Intervenciones farmacéuticas en usuarios de benzodiacepinas durante la pandemia COVID-19 / Pharmaceutical interventions in benzodiazepine users during the COVID-19 pandemic

Introducción: la Intervención Farmacéutica busca optimizar y racionalizar el uso, la efectividad y la seguridad de los medicamentos dispensados resolviendo problemas relacionados con el medicamento (PRM) y resultados negativos asociados a la medicación (RNM).Objetivo: evaluar las Intervenciones Farmacéuticas realizadas a usuarios de benzodiacepinas durante la pandemia COVID-19 desde una Farmacia Comunitaria.Método: estudio prospectivo observacional, descriptivo y transversal (código AEMPS: DAA-CLO-2020-01) de las Intervenciones Farmacéuticas llevadas a cabo por una farmacia comunitaria tinerfeña entre agosto 2020 y febrero 2021.Resultados: un total de 306 Intervenciones Farmacéuticas fueron realizadas sobre 127 pacientes. La educación sanitaria y la información personalizada sobre el medicamento fueron las Intervenciones Farmacéuticas mayoritarias tras detectar entre los pacientes un alto grado de desconocimiento sobre las benzodiacepinas usadas. Las Intervenciones Farmacéuticas que se acompañan de derivación al médico alcanzan el 37,8 % tras detectar PRM y/o RNM o identificar al paciente como candidato para deprescripción. Estas derivaciones incluyen a los pacientes con un estado de depresión muy alto según el test Euroqol 5D-3L. La Intervención Farmacéutica con derivación al Servicio de Seguimiento Farmacoterapéutico se realiza en el 3,1 % de los pacientes. El grado de aceptación de la Intervención Farmacéutica por parte de los pacientes alcanza el 98,4 %.Conclusiones: el alto porcentaje de aceptación de las Intervenciones Farmacéuticas refuerza el valor de la Farmacia Comunitaria en la optimización y racionalización del uso de benzodiacepinas y fortalece el vínculo farmacéutico-paciente. La pandemia COVID-19 dificultó la colaboración farmacéutico-médico, a pesar de la existencia de protocolos telemáticos de comunicación entre sanitarios.(AU)

Bocconia frutescens L. induces neurological defects in rat offspring.

Nearly 80% of the world's population trusts traditional medicine and plant-based drug compounds to improve health, and more than 50% of women who participated in a study have used herbal remedies during pregnancy. Bocconia frutescens L. is a plant native to tropical America, where infusion of its leaves has been widely used for the treatment of several gastrointestinal disorders. We have already shown that orogastric consumption of B. frutescens L. during the organogenesis period at concentrations equivalent to human consumption produces teratogenic effects in rats, but effects on progeny development have not yet been studied. In this study, we aimed to investigate the possible association between the consumption of B. frutescens L. at a dose equivalent to that consumed by humans and the neurological development of rat progeny. Pregnant Wistar rats were administered lyophilized B. frutescens L. extract at 300 mg/kg/day or vehicle via the orogastric route during the organogenesis period (gestation days 7-13). The physical development and sensory and motor maturation of their offspring during lactation were analyzed with a battery of reflex and physical tests. B. frutescens L. produced a significant delay in physical development and sensorimotor maturation, compared to the control group. Proton nuclear magnetic resonance spectroscopy analysis showed signals for both flavonoids and alkaloids in the B. frutescens L. extract. We conclude that the delay in physical and neurological development could be interpreted as alterations in the maturation of some neuronal circuitries induced by B. frutescens L.

Functional and structural characterisation of RimL from Bacillus cereus, a new Nα-acetyltransferase of ribosomal proteins that was wrongly assigned as an aminoglycosyltransferase.

Enzymes of the GNAT (GCN5-relate N-acetyltransferases) superfamily are important regulators of cell growth and development. They are functionally diverse and share low amino acid sequence identity, making functional annotation difficult. In this study, we report the function and structure of a new ribosomal enzyme, Nα-acetyl transferase from Bacillus cereus (RimLBC), a protein that was previously wrongly annotated as an aminoglycosyltransferase. Firstly, extensive comparative amino acid sequence analyses suggested RimLBC belongs to a cluster of proteins mediating acetylation of the ribosomal protein L7/L12. To assess if this was the case, several well established substrates of aminoglycosyltransferases were screened. The results of these studies did not support an aminoglycoside acetylating function for RimLBC. To gain further insight into RimLBC biological role, a series of studies that included MALDI-TOF, isothermal titration calorimetry, NMR, X-ray protein crystallography, and site-directed mutagenesis confirmed RimLBC affinity for Acetyl-CoA and that the ribosomal protein L7/L12 is a substrate of RimLBC. Last, we advance a mechanistic model of RimLBC mode of recognition of its protein substrates. Taken together, our studies confirmed RimLBC as a new ribosomal Nα-acetyltransferase and provide structural and functional insights into substrate recognition by Nα-acetyltransferases and protein acetylation in bacteria.

Sexual experiences and knowledge of people with moderate intellectual disability.

BACKGROUND: This study addresses the sexuality of people with moderate intellectual disabilities (PMID), a topic that has been little studied. Understanding romantic and sexual experiences is highly relevant for reducing stigma and prejudice related to their sexuality. Additionally, comprehending the level of sexual knowledge of PMID contributes to the development of preventive and sexual health education programmes tailored for this group. Our aim is to explore the sexual history (relationships, sexual behaviour, condom use and sexual abuse), sex education received and the level of sexual knowledge of PMID. METHOD: The total of 142 PMID completed questionnaires about sexual knowledge and experiences, and their support staff provided additional information. Data were analysed using chi-square test (χ2) and descriptive statistical analysis. RESULTS: Masturbation was the most common sexual behaviour (75.7%), especially among men (χ2 = 5.81, P < 0.05). Sexual intercourse was rare, and only 30.5% reported using condoms. Women reported a higher prevalence of self-reported sexual abuse (27.3% vs. 6% in men). The study also highlighted misconceptions about sexual intercourse risks and contraceptive methods. CONCLUSION: The results suggest that PMID need sexual education to ensure healthy sexual experiences and prevent risky behaviour.

Predictors of first-year postoperative complications after fixation of low-energy ankle fractures: A single-center, retrospective cohort study of 663 consecutive fractures. / [Artículo traducido] Predictores de las complicaciones postoperatorias en el primer año tras la fijación de fracturas de tobillo de baja energía. Estudio de cohortes retrospectivo sobre 663 fracturas intervenidas consecutivamente en un único centro.

INTRODUCTION: Rotational ankle fractures are common, have diverse personalities and affect both robust and fragile patients. Postoperative complications are frequent, creating a sizeable economic burden. The primary purpose of this study was to expand current knowledge on predictors of postoperative complications after low-energy ankle fracture fixation. MATERIALS AND METHODS: A retrospective single-center cohort study was completed of patients undergoing internal fixation OF low-energy ankle fractures. The primary outcome was first-year postoperative complications, classified as major (surgical) or minor (non-surgical). Data on patients, their injuries, and treatments were collected. To identify potential predictors of outcomes, logistic regression methods were used, with a backward-stepwise method used for model fitting. RESULTS: In total, 663 patients of median age 59 years were analysed. We found a high rate of complications (28.4%), with wound-healing issues and infections predominant. Overall, 14.8% had minor complications, while 13.6% required an unplanned reoperation. On multivariable analysis, the most consistent predictors of complications were older age (OR: 1.02 per year), longer operating time (3.32 per hour), and smoking (2.91). CONCLUSIONS: Older patients and smokers who sustain fractures requiring more complex surgery are at higher risk of postoperative complications.

Topical and Intralesional Therapies for Hidradenitis Suppurativa: A Systematic Literature Review. / [Artículo traducido] Tratamientos tópicos e intralesionales en hidradenitis supurativa. Una revisión sistemática de la literatura.

BACKGROUND AND OBJECTIVE: Topical and intralesional (IL) treatments may be considered the first-line therapy in patients with hidradenitis suppurativa (HS); however, the evidence supporting their use is limited. The aim of our review is to evaluate the efficacy and safety profile of topical and IL treatments in patients with HS. MATERIALS AND METHODS: We designed a systematic review of the current medical literature available following the PICO(T) method. And including all types of studies (Study type [T]) of individuals with HS of any sex, age, and ethnicity (Population [P]) who received any topical or IL treatment for HS (Intervention [I]) compared to placebo, other treatments, or no treatment at all (Comparator [C]), and reported efficacy and/or safety outcomes (Outcomes [O]). Two outcomes were defined: quality of life and the no. of patients with, at least, one adverse event. The search was conducted in the Cochrane Library, MEDLINE, and Embase databases; study selection was performed based on pre-defined criteria. The risk of bias was determined in each study. RESULTS: We obtained a total of 11,363 references, 31 of which met the inclusion criteria. These studies included 1143 patients with HS, 62% of whom were women. A total of 10, 8, 6, 2, and 5 studies, respectively, evaluated the use of photodynamic therapy (PDT), glucocorticoids, resorcinol, topical antibiotics, and other interventions. Most articles were case series (n=25), with only five randomized clinical trials (RCTs) and one cohort study. RCTs showed improvement in disease activity with topical clindamycin and botulinum toxin (BTX) vs placebo, and PDT with methylene blue (MB) niosomal vs free MB; however, intralesional triamcinolone acetonide was not superior to placebo. The risk of bias was low in three RCTs and high in two RCTs. CONCLUSION: The quality of evidence supporting the use of topical, or IL treatments is low. However, it supports the use of topical clindamycin, PDT, and BTX. Well-designed RCTs with standardized outcomes and homogeneous populations of patients and lesions are needed to support decision-making in the routine clinical practice.

Impact of a Community Pharmacy Pharmacotherapy Follow-up (PTF) service in patients using opioid analgesic.

The use of prescribed major opioid analgesics (fentanyl, tapentadol, morphine and oxycodone and combinations) for non-cancer chronic pain is fraught with risks that may generate Negative Medicine Outcomes (NMO). Among the factors associated with these risks, those related to the patient's characteristics and aberrant behavior, the treatment conditions, and the prescription health settings should be evaluated with the aim of minimizing unsafety during the health care process. The present study addresses, from a community pharmacy, the analysis of Drug Related Problems (DRP) and Negative Medicine Outcomes (NMO) in patients using these major opioid analgesics while it aims to demonstrate the role of pharmaceutical care interventions in promoting safety during the use of these molecules. A three step Pharmacotherapeutic Follow-up (PFT) protocol was designed to prevent, detect, and solve DRP and NMO associated with the use of opioid analgesics. 74.6% of the patients used opioid analgesics to treat musculoskeletal pain. Polypharmacy with benzodiazepines (61.9%); antidepressants (57.1%) and antiepileptics (30.2%) was detected in patients using these opioids. The Morisky-Green Adherence test revealed that 30.2% were nonadherent. It was observed, with statistical significance, that in all patients (63), the impact of the 14-week PFT supervised by the community pharmacist achieved an overall reduction in the prevalence of DRP and NMO. While the reduction in the number of DRPs reached 66.7%. Community pharmacies are a strategic point to promote and implement effective opioid stewardship due to both their central role in healthcare services and frequent interaction with patients.

Madagascar's burned area from Sentinel-2 imagery (2016-2022): Four times higher than from lower resolution sensors.

Madagascar is one of the most burned regions in the world, to the point that it has been called the 'Isle of fire' or the 'Burning Island'. An accurate characterization of the burned area (BA) is crucial for understanding the true situation and impacts of fires on this island, where there is an active scientific debate on how fire affects multiple environmental and socioeconomic aspects, and how fire regimes should be in a complex context with differing interests. Despite this, recent advances have revealed that BA in Madagascar is poorly characterised by the currently available global BA products. In this work, we present, validate, and explore a BA database at 20 m spatial resolution for Madagascar covering the period 2016-2022. The database was built based on 75,010 Sentinel-2 images using a two-phase BA detection algorithm. The validation with independent long-term reference units showed Dice coefficients ≥79 %, omission errors ≤24 %, commission errors ≤18 %, and a relative bias ≥ - 8 %. An intercomparison with other available global BA products (GABAM, FireCCI51, C3SBA11, or MCD64) demonstrated that our product (i) exhibits temporal consistency, (ii) represents a significant accuracy improvement, as it reduces BA underestimations by about eightfold, (iii) yields BA estimates four times higher, and (iv) shows enhanced capability in detecting fires of all sizes. The observed BA spatial patterns were heterogeneous across the island, with 32 % of the grasslands burning annually, in contrast to other land cover types such as the dense tropical forest where <2 % burned every year. We conclude that the BA characterization in Madagascar must be addressed using imagery at spatial resolution higher than MODIS or Sentinel-3 (≥250 m), and temporal resolution higher than Landsat (16 days) to deal with cloudiness, the rapid attenuation of burn scars signals, and small fire patches.

Topical and Intralesional Therapies for Hidradenitis Suppurativa: A Systematic Literature Review.

