Feasibility Study of Experimental Protocol for the Time-Dependent Mechanical Response of Synthetic Tibia.

In this research, an experimental biomechanics construct was developed to reveal the mechanics of distal tibial fracture by submitting synthetic tibiae to cyclic loading, resulting in a combined stress state due to axial compression and bending loads. The synthetic tibia was fixed at the knee but allowed to rotate in the coronal and sagittal planes at the ankle. The first three loading regimes lasted for 4000 cycles/each, and the final until ultimate failure. After 12k±80 cycles, the observed failure patterns closely resembled distal tibial fractures. The collected data during cyclic loading were fitted into a phenomenological model to deduce the time-dependent response of the synthetic tibiae. Images were also collected and analyzed using digital image correlation to deduce the full-field state of strain. The latter revealed that longitudinal strain contours extended in the proximal-distal direction. The transverse strain contours exemplified a medial-to-lateral distribution, attributed to the combined contributions of the Poisson's effect and the flexural deformation from axial and bending components of the applied load, respectively. The experimental construct, full-field characterization, and data analysis approaches can be extended to elucidate the effect of different fixation devices on the overall mechanical behavior of the bone and validate computational models in future research.

Cut-off points of neck and waist circumference as predictors of obstructive sleep apnea in the Colombian population: a comparison with polysomnography

ABSTRACT BACKGROUND: Neck circumference (NC) is a useful anthropometric measure for predicting obstructive sleep apnea (OSA). Ethnicity and sex also influence obesity phenotypes. NC cut-offs for defining OSA have not been established for the Latin American population. OBJECTIVES: To evaluate NC, waist circumference (WC), and body mass index (BMI) as predictors of OSA in the Colombian population and to determine optimal cut-off points. DESIGN AND SETTING: Diagnostic tests were conducted at the Javeriana University, Bogota. METHODS: Adults from three cities in Colombia were included. NC, WC, and BMI were measured, and a polysomnogram provided the reference standard. The discrimination capacity and best cut-off points for diagnosing OSA were calculated. RESULTS: 964 patients were included (57.7% men; median age, 58 years) and 43.4% had OSA. The discrimination capacity of NC was similar for men and women (area under curve, AUC 0.63 versus 0.66, P = 0.39) but better for women under 60 years old (AUC 0.69 versus 0.57, P < 0.05). WC had better discrimination capacity for women (AUC 0.69 versus 0.57, P < 0.001). There were no significant differences in BMI. Optimal NC cut-off points were 36.5 cm for women (sensitivity [S]: 71.7%, specificity [E]: 55.3%) and 41 cm for men (S: 56%, E: 62%); and for WC, 97 cm for women (S: 65%, E: 69%) and 99 cm for men (S: 53%, E: 58%). CONCLUSIONS: NC and WC have moderate discrimination capacities for diagnosing OSA. The cut-off values suggest differences between Latin- and North American as well as Asian populations.

Cut-off points of neck and waist circumference as predictors of obstructive sleep apnea in the Colombian population: a comparison with polysomnography.

BACKGROUND: Neck circumference (NC) is a useful anthropometric measure for predicting obstructive sleep apnea (OSA). Ethnicity and sex also influence obesity phenotypes. NC cut-offs for defining OSA have not been established for the Latin American population. OBJECTIVES: To evaluate NC, waist circumference (WC), and body mass index (BMI) as predictors of OSA in the Colombian population and to determine optimal cut-off points. DESIGN AND SETTING: Diagnostic tests were conducted at the Javeriana University, Bogota. METHODS: Adults from three cities in Colombia were included. NC, WC, and BMI were measured, and a polysomnogram provided the reference standard. The discrimination capacity and best cut-off points for diagnosing OSA were calculated. RESULTS: 964 patients were included (57.7% men; median age, 58 years) and 43.4% had OSA. The discrimination capacity of NC was similar for men and women (area under curve, AUC 0.63 versus 0.66, P = 0.39) but better for women under 60 years old (AUC 0.69 versus 0.57, P < 0.05). WC had better discrimination capacity for women (AUC 0.69 versus 0.57, P < 0.001). There were no significant differences in BMI. Optimal NC cut-off points were 36.5 cm for women (sensitivity [S]: 71.7%, specificity [E]: 55.3%) and 41 cm for men (S: 56%, E: 62%); and for WC, 97 cm for women (S: 65%, E: 69%) and 99 cm for men (S: 53%, E: 58%). CONCLUSIONS: NC and WC have moderate discrimination capacities for diagnosing OSA. The cut-off values suggest differences between Latin- and North American as well as Asian populations.

Co-Formulation of Recombinant Porcine IL-18 Enhances the Onset of Immune Response in a New Lawsonia intracellularis Vaccine.

Pig is one of the most consumed meats worldwide. One of the main conditions for pig production is Porcine Enteropathy caused by Lawsonia intracellularis. Among the effects of this disease is chronic mild diarrhea, which affects the weight gain of pigs, generating economic losses. Vaccines available to prevent this condition do not have the desired effect, but this limitation can be overcome using adjuvants. Pro-inflammatory cytokines, such as interleukin 18 (IL-18), can improve an immune response, reducing the immune window of protection. In this study, recombinant porcine IL-18 was produced and expressed in Escherichia coli and Pichia pastoris. The protein's biological activity was assessed in vitro and in vivo, and we determined that the P. pastoris protein had better immunostimulatory activity. A vaccine candidate against L. intracellularis, formulated with and without IL-18, was used to determine the pigs' cellular and humoral immune responses. Animals injected with the candidate vaccine co-formulated with IL-18 showed a significant increase of Th1 immune response markers and an earlier increase of antibodies than those vaccinated without the cytokine. This suggests that IL-18 acts as an immunostimulant and vaccine adjuvant to boost the immune response against the antigens, reducing the therapeutic window of recombinant protein-based vaccines.

New Formulation of a Subunit Vaccine Candidate against Lawsonia intracellularis Increases Humoral and Cellular Immune Responses.

Previously, we designed a subunit vaccine candidate based on three L. intracellularis antigens with promising results in pigs. In this study, antigens were produced individually to achieve an even antigen ratio in the formulation. The emulsion characterization included the drop size and the mechanical and thermal stability. Immune response was evaluated by indirect and sandwich ELISAs, qPCR, and flow cytometry. The vaccine candidate's safety was assessed by histopathology and monitoring the clinical behavior of animals. The average production yielded for the chimeric antigen as inclusion bodies was around 75 mg/L. The formulation showed mechanical and thermal stability, with a ratio Hu/Ho > 0.85 and a drop size under 0.15 nm. Antigens formulated at a ratio of 1:1:1 induced a significant immune response in inoculated pigs that persisted until the end of the experiment (week 14). The dose of 200 µg significantly activated cellular response measured by transcriptional and translational levels of cytokines. The cell proliferation assay revealed an increment of lymphocytes T CD4+ at the same dose. Animals gained weight constantly and showed proper clinical behavior during immunization assays. This research demonstrated the immunological robustness of the new subunit vaccine candidate against Porcine Proliferative Enteropathy evenly formulated with three chimeric antigens of L. intracellularis.

Safe Care and Medication Intake Provided by Caregivers at Home: Reality Care Study Protocol.

