Dualismo, modulación alostérica y señalización diferencial en los receptores opiáceos: futuro potencial terapéutico / Dualism, allosteric modulation and biased signaling of opioid receptors: Future therapeutic potential

Los fármacos opioides permanecen como fármacos de elección en el tratamiento del dolor agudo postoperatorio y del dolor crónico oncológico. Su prescripción inadecuada, ha dado lugar, en algunos países, a una verdadera «crisis de opioides». En este contexto, puede resultar interesante el potencial terapéutico de algunos ligandos que actúan como moduladores alostéricos de la fijación de los agonistas opioides y su capacidad de modular su actividad, modificando su afinidad, potencia e incluso eficacia. (AU)

Opioids are still the drugs of choice for the treatment of acute post-surgical pain and chronic cancer pain. Overprescribing of these drugs has given rise to an “opioid crisis” in some countries. In this context, attention has been drawn to the therapeutic potential of various ligands that act as allosteric modulators of orthosteric binding sites and modulate the drug's activity, affinity, potency, and even efficacy. (AU)

Homogeneous colleters in Myrteae (Myrtaceae).

Colleters are secretory structures characteristic of the apices of more than 60 botanical families. In the Myrtaceae, three types of colleters were previously described: petaloid, conical, and euriform. In Argentina, most species of the Myrtaceae family grow in subtropical regions and a few in the temperate-cold zones of Patagonia. We evaluated the vegetative buds of five species of the subfamily Myrtoideae, tribe Myrtea: Amomyrtus luma, Luma apiculata, and Myrceugenia exsucca, native to the temperate rainforests of Patagonia and Myrcianthes pungens and Eugenia moraviana from the riparian forest of northwestern Corrientes, in order to analyze the presence and morphological types and main secretion products of colleters. Optical and scanning electron microscopy was used to identify the presence of colleters in vegetative organs. Histochemical tests were performed to identify the main secretion products in these structures. The colleters are on the inner side of the leaf primordia and cataphylls and on the edge of the petiole, where they replace the stipules. They are classified as homogeneous because they consist of epidermis and internal parenchyma, both formed by cells with similar characteristics. They lack vascularization and originate from the protodermis. The colleters are of the conical type in L. apiculata, M. pungens, and E. moraviana and of the euriform type in A. luma and M. exsucca, the latter being identified by its dorsiventrally flattened shape. Histochemical tests showed the presence of lipids, mucilage, phenolic compounds, and proteins. This is the first time that colleters have been described in the analyzed species; the taxonomical and phylogenetic importance of this structures is discussed in relation to the Myrtaceae family.

Instrumentos predictores del éxito en la protetización de pacientes con amputaciones unilaterales mayores de miembro inferior / Objective measurement tools that predict success in the fitting of major unilateral lower limb amputations patients

El perfil del paciente que más frecuentemente sufre amputaciones de miembro inferior suele ser uno de edad avanzada y alta comorbilidad. Los médicos rehabilitadores precisamos en la valoración de estos pacientes de herramientas objetivas que predigan los resultados de los programas de protetización para aumentar la seguridad del paciente y eficiencia de los programas de rehabilitación protésica. Dada la necesidad de actualizar el conocimiento científico en este campo hemos realizado una revisión de la literatura con el objetivo de definir una propuesta de herramientas que faciliten la toma de decisiones en la indicación de rehabilitación protésica en estos pacientes. Para la realización de este trabajo se ha realizado una estrategia de búsqueda bibliográfica utilizando las bases de datos científicas PubMed, Web of Science, Scopus y Cochrane Library. La calidad de los artículos seleccionados se ha valorado según las herramientas propuestas por CASPe.(AU)

The profile of the patient who most frequently suffers lower limb amputations is usually an elderly patient with high comorbidity. Physiatrists need objective tools in the assessment of these patients that predict the results of prosthetic programs to increase patient safety and efficiency of prosthetic rehabilitation programs. Given the need to update scientific knowledge in this field, we have carried out a review of the literature with the aim of defining a proposal for tools that facilitate decision-making in the indication of prosthetic rehabilitation in these patients. A bibliographic search strategy has been carried out using the scientific databases PubMed, Web of Science, Scopus and Cochrane Library. The quality of the selected articles has been assessed according to the tools proposed by CASPe.(AU)