BACKGROUND AND OBJECTIVE: Topical and intralesional (IL) treatments may be considered the first-line therapy in patients with hidradenitis suppurativa (HS); however, the evidence supporting their use is limited. The aim of our review is to evaluate the efficacy and safety profile of topical and IL treatments in patients with HS. MATERIALS AND METHODS: We designed a systematic review of the current medical literature available following the PICO(T) method. And including all types of studies (Study type [T]) of individuals with HS of any sex, age, and ethnicity (Population [P]) who received any topical or IL treatment for HS (Intervention [I]) compared to placebo, other treatments, or no treatment at all (Comparator [C]), and reported efficacy and/or safety outcomes (Outcomes [O]). Two outcomes were defined: quality of life and the no. of patients with, at least, one adverse event. The search was conducted in the Cochrane Library, MEDLINE, and EMBASE databases; study selection was performed based on pre-defined criteria. The risk of bias was determined in each study. RESULTS: We obtained a total of 11,363 references, 31 of which met the inclusion criteria. These studies included 1143 patients with HS, 62% of whom were women. A total of 10, 8, 6, 2, and 5 studies, respectively, evaluated the use of photodynamic therapy (PDT), glucocorticoids, resorcinol, topical antibiotics, and other interventions. Most articles were case series (n=25), with only five randomized clinical trials (RCTs) and one cohort study. RCTs showed improvement in disease activity with topical clindamycin and botulinum toxin (BTX) vs placebo, and PDT with methylene blue (MB) niosomal vs free MB; however, intralesional triamcinolone acetonide was not superior to placebo. The risk of bias was low in three RCTs and high in two RCTs. CONCLUSION: The quality of evidence supporting the use of topical, or IL treatments is low. However, it supports the use of topical clindamycin, PDT, and BTX. Well-designed RCTs with standardized outcomes and homogeneous populations of patients and lesions are needed to support decision-making in the routine clinical practice.

Predictors of first-year postoperative complications after fixation of low-energy ankle fractures: A single-center, retrospective cohort study of 663 consecutive fractures.

INTRODUCTION: Rotational ankle fractures are common, have diverse personalities and affect both robust and fragile patients. Postoperative complications are frequent, creating a sizeable economic burden. The primary purpose of this study was to expand current knowledge on predictors of postoperative complications after low-energy ankle fracture fixation. MATERIALS AND METHODS: A retrospective single-center cohort study was completed of patients undergoing internal fixation OF low-energy ankle fractures. The primary outcome was first-year postoperative complications, classified as major (surgical) or minor (non-surgical). Data on patients, their injuries, and treatments were collected. To identify potential predictors of outcomes, logistic regression methods were used, with a backward-stepwise method used for model fitting. RESULTS: In total, 663 patients of median age 59 years were analyzed. We found a high rate of complications (28.4%), with wound-healing issues and infections predominant. Overall, 14.8% had minor complications, while 13.6% required an unplanned reoperation. On multivariable analysis, the most consistent predictors of complications were older age (OR=1.02 per year), longer operating time (3.32 per hour), and smoking (2.91). CONCLUSIONS: Older patients and smokers who sustain fractures requiring more complex surgery are at higher risk of postoperative complications.

Five-year airborne pollen calendar for a Sonoran Desert city and the relationships with meteorological variability.

Aerobiological studies are still scarce in northwestern Mexico where allergenic pollen have great impacts on health. Current global pollution and climate change problems are closely related to many allergic diseases, enhancing the need to continue researching these issues and improve life quality. This study provides the first Pollen Calendar for Hermosillo, Sonora, México. Airborne pollen were continuously collected for 5 years (2015-2019). The standardized methodology with a Hirst-type spore trap proposed for global aerobiological studies was used. Weather data were also taken from a station located in the city and used to explore correlations between climate and airborne pollen concentrations in different seasons. The most important pollen taxa recorded in air belongs to herbaceous pollen, such as Poaceae, Ambrosia, Asteraceae, Chenopodiaceae-Amaranthaceae, and some shrub trees typical of this arid region, such as Nyctaginaceae, Prosopis, Parkinsonia, and Fabaceae. The most critical herbaceous pollen related to allergies have a long mean pollen season throughout the years, and the most critical periods with high pollen concentration in air occur in two seasons, spring (March-April) and summer-fall (August-October). In these 5 years, the correlation analyses for these two peaks indicate that a link exists between pollen in the air and decreases in precipitation and temperatures, and an increase in relative humidity. An inter-annual variability in pollen concentrations was recorded related to different weather conditions. Although pollen calendars are location-specific, they are useful for future research on biological air quality scenarios in different cities. Using this standardized method for other regions can provide pollen calendars that have been proven clinically important in allergic disease management worldwide.

Isolation, characterization, and experimental infection of Streptococcus gallolyticus subspecies pasteurianus from commercial turkeys with acute septicemia: a pilot study.