JUSTIFICATION: Providing care to patients with several conditions and simultaneously taking several medications at home is inexorably growing in developed countries. This trend increases the chances of home caregivers experiencing diverse errors related with medication or care. OBJECTIVE: To determine the effectiveness of four different educational solutions compared to the natural intervention (absence of intervention) to provide a safer care at home by caregivers. METHOD: Prospective, parallel, and mixed research study with two phases. Candidates: Home-based caregivers caring a person with multiple comorbid conditions or polymedication who falls into one of the three profiles of patients defined for the study (oncology, cardiovascular, or pluripathological patients). First phase: Experts first answered an online survey, and then joined together to discuss the design and plan the content of educational solutions directed to caregivers including the identification of medication and home care errors, their causes, consequences, and risk factors. Second phase: The true experiment was performed using an inter- and intrasubject single-factor experimental design (five groups: four experimental groups against the natural intervention (control), with pre- and post-intervention and follow-up measures) with a simple random assignment, to determine the most effective educational solution (n = 350 participants). The participants will be trained on the educational solutions through 360 V, VR, web-based information, or psychoeducation. A group of professionals called the "Gold Standard" will be used to set a performance threshold for the caring or medication activities. The study will be carried out in primary care centers, hospitals, and caregivers' associations in the Valencian Community, Andalusia, Madrid, and Murcia. EXPECTED RESULTS: We expect to identify critical elements of risk management at home for caregivers and to find the most effective and optimal educational solution to reduce errors at home, increasing caregivers' motivation and self-efficacy whilst the impact of gender bias in this activity is reduced. TRIAL REGISTRATION: Clinical Trial NCT05885334.

HIPEC in Ovarian Cancer Is the Future and Always Will Be? Results from a Spanish Multicentric Survey.

Ovarian cancer is the leading cause of death due to gynecological tumors in the female population. Despite optimal first-line treatment, including cytoreduction and platinum-based systemic chemotherapy, recurrences are frequent. The use of hyperthermic intraperitoneal chemotherapy (HIPEC) has been criticized, especially because of the lack of randomized controlled trials (RCTs) with convincing results to support the use of HIPEC in patients with ovarian cancer with peritoneal dissemination. In 2018, the clinical trial published by Van Driel et al. reported improved outcomes in favor of HIPEC treatment with cisplatin. In this study, we conducted a national survey within the Spanish group of peritoneal surgical oncology (Grupo Español de Cirugía Oncológica Peritoneal, GECOP) to explore the impact of the results of this RCT on clinical practice. A total of 33 groups completed the survey. Routine clinical practice was not changed in 28 of the 33 groups (85%) based on the results of the Van Driel trial. Despite the results of this RCT, most groups considered that more RCTs are needed and that, in the future, HIPEC may become the standard of care. In conclusion, the results from RCTs evaluating HIPEC treatment in patients with ovarian cancer has not been transferred to clinical practice.

Symptoms of Anxiety in Mothers During the COVID-19 Lockdown: A Structural Equation Model Approach.

The COVID-19 global pandemic has forced millions of people to stay confined at home, increasing symptoms of anxiety and stress levels. Women who are also mothers, for their part, not only face the demands of motherhood but must combine working life with family life locked down in their homes. Main objective was to develop an explanatory model of the psychological consequences of COVID-19 and parental and perceived stress in mothers. A total of 261 mothers were evaluated coinciding with the lockdown imposed by the Spanish Government. The model displayed adequate indices and it was found that symptoms of anxiety in mothers increased the levels of perceived stress. The model allows to understand the close relationships between the psychological consequences of lockdown and stress in mothers. Understanding these relationships will help to prepare and direct psychological interventions in this population in the case of a possible new surge.

Sleep Quality, Insomnia, and Perceived Stress among Colombian Healthcare Workers during the COVID-19 Pandemic.

Objective The COVID-19 pandemic has imposed a great burden on healthcare workers worldwide. The aim of the present study was to assess sleep quality, insomnia, and perceived stress in healthcare workers of a high complexity hospital located in Bogota, Colombia. Methods Cross-sectional study in which 1,155 healthcare workers at the Hospital Universitario San Ignacio in Bogotá, Colombia were included, between September and October 2020. Using an online-based survey, self-reported variables were assessed including demographics, Pittsburgh Sleep Quality Index (PSQI), Insomnia Severity Index (ISI), and 10 item Perceived Stress Scale (PSS-10). Associations between these variables were evaluated. Results Fifty percent of the respondents were between 31 and 45 years old, and 76 percent were women. Most of the surveyed were the nursing staff. Poor sleep quality, insomnia, and high perceived stress was found in 74.9, 12.4, and 13.2%, respectively. Poor sleep quality was predominantly found in females, in the 31 to 45 years old group and in married personnel. Also, poor sleep quality was found in relation to a moderate to high perceived risk of COVID-19 infection by the family of the workers surveyed. Discussion Poor sleep quality, moderate rates of insomnia, and perceived stress were found among healthcare workers committed to COVID-19 infected patients in Colombia. The identification of workers at greater risk and the implementation of targeted interventions are called upon as the results.

A Standardized Physical Examination Method for Joints to Determine Rheumatoid Arthritis Activity Using the Modified RAND/UCLA Appropriateness Method.

Introduction: Rheumatoid arthritis activity is evaluated based on a physical examination of each of the joints. However, the joint examination is not standardized, and the techniques are variable and difficult to reproduce due to disagreements among examiners. Objective: To recommend standardized joint examination techniques based on the modified RAND-UCLA appropriateness method. Methods: A review of the literature was conducted to determine the items to be included in the joint examination; subsequently, a consensus of rheumatologists was achieved with the modified RAND-UCLA methodology to issue the recommendations. The diagnosis of RA and differential diagnoses were excluded. Results: Two hundred fifteen rheumatologists were invited to participate. Five were included in the core group and 26 in the group of clinical experts. Clinical experience ranged between 2 and 25 years (mean 15.6 years; standard deviation 6.3 years). Most rheumatologists participated in all rounds (Round 1: 100%, Round 2: 61%, and Round 3: 61%). Of the 45 statements in the questionnaire assessing the examination techniques, 28 (62%) were retained. In addition, 6 other statements were included during the face-to-face meeting for a total of 34 final statements. Conclusion: Physical examination techniques for joints that determine RA activity are heterogeneous and differ markedly in terms of several characteristics. A list of recommendations is proposed as a guide to improve and standardize the method for the physical examination of the joints. This standardization will improve the diagnosis and results for patients with RA and help health caregivers provide better treatment.

Unlocking cellular barriers: silica nanoparticles and fullerenol conjugated cell-penetrating agents for enhanced intracellular drug delivery.

The limited delivery of cargoes at the cellular level is a significant challenge for therapeutic strategies due to the presence of numerous biological barriers. By immobilizing the Buforin II (BUF-II) peptide and the OmpA protein on magnetite nanoparticles, a new family of cell-penetrating nanobioconjugates was developed in a previous study. We propose in this study to extend this strategy to silica nanoparticles (SNPs) and silanized fullerenol (F) as nanostructured supports for conjugating these potent cell-penetrating agents. The same molecule conjugated to distinct nanomaterials may interact with subcellular compartments differently. On the obtained nanobioconjugates (OmpA-SNPs, BUF-II-PEG12-SNPs, OmpA-F, and BUF-II-PEG12-F), physicochemical characterization was performed to evaluate their properties and confirm the conjugation of these translocating agents on the nanomaterials. The biocompatibility, toxicity, and internalization capacity of nanobioconjugates in Vero cells and THP-1 cells were evaluated in vitro. Nanobioconjugates had a high internalization capacity in these cells without affecting their viability, according to the findings. In addition, the nanobioconjugates exhibited negligible hemolytic activity and a low tendency to induce platelet aggregation. In addition, the nanobioconjugates exhibited distinct intracellular trafficking and endosomal escape behavior in these cell lines, indicating their potential for addressing the challenges of cytoplasmic drug delivery and the development of therapeutics for the treatment of lysosomal storage diseases. This study presents an innovative strategy for conjugating cell-penetrating agents using silica nanoparticles and silanized fullerenol as nanostructured supports, which has the potential to enhance the efficacy of cellular drug delivery.

