Retos y estrategias para recuperar y dinamizar la atención primaria. Metodología DAFO (Debilidades, Amenazas, Fortalezas y Oportunidades)-CAME (Corregir, Afrontar, Mantener y Explotar) en un departamento de salud / Challenges and strategies to recover and dynamize primary care: SWOT-CAME analysis in a Health Department

Objetivo: Identificar fortalezas, obstáculos, cambios en el entorno y capacidades de los equipos y unidades de apoyo en atención primaria, con el objetivo de proporcionar atención de alta calidad en un área de salud integrada. Diseño: Estudio de métodos mixtos basado en la matriz DAFO y el análisis CAME. Emplazamiento: Atención primaria, Comunidad Valenciana. Participantes: En total han participado 271 profesionales de los diferentes colectivos y representantes de asociaciones de pacientes, 99 en la fase de captura de ideas, 154 en la fase de elaboración de la matriz DAFO y 18 en la fase de elaboración del análisis CAME. Intervenciones: Se condujo un análisis DAFO-CAME a partir del cual se establecieron líneas de acción. La captura de información se realizó mediante grupos nominales, la fase de consenso integrando al conjunto de profesionales mediante Delphi y conferencia de consenso. Mediciones principales: Priorización de propuestas para mantener las fortalezas, afrontar las amenazas, explotar las oportunidades, corregir las debilidades en el marco de un plan de acción de un área de salud integrada. Resultados: Se propusieron un total de 82 ideas diferentes (20 fortalezas, 40 debilidades, 4 amenazas, 12 oportunidades y 6 amenazas-oportunidades). Este análisis condujo a un plan estratégico con 7 líneas y 33 acciones/intervenciones priorizadas. Conclusiones: Atención integrada buscando fórmulas colaborativas entre niveles asistenciales, redefinición de roles, soluciones digitales, capacitación del personal y mejoras en equipamientos y procesos de soporte, junto a medidas para afrontar el envejecimiento de la población y las necesidades de centros sociosanitarios constituyen los retos sobre los que actuar.(AU)

Objective: To identify strengths, obstacles, changes in the environment, and capabilities of primary care teams and support units, with the aim of providing high-quality care in an integrated healthcare area. Design: Mixed methods study based on the SWOT matrix and CAME analysis. Location: Primary care, Valencian community. Participants: A total of 271 professionals from different collectives and patient association representatives participated. 99 in the idea generation phase, 154 in the SWOT matrix development phase, and 18 in the CAME analysis development phase. Interventions: A SWOT-CAME analysis was conducted, from which action lines were established. Information capture was carried out through nominal groups, and the consensus phase involved integrating all professionals through Delphi and consensus conference techniques. Main measurements: Prioritization of proposals to maintain strengths, address threats, exploit opportunities, and correct weaknesses within the framework of an integrated healthcare area action plan. Results: A total of 82 different ideas were proposed (20 strengths; 40 weaknesses; 4 threats; 12 opportunities; 6 threats-opportunities), which, once prioritized, were translated into 7 lines and 33 prioritized actions/interventions (CAME analysis). Conclusions: Integrated care, seeking collaborative approaches between care levels, redefining roles, digital solutions, staff training, and improvements in equipment and support processes, along with measures to address the aging population and the needs of socio-sanitary centers, constitute the challenges to be addressed.(AU)

Tuberculosis among children visiting friends & relatives.