Streptococcus gallolyticus (SG) is a Gram-positive cocci found as commensal gut flora in animals and humans. SG has emerged as a cause of disease in young poults between 1 and 3 wk of age. SG is associated with septicemia resulting in acute mortality with no premonitory signs in turkeys. Three SG isolates were obtained from clinical field cases of acute septicemia of commercial turkeys and used in three independent experiments. In Experiment 1, embryos were inoculated 25 d of embryogenesis with varying concentrations of SG1, SG2, or SG3. In Experiment 2, day of hatch, poults were inoculated with varying concentrations using different routes of administration of SG1, SG2, or SG3. In Experiment 3, day of hatch, poults were inoculated with only isolate SG1 using different paths. Poults were randomly selected for necropsy on d 8 and d 15 and sampled to collect spleen, heart, and liver for SG on d 21, the remaining poults were necropsied and cultured. Samples were plated on Columbia nalidixic acid and colistin agar (CNA) (40°C, 18-24 h). Matrix-assisted laser desorption/ionization time-of-flight mass spectrometry (MALDI-TOF MS) confirmed suspect colonies. Data were analyzed using the chi-square test of independence, testing all possible combinations to determine significance (P < 0.05). Weight data were subjected to ANOVA using JMP with significance (P < 0.05). No differences were found in BW or BWG on d 0, 8, 15, or 22. Splenomegaly, focal heart necrosis, and pericarditis were observed in all groups in experiments 1 through 3. In Experiment 3, only airsacculitis was observed in a negative control in separate isolation (P > 0.05). On d 21 of Experiment 3, increased (P < 0.05) recovery of SG from spleens were observed in co-housed negative controls, as well as poults challenged by oral gavage (P > 0.05 for d 7 and d 14). These results confirm numerous previous studies indicating that SG subsp. pasteurianus is a primary infectious microorganism that causes septicemia in young poults.

Sleep deprivation increases pain sensitivity following acute muscle soreness.

OBJECTIVE: The aim of this cross-sectional group comparison study was to investigate whether sleep disturbance facilitates pain sensitivity caused by an acute muscle injury. METHODS: Thirty-six healthy individuals were included and randomly assigned to one of three groups in a non-balanced manner: a control group (n = 11) and two groups who performed eccentric exercise for quadriceps to cause delayed onset of muscle soreness (DOMS). The difference between the DOMS groups was that one followed their habitual sleep pattern (Sleep group, n = 12) and the other had their sleep withdrawn for one night (No-Sleep group, n = 13). The level of DOMS was indicated using a 6-point Likert Scale and pain sensitivity was assessed using Pressure Pain Thresholds (PPT) at the lower legs and shoulder at baseline (Day-1) and after 48 h (Day-3). Additionally, pain distribution following suprathreshold pressure stimulation (STPS) on the quadriceps muscle was assessed on the same days. RESULTS: PPTs were significantly reduced at Day-3 compared with Day-1 in both DOMS groups. The relative change between days was larger in the No-Sleep group compared with controls (P<0.05) whilst no significant change was seen in the Sleep group compared with controls. Furthermore, no significant differences were found between groups nor days for the subjective perception of DOMS (Likert Scale) and the size of the area of STPS. CONCLUSIONS: The loss of sleep further increases pain sensitivity following an acute soft tissue injury, demonstrating a potential causative role of the lack of sleep on complex pain states following musculoskeletal injuries.

Exposure to biologic therapy before and during pregnancy in patients with psoriasis: Systematic review and meta-analysis.

Biologicals have transformed the management of severe disease phenotypes in psoriasis and are often prescribed in women of childbearing age. However, information on safety of biologicals in pregnancy are lacking. We conducted a systematic review and meta-analysis aimed to describe the characteristics and pregnancy outcomes in women with psoriasis exposed to biologics within 3 months before or during pregnancy, and to estimate the pooled prevalence of spontaneous, elective and total abortions, and congenital malformations in their newborns. Bibliographic searches were performed in the PubMed, Embase, Scopus and Web of Science databases up to 14 April 2022. No restrictions on sample size or publication date were applied. Review performance complied with PRISMA guidelines, and two reviewers assessed randomized controlled trials and nonrandomized studies reporting pregnancy outcomes in women exposed to biologics indicated for psoriasis during the pre-gestational and/or gestational period. Studies focusing on rheumatologic or gastroenterological immune-mediated inflammatory diseases were excluded. Regardless of data heterogeneity, a random-effects model was used to pool prevalence estimates. We included 51 observational studies, involving 739 pregnancies exposed to approved biologics for psoriasis. Administration was mostly (70.4%) limited to the first trimester, and the most common drug was ustekinumab (36.0%). The estimated prevalence of miscarriage was 15.3% (95% confidence interval [CI] 12.7-18.0) and elective abortions, 10.8% (95% CI 7.7-14.3). Congenital malformations occurred in about 3.0% (95% CI 1.6-4.8) of live births exposed to biologics during pregnancy. Altogether, exposure to biologics for psoriasis during pregnancy and/or conception does not seem to be associated with an increased risk of miscarriage/abortion or congenital malformations, showing similar rates to the general population. These results suggest that biologic drugs are safe and pose an acceptable risk to the foetuses/neonates.

