[Infectious Disease Prevention Group: Update on vaccines, 2022]. / Prevención de las enfermedades infecciosas. Actualización en vacunas PAPPS 2022.

The update of the preventive activities for this year 2022 in the field of infectious diseases is of special relevance due to the importance that prevention has gained and more specifically, vaccination as a tool to control the pandemic caused by the SARS-CoV-2 virus declared on March 11, 2020. The pandemic has focused much of the prevention efforts on its containment, but the importance of maintaining high vaccination coverage of the rest of the recommended vaccines to maintain good control of vaccine-preventable diseases and avoid complications in particularly vulnerable patients should not be forgotten. In this year's review we present a practical document with the aim of providing tools to primary care professionals who work with adults, to make the indication of each vaccine whether it is systematically recommended or if it is because the patient belongs to some risk group due to their condition or underlying pathology. In this way, throughout the document, we will comment on the most innovative aspects of systematic vaccination (flu, pneumococcus, meningococcal vaccines and vaccines against the human papillomavirus [HPV]), the new vaccines (pandemic vaccines against COVID-19, vaccines against herpes zoster of subunits, vaccines against monkeypox) and the recommended vaccines according to risk condition (pregnancy and lactation, travelers, patients with immunosuppression or underlying pathology).

Advances in Citrus Flowering: A Review.

Citrus are polycarpic and evergreen species that flower once in spring or several times a year depending on the genotype and the climatic conditions. Floral induction is triggered by low temperature and water-deficit stress and occurs 2-3 months before bud sprouting, whereas differentiation takes place at the same time as sprouting. The induced buds develop single flowers or determinate inflorescences, so that vegetative growth is required at the axillary buds to renew the polycarpic habit. The presence of fruits inhibits sprouting and flower induction from nearby axillary buds in the current season. In some species and cultivars, this results in low flowering intensity the following spring, thus giving rise to alternate bearing. A number of key flowering genes act in the leaf (CiFT3, CcMADS19, etc.) or in the bud (CsLFY, CsTFL1, etc.) to promote or inhibit both flowering time and reproductive meristem identity in response to these climatic factors, the fruit dominance, or the age of the plant (juvenility). The expression of some of these genes can be modified by gibberellin treatments, which reduce bud sprouting and flowering in adult trees, and constitute the main horticultural technique to control flowering in citrus. This review presents a comprehensive view of all aspects of the flowering process in citrus, converging the research published during the past half century, which focused on plant growth regulators and the nutritional source-sink relationships and guided research toward the study of gene transcription and plant transformation, and the advances made with the development of the tools of molecular biology published during the current century.

Oral cavity colon adenocarcinoma metastases: case report with surgical approach and review of more than 30 years literature.

INTRODUCTION: Metastatic oral tumours are rare, contributing to 1% of all malignant oral cavity tumours. CASE REPORT: We report the case of a 59-year-old man with colon cancer at an advanced disease stage, with progression to the peritoneum and maxillary gingiva. Palliative surgery was indicated to improve the patient's quality of life. DISCUSSION: In a review of the literature, we compiled a list of 27 cases (including the present case) reflecting some 30 years of literature on oral cavity metastatic disease originating in colon cancer. CONCLUSION: Oral cavity metastasis should be taken into account in the differential diagnosis of a synchronous or metachronous oral cavity lesion. The therapeutic goal should include palliative alternatives when necessary. Intraoral reconstruction using local flaps may be a simple and reliable palliative resection option aimed at improving the patient's quality of life.

Pharyngeal closure after a total laryngectomy: mechanical versus manual technique.

OBJECTIVE: To verify the main advantages and drawbacks of mechanical suturing for pharyngeal closure after total laryngectomy versus a manual suturing technique. METHODS: A retrospective review was carried out of 126 total laryngectomies performed between 2008 and 2018. Manual closure was performed in 80 cases (63.5 per cent) and mechanical suturing was performed in 46 cases (36.5 per cent). RESULTS: Mechanical suturing was used significantly more frequently in patients with: glottic tumours (p = 0.008), less local tumour extension (p = 0.017) and less pre-operative morbidity (p = 0.014). There were no significant differences in the incidence of pharyngocutaneous fistula between the manual suture group (16.3 per cent) and the mechanical suture group (13.0 per cent) (p = 0.628). None of the patients treated with mechanical suturing had positive surgical margins. Cancer-specific survival for the mechanical suture group was higher than that for the manual suture group (p = 0.009). CONCLUSION: Mechanical suturing of the pharynx after total laryngectomy is an oncologically safe technique if used in suitable cases.