Eficacia de la fisioterapia para mejorar la calidad de vida y el dolor en el tratamiento del linfedema postmastectomía. Una revisión sistemática / Efficacy of physiotherapy to improve quality of life and pain in the treatment of postmastectomy lymphedema. A systematic review

Objetivo Comparar la evidencia de los diferentes tratamientos para el linfedema y los posibles dolores miofasciales postmastectomía, para conseguir la máxima calidad de vida de los pacientes. Estrategia de búsqueda y selección de estudios Se realizó una búsqueda en las bases de datos PubMed, Phisiotherapy Evidence Database (PEDro) y Web of Science (WOS) durante marzo y abril del año 2022. Se tuvo en cuenta que los pacientes hubiesen sido intervenidos quirúrgicamente por cáncer de mama (CaMama), mayores de 18 años y que los estudios fuesen ensayos clínicos; resultando un total de 10 artículos seleccionados. Se evaluó la calidad metodológica y factor de impacto de cada uno de ellos. Síntesis de resultados Las variables analizadas fueron reducción del linfedema, calidad de vida y abordaje del dolor. El tratamiento a través de drenaje linfático manual (DLM) presentó mejorías en todos los artículos que hacían referencia a la reducción del linfedema, tanto de forma individual como de forma aislada; en cambio, respecto a los dolores miofasciales el tratamiento de liberación miofascial mostró mejoras tanto en la calidad emocional como en la disminución del dolor, siendo más efectivo en esta última variable. Conclusiones Los tratamientos que mejoran la calidad de vida y dolor de los pacientes que han sufrido una intervención quirúrgica debido al CaMama, además de reducir el linfedema son DLM, facilitación neuromuscular propioceptiva (FNP), liberación miofascial y programas de ejercicios y entrenamientos. La limitación principal respecto a los tratamientos, es que no existe ningún programa de intervención específico (AU)

Objective To compare the evidence of the different treatments for lymphedema and possible postmastectomy myofascial pain, to achieve the highest quality of life for patients. Search strategy and selection of studies A search was carried out in the PubMed, Physiotherapy Evidence Database (PEDro) and Web of Science (WOS) databases during March and April 2022. It was taken into account that the patients had undergone surgery surgically for breast cancer, that they were over 18 years of age and that the studies were clinical trials; resulting in a total of 10 selected articles. The methodological quality and impact factor of each of them were evaluated. Summary of results The variables analyzed were reduction of lymphedema, quality of life and pain management. Treatment through manual lymphatic drainage (MLD) presented improvements in all the articles that made reference to the reduction of lymphedema, both individually and in isolation; On the other hand, regarding myofascial pain, myofascial release treatment showed improvements in both emotional quality and pain reduction, being more effective in this last variable. Conclusions The treatments that improve the quality of life and pain of patients who have undergone surgery due to breast cancer, in addition to reducing lymphedema, are manual lymphatic drainage, proprioceptive neuromuscular facilitation, myofascial release, and exercise and training programs. The main limitation regarding treatments is that there is no specific intervention program (AU)

Dualism, allosteric modulation, and biased signaling of opioid receptors: Future therapeutic potential.

Opioids are still the drugs of choice for the treatment of acute post-surgical pain and chronic cancer pain. Overprescribing of these drugs has given rise to an "opioid crisis" in some countries. In this context, attention has been drawn to the therapeutic potential of various ligands that act as allosteric modulators of orthosteric binding sites and modulate the drug's activity, affinity, potency, and even efficacy.

Magnetic resonance in patients with cardiovascular devices. SEC-GT CRMTC/SEC-Heart Rhythm Association/SERAM/SEICAT consensus document.

Magnetic resonance has become a first-line imaging modality in various clinical scenarios. The number of patients with different cardiovascular devices, including cardiac implantable electronic devices, has increased exponentially. Although there have been reports of risks associated with exposure to magnetic resonance in these patients, the clinical evidence now supports the safety of performing these studies under specific conditions and following recommendations to minimize possible risks. This document was written by the Working Group on Cardiac Magnetic Resonance Imaging and Cardiac Computed Tomography of the Spanish Society of Cardiology (SEC-GT CRMTC), the Heart Rhythm Association of the Spanish Society of Cardiology (SEC-Heart Rhythm Association), the Spanish Society of Medical Radiology (SERAM), and the Spanish Society of Cardiothoracic Imaging (SEICAT). The document reviews the clinical evidence available in this field and establishes a series of recommendations so that patients with cardiovascular devices can safely access this diagnostic tool.

Resonancia magnética para portadores de dispositivos cardiovasculares. Consenso SEC-GT CRMTC/SEC-Asociación del Ritmo Cardiaco/SERAM/SEICAT / Magnetic resonance in patients with cardiovascular devices. SEC-GT CRMTC/SEC-Heart Rhythm Association/SERAM/SEICAT consensus document

La resonancia magnética se ha convertido en técnica de imagen de primera línea en muchas situaciones clínicas. El número de pacientes portadores de dispositivos cardiovasculares, como los dispositivos cardiovasculares electrónicos implantables, ha crecido de modo exponencial. Aunque se han descrito complicaciones y efectos adversos cuando estos pacientes se someten a exploraciones de resonancia magnética, la evidencia clínica actual respalda la seguridad de realizar estos estudios cuando se cumplen unas normas y recomendaciones dirigidas a minimizar los posibles riesgos. El Grupo de Trabajo de Cardiorresonancia Magnética y Cardiotomografía Computarizadas de la Sociedad Española de Cardiología (SEC-GT CRMTC), la Asociación del Ritmo Cardiaco de la Sociedad Española de Cardiología (SEC-Asociación del Ritmo Cardiaco de la Sociedad Española de Cardiología), la Sociedad Española de Radiología Médica (SERAM) y la Sociedad Española de Imagen Cardiotorácica (SEICAT) han elaborado el presente documento, que revisa la evidencia disponible en este campo y establece las recomendaciones necesarias para que los pacientes portadores de dispositivos cardiovasculares electrónicos implantables y otros dispositivos puedan acceder con seguridad a este instrumento diagnóstico.(AU)

Magnetic resonance has become a first-line imaging modality in various clinical scenarios. The number of patients with different cardiovascular devices, including cardiac implantable electronic devices, has increased exponentially. Although there have been reports of risks associated with exposure to magnetic resonance in these patients, the clinical evidence now supports the safety of performing these studies under specific conditions and following recommendations to minimize possible risks. This document was written by the Working Group on Cardiac Magnetic Resonance Imaging and Cardiac Computed Tomography of the Spanish Society of Cardiology (SEC-GT CRMTC), the Heart Rhythm Association of the Spanish Society of Cardiology (SEC-Heart Rhythm Association), the Spanish Society of Medical Radiology (SERAM), and the Spanish Society of Cardiothoracic Imaging (SEICAT). The document reviews the clinical evidence available in this field and establishes a series of recommendations so that patients with cardiovascular devices can safely access this diagnostic tool.(AU)

Valoración multidisciplinar de las secuelas al mes del alta hospitalaria por neumonía grave COVID-19, ¿existen diferencias en función de la terapia respiratoria empleada durante su ingreso en Cuidados Intensivos? / Multidisciplinary approach of the sequelae one month after hospital discharge in patients with severe bilateral COVID-19 pneumonia, are there differences depending on the respiratory therapy used during admission to intensive care?

Objetivo Describir las secuelas al mes del alta hospitalaria en pacientes que precisaron ingreso en Cuidados Intensivos por neumonía grave COVID-19 y analizar las diferencias entre los que recibieron terapia exclusivamente con oxigenoterapia con alto flujo con respecto a los que precisaron ventilación mecánica invasiva (VMI). Diseño Estudio de cohorte, prospectivo y observacional. Ámbito Consulta multidisciplinar pos Cuidados Intensivos. Pacientes o participantes Pacientes que superaron el ingreso en la Unidad de Cuidados Intensivos (UCI) por neumonía grave COVID-19 desde abril 2020 hasta octubre 2021. Intervenciones Inclusión en el programa multidisciplinar pos UCI. Variables de interés principales Secuelas motoras, sensitivas, psicológicas/psiquiátricas, respiratorias y nutricionales tras el ingreso hospitalario. Resultados Se incluyeron 104 pacientes. 48 pacientes recibieron oxigenoterapia nasal de alto flujo (ONAF) y 56 VMI. Las principales secuelas encontradas fueron la neuropatía distal (33,9% VMI vs. 10,4% ONAF); plexopatía braquial (10,7% VMI vs. 0% ONAF); disminución de fuerza de agarre: mano derecha 20,67 kg (± 8,27) en VMI vs. 31,8 kg (± 11,59) en ONAF y mano izquierda 19,39 kg (± 8,45) en VMI vs. 30,26 kg (± 12,74) en ONAF; y balance muscular limitado en miembros inferiores (28,6% VMI vs. 8,6% ONAF). Las diferencias observadas entre ambos grupos no alcanzaron significación estadística en el estudio multivariable. Conclusiones Los resultados obtenidos tras el estudio multivariable sugieren no existir diferencias en cuanto a las secuelas físicas percibidas al mes del alta hospitalaria en función de la terapia respiratoria empleada, ya fuera ONAF o ventilación mecánica prolongada, si bien son precisos más estudios para poder obtener conclusiones al respecto (AU)

Objective To describe the sequelae one month after hospital discharge in patients who required admission to intensive care for severe COVID-19 pneumonia and to analyze the differences between those who received therapy exclusively with high-flow oxygen therapy compared to those who required invasive mechanical ventilation. Design Cohort, prospective and observational study. Setting Post-intensive care multidisciplinary program. Patients or participants Patients who survived admission to the intensive care unit (ICU) for severe COVID-19 pneumonia from April 2020 to October 2021. Interventions Inclusion in the post-ICU multidisciplinary program. Main variables of interest Motor, sensory, psychological/psychiatric, respiratory and nutritional sequelae after hospital admission. Results One hundred and four patients were included. 48 patients received high-flow nasal oxygen therapy (ONAF) and 56 invasive mechanical ventilation (IMV). The main sequelae found were distal neuropathy (33.9% IMV vs. 10.4% ONAF); brachial plexopathy (10.7% IMV vs. 0% ONAF); decrease in grip strength: right hand 20.67 kg (± 8.27) in VMI vs. 31.8 kg (± 11.59) in ONAF and left hand 19.39 kg (± 8.45) in VMI vs. 30.26 kg (± 12.74) in ONAF; and limited muscle balance in the lower limbs (28.6% VMI vs. 8.6% ONAF). The differences observed between both groups did not reach statistical significance in the multivariable study. Conclusions The results obtained after the multivariate study suggest that there are no differences in the perceived physical sequelae one month after hospital discharge depending on the respiratory therapy used, whether it was high-flow nasal oxygen therapy or prolonged mechanical ventilation, although more studies are needed to be able to draw conclusions (AU)

Growth patterns and outcomes of growth hormone therapy in patients with acrodysostosis.

INTRODUCTION: Severe short stature is a feature of acrodysostosis, but data on growth are sparse. Treatment with recombinant human growth hormone (rhGH) is used in some centers to increase final height, but no studies have been published so far. Our objective was to conduct a multicenter, retrospective, cohort study to investigate growth in individuals with both types of acrodysostosis, treated with rhGH or not; we used the new nomenclature to describe acrodysostosis, as this disease belongs to the large group of inactivating PTH/PTHrP signaling disorders (iPPSD); acrodysostosis refers to iPPSD4 (acrodysostosis type 1 due to PRKAR1A mutations) and iPPSD5 (acrodysostosis type 2, due to PDE4D mutations). METHODS: We present auxological data from individuals with genetically characterized iPPSD4, and participants with clinical features of iPPSD5. RESULTS: We included 20 and 17 individuals with iPPSD4 and iPPSD5, respectively. The rhGH-treated iPPSD4 patients (n = 9) were smaller at birth than those who did not receive rhGH (median - 2.2 SDS vs. - 1.7 SDS); they showed a trend to catch-up growth during rhGH therapy (median 0.5 SDS in the first year). The rhGH-treated patients (n = 5) reached a better final height compared to those who did not receive rhGH (n = 4) (median - 2.8 SDS vs. - 3.9 SDS), suggesting that rhGH is efficient to increase height in those patients. The difference in target height to final height ranged between 1.6 and 3.0 SDS for iPPSD4 not treated with rhGH (n = 4), 2.1-2.8 SDS for rhGH-treated iPPSD4 (n = 5), 0.6-5.5 SDS for iPPSD5 not treated with rhGH (n = 5) and 2.5-3.1 for rhGH-treated iPPSD5 (n = 2). CONCLUSION: Final height may be positively influenced by rhGH in patients with acrodysostosis/iPPSD. Our rhGH-treated cohort started therapy relatively late, which might explain, at least in part, the limited effect of rhGH on height.

[Objective measurement tools that predict success in the fitting of major unilateral lower limb amputations patients]. / Instrumentos predictores del éxito en la protetización de pacientes con amputaciones unilaterales mayores de miembro inferior.

The profile of the patient who most frequently suffers lower limb amputations is usually an elderly patient with high comorbidity. Physiatrists need objective tools in the assessment of these patients that predict the results of prosthetic programs to increase patient safety and efficiency of prosthetic rehabilitation programs. Given the need to update scientific knowledge in this field, we have carried out a review of the literature with the aim of defining a proposal for tools that facilitate decision-making in the indication of prosthetic rehabilitation in these patients. A bibliographic search strategy has been carried out using the scientific databases PubMed, Web of Science, Scopus and Cochrane Library. The quality of the selected articles has been assessed according to the tools proposed by CASPe.

Multidisciplinary approach of the sequelae one month after hospital discharge in patients with severe bilateral COVID-19 pneumonia, are there differences depending on the respiratory therapy used during admission to intensive care?

OBJECTIVE: To describe the sequelae one month after hospital discharge in patients who required admission to Intensive Care for severe COVID 19 pneumonia and to analyze the differences between those who received therapy exclusively with high-flow oxygen therapy compared to those who required invasive mechanical ventilation. DESIGN: Cohort, prospective and observational study. SETTING: Post-intensive care multidisciplinary program. PATIENTS OR PARTICIPANTS: Patients who survived admission to the intensive care unit (ICU) for severe COVID 19 pneumonia from April 2020 to October 2021. INTERVENTIONS: Inclusion in the post-ICU multidisciplinary program. MAIN VARIABLES OF INTEREST: Motor, sensory, psychological/psychiatric, respiratory and nutritional sequelae after hospital admission. RESULTS: 104 patients were included. 48 patients received high-flow nasal oxygen therapy (ONAF) and 56 invasive mechanical ventilation (IMV). The main sequelae found were distal neuropathy (33.9% IMV vs 10.4% ONAF); brachial plexopathy (10.7% IMV vs 0% ONAF); decrease in grip strength: right hand 20.67kg (±8.27) in VMI vs 31.8kg (±11.59) in ONAF and left hand 19.39kg (±8.45) in VMI vs 30.26kg (±12.74) in ONAF; and limited muscle balance in the lower limbs (28.6% VMI vs 8.6% ONAF). The differences observed between both groups did not reach statistical significance in the multivariable study. CONCLUSIONS: The results obtained after the multivariate study suggest that there are no differences in the perceived physical sequelae one month after hospital discharge depending on the respiratory therapy used, whether it was high-flow nasal oxygen therapy or prolonged mechanical ventilation, although more studies are needed to be able to draw conclusions.

Clinical and psychological implications of secondary and incidental findings in cancer susceptibility genes after exome sequencing in patients with rare disorders.

BACKGROUND/OBJECTIVES: Exome sequencing may identify pathogenic variants unrelated with the purpose of the analysis. We investigated the frequency of secondary and incidental findings (SF/IF) in cancer susceptibility genes (CSG), their clinical actionability and the psychological impact in individuals with an SF/IF (cases) compared with individuals tested due to their cancer history (controls). METHODS: This study analysed 533 exomes ordered for non-cancer conditions. Medical records were reviewed for clinical actionability of SF/IF. Psychological impact was analysed using the Multidimensional Impact of Cancer Risk Assessment (MICRA) scale and compared between cases and controls with a propensity score weighting method. RESULTS: The frequency of SF/IF in CSG was 2.1% (95% CI 1.1% to 3.8%): three BRCA2, three PMS2, two SDHB, and one each in BRCA1, MLH1 and RAD51C. Among the relatives, 18 were carriers. Twenty enrolled for surveillance, and a neoplasm was diagnosed in 20%: three paragangliomas and one breast cancer. Cases presented higher MICRA mean scores than controls (21.3 vs 16.2 in MICRA total score, 6.3 vs 4.2 in the distress subscale, and 8.3 vs 6.6 in the uncertainty subscale; all p<0.001). CONCLUSION: SF/IF in CSG were identified in 2.1% of patients. Despite a numerically higher psychological impact, the identification of SF/IF allowed early detection and cancer prevention in families without cancer history.