Efectividad de la aplicación del programa Echomantra en una adolescente con anorexia nerviosa y su familiar: Un estudio de caso / Effectiveness of the application of the Echomantra in an adolescent girl with anorexia nervosa and her caregiver: A case study

El programa ECHOMANTRA tiene como finalidad facilitar la transición de las pacientes con un trastorno de la conducta alimentaria desde el ingreso hospitalario a su vida cotidiana. Consta de una intervención para los/las familiares (ECHO; Treasure et al., 2015) y otra para las pacientes (MANTRA, Schmidt, et al, 2014). El objetivo de este estudio fue evaluar la efectividad del programa ECHOMANTRA, aplicado junto al tratamiento usual, en una adolescente de 15 años con anorexia nerviosa (AN) y su madre. Se utilizó un diseño de caso único y medidas pre-post, con seguimiento a los 3 y 6 meses. En la paciente se evaluó: patología alimentaria (EDE-Q), estado emocional (DASS-21), ajuste psicosocial (EQ-5D-5L y el CIA 3.0) y motivación al cambio; y en la madre: emoción expresada (FQ), impacto de los síntomas (EDSIS), acomodación a la enfermedad (EAISA), estado emocional (DASS-21) y habilidades de cuidadora (CSS). Ambos programas constaban de 8 sesiones online individuales y semanales. Los resultados mostraron una reducción en la sintomatología de AN, aumento del IMC, mejora del estado emocional, motivación al cambio y ajuste psicosocial; y en la madre, mejoró el estado emocional y las habilidades de cuidado, y disminuyó la acomodación a la enfermedad, la emoción expresada y el impacto de los síntomas. Estos cambios se mantuvieron en el seguimiento. Ambas valoraron el programa como satisfactorio. La aceptabilidad y la eficiencia del tratamiento de la AN puede mejorarse utilizando el ECHOMANTRA para preparar la transición de la atención hospitalaria, apoyando a las pacientes y familiares. (AU)

The aim of the ECHOMANTRA program is to facilitate the transition from hospital back into the community. ECHOMANTRA is based on interventions for carers (Experienced Carers Helping Others, ECHO; Treasure et al. 2016) and patients (Maudsley Model of Anorexia Nervosa Treatment for Adults, MANTRA; Schmidt, et al., 2014). The aim of this study was to evaluate the effectiveness of the ECHOMANTRA program, applied together with the usual treatment, in a 15-yearold adolescent girl with anorexia nervosa (AN) and her mother. A single case design and pre-post measures were used, as well as follow-up at 3 and 6 months. The patient was assessed for: eating pathology (EDE-Q), emotional state (DASS-21), psychosocial adjustment (EQ-5D-5L and CIA 3.0) and motivation to change. In the mother: expressed emotion (FQ), symptom impact (EDSIS), accommodation to illness (EAISA), emotional state (DASS-21) and her caregiver skills (CSS) were assessed. Both programs consisted of 8 on-line sessions, which were conducted individually and on a weekly basis. The results showed a reduction in AN symptomatology, increased BMI, improved emotional state, motivation to change and psychosocial adjustment; and in the mother, improved emotional state and caregiving skills, and reduced accommodation to illness, expressed emotion and the impact of symptoms. These changes were maintained at follow-up. Both patient and family valued the program as satisfactory. Both the acceptability and efficiency of treatment for AN may be improved by using ECHOMANATRA to prepare for transition from inpatient care, by giving support to both patients and their carers. (AU)

Mental health and psychosocial interventions integrating sexual and reproductive rights and health, and HIV care and prevention for adolescents and young people (10-24 years) in sub-Saharan Africa: a systematic scoping review.