Modelo para la evaluación de la eficacia diagnóstica de la tomografía computarizada de haz cónico en odontología / A model of diagnostic efficacy for the evaluation of CBCT in dentistry

Introducción: Debido al riesgo que conlleva la exposición a radiación ionizante, se han establecido los principios de protección radiológica, con el propósito de regular las actividades que involucran su uso. Uno de estos principios es la justificación de los exámenes, es decir, la indicación del examen cuando exista la posibilidad de que éste entregue información en beneficio del paciente. Esto implica que dicho examen se evalúe en cuanto a su rendimiento, de manera que exista evidencia que indique su capacidad de entregar la información necesaria para la indicación específica del paciente. Revisión: Para evaluar el rendimiento de los exámenes imagenológicos, con el fin de orientar su uso como herramienta diagnóstica en las distintas indicaciones odontológicas, se ha usado el modelo de Eficacia Diagnóstica descrito por Fryback y Thornbury en 1991.En odontología, el uso de la tomografía computarizada de haz cónico (TCHC) ha aumentado debido a sus ventajas como herramienta diagnóstica. Aún así, son pocas las investigaciones en altos niveles del modelo de Eficacia Diagnóstica -más relacionados con características aplicables al paciente--y muchas las investigaciones en bajos niveles -más relacionado con calidad técnica y de exactitud diagnóstica-. Conclusiones: La evidencia del rendimiento de la TCHC en bajos niveles puede generar una idea equivoca sobre sus indicaciones, dando la impresión de que cuenta con respaldo científico suficiente que justifica su uso. Es necesaria investigación enfocada en el beneficio de los pacientes con el uso de TCHC para las distintas indicaciones en odontología. (AU)

Introduction: Due to the risk of exposure to ionizing radiation, principles of radiation protection have been established, with the aimto regulate activities that involve the use of ionizing radiation. The principle of justification means that the indication of the exam must be associated to the possibility of providing information for the benefit of the patient. The indication of an exam that results in a benefit for the patient entails the evaluation of the exam in terms of its performance. This evaluation should demonstrate the exam has ability to deliver the necessary information for the specific need of the patient. Review: The Diagnostic Efficacy model, described by Fryback and Thornbury in 1991, is used to evaluate the performance of imaging tests, in order to guide its use as a diagnostic tool in different dental indications. In dentistry, the use of TCHC has increased due to the advantages as a diagnostic tool. Still, there are few investigations at high levels of the Diagnostic Efficacy model - related to characteristics that involve the patient - and many investigations at low levels - more related to technical quality and diagnostic accuracy. Conclusions: Evidence of the performance of CBCT at low levels generates a misunderstanding about its use, giving the impression that CBCT has sufficient scientific support to justify its use. Currently, the evaluation of the performance of the TCHC has focused on evaluating the lowest levels of this model, the image quality and the diagnostic precision, although evidence at this level remains limited. Research focusing on the benefit of patients with the use of CBCT for the different indications in dentistry is needed. (AU)

Riesgo de Retención de Secreciones en Pacientes con Ventilación Mecánica Invasiva / Risk of Retention of Secretions in Patients with Invasive Mechanical Ventilation

Introducción. Los pacientes conectados a ventilación mecánica invasiva pueden presentar complicaciones respiratorias, donde la retención de secreciones es una de las más frecuentes. El drenaje y eliminación de las secreciones depende entre otras variables de los flujos respiratorios generados, donde una diferencia absoluta entre el flujo espiratorio máximo (FEM) y flujo inspiratorio máximo (FIM) menor a 17 L•min-1 o una relación FIM/FEM mayor a 0.9 favorecerían la retención de secreciones. Sin embargo, falta por determinar los flujos respiratorios resultantes y la proporción de pacientes con riesgo de retención de secreciones según estos parámetros. Objetivo. Determinar los flujos respiratorios durante la ventilación mecánica invasiva y la proporción de pacientes que se encuentra en riesgo de retención de secreciones. Métodos. Estudio descriptivo transversal desarrollado en la Unidad de Paciente Crítico Médico-Quirúrgico del "Hospital Clínico de la Red de Salud UC-CHRISTUS". Se incluyeron pacientes adultos intubados y conectados a ventilación mecánica, en quienes se determinó los flujos respiratorios resultantes y se estimó la diferencia absoluta FEM-FIM, la relación FIM/FEM y la proporción de pacientes con riesgo de retención de secreciones. Resultados. Se incluyeron 100 pacientes, 45% presentaba entre sus diagnósticos patología respiratoria. La mediana de la diferencia absoluta entre FEM y FIM fue de 6 L•min-1 (-5 - 14.5) y la mediana de la tasa FIM/FEM de 0.87 (0.7 - 1.13). Un 84% presentó una diferencia absoluta entre FEM y FIM menor a 17 L•min-1, mientras que el 46% presentó una relación FIM/FEM mayor a 0.9. Conclusión. Una alta proporción de pacientes conectados a ventilación mecánica presenta riesgo de retención de secreciones independiente de la presencia o ausencia de patología respiratoria. Se requieren futuras investigaciones para evaluar el impacto de este criterio sobre complicaciones respiratorias.