[Multidisciplinary approach of the sequelae one month after hospital discharge in patients with severe bilateral COVID-19 pneumonia, are there differences depending on the respiratory therapy used during admission to intensive care?] / Valoración multidisciplinar de las secuelas al mes del alta hospitalaria por neumonía grave COVID-19, ¿existen diferencias en función de la terapia respiratoria empleada durante su ingreso en Cuidados Intensivos?

Objective: To describe the sequelae one month after hospital discharge in patients who required admission to intensive care for severe COVID-19 pneumonia and to analyze the differences between those who received therapy exclusively with high-flow oxygen therapy compared to those who required invasive mechanical ventilation. Design: Cohort, prospective and observational study. Setting: Post-intensive care multidisciplinary program. Patients or participants: Patients who survived admission to the intensive care unit (ICU) for severe COVID-19 pneumonia from April 2020 to October 2021. Interventions: Inclusion in the post-ICU multidisciplinary program. Main variables of interest: Motor, sensory, psychological/psychiatric, respiratory and nutritional sequelae after hospital admission. Results: One hundred and four patients were included. 48 patients received high-flow nasal oxygen therapy (ONAF) and 56 invasive mechanical ventilation (IMV). The main sequelae found were distal neuropathy (33.9% IMV vs. 10.4% ONAF); brachial plexopathy (10.7% IMV vs. 0% ONAF); decrease in grip strength: right hand 20.67 kg (± 8.27) in VMI vs. 31.8 kg (± 11.59) in ONAF and left hand 19.39 kg (± 8.45) in VMI vs. 30.26 kg (± 12.74) in ONAF; and limited muscle balance in the lower limbs (28.6% VMI vs. 8.6% ONAF). The differences observed between both groups did not reach statistical significance in the multivariable study. Conclusions: The results obtained after the multivariate study suggest that there are no differences in the perceived physical sequelae one month after hospital discharge depending on the respiratory therapy used, whether it was high-flow nasal oxygen therapy or prolonged mechanical ventilation, although more studies are needed to be able to draw conclusions.

3D scaffolds of caprolactone/chitosan/polyvinyl alcohol/hydroxyapatite stabilized by physical bonds seeded with swine dental pulp stem cell for bone tissue engineering.

Bone Regeneration represents a clinical need, related to bone defects such as congenital anomalies, trauma with bone loss, and/or some pathologies such as cysts or tumors This is why a polymeric biomaterial that mimics the osteogenic composition and structure represents a high potential to face this problem. The method of obtaining these materials was first to prepare a stabilized hydrogel by means of physical bonds and then to make use of the lyophilization technique to obtain the 3D porous scaffolds with temperature conditions of -58 °C and pressure of 1 Pa for 16 h. The physicochemical and bioactive properties of the scaffolds were studied. FTIR and TGA results confirm the presence of the initial components in the 3d matrix of the scaffold. The scaffolds exhibited a morphology with pore size and interconnectivity that promote good cell viability. Together, the cell viability and proliferation test, Alamar BlueTM and the differentiation test: alizarin staining, showed the ability of physically stabilized scaffolds to proliferate and differentiate swine dental pulp stem cell (DPSCs) followed by mineralization. Therefore, the Cs-PCL-PVA-HA scaffold stabilized by physical bonds has characteristics that suggest great utility for future complementary in vitro tests and in vivo studies on bone defects. Likewise, this biomaterial was enhanced with the addition of HA, providing a scaffold with osteoconductive properties necessary for good regeneration of bone tissue. Graphical abstract.

Hyptis mociniana: phytochemical fingerprint and photochemoprotective effect against UV-B radiation-induced erythema and skin carcinogenesis.