Background: Interventions targeting combined sexual and reproductive health, Human Immunodeficiency Virus (HIV) management and mental health care in sub-Saharan Africa (SSA) are few. There is a need to address common determinants of poor mental, psychosocial and sexual and reproductive health and rights (SRHR) through multimodal and multipronged interventions for adolescents. The main objective of this study was to identify whether and how interventions targeting adolescent SRHR and HIV with a focus on pregnant and parenting adolescents in SSA include mental health components and how these components and their outcomes have been reported in the literature. Methods: We carried out a two process scoping review approach between 01.04.2021 and 23.08.2022. In the first stage, we searched the PubMed database to identify studies focusing on adolescents and young people aged 10 to 24 from 2001 to 2021. We identified studies focusing on HIV and SRHR that had mental health and psychosocial aspects to the interventions. Our search yielded 7025 studies. Of these 38 were eligible based on our screening criteria that covered interventions, and on further scrutiny, using PracticeWise, an established coding system, we identified select problems and practices to provide a more granular assessment of how interventions developed for this context mapped on to specific problems. At this second stage process, we selected 27 studies for inclusion as actual interventional designs for further systematic scoping of their findings and we used the Joanna Briggs Quality Appraisal checklist to rate these studies. This review was registered within the International Prospective Register of Systematic Reviews (PROSPERO), number CRD42021234627. Findings: Our first set of findings is that when coding problems and solutions, mental health concerns were the least common category of problems targeted in these SRHR/HIV interventions; nevertheless, psychoeducation and cognitive behavioral strategies such as improved communication, assertiveness training, and informational support were offered widely. Of the 27 interventional studies included in the final review, 17 RCTs, 7 open trials, and 3 mixed designs, represented nine countries of the 46 countries in SSA. Intervention types included peer, community, family, digital, and mixed modality interventions. Eight interventions focused on caregivers and youth. Social or community ecology associated problems (being an orphan, sexual abuse, homelessness, negative cultural norms) were the most common risk factors and were more frequent than medical issues associated with HIV exposure. Our findings highlight the relevance and centrality of social issues related to adolescent mental and physical health along with the need to strengthen multimodal interventions along the lines of problems we have identified in our review. Interpretation: Combined interventions jointly addressing adolescent SRHR, HIV, and mental health have been relatively understudied, despite evidence that adverse social and community factors are rampant in this population. Funding: MK was funded by Fogarty International CenterK43 TW010716-05 and lead the initiative.

Hyperthermia Treatment Monitoring via Deep Learning Enhanced Microwave Imaging: A Numerical Assessment.

The paper deals with the problem of monitoring temperature during hyperthermia treatments in the whole domain of interest. In particular, a physics-assisted deep learning computational framework is proposed to provide an objective assessment of the temperature in the target tissue to be treated and in the healthy one to be preserved, based on the measurements performed by a microwave imaging device. The proposed concept is assessed in-silico for the case of neck tumors achieving an accuracy above 90%. The paper results show the potential of the proposed approach and support further studies aimed at its experimental validation.

An Effective Framework for Deep-Learning-Enhanced Quantitative Microwave Imaging and Its Potential for Medical Applications.

Microwave imaging is emerging as an alternative modality to conventional medical diagnostics technologies. However, its adoption is hindered by the intrinsic difficulties faced in the solution of the underlying inverse scattering problem, namely non-linearity and ill-posedness. In this paper, an innovative approach for a reliable and automated solution of the inverse scattering problem is presented, which combines a qualitative imaging technique and deep learning in a two-step framework. In the first step, the orthogonality sampling method is employed to process measurements of the scattered field into an image, which explicitly provides an estimate of the targets shapes and implicitly encodes information in their contrast values. In the second step, the images obtained in the previous step are fed into a neural network (U-Net), whose duty is retrieving the exact shape of the target and its contrast value. This task is cast as an image segmentation one, where each pixel is classified into a discrete set of permittivity values within a given range. The use of a reduced number of possible permittivities facilitates the training stage by limiting its scope. The approach was tested with synthetic data and validated with experimental data taken from the Fresnel database to allow a fair comparison with the literature. Finally, its potential for biomedical imaging is demonstrated with a numerical example related to microwave brain stroke diagnosis.

Effectiveness of Blood Flow Restriction on Functionality, Quality of Life and Pain in Patients with Neuromusculoskeletal Pathologies: A Systematic Review.

