Primer consenso cubano sobre el uso de terapia convencional y biológica en pacientes con artritis reumatoide / First Cuban consensus on the use of conventional and biological therapy in patients with rheumatoid arthritis

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Introduction: The development of recommendations for the treatment of rheumatoid arthritis (RA) in the Cuban context may be one of the ways to achieve better control of this disease. Objective: To reach a consensus and update relevant aspects of conventional and biological RA modifier therapy in Cuba. Methods: 18 specialists from 8 Cuban provinces, experts in RA care, were summoned, according to the years of dedication to the specialty, the conferences on this topic and their publications. The first meeting took place in March 2016 in the provincial hospital of Villa Clara, Cuba, with the participation of all the experts. A review of the literature on conventional and biological therapy previously collected by the participants was developed, and two teams were formed: the first would address everything related to conventional therapy in RA (HRCT) and the other, biological therapy in RA (TBAR). Three questionnaires related to the use of corticosteroids, HRCT and TBAR, were prepared, answered by the participants via email. In a second meeting, held in October 2016 in Havana, the analysis of all the responses provided was carried out. Questions with a response of 90% or more votes were considered as recommendations. Results: The questionnaires were answered by 95% of the participants. 9 recommendations and 1 algorithm were established. The recommendations are as follows: methotrexate is the drug of choice in the treatment of RA after diagnosis; The administration of another conventional drug (DMARDc) (azathioprine, salazosulfapyridine, antimalarials and leflunomide) is recommended in patients with a diagnosis of active RA in whom methotrexate is contraindicated or there is a failure in response - consider the administration of low doses of prednisone or equivalent (<7.5 mg/d) associated with DMARDc in patients with active moderate to severe RA, for the shortest possible time; perform serological control including tests for hepatitis B and C viruses and screening for HIV in all patients diagnosed with RA before starting treatment with DMARDc and biologics; in patients in remission or, at least, with a DAS-28 below 3.2, consideration should be given to withdrawing one of the DMARDs or reducing, to the minimum possible expression, the dose of both disease modifiers; if methotrexate fails, tocilizumab in combination with methotrexate or as monotherapy will be indicated. Conclusions: Aspects related to conventional therapy with methotrexate, azathioprine, salazosulfapyridine, antimalarials and leflunomide were agreed. The value of early diagnosis and immediate initiation of DMARDc therapy and the use of glucocorticoids was analyzed. Treatment with tocilizumab, the only biological available in Cuba against RA, will be administered when there is a failure in the response to conventional therapy and combinations between these drugs. It is recommended to hold educational conferences through the mass media aimed at patientshttp(AU)

Inadequate use of antibiotics in the covid-19 era: effectiveness of antibiotic therapy.

BACKGROUND: Since December 2019, the COVID-19 pandemic has changed the concept of medicine. This work aims to analyze the use of antibiotics in patients admitted to the hospital due to SARS-CoV-2 infection. METHODS: This work analyzes the use and effectiveness of antibiotics in hospitalized patients with COVID-19 based on data from the SEMI-COVID-19 registry, an initiative to generate knowledge about this disease using data from electronic medical records. Our primary endpoint was all-cause in-hospital mortality according to antibiotic use. The secondary endpoint was the effect of macrolides on mortality. RESULTS: Of 13,932 patients, antibiotics were used in 12,238. The overall death rate was 20.7% and higher among those taking antibiotics (87.8%). Higher mortality was observed with use of all antibiotics (OR 1.40, 95% CI 1.21-1.62; p < .001) except macrolides, which had a higher survival rate (OR 0.70, 95% CI 0.64-0.76; p < .001). The decision to start antibiotics was influenced by presence of increased inflammatory markers and any kind of infiltrate on an x-ray. Patients receiving antibiotics required respiratory support and were transferred to intensive care units more often. CONCLUSIONS: Bacterial co-infection was uncommon among COVID-19 patients, yet use of antibiotics was high. There is insufficient evidence to support widespread use of empiric antibiotics in these patients. Most may not require empiric treatment and if they do, there is promising evidence regarding azithromycin as a potential COVID-19 treatment.

African immigrant child health: A scoping review.

The health of migrant children is a pressing issue. While most African migration takes place within Africa, a significant number of African migrants travel to outside of the continent. This article reports findings from a scoping review on the health of African immigrant children from sub-Saharan Africa now living outside of Africa. A systematic search for studies published between 2000 and 2019 resulted in only 20 studies reporting on the health of children up to 18 years of age migrating from sub-Saharan Africa. Data from these articles were thematically analyzed, highlighting concerns related to the children's nutrition status (n = 8), mental health (n = 7), and physical health (n = 5). Study participants were primarily from Somali and Ethiopia, and most studies were conducted in Australia or Israel. The review highlights several gaps related to the scope, range, and nature of evidence on the health of African immigrant children living outside of Africa. In particular, most focus on children's nutritional and mental health, but pay little attention to other health concerns this specific population may encounter or to the benefits associated with effective responses.

Synthesis, optical and thermoluminescence properties of thulium-doped KMgF3 fluoroperovskite.

KMgF3 fluoroperovskite doped with thulium at different concentrations were synthesized by the solid-state reaction method. The phase composition and the thermal stability up to 600 °C of the polycrystals were analyzed by X-ray diffraction and thermogravimetric analysis, respectively. The KMgF3 at 1.0 mol% of Tm polycrystals showed the best thermal stability and did not present another phase. The gamma radiation (0.1-10 kGy) effect in thulium-doped KMgF3 produced the F color centers, and their aggregates such as F2, and F3 centers. The F centers, and the potassium vacancies (VK-) in the fluoroperosvkites were analyzed by the optical absorption and emission measurements. Optical absorption at 275 nm and 443 nm were assigned to F and F2, respectively, in undoped KMgF3. Tm-doped fluoroperovskite shows the optical absorption bands at 277, 393, 432, and 577 nm, which were ascribed to the F, F3, F2 and VK- centers, respectively. When the F band for undoped polycrystals was excited at 275 nm, a clear emission associated with F2 and F3 centers was observed. In the case of Tm-doped, an enhancement of the blue emission at 457 nm occurred and a UV band (354 nm) was observed upon exciting the F band. The blue emission of thulium was overlapped with the F3 color center band. The emission bands at 457 and 354 nm were ascribed to 1D2 - 3F4 and 1D2 - 3H6 transitions of Tm in KMgF3. The optical absorption and glow curves were investigated too. The glow curves were assisted by the color centers, vacancies, and thulium impurity. Thermal bleaching shows that the F center was the main participant to give rise to the TL intensity of the glow curves. Thulium acts as a deep electron trap in the bandgap of the KMgF3 fluoroperovskites forming TL peak at the higher temperature, from 430 to 408 °C. The absorption, emission, and thermoluminescence glow peaks of the undoped and Tm-doped KMgF3 were compared.

Systemic bevacizumab as adjuvant therapy for recurrent respiratory papillomatosis in children: A series of three pediatric cases and literature review.

Recurrent respiratory papillomatosis (RRP), a viral disease caused by human papillomavirus (HPV), is the most common benign neoplasm of the larynx among children and the second most frequent cause of infantile hoarseness. The course of the disease is variable; some patients experience spontaneous remission, while others may develop an aggressive respiratory compromise. Especially juvenile-onset RRP cases experience shorter intervals between surgical interventions and thus more surgeries overall, causing high rates of depression and voice-related quality of life. Various local adjuvant therapies have been studied with mixed efficacy and some early potential but have failed to show consistent effect across large cohorts of patients. Bevacizumab, a recombinant monoclonal antibody that inhibits VEGF, has shown efficacy in patients with rapid regrowth of papillomas with severe airway compromise, and/or distal multisite spread of disease. We present three juvenile-onset RRP cases successfully managed with systemically administered bevacizumab.

Estrés percibido en madres mexicanas de niños con necesidades especiales: un estudio etnográfico / Perceived stress among mexican mothers of children with special needs: an ethnographic study / Estresse percebido em mães mexicanas de crianças com necessidades especiais: um estudo etnográfico

RESUMEN Objetivo: Examinar las percepciones sobre los factores exploratorios, las manifestaciones y consecuencias del estrés en madres cuidadoras de niños con necesidades especiales en Veracruz, México. Métodos: Estudio cualitativo con diseño etnográfico focalizado. La muestra (n=20) se obtuvo de un grupo de madres cuidadoras del estado de Veracruz, México. El criterio de participación fue ser el tutor principal del niño dependiente. Los datos se recolectaron a través de cuatro grupos de discusión conformado cada uno por cinco cuidadoras. Las discusiones fueron audio-grabadas y los datos transcritos textualmente previo análisis. La información fue tratada mediante análisis temático, con el apoyo del programa QUIRKOS. Resultados: Las madres de los niños fueron el cien por ciento de las cuidadoras. La edad promedio de ellas fue de 36.95 años (DE= ±7.66). Las temáticas que surgieron del análisis inductivo fueron las siguientes: a) la situación económica familiar, b) el comportamiento de los niños, c) la falta de información sobre el diagnóstico del niño y, d) los problemas conyugales. Estas se identificaron como categorías que juegan un rol importante en el estrés percibido por las cuidadoras. Discusión y Conclusiones: Es claro que el rol y la responsabilidad de las madres cuidadoras es muy demandante, provocando manifestaciones físicas, mentales y emocionales. El profesional de enfermería juega un papel importante en el diseño de intervenciones de salud que favorezcan la reducción de los factores causales del estrés percibido, además de implementar estrategias que restrinjan sus manifestaciones.

ABSTRACT Objective: To explore factors, manifestations, and consequences related to the stress perceived by Mexican mothers of children with special needs in Veracruz, Mexico. Methods: This is a qualitative study with a focalized ethnographic design. The sample (n=20) was constituted by healthcare providing mothers of the state of Veracruz, Mexico. The participation requirement was being the main tutor of a dependent child. Data were collected in four discussion groups of 5 healthcare providing mothers each. The discussions were recorded and the data were transcribed. The information was produced through a thematic analysis using the QUIRKOS program. Results: The average age of these mothers was 36.95 years old (SD= ±7.66). The topics arising from the analysis were: a) the economical situation of the family; b) the behavior of the children; c) the lack of information regarding the child's diagnosis; and d) the marital problems. All these categories were important sources of the stress perceived by these healthcare providers. Discussion and Conclusions: It is clear that the role and the responsibility of healthcare mothers is very demanding, provoking diverse physical, mental, and emotional responses. The nursing professionals play an important role in the design of health interventions which can favor the reduction of the perceived stress causing factors and thus the reduction of their associated impacts.

RESUMO Objetivo: Examinar as percepções sobre os fatores exploratórios, as manifestações e consequências do estresse em mães cuidadoras de crianças com necessidades especiais em Veracruz, México. Métodos: Estudo qualitativo com desenho etnográfico focalizado. A amostra (n=20) foi obtida de um grupo de mães cuidadoras do estado de Veracruz, México. O critério de participação era ser o cuidador principal da criança dependente. Os dados foram coletados através de quatro grupos de discussão, cada um conformado por cinco cuidadoras. As discussões foram áudio-gravadas e os dados transcritos textualmente antes da análise. A informação foi tratada por meio de análise temática, com apoio do programa QUIRKOS. Resultados: As mães das crianças eram cem por cento das cuidadoras. A idade média delas era de 36.95 anos (DE= ±7.66). As temáticas que emergiram da análise indutiva foram as seguintes: a) a situação económica familiar, b) o comportamento das crianças, c) a falta de informação sobre o diagnóstico da criança, e d) os problemas conjugais. Estas foram identificadas como categorias que desempenham um papel importante no estresse percebido pelas cuidadoras. Discussão e Conclusões: Fica claro que o papel e a responsabilidade das mães cuidadoras é muito exigente, provocando manifestações físicas, mentais e emocionais. O profissional de enfermagem desempenha um papel importante no desenho de intervenções de saúde que favorecem a redução dos fatores causais do estresse percebido, além de implementar estratégias que restrinjam suas manifestações.

Estresores de aculturación de los inmigrantes hispanos en Estados Unidos de América. Revisión sistemática exploratoria / Stressors during the process of culture adaptation of hispanic migrants in the United States of America: An exploratory systematic review / Estressores de aculturação de imigrantes hispânicos nos Estados Unidos da América. Revisão sistemática exploratoria

RESUMEN Introducción: Los inmigrantes hispanos que se desplazan hacia Estados Unidos experimentan una transición migratoria altamente estresante, padeciendo alteraciones en la salud que continúan después de su llegada, lo que puede dificultar su adaptación a la nueva cultura. Identificar los factores más estresantes en el inmigrante hispano en su proceso de aculturación es primordial para el diseño de intervenciones puntuales y oportunas, donde el personal de enfermería es un elemento central para ello. Objetivo: Identificar los estresores de aculturación que presentan los inmigrantes hispanos en Estados Unidos. Desarrollo: Mediante un análisis numérico de los datos cuantitativos y el análisis temático de los hallazgos cualitativos, sugerido por metodología para revisiones sistemáticas exploratorias, se identificaron estresores personales, del entorno, sociales y globales, que enfrentan los inmigrantes hispanos. De igual manera, se describen las principales repercusiones a la salud tales como: angustia, ansiedad, depresión, ideación suicida, riesgo de consumo de alcohol, conductas sexuales de riesgo, entre otras, que se derivan de dicho proceso de transición. Conclusiones: Los encuentros más comunes entre el profesional de enfermería se dan durante momentos de transición de las personas, por ello es importante resaltar que la transición cultural de los inmigrantes hispanos es acompañada de estresores que afectan directamente su salud. El presente estudio muestra y clasifica los estresores más comunes, evidencia la necesidad de la creación de estrategias encaminadas a la adaptación social del inmigrante hispano y el involucramiento de la enfermería tanto en el diseño como liderazgo de estas.

ABSTRACT Introduction: Hispanic migrants who settle in the United States experience a highly stressful transition period, which not only has an impact on their process of adaptation to the new culture but also on their health. Therefore, identifying stressing factors which influence the hispanic migrants during their process of culture adaptation is a key goal in the design and implementation of timely interventions led by nursing professionals. Objective: To identify stressing factors which have an influence on the process of culture adaptation of hispanic migrants in the United States. Development: Based on the numeric analysis of quantitative data, and the thematic analysis of the qualitative data which was informed by an exploratory systematic review methodology, personal, social, global stressors were identified influencing hispanic migrants in the United States. Among the identified health issues were: anguish, anxiety, depresion, suicide thoughts, alcohol consumption, and risky sexual behaviors. Conclusions: The present study showed some important stressors influencing the hispanic migrants in the United States in their process of culture adaptation. These factors can be considered by the nursing professionals who are addressing the process of social adaptation of these populations.

RESUMO Introdução: Os imigrantes hispânicos que se mudam para os Estados Unidos passam por uma transição migratória altamente estressante, sofrendo alterações de saúde que continuam após sua chegada, o que pode dificultar sua adaptação à nova cultura. Identificar os fatores mais estressantes para os imigrantes hispânicos em seu processo de aculturação é essencial para a concepção de intervenções oportunas, nas quais o pessoal de enfermagem é um elemento central para isso. Objetivo: Identificar os estressores de aculturação entre os imigrantes hispânicos nos Estados Unidos. Desenvolvimento: Através de uma análise numérica dos dados quantitativos e análise temática dos resultados qualitativos, sugeridos pela metodologia de revisões sistemáticas exploratórias, foram identificados os estresses pessoais, ambientais, sociais e globais enfrentados pelos imigrantes hispânicos. Da mesma forma, são descritas as principais repercussões na saúde, tais como: angústia, ansiedade, depressão, ideação suicida, risco de consumo de álcool, comportamentos sexuais de risco, entre outros, que são derivados deste processo de transição Conclusões: Os encontros mais comuns entre os profissionais de enfermagem ocorrem durante os momentos de transição das pessoas, portanto é importante salientar que a transição cultural dos imigrantes hispânicos é acompanhada por fatores de estresse que afetam diretamente sua saúde. Este estudo mostra e classifica os fatores de estresse mais comuns, demonstra a necessidade da criação de estratégias voltadas para a adaptação social do imigrante hispânico e o envolvimento da enfermagem tanto no desenho quanto na liderança dessas estratégias.

Simplified biplanar (0-90°) fluoroscopic puncture technique for percutaneous nephrolithotomy: the learning curve.

PURPOSE: To evaluate the learning curve of the simplified fluoroscopic biplanar (0-90º) puncture technique for percutaneous nephrolithotomy. METHODS: We prospectively evaluated patients with renal stones treated with percutaneous nephrolithotomy by a single institution's fellows employing the simplified bi-planar (0-90º) fluoroscopic puncture technique for renal access. The learning curve was assessed with the fluoroscopic screening time and the percutaneous renal puncture time. Data obtained were compared to a subset of patients operated by a senior surgeon. RESULTS: Eighty-nine patients were included in the study. Forty patients were operated by fellow-1, 39 by fellow-2, and 10 patients by the senior surgeon. Demographic data of all patients between groups were homogeneous, with no difference in gender (p = 0.432), age (p = 0.92), stone volume (p = 0.78), puncture laterality (p = 0.755), and body mass index (p = 0.365). The mean puncture time was 7.5, 4, and 3.1 min for fellow-1, fellow-2, and expert, respectively. The mean fluoroscopic screening time for the puncture was 10, 11, and 5.1 s for fellow-1, fellow-2, and the expert, respectively. Stone cases, both fellows needed to complete 10 procedures to match the senior surgeon in the mean puncture time (p = 0.046); meanwhile, the fluoroscopic screening time was equal even before to complete 10 procedures. CONCLUSION: This study suggests that with the simplified biplanar (0-90º) puncture technique, the fluoroscopic screening time used in the learning process is brief. A novice fellow could require to complete ten cases to flatten the learning curve treating complex stone cases, and a flat learning curve is seen since the beginning when treating simple renal stones.

Causas de la lesión de isquiosurales en fútbol: una revisión bibliográfica desde las etapas formativas hasta la profesional / Causes of hamstring injury in soccer: a review from high-level youth academy to proffesional level / Causas do prejuízo dos isquiotibiais no futebol: uma revisão bibliográfica das etapas de formação ao profissional

OBJETIVOS: identificar las principales causas de lesión de isquiosurales en las diferentes etapas de formación, desde la etapa sub-12 hasta la etapa profesional, y establecer la influencia de la lesión previa de isquiosurales como causa principal de sufrir una nueva lesión. MÉTODO: la búsqueda bibliográfica se realizó en Dialnet, