alta correlação entre o consumo de plantas medicinais e o alívio dos sintomas desse vírus e das doenças respiratórias; portanto, o consumo de ervas em muitos casos, em conjunto com a terapia médica, melhorou os males dessas doenças.

The Yin and Yang of Breast Cancer: Ion Channels as Determinants of Left-Right Functional Differences.

Breast cancer is a complex and heterogeneous disease that displays diverse molecular subtypes and clinical outcomes. Although it is known that the location of tumors can affect their biological behavior, the underlying mechanisms are not fully understood. In our previous study, we found a differential methylation profile and membrane potential between left (L)- and right (R)-sided breast tumors. In this current study, we aimed to identify the ion channels responsible for this phenomenon and determine any associated phenotypic features. To achieve this, experiments were conducted in mammary tumors in mice, human patient samples, and with data from public datasets. The results revealed that L-sided tumors have a more depolarized state than R-sided. We identified a 6-ion channel-gene signature (CACNA1C, CACNA2D2, CACNB2, KCNJ11, SCN3A, and SCN3B) associated with the side: L-tumors exhibit lower expression levels than R-tumors. Additionally, in silico analyses show that the signature correlates inversely with DNA methylation writers and with key biological processes involved in cancer progression, such as proliferation and stemness. The signature also correlates inversely with patient survival rates. In an in vivo mouse model, we confirmed that KI67 and CD44 markers were increased in L-sided tumors and a similar tendency for KI67 was found in patient L-tumors. Overall, this study provides new insights into the potential impact of anatomical location on breast cancer biology and highlights the need for further investigation into possible differential treatment options.

Mapping Long-acting Reversible Contraceptive Interventions to the Social Ecological Model: A Scoping Review.

INTRODUCTION: Long-acting reversible contraception (LARC) is one option for preventing unintended pregnancies and short interpregnancy intervals. Efforts to increase access to contraception may benefit from applying the social ecological model (SEM), a framework that considers individual, interpersonal, organizational, community, and policy influences on behavior. We aimed to summarize findings from interventions on LARC use and map interventions to SEM levels. METHODS: We conducted a scoping review of the 2010-2020 literature in PubMed/MEDLINE and Embase databases to summarize interventions that did and did not increase LARC use. Although increasing LARC use is not an appropriate goal from a reproductive autonomy standpoint, it is the stated goal of much of the research conducted to date and typically indicates an improvement in access. We mapped these interventions to SEM levels and categorized their strategies: cost support, patient counseling, administrative support, provider training, and other. RESULTS: Of 27 interventions reviewed, 17 (63%) increased LARC use. We observed a greater proportion of interventions that increased LARC uptake among those with strategies implemented at policy (8/10 [80%]) or organizational (14/19 [74%]) SEM levels compared with interventions implemented at other SEM levels. When both individual and organizational SEM-level components were implemented, five of six interventions (83%) increased uptake. All five interventions with both organizational- and policy-level components increased LARC use. Among the 27 interventions, patient counseling (n = 12) and cost support (n = 12) were common strategies. Five of 12 interventions (42%) involving patient counseling and 11 of 12 (92%) involving cost support increased LARC use. CONCLUSIONS: Organizational and policy SEM components and cost support strategies were most prevalent in interventions that increased LARC use. Future interventions to improve access to contraception, while respecting patient autonomy, could incorporate more than one SEM level.

Women's health, hormonal balance, and personal autonomy.

Hormone-based contraception disrupts hormonal balance, creating artificial states of anovulation and threatening women's health. We reviewed its main adverse effects and mechanisms on accelerated ovarian aging, mental health (emotional disruptions, depression, and suicide), sexuality (reduced libido), cardiovascular (brain stroke, myocardial infarction, hypertension, and thrombosis), and oncological (breast, cervical, and endometrial cancers). Other "collateral damage" includes negative effects on communication, scientific mistrust, poor physician-patient relationships, increased patient burden, economic drain on the healthcare system, and environmental pollution. Hormone-sensitive tumors present a dilemma owing to their potential dual effects: preventing some cancers vs. higher risk for others remains controversial, with denial or dismissal as non-relevant adverse effects, information avoidance, and modification of scientific criteria. This lack of clinical assessment poses challenges to women's health and their right to autonomy. Overcoming these challenges requires an anthropological integration of sexuality, as the focus on genital bodily union alone fails to encompass the intimate relational expression of individuals, complete sexual satisfaction, and the intertwined feelings of trust, safety, tenderness, and endorsement of women's femininity.