BACKGROUND: Blood flow restriction is characterized as a method used during exercise at low loads of around 20-40% of a repetition maximum, or at a low-moderate intensity of aerobic exercise, in which cuffs that occlude the proximal part of the extremities can partially reduce arterial flow and fully restrict the venous flow of the musculature in order to achieve the same benefits as high-load exercise. OBJECTIVE: The main objective of this systematic literature review was to analyze the effects of BFR intervention on pain, functionality, and quality of life in subjects with neuromusculoskeletal pathologies. METHODS: The search to carry out was performed in PubMed, Cochrane, EMBASE, PEDro, CINHAL, SPORTDiscus, Trip Medical Database, and Scopus: "kaatsu" OR "ischemic training" OR "blood flow restriction" OR "occlusion resistance training" OR "vascular occlusion" OR "vascular restriction". RESULTS: After identifying 486 papers and eliminating 175 of them due to duplication and 261 after reading the title and abstract, 50 papers were selected. Of all the selected articles, 28 were excluded for not presenting a score equal to or higher than 6 points on the PEDro scale and 8 for not analyzing the target outcome variables. Finally, 14 papers were selected for this systematic review. CONCLUSIONS: The data collected indicate that the blood flow restriction tool is a therapeutic alternative due to its effectiveness under different exercise modalities. The benefits found include decreases in pain thresholds and improvement in the functionality and quality of life of the neuro-musculoskeletal patient during the first six weeks. However, the results provided by this tool are still not clear for medium- and long-term interventions.

Opciones terapéuticas para la retirada de “superpegamentos” de la piel / Therapeutic options for removing superglues from the skin

El cianocrilato es un compuesto adhesivo que se utiliza en la fabricación de “superpegamentos”. En contacto con tejidos de algodón o lana puede producir quemaduras térmicas. Por el contrario, en contacto sobre piel sana se han descrito dermatitis de contacto o alérgica pero no quemaduras. Caso clínico. Niña de 8 años que acude a urgencias tras haber derramado de manera accidental un “superpegamento” directamente sobre una mano y ambas extremidades inferiores, permaneciendo con el pegamento en contacto con la piel durante 3 horas sin poder retirarlo en domicilio. En la exploración destacaba gran eritema en varias regiones subyacentes al pegamento, sin ampollas, heridas ni sangrado. El pegamento se retiró bajo sedoanalgesia con lavavajillas líquido diluido en agua tibia, sin apreciarse solución de continuidad ni quemadura. Conclusiones. Existen numerosas medidas para la retirada de adhesivos de la piel. Escoger la opción terapéutica viene determinado, entre otros factores, por la presencia de lesiones cutáneas bajo el adhesivo. La aplicación de acetona está contraindicada en pieles con lesiones debido a que puede empeorar la irritación de las mismas. La demora hasta la retirada del adhesivo puede influir en el éxito del tratamiento; así como en la aparición de posibles secuelas (AU)

Cyanoacrylate is an adhesive used as a component in most of “super glues”. It can cause thermal burns if in contact with wool or cotton fabric. Nevertheless, in contact with intact skin it can cause contact or allergic dermatitis, but no thermal burns have been described.Clinical case: 8-year-old girl who had suffered an accidental fall of one of these glues directly on one of her hands and both lower extremities, and who had remained with the glue in contact with the skin for 3 hours. On examination we observed erythema on several regions underlying the glue, without blisters, wounds or bleeding. The glue was removed with warm water and detergent. No open wounds or burns were noticed.Conclusions: There are different ways to remove adhesives from the skin. Choosing the correct therapeutic option is determined, among other factors, by the presence of skin lesions under the adhesive. The use of acetone is contraindicated in injured skin because it can worsen the irritation. The delay in the removal of the adhesive can influence the success of the treatment and the type of treatment to be applied. (AU)

Síndrome de Loeffler, ¿más frecuente de lo que pensamos?: un caso asociado a Ascaris lumbricoides y Strongyloides stercolaris