Background. Patients connected to invasive mechanical ventilation may develop respiratory complications, where retention of secretions is one of the most frequent. The drainage and elimination of the secretions depend on other variables of the respiratory flows generated, where an absolute difference between the peak expiratory flow (PEF) and peak inspiratory flow (PIF) less than 17 L•min-1 or a PIF/PEF ratio greater than 0.9 would favor secretion retention. However, it is necessary to determine the respiratory flows and the proportion of patients, with and without respiratory pathology, with a risk of secretions retention according to these parameters. Objective. Determine respiratory flows during connection to invasive mechanical ventilation and the proportion of patients with and without respiratory pathology at risk of secretions retention. Methods. A descriptive cross-sectional study was conducted in the Medical-Surgical Intensive Care Unit of the "Hospital Clínico de la Red de Salud UC-CHRISTUS". Intubated adult patients connected to mechanical ventilation were included, in whom the respiratory flows were assessed, and the absolute PEF-PIF difference, PIF/PEF ratio, and the proportion of patients with a risk of secretions retention were determined. Results. 100 patients were included, of which 45% presented among their diagnoses acute or chronic respiratory pathology. For the total number of patients, the median of the absolute difference between PEF and PIF was 6 L•min-1 (-5 - 14.5), and the median of the PIF/PEF ratio of 0.87 (0.7 - 1.13). Of the total of patients, 84% presented an absolute difference between PEF and PIF less than 17 L• min-1, while 46% presented a PIF/PEF ratio greater than 0.9. Conclusion. Considering the absolute difference between PEF-PIF and the PIF/PEF ratio, many patients present a risk of secretions retention. However, whether this is associated with severe respiratory complications in patients connected to invasive mechanical ventilation should be clarified in future research.

Impacto del periodo de confinamiento por la pandemia COVID-19 en España sobre la salud y la atención recibida por los niños, niñas y jóvenes con discapacidad originada en la infancia / The impact of COVID-19 lockdown on the health and care of children and adolescents with a childhood-onset disability

Introducción Durante el periodo inicial del confinamiento por la COVID-19 se tomaron una serie de medidas de restricción que modificaron el día a día de la población. En este estudio se buscó conocer el impacto de este periodo en la salud física y mental de niños y jóvenes con discapacidad originada en la infancia, y de sus familias, y describir los cambios que se produjeron en el acceso a la educación y a los servicios de salud. Material y métodos Se realizó un estudio analítico observacional y transversal. Los datos se obtuvieron mediante una encuesta electrónica a través de una plataforma online realizada por la Academia Europea de Discapacidad Infantil. La encuesta incluyó preguntas sobre cuatro bloques temáticos: características sociodemográficas y de salud, impacto del confinamiento en la salud y bienestar, acceso a la educación y a los servicios de salud. Resultados Se obtuvieron 145 respuestas. El 45,5% de los niños y jóvenes eran totalmente dependientes. Se percibió un impacto sobre su salud física (54,5%), mental (47,6%) y sobre ambas (32%), mayores niveles de estrés (68,3%) y problemas de sueño (41,4%), así como una sobrecarga muy elevada en el 84,8% de los progenitores, sobre todo en familias de niños con mayor nivel de dependencia (p<0,001). El 55% de los niños y jóvenes no recibieron ningún tratamiento durante este periodo, ni siquiera remoto. Conclusiones El confinamiento afectó en gran medida la salud física y mental, así como a los servicios recibidos por los niños y jóvenes con discapacidad y sus familias (AU)

Introduction During the initial period of COVID-19 lockdown, restriction measures modified the day-to-day life of the population. This study sought to know the impact of this period on the physical and mental health of children and young people with disabilities originating in childhood, and their families, and to describe the changes that occurred in access to education and health services. Material and methods An observational and cross-sectional analytical study was carried out. The data were obtained by means of an electronic survey through an online platform carried out by the European Academy of Childhood Disability. The survey included questions on four thematic blocks: sociodemographic and health characteristics, impact of lock down on health and well-being, and access to education and health services. Results One hundred and forty-five responses were obtained. 45.5% of the children and young people were totally dependent. There was an impact on their physical (54.5%), mental health (47.6%) and both (32%), higher levels of stress (68.3%), and sleep problems (41.4%), as well as a high burden in 84.8% of parents, especially in families of children with a higher level of dependency (P=.00). 55% of children and young people did not receive any treatment during this period, not even remotely. Conclusions COVID lock down period greatly affected physical and mental health, as well as the services for children and young people with disabilities and their families (AU)

Mental stress induces endothelial dysfunction by AT1R-mediated redox imbalance in overweight/obese men.

The main goal of this study was to determine whether oxidative imbalance mediated by AT1 receptor (AT1R) is responsible for deleterious endothelial responses to mental stress (MS) in overweight/obese class I men. Fifteen overweight/obese men (27±7 years old; 29.8±2.6 kg/m2) participated in three randomized experimental sessions with oral administration of the AT1R blocker olmesartan (40 mg; AT1R blockade) or ascorbic acid (AA; 3g) infusion or placebo [both intravenously (0.9% NaCl) and orally]. After two hours, endothelial function was determined by flow-mediated dilation (FMD) before (baseline), 30 min (30MS), and 60 min (60MS) after a five-minute acute MS session (Stroop Color Word Test). Blood was collected before (baseline), during MS, and 60 min after MS for redox homeostasis profiling: lipid peroxidation (TBARS; thiobarbituric acid reactive species), protein carbonylation, and catalase activity by colorimetry and superoxide dismutase (SOD) activity by an ELISA kit. At the placebo session, FMD significantly decreased 30MS (P=0.05). When compared to baseline, TBARS (P<0.02), protein carbonylation (P<0.01), catalase (P<0.01), and SOD (P<0.01) increased during the placebo session. During AT1R blockade, FMD increased 30 min after MS (P=0.01 vs baseline; P<0.01 vs placebo), while AA infusion increased FMD only 60 min after MS. No differences were observed during MS with the AT1R blockade and AA regarding TBARS, protein carbonylation, catalase, and SOD. AT1R-mediated redox imbalances played an important role in endothelial dysfunction to mental stress.

Dietary soy galactooligosaccharides affect the performance, intestinal function, and gut microbiota composition of growing chicks.

The objective of this experiment was to investigate the effects of the dietary soy galactooligosaccharides (GOS), raffinose and stachyose, on performance, gastrointestinal health, and systemic stress in young broilers. Birds were fed a GOS-devoid diet based on soy protein isolate (SPI) or the SPI diet with 0.9, 1.8, 2.7, or 3.6% added stachyose and raffinose in a ratio of 4:1 at the expense of corn starch. These 5 treatments were administered to 10 replicate cages of 8 birds. Performance was measured weekly and excreta moisture, N retention, apparent metabolizeable energy, and complete blood cell counts were determined at 14 and 21 d. At 21 d, 2 birds per cage were orally gavaged with fluorescein isothiocyanate-dextran (FITC-d) and serum samples were analyzed for FITC-d as a marker of gut leakage. Additionally, intestinal morphology, crop presumptive lactic acid bacteria (LAB) counts, crop and cecal pH, and cecal microbiota via16S rRNA microbial sequencing were evaluated at 21 d. From 0 to 21 d, feed intake increased linearly (P < 0.01) as dietary GOS increased, whereas BWG increased (P < 0.05) quadratically. Feed conversion ratio increased (P < 0.01) linearly as GOS increased. There were linear increases (P < 0.05) in excreta moisture as dietary GOS increased at 14 and 21 d, as well as dose-dependent responses (P < 0.05) in N retention, AME, and AMEn. There was a quadratic increase (P < 0.05) in crop LAB recovery and a linear decrease (P < 0.01) in ceca pH as GOS increased. At 14 d, a linear increase (P < 0.05) in blood heterophil to lymphocyte ratio was observed as dietary GOS increased. Serum concentrations of FITC-d increased quadratically (P < 0.01) to dietary GOS. Increasing levels of GOS influenced alpha and beta diversities and composition of gut microbiota, including the abundance of Ruminococcus and Bifidobacterium. Results from this trial indicate that soy-derived GOS exert dose-dependent effects on nutrient utilization and intestinal health in young broilers.