[Infectious Disease Prevention Group. Update on vaccines, 2020]. / Prevención de las enfermedades infecciosas. Actualización en vacunas, 2020.

Vaccine development is one of the fastest growing sectors in medicine now and in the future, as we are living with the emergency health care for the SARS-CoV-2 coronavirus. The semFYC PAPPS program biannually publishes the recommendations of the group and, in this edition, special emphasis is placed on the common vaccination proposed by the Ministry of Health, where, at last, it no longer discriminates between paediatrics and adults, and proposes a calendar throughout life. The main novelties in the field of vaccinology today are focused on the consolidation of the nonavalent vaccine against the human papilloma virus and in the change of the dose of monovalent meningitis vaccine C for the tetravalent one, ACWY, at age 12. The pandemic we are experiencing has led to the postponement of most preventive activities. On the return to «normality¼, the vaccination calendar must be examined, and completed if necessary.

The flower to fruit transition in Citrus is partially sustained by autonomous carbohydrate synthesis in the ovary.

Why evergreen fruit tree species accumulate starch in the ovary during flower bud differentiation in spring, as deciduous species do during flower bud dormancy, is not fully understood. This is because in evergreen species carbon supply is assured by leaves during flower development. We suggest the existence of an autonomous mechanism in the flowers which counteracts the competition for photoassimilates with new leaves, until they become source organs. Our hypothesis is that starch accumulated during Citrus ovary ontogeny originates from 1) its own photosynthetic capacity and 2) the mobilization of reserves. Through defoliation experiments, we found that ovaries accumulate starch during flower ontogeny using a dual mechanism: 1) the autotrophic route of source organs activating Rubisco (RbcS) genes expression, and 2) the heterotrophic route of sink organs that hydrolyze sucrose in the cytosol. Defoliation 40 days before anthesis did not significantly reduce ovary growth, flower abscission or starch concentration up to 20 days after anthesis (i.e. 60 days later). Control flowers activated the energy depletion signaling system (i.e. SnRK1) and RbcS gene expression around athesis. Defoliation accelerated and boosted both activities, increasing SPS gene expression (sucrose synthesis), and SUS1, SUS3 and cwINV (sucrose hydrolysis) to maintain a glucose threshold which satisfied its need to avoid abscission.

Genetic inhibition of flowering differs between juvenile and adult Citrus trees.

BACKGROUND AND AIMS: In woody species, the juvenile period maintains the axillary meristems in a vegetative stage, unable to flower, for several years. However, in adult trees, some 1-year-old meristems flower whereas others remain vegetative to ensure a polycarpic growth habit. Both types of trees, therefore, have non-flowering meristems, and we hypothesize that the molecular mechanism regulating flower inhibition in juvenile trees is different from that in adult trees. METHODS: In adult Citrus trees, the main endogenous factor inhibiting flower induction is the growing fruit. Thus, we studied the expression of the main flowering time, identity and patterning genes of trees with heavy fruit load (not-flowering adult trees) compared to that of 6-month-old trees (not-flowering juvenile trees). Adult trees without fruits (flowering trees) were used as a control. Second, we studied the expression of the same genes in the meristems of 6-month, and 1-, 3-, 5- and 7-year-old juvenile trees compared to 10-year-old flowering trees. KEY RESULTS: The axillary meristems of juvenile trees are unable to transcribe flowering time and patterning genes during the period of induction, although they are able to transcribe the FLOWERING LOCUS T citrus orthologue (CiFT2) in leaves. By contrast, meristems of not-flowering adult trees are able to transcribe the flowering network genes but fail to achieve the transcription threshold required to flower, due to CiFT2 repression by the fruit. Juvenile meristems progressively achieve gene expression, with age-dependent differences from 6 months to 7 years, FD-like and CsLFY being the last genes to be expressed. CONCLUSIONS: During the juvenile period the mechanism inhibiting flowering is determined in the immature bud, so that it progressively acquires flowering ability at the gene expression level of the flowering time programme, whereas in the adult tree it is determined in the leaf, where repression of CiFT2 gene expression occurs.