BACKGROUND: Most paediatric tuberculosis (TB) cases in low-TB-incidence countries involve children born to migrant families. This may be partially explained by trips to their countries of origin for visiting friends and relatives (VFR). We aimed to estimate the risk of latent TB infection (LTBI) and TB in children VFR. METHODS: We conducted a prospective multicentric observational study in Catalonia (Spain) from 06/2017 to 12/2019. We enrolled children aged < 15 years with a negative tuberculin skin test (TST) at baseline and at least one parent from a high-TB-incidence country, and who had travelled to their parent's birth country for ≥21 days. TST and QuantiFERON-TB Gold Plus (QFT-Plus) were performed within 8-12 weeks post-return. LTBI was defined as a TST ≥5 mm and/or a positive QFT-Plus. RESULTS: Five hundred children completed the study, equivalent to 78.2 person-years of follow-up (PYFU). Thirteen children (2.6%) were diagnosed with LTBI (16.6/per100 PYFU,95%CI = 8.8-28.5), including two cases (0.4%) of TB (2.5/per100 PYFU, 95%CI = 0.3-9.3). LTBI incidence rates remained high after excluding BCG-vaccinated children (9.7/per100 PYFU,95%CI = 3.9-20.0). Household tobacco smoke exposure was associated with LTBI (aOR = 3.9, 95%CI = 1.1-13.3). CONCLUSIONS: The risk of LTBI in children VFR in high-TB-incidence countries may equal, or perhaps even exceed, the infection risk of the native population. The primary associated risk factor was the presence of smokers in the household. Furthermore, the incidence rate of active TB largely surpassed that of the countries visited. Children VFR in high-TB-incidence countries should be targeted for diagnostic and preventive interventions.

Doubling the life of Cu/ZnO methanol synthesis catalysts via use of Si as a structural promoter to inhibit sintering.

Cu/ZnO/Al2O3 catalysts used to synthesize methanol undergo extensive deactivation during use, mainly due to sintering. Here, we report on formulations wherein deactivation has been substantially reduced by the targeted use of a small quantity of a Si-based promoter, resulting in accrued activity benefits that can exceed a factor of 1.8 versus unpromoted catalysts. This enhanced stability also provides longer lifetimes, up to double that of prior generation catalysts. Detailed characterization of a library of aged catalysts has allowed the most important deactivation mechanisms to be established and the chemical state of the silicon promoter to be identified. We show that silicon is incorporated within the ZnO lattice, providing a pronounced improvement in the hydrothermal stability of this component. These findings have important implications for sustainable methanol production from H2 and CO2.

[Challenges and strategies to recover and dynamize primary care: SWOT-CAME analysis in a Health Department]. / Retos y estrategias para recuperar y dinamizar la atención primaria. Metodología DAFO (Debilidades, Amenazas, Fortalezas y Oportunidades)-CAME (Corregir, Afrontar, Mantener y Explotar) en un departamento de salud.

OBJECTIVE: To identify strengths, obstacles, changes in the environment, and capabilities of primary care teams and support units, with the aim of providing high-quality care in an integrated healthcare area. DESIGN: Mixed methods study based on the SWOT matrix and CAME analysis. LOCATION: Primary care, Valencian community. PARTICIPANTS: A total of 271 professionals from different collectives and patient association representatives participated. 99 in the idea generation phase, 154 in the SWOT matrix development phase, and 18 in the CAME analysis development phase. INTERVENTIONS: A SWOT-CAME analysis was conducted, from which action lines were established. Information capture was carried out through nominal groups, and the consensus phase involved integrating all professionals through Delphi and consensus conference techniques. MAIN MEASUREMENTS: Prioritization of proposals to maintain strengths, address threats, exploit opportunities, and correct weaknesses within the framework of an integrated healthcare area action plan. RESULTS: A total of 82 different ideas were proposed (20 strengths; 40 weaknesses; 4 threats; 12 opportunities; 6 threats-opportunities), which, once prioritized, were translated into 7 lines and 33 prioritized actions/interventions (CAME analysis). CONCLUSIONS: Integrated care, seeking collaborative approaches between care levels, redefining roles, digital solutions, staff training, and improvements in equipment and support processes, along with measures to address the aging population and the needs of socio-sanitary centers, constitute the challenges to be addressed.

ANCA detection with solid phase chemiluminescence assay: diagnostic and severity association in vasculitis.