Skin cancer is a public health problem due to its high incidence. Ultraviolet radiation (UVR) is the main etiological agent of this disease. Photochemoprotection involves the use of substances to avoid damage caused by UV exposure. The aim of this work was to determine the phytochemical fingerprint and photochemoprotective effect against UVB radiation-induced skin damage such as erythema and carcinogenesis of H. mociniana methanolic extract (MEHm). The chemical composition of the MEHm was analysed by LC/ESI-MS/MS. Three quercetin derivatives, two pectinolides, and two caffeic acid derivatives were identified in the methanolic extract. MEHm has antioxidant effect and it is not cytotoxic in HaCaT cells. Phytochemicals from H. mociniana have a photochemopreventive effect because they absorb UV light and protect HaCaT cells from UVR-induced cell death. Also, in SKH-1 mice -acute exposure-, it decreased erythema formation, modulating the inflammatory response, reduced the skin damage according to histological analysis and diminished p53 expression. Finally, MEHm protects from photocarcinogenesis by reducing the incidence and multiplicity of skin carcinomas in SKH-1 mice exposed chronically to UVB radiation.

[Implementation of the Lean Six Sigma in the improvement of the medication dispensing circuit]. / Implementación Lean Six Sigma en la mejora del circuito de dispensación de medicación.

OBJECTIVE: Lean Six Sigma (LSS) methodology is used to increase productivity and to improve performance, by eliminating processes that do not add value to the customer, as well as reducing variability. In recent years, its application in healthcare sector is increasing in order to improve the efficiency of processes. The aim of this study was to evaluate the results obtained in terms of efficiency in the medication dispensing circuit, after application of LSS methodology. MATERIAL AND METHODS: A multidisciplinary team was created in order to analyse and improve the medication dispensing circuit. The main tools used in LSS methodology were the DMAIC cycle (Define, Measure, Analyse, Improve and Control), SIPOC diagram (Suppliers, Inputs, Process, Outputs, and Customers), a root-cause analysis; a survey to determine the "Customer's voice" about the circuit; and the cost of each task in terms of staff time. Two Pilot Nursing Units (Thoracic Surgery and Cardiology) were selected to introduce the improvement actions. The main analysed variables were: urgent medication orders per day, and percentage of medication orders made online. RESULTS: After the application of LSS methodology, a significant reduction was found in urgent medicament orders per day in both nursing units, and a significant improvement in the electronic processing of urgent orders. The performance of medication dispensing circuit was increased from 60% (1.76 sigma) during initial data analysis, to 93% (3 sigma) in Thoracic Surgery, and from 71% (2.11 sigma) to 81% (2.4 sigma) in Cardiology. Six months after the implementation of improvements, the performance values were increased to 94% (3.1 sigma) and 93% (3 sigma), respectively. Estimated cost savings related to staff were 798.2 € (266 € per month) after implementation, ascending to 2, 228.5 € (371.4 € per month) after 6months. CONCLUSION: The use of LSS methodology has improved the performance of medication dispensing circuits, reducing costs in terms of staff time, and obtaining satisfactory results.

Analysis of the care management protocol for COVID pregnant women and detection of improvement proposals applying clinical simulation methodology. / Análisis del protocolo de atención a las gestantes COVID y detección de puntos de mejora aplicando metodología de simulación clínica.

INTRODUCTION: The current SARS-CoV-2 pandemic has been the world's largest socio-health crisis experienced in the last century. Each healthcare center has been compelled to adapt the treatment guidelines established by the different scientific societies. OBJECTIVES: Analyze the impact of the methodology based on simulation as a tool to improve our clinical practice: work dynamics, effectiveness and safety of all the physicians involved in the management of labor in COVID pregnant women and its usefulness to facilitate the adaptation of protocols to a specific clinical context. METHOD: Descriptive observational study that includes the C-sections and deliveries of COVID pregnant women performed in our hospital. The actions carried out in each procedure were analyzed using the simulation multidisciplinary briefing and debriefing tools, before and after each case. RESULTS: A total of 5 clinical cases were analyzed. Difficulties were found in the execution of the protocols established for the care of the COVID pregnant. Organizational, structural, material resources and human factors obstacles were the most common. CONCLUSIONS: Our results showed that the analysis example using simulation methodology was a tool of great value in three aspects: teamwork improvement, actions consent and improvement proposals for the adaptation and implementation of protocols.