Hormonal control of parthenocarpic fruit set in 'Rojo Brillante' persimmon (Diospyros kaki Thunb.).

In persimmon (Diospyros kaki Thunb.), one to three waves of fruit abscission can occur. The parthenocarpic cv. Rojo Brillante may abscise close to 50% of flowers, which implies a major economic losses. In order to study this process, 700 flowers were labelled, 600 had the lobes of the calyx removed at three stages to promote abscission. Half of them were also treated with gibberellic acid (GA3; 10 mg l-1) to counteract the effect, and 100 were used as control. In the second year, GA3 (25 mg l-1) was applied to whole trees. Calyx lobe removal (CLR) reduced fruit growth rates and advanced and increased fruitlet abscission, whereas GA3 counteracted this effect. Furthermore, when GA3 was applied to the whole tree, fruit set was increased. The time-course of fruit abscission paralleled a decreased in hormonal and carbohydrate contents. Control fruit showed a peak of gibberellin (GA1 and GA4) and IAA concentration at anthesis. Hexose concentrations remained almost constant from flower bud to fruit set, whereas that of sucrose diminished with time. A peak in ethylene production occurred at anthesis, which increased when CLR was performed prior to or at anthesis, but not when performed at fruit set, when ethylene was markedly smaller. GA3 also counteracted it. Accordingly, we suggest that fruit set depends on the induction of gibberellin (GA) and IAA responses in the persimmon, and since there is no shortage of hormones or carbohydrates at anthesis, ethylene production at anthesis seems the most plausible cause of the physiological fruitlet abscission.

Prevención de las enfermedades infecciosas. Actualización PAPPS en vacunas 2018 / No disponible

No disponible

Effectiveness of the I2AO2 interdisciplinary programme led by nurses on metabolic syndrome and cardiovascular risk: a randomized, controlled trial.

Objective To evaluate the effectiveness of an interdisciplinary programme led by nurses in relation to metabolic syndrome (MS) and cardiovascular risk (CVR). Methods This randomized, controlled, clinical trial included 74 patients diagnosed with MS (experimental group [EG], n = 37; control group [CG], n = 37). The intervention consisted of a 12-month interdisciplinary programme (pre-test, 6 months of intervention, 12 months of intervention, and 1-year follow-up post-intervention) coordinated by nursing. Results We found a progressive and significant reduction for all clinical, biochemical, and anthropometric parameters analysed at different time points. In the EG, remission of MS by 48.1% in the short term was observed (83.8% in the medium term) and maintained at 1 year post-intervention. In the CG, the prevalence of MS increased by 2.7% from the initial evaluation to study completion. A similar trend was observed for CVR. In the EG, 100% of subjects had a moderate-low risk of CVR at 1 year post-intervention, whereas the CG had CVR in all categories. Conclusion An interdisciplinary, nurse-led programme improves participants' metabolic and cardiovascular health, while maintaining long-term effects. Our findings suggest an important role of the professional nurse as a nexus between the patient, different professionals, and the community.

Manejo de las infecciones odontogénicas en las consultas de atención primaria: ¿antibiótico? / Management of odontogenic infections in Primary Care: Antibiotic?

Nuestro objetivo es intentar contribuir al uso racional de los antibióticos prescritos por los médicos de familia cuando un paciente consulta por un problema odontológico. Actualmente la pregunta que nos debemos hacer es si hay que tomar antibiótico, en lugar de cuál dar. Revisamos las principales infecciones odontológicas, cuál debe ser el tratamiento adecuado y el papel de la prevención. Es necesario conocer la complejidad de la microflora de la cavidad oral, pues de ella dependerá la conveniencia de antibioterapia, la evolución hacia la curación o la progresión de algunas infecciones odontogénicas. La placa bacteriana, formada por el biofilm, se comporta como una barrera para la acción de los antimicrobianos. Es en la prevención de su formación, así como en la eliminación mecánica de esta una vez formada, en lo que el médico de familia debe insistir. Debemos transmitir a la población que los antibióticos no curan el dolor dental

Our aim is to contribute to the rational use of antibiotics prescribed by family doctors when a patient consults for a dental problem. Nowadays we should not ask which antibiotic to give. The question has to be if we need to prescribe antibiotics in front of the most common odontogenic infections seen in our practice. We review the main dental infections, which should be their appropriate management and the role of prevention. We need to know the complexity of the oral microbiome because it’l depend on the appropriateness of the antibiotherapy, the evolution towards cure or progression of some odontogenic infections. The bacterial plaque, formed by the biofilm, behaves as a barrier to the action of antimicrobials. It’s in the prevention of its development as well as in it mechanical elimination once shaped, in what the family doctor should insist. We must transmit antibiotics don’t heal dental pain

[Management of odontogenic infections in Primary Care: Antibiotic?] / Manejo de las infecciones odontogénicas en las consultas de atención primaria: ¿antibiótico?

Our aim is to contribute to the rational use of antibiotics prescribed by family doctors when a patient consults for a dental problem. Nowadays we should not ask which antibiotic to give. The question has to be if we need to prescribe antibiotics in front of the most common odontogenic infections seen in our practice. We review the main dental infections, which should be their appropriate management and the role of prevention. We need to know the complexity of the oral microbiome because it?ll depend on the appropriateness of the antibiotherapy, the evolution towards cure or progression of some odontogenic infections. The bacterial plaque, formed by the biofilm, behaves as a barrier to the action of antimicrobials. It?s in the prevention of its development as well as in it mechanical elimination once shaped, in what the family doctor should insist. We must transmit antibiotics don?t heal dental pain.

Estimación del volumen de anestésico local en contacto con el nervio ciático en el bloqueo poplíteo / 3D ultrasound estimation of the effective volume for popliteal block at the level of division

La administración del anestésico local en el tejido conectivo que une los componentes tibial y peroneo del nervio ciático a nivel de su división en el hueco poplíteo produce una distribución muy eficiente de anestésico para conseguir un bloqueo efectivo. Mediante ecografía en 3dimensiones podemos cuantificar este volumen de contacto en una longitud determinada del nervio. Métodos. Se incluyó a 20 pacientes consecutivos programados para cirugía de hallux valgus. En todos los casos se realizó un bloqueo poplíteo ecoguiado en la división del nervio ciático, en abordaje «fuera de plano» con el paciente en decúbito prono. Se administraron 30ml de anestésico local y se evaluó su difusión. Se realizó una adquisición volumétrica del nervio ciático antes e inmediatamente después de finalizar la inyección del fármaco para cuantificar el volumen del nervio ciático y el volumen contenido en el interior del tejido conectivo que envuelve ambos componentes del nervio ciático; todo ello en un segmento de 5cm de nervio. Resultados. Todos los bloqueos fueron efectivos a los 20 min. El volumen de anestésico local contenido en el interior del tejido conectivo fue de 6,8±2,6cm3. De este volumen, 4,4±1,7cm3 se situaban en el halo que envolvía los componentes del nervio y 2,4±1,7cm3 se ubicaban en el interior del nervio ciático o sus componentes. Conclusiones. El volumen en contacto con el nervio ciático puede ser estimado mediante la adquisición volumétrica. Nuestros resultados indican que el volumen para el bloqueo efectivo del nervio ciático a nivel poplíteo quizás se podrá reducir de forma significativa en un futuro (AU)

Local anaesthetic injection between the tibial and commmon peroneal nerves within connective tissue sheath results in a predictable diffusion and allows for a reduction in the volume needed to achieve a consistent sciatic popliteal block. Using 3D ultrasound volumetric acquisition, we quantified the visible volume in contact with the nerve along a 5cm segment. Methods. We included 20 consecutive patients scheduled for bunion surgery. Ultrasound guided popliteal block was performed using a posterior, out of plane approach at the level of división of the sciatic nerve. Thirty ml of mepivacaine 1.5% and levobupivacaine 0.5% were slowly injected while assessing the injection pressure and the diffusion of the local anaesthetic. Volumetric acquisition was performed before and after the block to quantify the the volume of the sciatic nerve and the volume of the surrounding hypoechoic halo contained inside the connective tissue in a 5cm segment. Results. All blocks were successful within 20min after the injection. The total estimated volume contained inside the common connective tissue sheath was 6.8±2.6cm3. Of this, the volume of the halo sorrounding the nerve was 4.4±1.7cm3 and the volume inside the sciatic nerve was 2.4±1.7cm3. Conclusions. The volume of local anaesthetic in close contact with the sciatic nerve can be estimated by volumetric acquisition. Our results suggest that the effective volume of local anaesthetic needed for a successful sciatic popliteal block could be reduced to less than 7ml (AU)

Roux-en-Y Gastric Bypass.

BACKGROUND: Roux-en-Y gastric bypass (RYGB) is considered the gold standard for gastric bypass, displaying better results for metabolic disorders than other surgical procedures over the long term. The aim of this study was to determine the effects of bariatric surgery, in particular the RYGB technique, on metabolic syndrome (MS) and other biochemical parameters implicit in the comorbid conditions associated with obesity, as well as to explore the influence of this surgical procedure on psychiatric comorbidity in the study population. METHOD: An observational retrospective cohort study based on 146 clinical records of patients having undergone RYGB between January 1, 2011, and January 1, 2014, was performed. Data related to metabolic and psychiatric comorbidity were gathered at three stages: prior to surgery and at 3 and 9 months following surgery. RESULTS: There was a progressive and statistically significant reduction of all biochemical parameters analyzed at 3 and 9 months following surgery except high-density lipoprotein cholesterol, which significantly increased (beneficial) in value. These changes imply a remission of >90% for all metabolic disorders and the consequent tendency toward a reduction in prescribed pharmacological treatments, with MS found in only one subject at 9 months. There was, however, no significant reduction in pharmacological treatments for psychiatric comorbidities. CONCLUSION: Findings suggest that RYGB is an effective treatment for MS and other metabolic disorders but not for psychiatric comorbidities accompanying MS.

Ethylene biosynthesis and perception during ripening of loquat fruit (Eriobotrya japonica Lindl.).

In order to gain insights into the controversial ripening behavior of loquat fruits, in the present study we have analyzed the expression of three genes related to ethylene biosynthesis (ACS1, ACO1 and ACO2), two ethylene receptors (ERS1a and ERS1b), one signal transduction component (CTR1) and one transcription factor (EIL1) in peel and pulp of loquat fruit during natural ripening and also in fruits treated with ethylene (10µLL-1) and 1-MCP (10µLL-1), an ethylene action inhibitor. In fruits attached to or detached from the tree, a slight increase in ethylene production was detected at the yellow stage, but the respiration rate declined progressively during ripening. Accumulation of transcripts of ethylene biosynthetic genes did not correlate with changes in ethylene production, since the maximum accumulation of ACS1 and ACO1 mRNA was detected in fully coloured fruits. Expression of ethylene receptor and signaling genes followed a different pattern in peel and pulp tissues. After fruit detachment and incubation at 20°C for up to 6days, ACS1 mRNA slightly increased, ACO1 experienced a substantial increment and ACO2 declined. In the peel, these changes were advanced by exogenous ethylene and partially inhibited by 1-MCP. In the pulp, 1-MCP repressed most of the changes in the expression of biosynthetic genes, while ethylene had almost no effects. Expression of ethylene perception and signaling genes was barely affected by ethylene or 1-MCP. Collectively, a differential transcriptional regulation of ethylene biosynthetic genes operates in peel and pulp, and support the notion of non-climacteric ripening in loquat fruits. Ethylene action, however, appears to be required to sustain or maintain the expression of specific genes.

3D ultrasound estimation of the effective volume for popliteal block at the level of division. / Estimación del volumen de anestésico local en contacto con el nervio ciático en el bloqueo poplíteo.

Local anaesthetic injection between the tibial and commmon peroneal nerves within connective tissue sheath results in a predictable diffusion and allows for a reduction in the volume needed to achieve a consistent sciatic popliteal block. Using 3D ultrasound volumetric acquisition, we quantified the visible volume in contact with the nerve along a 5cm segment. METHODS: We included 20 consecutive patients scheduled for bunion surgery. Ultrasound guided popliteal block was performed using a posterior, out of plane approach at the level of división of the sciatic nerve. Thirty ml of mepivacaine 1.5% and levobupivacaine 0.5% were slowly injected while assessing the injection pressure and the diffusion of the local anaesthetic. Volumetric acquisition was performed before and after the block to quantify the the volume of the sciatic nerve and the volume of the surrounding hypoechoic halo contained inside the connective tissue in a 5cm segment. RESULTS: All blocks were successful within 20min after the injection. The total estimated volume contained inside the common connective tissue sheath was 6.8±2.6cm3. Of this, the volume of the halo sorrounding the nerve was 4.4±1.7cm3 and the volume inside the sciatic nerve was 2.4±1.7cm3. CONCLUSIONS: The volume of local anaesthetic in close contact with the sciatic nerve can be estimated by volumetric acquisition. Our results suggest that the effective volume of local anaesthetic needed for a successful sciatic popliteal block could be reduced to less than 7ml.

Pomological Traits, Sensory Profile and Nutraceutical Properties of Nine Cultivars of Loquat (Eriobotrya japonica Lindl.) Fruits Grown in Mediterranean Area.

In this paper the diversity of fruit quality within nine loquat cultivars, including five international affirmed cultivars (Algerie, Golden Nugget, Peluche, Bueno, El Buenet) and four local cultivars (Sanfilippara, Nespolone di Trabia, BRT20 and Claudia), were investigated in order to discriminate the variation in pomological characteristics, sensory profile, and antioxidant properties. Finally, to evaluate potential bioactivity, antiproliferative activity of hydrophilic extracts from loquat fruits was assessed, at dietary relevant concentrations, against three human epithelial cell lines. Even though the international cultivars confirmed an appropriate level of commercial qualities in association to high levels in antioxidant compounds, the local cultivars revealed the best performances in a wide range of chemical-physical and sensory characteristics. Concerning bioactivity, our results indicate that hydrophilic extracts from all tested cultivars showed concentration-dependent antiproliferative activity with a significant variability of effects between different cell lines and between different cultivars. HeLa cells, the most sensitive and hydrophilic extracts from Peluche, showed the highest inhibitory effect followed by Nespolone di Trabia and Claudia. The results of this trial provide useful information on the pomological traits and the not yet known specific nutritional and functional properties of loquat fruits. Our data, besides helping to promote specific local cultivars, could serve to establish a database that will permit to improve the utilization of specific genetic resources in breeding programs.

[Introduction to antiseptics]. / Introducción a los antisépticos.

Antiseptics are anti-infectious agents for local use on the skin or mucosa, which distinguishes them from disinfectants, which are used on inanimate surfaces usually because of their toxicity. The present article explains the differences among the multiple possible antiseptics; special attention is paid to the most common, such as alcohol, chlorhexidine, povidone iodine, and oxygenated water. Finally, we stress the different antiseptic formulations, which increase the usefulness of these agents in specific indications.

[Antiseptic use in primary care]. / Uso de los antisépticos en atención primaria.

Wounds can be classified according to their mechanism of action into surgical or traumatic (which may be incision wounds, such as those provoked by a sharp object; contusions, caused by a blunt force; puncture wounds, caused by long, sharp objects; lacerations, caused by tears to the tissue; or bites, which have a high risk of infection and consequently should not be sutured). Wounds can also be classified by their healing process into acute or chronic (pressure ulcers, vascular ulcers, neuropathic ulcers, acute wounds with torpid clinical course). The use of antiseptics in any of these wounds is usually limited to cleaning and initial care -up to 48 hours- and to washing of hands and instruments. The use of antiseptics in chronic or persistent wounds is more debatable. The same is true of burns, in which the use of formulations that encourage hydration is recommended. In the pediatric population, the use of antiseptics with a known safety profile and low absorption is usually recommended, especially in the care of the umbilical cord, in which evidence supports the use of chlorhexidine gluconate. Another use of antiseptics is the care of wounds produced by procedures used in body esthetics, such as piercings; in these procedures, it is advisable to use transparent antiseptics that allow visualization of the technique.