ANCA-associated vasculitis (AAV) comprises a group of necrotizing vasculitis that mainly affects small- and medium-sized vessels. Serum anti-neutrophil cytoplasmic antibodies (ANCA), mainly anti-myeloperoxidase (anti-MPO) and anti-proteinase 3 (anti-PR3), levels may correlate to severity, prognosis, and recurrence of the disease. A retrospective analysis of 101 patients with MPO-positive and 54 PR3-positive vasculitis was performed, using laboratory established cut-off value, measured by chemiluminescence. Furthermore, data of renal disease and pulmonary involvement were collected at vasculitis diagnosis, as well as the progress, requiring dialysis, transplant, or mortality. For anti-MPO antibodies with a diagnosis of vasculitis (n = 77), an area under the curve (AUC) was calculated (AUC = 0.8084), and a cut-off point of 41.5 IU/ml was determined. There were significant differences in anti-MPO levels between patients with renal or pulmonary dysfunction (n = 65) versus those without them (n = 36) (p = 0.0003), and a cut-off threshold of 60 IU/ml was established. For anti-PR3 antibodies with a diagnosis of vasculitis (n = 44), an area under the curve (AUC) was calculated (AUC = 0.7318), and a cut-off point of 20.5 IU/ml was determined. Significant differences in anti-PR3 levels were observed between those patients with renal or pulmonary dysfunction (n = 30) and those without them (n = 24) (p = 0.0048), and a cut-off threshold of 41.5 IU/ml was established. No significant differences between those patients who had a worse disease progression and those who did not were found for anti-MPO and anti-PR3. Anti-MPO and anti-PR3 levels at the moment of vasculitis diagnosis are related with disease severity but not with disease outcome or vasculitis recurrence.

Case report: Self-administration of alpha-1 antitrypsin therapy: a report of two cases.

Intravenous augmentation therapy with human alpha-1 proteinase inhibitor for the management of respiratory disease is recommended for people with alpha-1 antitrypsin deficiency (AATD) who are nonsmokers or former smokers. Augmentation therapy usually requires weekly administration at the hospital or clinic and poses an additional burden for patients due to interference with daily life, including work and social activities. Self-administration is a useful alternative to overcome this limitation, but there is a lack of published information on clinical outcomes. We report two cases of individuals with AATD at different stages of the disease who were successfully managed with self-administered augmentation therapy, with increased satisfaction because of the independence gained, lack of interference with clinical stability, and no relevant safety issues.

Patrones y factores dietéticos y su asociación con la ansiedad en población adulta: propuesta de recomendaciones basada en una revisión de alcance de revisiones sistemáticas y metaanálisis / Dietary patterns and factors and their association with the anxiety in adult population: proposed recommendations based on a scoping review of systematic reviews and meta-analyses

Un alto porcentaje de la población sufre ansiedad, trastorno que puede verse influenciado por los hábitos dietéticos. El objetivo de esta revisión fue recopilar la evidencia existente sobre los patrones y factores dietéticos, y su asociación con la ansiedad para proponer unas recomendaciones clínicamente aplicables. Se realizó una revisión de alcance (Scoping Review) de revisiones sistemáticas y metaanálisis en la base de datos MEDLINE (PubMed) hasta enero de 2021, informando de los principales hallazgos según PRISMA (2020). Para construir la estrategia de búsqueda, se emplearon el lenguaje MeSH, palabras clave (“dieta”, “nutrientes”, “estilo de vida saludable”, “ansiedad”) y filtros, combinándose mediante operadores booleanos. Se seleccionaron 12 artículos, siete revisiones sistemáticas con metaanálisis y cinco revisiones sistemáticas. Se obtuvieron diversos resultados en los que se evaluaba la relación entre la ansiedad y diferentes aspectos de la dieta. Las principales asociaciones encontradas se observaron entre un mayor consumo de verduras crudas y frutas, la sustitución de cereales refinados por integrales, la ingesta de AGP omega-3 y omega-6 y el incremento del consumo de minerales y vitaminas, triptófano y antioxidantes. De acuerdo con las revisiones sistemáticas y metaanálisis incluidos como resultados, se propusieron diez recomendaciones sobre el consumo de alimentos y la ingesta de nutrientes que deberían priorizarse en estos pacientes. Según la literatura revisada, se concluye que existen patrones y factores dietéticos que podrían ejercer una mayor influencia protectora sobre la ansiedad. Esta propuesta de recomendaciones dietéticas basadas en la evidenciapermitirá a los profesionales sanitarios disponer de unas pautas actualizadas que sirvan como una primera guía. (AU)

A high percentage of the population suffers from anxiety, a disorder that can be influenced by dietary habits. The aim of this review was to compile the existing evidence on dietary patterns and factors, and their association with anxiety to propose clinically applicable recommendations. A scoping review of systematic reviews and meta-analyses was conducted in the MEDLINE database (PubMed) until January 2021, reporting the main findings based on PRISMA (2020). To construct the search strategy, MeSH language, keywords (“diet”, “nutrients”, “healthy lifestyle”, “anxiety”) and filters were used, combined using Boolean operators. Twelve articles, seven systematic reviews with meta-analysis and five systematic reviews were selected. Several results were obtained evaluating the relationship between anxiety and different aspects of diet. The main associations found were between increased consumption of raw vegetables and fruits, substitution of refined cereals by whole grains, intake of omega-3 and omega-6 fats, and increased intake of minerals and vitamins, tryptophan and antioxidants. Based on the systematic reviews and meta-analyses included as findings, ten recommendations on food consumption that should be considered as a priority for these patients were proposed. Based on the literature reviewed, it is concluded that there are dietary patterns and factors that could have a stronger positive influence on anxiety. This proposal of evidence-based dietary recommendations may allow healthcare professionals to have updated recommendations to provide a first orientation. (AU)

[Dietary patterns and factors and their association with the anxiety in adult population: proposed recommendations based on a scoping review of systematic reviews and meta-analyses]. / Patrones y factores dietéticos y su asociación con la ansiedad en población adulta: propuesta de recomendaciones basada en una revisión de alcance de revisiones sistemáticas y metaanálisis.

Introduction: A high percentage of the population suffers from anxiety, a disorder that can be influenced by dietary habits. The aim of this review was to compile the existing evidence on dietary patterns and factors, and their association with anxiety to propose clinically applicable recommendations. A scoping review of systematic reviews and meta-analyses was conducted in the MEDLINE database (PubMed) until January 2021, reporting the main findings based on PRISMA (2020). To construct the search strategy, MeSH language, keywords ("diet", "nutrients", "healthy lifestyle", "anxiety") and filters were used, combined using Boolean operators. Twelve articles, seven systematic reviews with meta-analysis and five systematic reviews were selected. Several results were obtained evaluating the relationship between anxiety and different aspects of diet. The main associations found were between increased consumption of raw vegetables and fruits, substitution of refined cereals by whole grains, intake of omega-3 and omega-6 fats, and increased intake of minerals and vitamins, tryptophan and antioxidants. Based on the systematic reviews and meta-analyses included as findings, ten recommendations on food consumption that should be considered as a priority for these patients were proposed. Based on the literature reviewed, it is concluded that there are dietary patterns and factors that could have a stronger positive influence on anxiety. This proposal of evidence-based dietary recommendations may allow healthcare professionals to have updated recommendations to provide a first orientation.

Introducción: Un alto porcentaje de la población sufre ansiedad, trastorno que puede verse influenciado por los hábitos dietéticos. El objetivo de esta revisión fue recopilar la evidencia existente sobre los patrones y factores dietéticos, y su asociación con la ansiedad para proponer unas recomendaciones clínicamente aplicables. Se realizó una revisión de alcance (Scoping Review) de revisiones sistemáticas y metaanálisis en la base de datos MEDLINE (PubMed) hasta enero de 2021, informando de los principales hallazgos según PRISMA (2020). Para construir la estrategia de búsqueda, se emplearon el lenguaje MeSH, palabras clave ("dieta", "nutrientes", "estilo de vida saludable", "ansiedad") y filtros, combinándose mediante operadores booleanos. Se seleccionaron 12 artículos, siete revisiones sistemáticas con metaanálisis y cinco revisiones sistemáticas. Se obtuvieron diversos resultados en los que se evaluaba la relación entre la ansiedad y diferentes aspectos de la dieta. Las principales asociaciones encontradas se observaron entre un mayor consumo de verduras crudas y frutas, la sustitución de cereales refinados por integrales, la ingesta de AGP omega-3 y omega-6 y el incremento del consumo de minerales y vitaminas, triptófano y antioxidantes. De acuerdo con las revisiones sistemáticas y metaanálisis incluidos como resultados, se propusieron diez recomendaciones sobre el consumo de alimentos y la ingesta de nutrientes que deberían priorizarse en estos pacientes. Según la literatura revisada, se concluye que existen patrones y factores dietéticos que podrían ejercer una mayor influencia protectora sobre la ansiedad. Esta propuesta de recomendaciones dietéticas basadas en la evidenciapermitirá a los profesionales sanitarios disponer de unas pautas actualizadas que sirvan como una primera guía.

Relationship of Morphometrics and Symptom Severity in Female Type I Chiari Malformation Patients with Biological Resilience.

In the present study we report the relationship among MRI-based skull and cervical spine morphometric measures as well as symptom severity (disability-as measured by Oswestry Head and Neck Pain Scale and social isolation-as measured by the UCLA Loneliness scale) on biomarkers of allostatic load using estrogen, interleukin-6, C-reactive protein, and cortisol in a sample of 46 CMI patients. Correlational analyses showed that McRae line length was negatively associated with interleukin-6 and C-reactive protein levels, and Analysis of Variance (ANOVA) showed joint effects of morphometric measures (McRae line length, anterior CSF space) and symptom severity (disability and loneliness) on estrogen and intereukin-6 levels. These results are consistent with allostatic load. That is, when the combination of CSF crowding and self-report symptom (disability and loneliness) severity exceed the capacity of biological resilience factors, then biomarkers such as neuroprotective estrogen levels drop, rather than rise, with increasing symptom severity.

House dust mite subcutaneous immunotherapy has sustained long-term effectiveness on allergic rhinitis and asthma: A 10-year follow-up.

BACKGROUND: Maintenance doses for allergen immunotherapy (AIT) have been recommended for at least 3 years but little data on long-term efficacy is available depending on AIT duration. To show sustained efficacy 10 years after completion of treatment with depigmented-polymerized house dust mite (dpg-pol HDM) allergen extract in adults with asthma and/or rhinoconjunctivitis. METHODS: Patients included in a double-blind placebo-controlled AIT study with dpg-pol HDM allergen extract were reviewed at completion of the perennial treatment and 10-year follow-up (10y-FU). Change in symptom and rescue medication score was the primary objective. Visual analog scale (VAS), asthma control test (ACT), and degree of disease control were the secondary objectives. A comparative analysis between patients who underwent AIT treatment for <3 years and ≥3 years was performed. RESULTS: Data from 31 patients (mean age 38 years) were available at 10y-FU. All had asthma and 29 had rhinoconjunctivitis at baseline. Twenty-three patients were treated ≥3 years and 8 for <3 years. Seventeen (55%) patients were asymptomatic at completion of AIT, with significant differences for nasal, conjunctival, and bronchial symptoms (p < .0001) compared with baseline only in those patients treated ≥3 years. Nine (52.9%) patients remained completely asymptomatic at 10y-FU, all were treated for ≥3 years. Moreover, significant reduction in the number of patients with rhinitis (p = .0117), conjunctivitis (p < .0001), and bronchial (p = .0005) symptoms was observed at 10y-FU compared with baseline only in the ≥3 years treated. Ten (32.3%) patients did not require any rescue medication at 10y-FU, all had been treated for ≥3 years. ACT at 10y-FU showed a good control of asthma (median 23.5; 95% IC[22.0, 25.0]). No significant differences were observed between VAS at end of treatment compared with VAS at 10y-FU. CONCLUSIONS: Sustained clinical efficacy is achieved 10 years after completion of depigmented-polymerized HDM, however, these findings were observed only if patients are treated for at least 3 years.

Donor-Derived Cell-Free DNA at 1 Month after Kidney Transplantation Relates to HLA Class II Eplet Mismatch Load.

Kidney transplantation is the preferred therapeutic option for end-stage renal disease; however, the alloimmune response is still the leading cause of renal allograft failure. To better identify immunologic disparities in order to evaluate HLA compatibility between the donor and the recipient, the concept of eplet load has arisen. Regular kidney function monitoring is essential for the accurate and timely diagnosis of allograft rejection and the appropriate treatment. Donor-derived cell-free DNA (dd-cfDNA) has been proposed as a potential biomarker of acute rejection and graft failure in kidney transplantation. The proportion of plasma dd-cfDNA was determined in forty-two kidney patients at 1 month after transplantation. A total of eleven (26.2%) patients had a dd-cfDNA proportion of ≥1.0%. The only pretransplant variable related to dd-cfDNA > 1.0% was the HLA class II eplet mismatch load, mainly the HLA-DQB1 eplet mismatch load. Furthermore, dd-cfDNA was able to discriminate the patients with antibody-mediated rejection (AbMR) (AUC 87.3%), acute rejection (AUC 78.2%), and troubled graft (AUC 81.4%). Increased dd-cfDNA levels were associated with kidney allograft deterioration, particularly rejection, as well as a greater HLA class II eplet mismatch load. Consequently, combining dd-cfDNA determination and HLA eplet mismatch load calculation should improve the assessment of the risk of short- and long-term allograft damage.

Impacto de la pandemia por SARS-CoV2 en la actividad asistencial y en la salud del personal de hemodiálisis en las diferentes oleadas / Impact of the SARS-CoV-2 Pandemic on Dialysis Care Activity and the Health of Dialysis Staff During Different Waves

Introducción: Además de las consecuencias del SARS-CoV-2 sobre los pacientes renales infectados, mantener la actividad durante la pandemia ha supuesto todo un reto dada la escasez de personal por las ausencias por enfermedad. Objetivo: Analizar la incidencia de contagios por Covid-19 entre los profesionales de hemodiálisis, sus características y su repercusión en bajas laborales en las diferentes oleadas.Material y Método: Estudio observacional longitudinal desde el 3/03/2020 hasta el 23/04/2022 (776 días) en una media de 406 profesionales sanitarios y no sanitarios de 18 unidades de diálisis y dos unidades administrativas de apoyo de la Fundación Renal Iñigo Álvarez de Toledo.La recogida de datos se realizó a través de la comunicación de las distintas supervisoras al departamento de recursos humanos. Resultados: 179 profesionales de un promedio de 406 (44,1%) se infectaron en el periodo de estudio, siendo el 52% enfermeras, 25% auxiliares, 11% nefrólogos y 12% otros profesionales. Un 40,2% de los casos presentaron síntomas. Un total de 160 contagiados estuvo ausente por enfermedad (89,3%), con una media de 15,9±14,3 días. En el 71,6% se detectó un contacto estrecho (todos fuera de las unidades) y esta identificación de contactos fue creciente según avanzaban las oleadas, pasando de un 6,7% en la 1ª ola a un 40% en la 6ª ola (p=0,016). Conclusiones: La sintomatología ha sido leve, al menos de dos semanas de ausencia por enfermedad; los contactos estrechos detectados han sido fundamentalmente comunitarios, sin registrarse contagios a través de los pacientes renales en las unidades. (AU)

Introduction: In addition to the consequences of SARS-CoV-2 infection in renal patients, maintaining dialysis activity during the pandemic has been a significant challenge due to staff shortages resulting from illness-related absences. Objetives: To analyze the incidence of COVID-19 infections among hemodialysis professionals, their characteristics, and their impact on work absences during different waves of the pandemic.Material and Method: Longitudinal observational study conducted from March 3, 2020, to April 23, 2022 (776 days), involving an average of 406 healthcare and non-healthcare professionals from 18 dialysis units and two administrative support units of the Renal Foundation. Data collection was carried out through communication from various supervisors to the human resources department.Results: During the study period, 179 professionals out of an average of 406 (44.1%) became infected. Among these, 52% were nurses, 25% were nursing assistants, 11% were nephrologists, and 12% were other professionals. 40.2% of cases exhibited symptoms. A total of 160 infected individuals were absent from work due to illness (89.3%), with an average duration of 15.9 ± 14.3 days. In 71.6% of cases, close contacts were identified outside the dialysis units, and this contact identification increased with each wave of the pandemic, rising from 6.7% in the 1st wave to 40% in the 6th wave (p=0.016).Conclusions: The symptoms have generally been mild, with absences from work lasting at least two weeks. Close contacts were mainly identified within the community, and there were no recorded infections transmitted through renal patients in the units. (AU)

The Effect of Third Dose of Pfizer/BioNTech and Moderna COVID-19 mRNA Vaccines on IgG Antibody Titers.

With the emergence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) variants, the Centers for Disease Control and Prevention (CDC) authorized the third dose of the Pfizer-BioNTech (BNT162b2) vaccine with the rationale for prolonged elevation of anti-SARS-CoV-2 antibody titers and protection against the SARS-CoV-2 virus. To better understand how administration of the third dose of the Pfizer/BioNTech coronavirus disease 2019 (COVID-19) vaccine affects the incidence and severity of SARS-CoV-2 infections, we administered the third dose of the Pfizer-BioNTech (BNT162b2) to 189 participants. Blood samples were collected from participants during each of their scheduled visits (baseline, week two, week 12, and week 24) and tested for semi-quantitative anti-SARS-CoV-2 immunoglobulin G (IgG) titers. Our results showed that administration of the third dose of the Pfizer-BioNTech (BNT162b2) vaccine elicited elevated anti-SARS-CoV-2 IgG antibodies for the 24-week duration of the study. IgG antibody titers were greatest in week two, and progressively decreased by week 12 and week 24, with statistically significant differences between the IgG antibody titers for each collection date.

Pharmacokinetics of Curcumin Delivered by Nanoparticles and the Relationship with Antitumor Efficacy: A Systematic Review.

Curcumin is a polyphenolic compound, derived from Curcuma longa, and it has several pharmacological effects such as antioxidant, anti-inflammatory, and antitumor. Although it is a pleiotropic molecule, curcumin's free form, which is lipophilic, has low bioavailability and is rapidly metabolized, limiting its clinical use. With the advances in techniques for loading curcumin into nanostructures, it is possible to improve its bioavailability and extend its applications. In this review, we gather evidence about the comparison of the pharmacokinetics (biodistribution and bioavailability) between free curcumin (Cur) and nanostructured curcumin (Cur-NPs) and their respective relationships with antitumor efficacy. The search was performed in the following databases: Cochrane, LILACS, Embase, MEDLINE/Pubmed, Clinical Trials, BSV regional portal, ScienceDirect, Scopus, and Web of Science. The selected studies were based on studies that used High-Performance Liquid Chromatography (HPLC) as the pharmacokinetics evaluation method. Of the 345 studies initially pooled, 11 met the inclusion criteria and all included studies classified as high quality. In this search, a variety of nanoparticles used to deliver curcumin (polymeric, copolymeric, nanocrystals, nanovesicles, and nanosuspension) were found. Most Cur-NPs presented negative Zeta potential ranging from -25 mV to 12.7 mV, polydispersion index (PDI) ranging from 0.06 to 0.283, and hydrodynamic diameter ranging from 30.47 to 550.1 nm. Selected studies adopted mainly oral and intravenous administrations. In the pharmacokinetics analysis, samples of plasma, liver, tumor, lung, brain, kidney, and spleen were evaluated. The administration of curcumin, in nanoparticle systems, resulted in a higher level of curcumin in tumors compared to free curcumin, leading to an improved antitumor effect. Thus, the use of nanoparticles can be a promising alternative for curcumin delivery since this improves its bioavailability.

Effect of the ketogenic diet as a treatment for refractory epilepsy in children and adolescents: a systematic review of reviews.

CONTEXT: Epilepsy is one of the most prevalent neurological disorders in childhood. Antiepileptic drugs are the preferred treatment. However, 30% of children continue suffering seizures. A ketogenic diet (KD) is one of the emerging alternative treatments. OBJECTIVE: This review aims to analyze the current evidence regarding the use of a KD for the treatment of refractory epilepsy (RE) in childhood. DATA SOURCES: A systematic review of reviews was performed, based on MEDLINE (PubMed) as at January 2021. DATA EXTRACTION: The data extracted included the first author's last name; the year of publication; the country; the study design; the population; the diagnosis, concept, and description of KD types; and major outcome. RESULTS: Twenty-one reviews were included, 8 with systematic methodology (2 of them included a meta-analysis) and 13 with unsystematic methodology. The main difference between the 2 types of reviews is the reproducibility of their methodology. Therefore, the results of each type of review were analyzed separately. Each type of review described 4 categories of KD: classic KD, modified Atkins diet (MAD), use of medium-chain triglycerides (MCTs), and low glycemic index treatment (LGIT). In terms of effectiveness, the considered systematic reviews reported reductions in the frequency of seizures greater than 50% in about half of the patients. Reviews without systematic methodology reported that 30%-60% of the children showed a 50% or greater reduction in seizures. The most frequently described adverse effects in the 8 systematic reviews were: vomiting (6/8), constipation (6/8), and diarrhea (6/8); and in the unsystematic reviews: vomiting and nausea (10/13), constipation (10/13), and acidosis (9/13). CONCLUSION: KD can be an effective treatment for RE, with a more than 50% reduction in the frequency of seizures and cognitive improvement being achieved in half of the pediatric patients. The effectiveness of the various types of KD is comparable, and the KD can be adapted to the needs of the patient. SYSTEMATIC REVIEW REGISTRATION: PROSPERO registration no. CRD42021244142.