El síndrome de Loeffler consiste en una neumonía eosinofílica aguda consecuencia de una reacción inmunológica de tipo alérgico, principalmente secundario a la fase pulmonar de los ciclos de algunos parásitos. Los parásitos más frecuentemente asociados son los nemátodos, y, entre ellos, Ascaris lumbricoides que es el principal causante de Síndrome de Loeffler. Clínicamente puede cursar con tos, dificultad respiratoria de distinto grado, sibilancias y subcrepitantes en la auscultación y fiebre. Como hallazgos radiológicos suelen apreciarse infiltrados intersticiales y en los exámenes de laboratorio destaca la presencia de eosinofilia en el hemograma. Se trata de un síndrome con muy baja incidencia a nivel global, probablemente debido a su infradiagnóstico, por lo que presentamos el caso de un paciente de 14 años con diagnóstico de Síndrome de Loeffler asociado a Ascaris lumbricoides y a Strongyloides stercolaris. (provisto por Infomedic International)

Loeffler's syndrome consist of an acute eosinophilic pneumonia due to an immunnologic reaction, mainly owing to the pulmonary phase of the life's cycles of some parasites. Nematodes are the most common parasites related to the syndrome, and between them, Ascaris lumbricoides is the one that causes most of the Loeffler's Syndrome. Symptoms that can be caused by the syndrome are cough, breath difficulties of different grades, fever and wheezing and crackling on auscultation. Radiological findings are bilateral interstitial infiltrates and in laboratory test eosinophilia stands out in blood count. The global incidence of the syndrome is very low, maybe due to an underdiagnosis, so we present the case of a 14-year-old male child with Loeffler´s Syndrome caused by Ascaris lumbricoides and Strongyloides stercolaris. (provided by Infomedic International)

Epigenetics in advanced renal cell carcinoma: Potential new targets.

Renal cell carcinoma (RCC) is the seventh most frequently diagnosed tumor in adults in Europe and represents approximately 2.5 % of cancer deaths. In metastatic setting, clinical strategies including angiogenesis inhibition with tyrosine kinase inhibitors, as well as immunotherapy against immune checkpoint proteins, such as PD-1/PDL-1 and CTLA-4, have revolutionized the treatment landscape. Unfortunately, most patients progress to anti angiogenic and immunotherapy treatment. Epigenetic aberrations are commonly found in RCC, showing that changes in epigenetic modifications, like promoter methylation or abnormal microRNA expression, are key in the development of RCC due to gene expression alterations without changes in the genome sequence. Nowadays, new drugs in the field of epigenetics are able to modify gene expression to induce antitumoral effect in the tumor cell. In kidney cancer, drugs targeting epigenetics are in early development, but could be promising in the near future. In this review, we summarize the main epigenetic alterations found in RCC and their involvement in pathological signaling pathways, being a new potential target that could potentially be added to the treatment flow of patients with advanced RCC.

Sleep problems in low income, urban pediatric populations living at different altitudes in Colombia.

OBJECTIVE: To determine the frequency of sleep problems in low-income, urban pediatric populations in cities at different altitudes in Colombia. METHODS: A descriptive, cross-sectional population-based observational study was conducted in children aged between 2 and 12 years in the low income, urban areas of three cities in Colombia (Santa Marta, Bucaramanga, and Bogotá) located at 15, 959, and 2640 m above sea level, respectively. Sociodemographic data were collected, and the Spanish version of the Pediatric Sleep Questionnaire was used. RESULTS: 1989 children were surveyed, distributed as follows: Santa Marta (32.0%), Bucaramanga (33.4%), and Bogotá (34.6%). The overall prevalence of sleep problems was 39.0%. Children from Santa Marta had the highest frequency of parasomnias (58.0%); those from Bucaramanga had the highest frequency of attention deficit symptoms (4.0%) and apneic pauses witnessed by parents or caregivers (5.7%). Finally, Bogotá, the only high-altitude location, had the highest frequency of sleep disordered breathing (17.2%). CONCLUSIONS: The study found a high frequency of sleep problems in the pediatric population, especially at higher altitudes when compared to lower altitude settings. Sleep disorders warrant early detection and timely therapeutic intervention.