Psicopedagogia para gente grande Atendimento psicopedagógico na idade madura / Psychopedagogy for grown-ups Psychopedagogical care in the mature age

O presente estudo surgiu da observação, em nossa prática profissional, de que o adulto, para lidar com questões de aprendizagem, por diferentes motivos, pode se beneficiar de atendimento psicopedagógico. Para tanto, o levantamento de fontes, de leitura e análise bibliográfica possibilitou investigarmos as necessidades da fase madura, revisando paradigmas, suas características e peculiaridades. Ao longo do trabalho, ressaltamos o resgate e/ou fortalecimento da autonomia e autoria como personagens de grande valor, sempre tendo como alvo a qualidade de vida. O estudo nos leva, ainda, a pensar no seguinte questionamento proposto por vários autores: temos mais um estágio cognitivo além dos propostos por Piaget? Propomos também a intenção de pensar acerca das diferentes possibilidades do atendimento psicopedagógico, ampliando nosso olhar e nossa escuta.

The present study arose from the observation, in our professional practice, that the adult, to deal with learning issues, for different reasons, can benefit from psychopedagogical care. Therefore, the survey of sources of reading and bibliographic analysis made it possible to investigate the needs of the mature phase, reviewing paradigms, their characteristics and peculiarities. Throughout the work, we emphasize the rescue and/or strengthening of autonomy and authorship as characters of great value, always having as a target the quality of life. The study also leads us to think about the following question proposed by several authors: do we have one more cognitive stage in addition to those proposed by Piaget? We also propose the intention of thinking about the different possibilities of psychopedagogical care, expanding our look and our listening.

Estudio de familia vulnerable de zona rural peruana aplicando el proceso de enfermería / Study of a vulnerable family in a Peruvian rural area applying the nursing process / Estudo de uma família vulnerável em uma área rural peruana aplicando o processo de enfermagem

Se realizó un estudio de caso, en una familia vulnerable de una zona rural. La información se recolectó utilizando como técnicas de la observación, la entrevista, el análisis documental; y de instrumento el formato de valoración de los once Patrones Funcionales de Gordon, mediante visitas domiciliarias; ejecutado de abril a junio del 2021. Se solicitó permiso a la familia previa autorización y consentimiento informado, respetándose la confidencialidad de los datos. Se brindó cuidado enfermero a una familia vulnerable aplicando las etapas del proceso de atención de enfermería, utilizando las taxonomías Diagnostico Enfermeros: Definiciones y Clasificación, Calificación de los Resultados de Enfermería, Clasificación de las Intervenciones de Enfermería. Los diagnósticos priorizados fueron: Mantenimiento ineficaz de la salud relacionado con recursos insuficientes e/p conocimiento insuficiente sobre prácticas básicas de salud; obesidad relacionada con conocimientos insuficientes sobre los factores modificables evidenciado por índice de masa corporal de 34,5 y perímetro abdominal de 1,50 m. de la madre. El último diagnóstico fue: estreñimiento relacionado con cambios en el patrón intestinal manifestado por ingesta insuficiente de fibras, de líquido y falta de ejercicio. La aplicación del plan de cuidados estandarizados en una familia vulnerable en tiempos de pandemia, permitió el abordaje holístico de los problemas identificados, que posibilitó establecer tres diagnósticos, ejecutar las intervenciones, para pasar de una puntuación diana de dos a cuatro, que evidencian la efectividad en el logro de los resultados esperados.

A case study was carried out in a vulnerable family in a rural area. The information was collected using as techniques of observation, interview, documentary analysis; and as an instrument, the evaluation format of the 11 Gordon Functional Patterns, through home visits; executed from April to June 2021. Permission was requested from the family with prior authorization and informed consent, respecting the confidentiality of the data. Nursing care was provided to a vulnerable family applying the stages of the nursing care process, using the Taxonomies of Nursing Diagnosis: Definitions and Classification, Qualification of Nursing Results, Classification of Nursing Interventions. The prioritized diagnoses were: Ineffective health maintenance related to insufficient resources and / or insufficient knowledge about basic health practices; obesity related to insufficient knowledge about modifiable factors evidenced by body mass index of 34.5 and abdominal circumference of 1.50 m. of the mother. The last diagnosis was: constipation related to changes in the intestinal pattern manifested by insufficient fiber and fluid intake and lack of exercise. The application of the standardized care plan in a vulnerable family in times of pandemic, allowed a holistic approach to the problems identified, which made it possible to establish three diagnoses, execute the interventions, to go from a target score of two to four, which show the effectiveness in achieving the expected results.

Foi realizado um estudo de caso em uma família vulnerável em uma área rural. As informações foram coletadas por meio de observação, entrevista, análise documental e o formulário de avaliação dos onze Padrões Funcionais de Gordon como instrumento, por meio de visitas domiciliares; realizadas de abril a junho de 2021. A permissão foi solicitada à família com autorização prévia e consentimento informado, respeitando a confidencialidade dos dados. O atendimento de enfermagem foi prestado a uma família vulnerável aplicando as etapas do processo de atendimento de enfermagem, utilizando as taxonomias Diagnóstico de Enfermagem: Definições e Classificação, Classificação de Resultados de Enfermagem, Classificação de Intervenções de Enfermagem. Os diagnósticos priorizados foram: manutenção ineficaz da saúde relacionada à insuficiência de recursos e/ou conhecimento insuficiente das práticas básicas de saúde; obesidade relacionada ao conhecimento insuficiente dos fatores modificáveis como evidenciado pelo índice de massa corporal da mãe de 34,5 e circunferência abdominal de 1,50 m. O último diagnóstico foi constipação. O último diagnóstico foi constipação relacionada a mudanças no padrão intestinal manifestadas por ingestão insuficiente de fibras, ingestão de líquidos e falta de exercício. A aplicação do plano de atendimento padronizado em uma família vulnerável em tempos de pandemia permitiu uma abordagem holística dos problemas identificados, o que possibilitou estabelecer três diagnósticos, implementar as intervenções e passar de uma pontuação alvo de dois para quatro, demonstrando a eficácia na obtenção dos resultados esperados.

When left does not seem right: epigenetic and bioelectric differences between left- and right-sided breast cancer.

BACKGROUND: During embryogenesis lateral symmetry is broken, giving rise to Left/Right (L/R) breast tissues with distinct identity. L/R-sided breast tumors exhibit consistently-biased incidence, gene expression, and DNA methylation. We postulate that a differential L/R tumor-microenvironment crosstalk generates different tumorigenesis mechanisms. METHODS: We performed in-silico analyses on breast tumors of public datasets, developed xenografted tumors, and conditioned MDA-MB-231 cells with L/R mammary extracts. RESULTS: We found L/R differential DNA methylation involved in embryogenic and neuron-like functions. Focusing on ion-channels, we discovered significant L/R epigenetic and bioelectric differences. Specifically, L-sided cells presented increased methylation of hyperpolarizing ion channel genes and increased Ca2+ concentration and depolarized membrane potential, compared to R-ones. Functional consequences were associated with increased proliferation in left tumors, assessed by KI67 expression and mitotic count. CONCLUSIONS: Our findings reveal considerable L/R asymmetry in cancer processes, and suggest specific L/R epigenetic and bioelectric differences as future targets for cancer therapeutic approaches in the breast and many other paired organs.

CDC42 as an epigenetic regulator of ID4 in triple-negative breast tumors.

BACKGROUND: Triple-negative (TN) breast cancer represents a subtype of breast cancer that does not express estrogen receptor (ER), progesterone receptor (PR), or human epidermal growth factor receptor 2 (HER-2). Clinically, it is characterized by high invasiveness, high metastatic potential, and poor prognosis. Inhibitor of DNA binding 4 (ID4) has been shown to be overexpressed in these tumors acting as an oncogene responsible for many of its aggressive features. CDC42, a plasma membrane-associated small GTPase, can downregulate ID4 gene expression through hypermethylation of its promoter in colorectal adenocarcinomas. Since ID4 acts as an oncogene and is hypomethylated in TN breast tumors, here we asked whether CDC42 could also epigenetically silence ID4 and in doing so revert aggressive features of this tumor type. METHODS: Gene expression was retrieved from TCGA database using UCSC Xena. Association between overall survival (OS) and gene expression was assessed using Kaplan-Meier plotter. In vitro experiments involved ectopic expression of CDC42 in MDA-MB231and in MDA-MB468 breast cancer cell lines. Gene expression was analyzed by qPCR, western blot and inmunofluorescence assays and methylation by MSP, MS-MLPA, or ddMSP. RESULTS: Data mining analysis revealed that CDC42 expression varies among breast cancer subtypes that in the basal-like subtype there is an inverse correlation between CDC42 and ID4 expression and a positive correlation between CDC42 expression and ID4 methylation. In vitro experiments revealed that CDC42 overexpression induced ID4 methylation through the activation of the EZH2 pathway. ID4 silencing produced an increase in BRCA1 expression and a less aggressive phenotype in the tested cell line. CONCLUSION: We show that CDC42 silences ID4 through methylation in TN breast cancer. Given that ID4 acts as an oncogene in these tumors, we think that finding an epigenetic regulator of ID4 contributes to the research and clinical management of TN breast tumors.

Analysis in the ethical decision-making of dental, nurse and physiotherapist students, through case-based learning.

INTRODUCTION: Training in ethical competencies is perceived with special interest among the objectives of health education. The dimensions of the person such as integrity, autonomy and dignity influence the choice of interventions, but the different specialties of the health sciences conceive these dimensions with different perspectives depending on the clinical setting. These divergences can be detected during the first years of undergraduate studies, and it is important to know the professional bias and its possible causes. MATERIALS AND METHODS: A procedure was developed through case-based learning (CBL) to assess various characteristics of decision-making during the early stages of student training. A semi-quantitative method was designed based on the narrative responses of a case with ethical implications in the field of gender violence. The method was applied to 294 undergraduate students in nursing (95), physiotherapy (109) and dentistry (90) from the Faculty of Health Sciences of a Spanish university. A frequency analysis of the narrative responses of the students to the proposed case was carried out, using the chi-square test to determine any association between the variables studied: gender, specialty and ethical knowledge. RESULTS: Four types of response categories were detected, as a result of combining the personal conversation, report to legal authority or require assistance of other teams. The most common option in dentists is conversation only, while physical therapists include the assistance of other teams. In nursing, a balance is observed between both possibilities. The results show that student responses differ significantly among specialties and also differ significantly according to test scores on ethical knowledge. However, no significant differences were found between the responses provided by men and women. CONCLUSION: Most of the health sciences students highly valued their own capacity for dialogue and reflection to approach situations with complex ethical dimensions. We consider that case-based learning (CBL), in combination with narrative analysis is a valid means of evaluating the professional ethical competencies of students in health sciences careers applied to a common goal.

Intestinal chemosensitivity in irritable bowel syndrome associates with small intestinal TRPV channel expression.

BACKGROUND: Irritable bowel syndrome (IBS) patients often experience meal-associated symptoms. However, the underlying mechanisms are unclear. AIM: To determine small intestinal mechanisms of lipid-induced symptoms and rectal hypersensitivity in IBS METHODS: We recruited 26 IBS patients (12 IBS-C, 14 IBS-D) and 15 healthy volunteers (HV). In vivo permeability was assessed using saccharide excretion assay. Rectal sensitivity was assessed using a barostat before and after small bowel lipid infusion; symptoms were assessed throughout. Next, an extended upper endoscopy with probe-based confocal laser endomicroscopy (pCLE) was performed with changes induced by lipids. Duodenal and jejunal mucosal biopsies were obtained for transcriptomics. RESULTS: Following lipid infusion, a higher proportion of HV than IBS patients reported no pain, no nausea, no fullness and no urgency (P < 0.05 for all). In a model adjusted for sex and anxiety, IBS-C and IBS-D patients had lower thresholds for first rectal sensation (P = 0.0007) and pain (P = 0.004) than HV. In vivo small intestinal permeability and mean pCLE scores were similar between IBS patients and HV. Post-lipid, pCLE scores were higher than pre-lipid but were not different between groups. Baseline duodenal transient receptor potential vanilloid (TRPV) 1 and 3 expression was increased in IBS-D, and TRPV3 in IBS-C. Duodenal TRPV1 expression correlated with abdominal pain (r = 0.51, FDR = 0.01), and inversely with first rectal sensation (r = -0.48, FDR = 0.01) and pain (r = -0.41, FDR = 0.02) thresholds. CONCLUSION: Lipid infusion elicits a greater symptom response in IBS patients than HV, which is associated with small intestinal expression of TRPV channels. TRPV-mediated small intestinal chemosensitivity may mediate post-meal symptoms in IBS.

Insomnia and sleep quality in healthcare workers fighting against COVID-19: a systematic review of the literature and meta-analysis.

The COVID-19 pandemic has the potential to significant- ly affect the mental health of healthcare workers, who stand in the frontline of this crisis. Insomnia is often related to exposure to stressful situations, such as the current health crisis, as well as other mental disorders, physical conditions and work-related problems. The objectives of this systematic review were: 1) to examine the impact of the current health pandemic produced by COVID-19 on insomnia and sleep quality of health professionals, and 2) to identify risk factors associated with insomnia. After a literature search in MEDLINE, EMBASE, and PsycINFO, 18 relevant studies were identified. The prevalence of insomnia estimated by random effects meta-analysis was 38% (95%CI= 37 to 39%), being slightly higher in women (29%, 95%CI= 27% to 30%) than in men (24%, 95%CI= 21 to 27%). The main risk factor associated with insomnia was working in a high-risk environment, followed by female sex and having a lower educational level. The high figures of self-reported insomnia and poor sleep quality observed indicate the need to develop interventions aimed at mitigating and caring for the mental health of healthcare workers fighting against this pandemic.

Changes in Levels and Determinants of Maternal Health Service Utilization in Ethiopia: Comparative Analysis of Two Rounds Ethiopian Demographic and Health Surveys.

BACKGROUND: Antenatal care (ANC), delivery by skilled birth attendants, and postnatal care (PNC) are critical components of maternal health services for reducing maternal mortality. The study aimed to compare the utilization of maternal health services in the two most recent rounds of Ethiopia Demographic and Health Surveys (EDHS) and identify the factors influencing the utilization of these services using the 2016 EDHS. METHODS: Two rounds of EDHS data in 2011 and 2016 were used to estimate the proportion of women who had ANC, delivered by skilled birth attendants, and had a postnatal checkup and other characteristics of the surveyed population. The most recent round of data-the 2016 EDHS-was used to examine the socio-cultural and reproductive health factors associated with the three maternal health services utilization. Chi-square tests and multivariate logistic regression analyses with adjusted Odds Ratios (AOR) were conducted using Stata 15.0. RESULTS: The use of ANC services and skilled birth attendants increased significantly between 2011 and 2016 EDHS, utilization of ANC services increased from 34.0 to 65.5%, and use of skilled birth attendants increased from 11.7 to 35.9%, respectively. The use of postnatal care decreased from 9.3 to 6.9%. Utilization of maternal health service was significantly associated with urban residence, Protestant religion, Oromo ethnicity, more education, more household wealth, and less parity. Furthermore, women who had ANC visits during pregnancy were more likely to subsequently use skilled birth attendants (AOR 5.5, p < 0.001) and PNC (AOR 2.9, p < 0.001). CONCLUSION: The study highlighted the inequalities in the utilization of maternal health services between rural and urban areas, and the need of addressing the social, economic, and physical barriers that prevent women from using these services. Further, programs should be targeted at promoting the use of professional birth and postnatal services in Ethiopia.