Validity of the Maternal Antenatal Attachment Scale-Spanish Version for Mexican Pregnant Women / Validez de la Escala de Apego Prenatal Materno: versión en español para mujeres mexicanas embarazadas

During pregnancy, parents experiment emotions, thoughts, and behaviors related to their unborn child as precursors of attachment in the caretaker-infant dyad. The Maternal Antenatal Attachment Scale (MAAS) is an instrument that has shown adequate psychometric properties to evaluate this construct in developed countries. The aim of this study was to assess the reliability and concurrent validity of the Maternal Antenatal Attachment Scale-Spanish version for Mexican women (MAAS-Spanish version). A sample of 142 women in their third trimester of pregnancy who received care in a tertiary hospital was selected. The full scale of the MAAS-Spanish version obtained a Cronbach alpha of .79. A significant negative correlation was found between the global MAAS-Spanish version score (r = -.23, p ≤ .01) and the Postpartum Depression Predictors Inventory-Revised and depressive symptoms (r = -.36 , p ≤ .01). The translated and adapted scale has adequate internal consistency and concurrent validity to measure this construct in this population. ()AU)

Durante el embarazo, los padres experimentan emociones, pensamientos e ideas sobre su nonato relevantes en el estudio de precursores del apego en la díada cuidador-infante. La Escala de Apego Prenatal Materno (MAAS) es un instrumento que ha mostrado adecuadas propiedades psicométricas para evaluar este constructo en países desarrollados. El propósito de este estudio fue evaluar la confiabilidad y validez concurrente de dicha escala—versión en español para mujeres mexicanas (MAAS—versión en español). Se seleccionó a una muestra de 142 mujeres en tercer trimestre gestacional, que recibían atención en un hospital de tercer nivel. La escala total obtuvo un alfa de Cronbach de .79. Se evidenció una correlación negativa significativa de la puntuación global de la MAAS de r = -.23, (p ≤ .01) con la PDPI-R y de r = -.36, (p ≤ .01) con la sintomatología depresiva (EPDS). La escala traducida cuenta con una consistencia interna y validez concurrente adecuadas para medir este constructo en esta población. (AU)

Questionable utility of the Montreal Cognitive Assessment (MoCA) in detecting cognitive impairment in individuals with comorbid PTSD and SUD.

Posttraumatic stress disorder (PTSD) is frequently comorbid with substance use disorder (SUD) in individuals seeking treatment for substance use. Further, SUD and PTSD are individually associated with cognitive impairment (CI) and poor treatment outcomes. Despite the frequent use of the Montreal Cognitive Assessment (MoCA) as a screening tool for CI, the validity of the MoCA has not been established in individuals with comorbid SUD-PTSD. We assessed the criterion validity of the MoCA in 128 participants seeking inpatient medically-assisted detoxification using the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS) as a reference for CI. The correlation between the RBANS and MoCA was weaker in those with SUD-PTSD (r = .32) relative to SUD alone (r = .56). Receiver operating characteristic (ROC) curves demonstrated that the MoCA had moderate-to-high ability to discriminate CI in individuals with SUD alone, with an area under the ROC curve of .82 (95% CI .69-.92) and optimal cutoff score of ≤23. However, in individuals with comorbid SUD-PTSD, the ROC analysis was not significant. Results suggest that PTSD, when comorbid with SUD, reduces the criterion-related validity of the MoCA. We recommend exercising caution when classifying CI in individuals with SUD-PTSD using the MoCA and suggest reducing the cutoff score to ≤23 in order to limit the rate of false-positive CI diagnoses in SUD-PTSD populations.