[Epidemiology and etiology of vulvovaginal candidiasis in Spanish and immigrants' women in Fuenlabrada (Madrid)]. / Epidemiología y etiología de la candidiasis vaginal en mujeres españolas e inmigrantes en Fuenlabrada (Madrid).

OBJECTIVE: Vulvovaginal candidiasis (VVC) is a common vaginal infection. Risk factors include diabetes, antibiotic use and pregnancy. Candida albicans is the most common species identified but non-C. albicans species appear to be more commonly associated with VVC in some Asian and African countries. We had studied the distribution of Candida species in Spanish and immigrants' women residents in Spain. METHODS: Retrospective study of vaginal yeast cultures between 2015 and 2018. RESULTS: A total of 2,283 vaginal yeast cultures were collected. Candida spp. was detected in 25.7% from Spanish women and in 28.5% from immigrants (no significant differences). Immigrants have higher rates of vaginal candidiasis compared other studies in Spain. C. albicans was the most common species isolated (82.4%). CONCLUSIONS: There were no differences in vaginal candidiasis rate between Spanish and immigrants' women. Immigrants consulted proportionally more compared with the Spanish women.

[Virtual reality rehabilitation in paediatric patients with hemophilia. Retrospective study]. / Rehabilitación con realidad virtual en pacientes pediátricos con hemofilia. Estudio retrospectivo.

INTRODUCTION: Joint affection is a frequent complication of hemophilia. Virtual reality programs offer the patient a dynamic plan with maximum functional benefit. The objective of this work is to evaluate the effect of a rehabilitation program combined with conventional therapy and virtual reality on joint function, in patients with hemophilic arthropathy and the impact on the gait. MATERIAL AND METHODS: Eleven pediatric patients with hemophilia and history of hemophilic arthropathy grade I or II were evaluated. An 8-week rehabilitation program was carried out with Xbox KinectTM and mechanotherapy. Movement analysis laboratory to evaluate the gait pattern and the Joint Health Scale was performed at the beginning and end of the program. RESULTS: A reduction of 50% (p = 0.000), 68% (p = 0.016) and 48% (p = 0.000) were observed in the Total Joint Health score (STA), Global Gait Score (PMG) and Total Score of the Joint Health Scale (P-HJHS-T) respectively. There is a decrease in the support phase and right stride, and increase in cadence, step length, left stride and swing phase. CONCLUSIONS: The overall improvement of the patients makes us conclude that this pilot study opens a window of opportunity to continue the study of an integral rehabilitation program based on the use of virtual reality in pediatric patients with hemophilic arthropathy.

INTRODUCCIÓN: La afección articular es una complicación frecuente de la hemofilia. Los programas de realidad virtual ofrecen al paciente pediátrico un esquema dinámico con máximo beneficio funcional. El objetivo de este trabajo es evaluar el efecto de un programa de rehabilitación combinado con terapia convencional y realidad virtual sobre la función articular en pacientes con artropatía hemofílica y el impacto sobre el patrón de la marcha. MATERIAL Y MÉTODOS: Se evaluaron 11 pacientes pediátricos con hemofilia A o B y antecedente de artropatía hemofílica en grado I o II. Se sometieron a un programa de rehabilitación de ocho semanas con Xbox KinectTM y mecanoterapia. Se utilizó el laboratorio de análisis de movimiento para evaluar el patrón de marcha y la escala de salud articular al inicio y término del programa. RESULTADOS: Se redujo 50% (p = 0.000), 68% (p = 0.016) y 48% (p = 0.000) el puntaje de la escala de salud total articular (STA), puntaje marcha global (PMG) y puntaje total de la escala de salud articular (P-HJHS-T) respectivamente. Se observó disminución en la fase de apoyo y zancada derecha y aumento en cadencia, longitud de paso, zancada izquierda y fase de balanceo. CONCLUSIONES: La mejoría global de los pacientes nos hace concluir que este estudio piloto abre una ventana de oportunidades para continuar el estudio de un programa integral de rehabilitación con base en el uso de la realidad virtual en pacientes pediátricos con artropatía hemofílica.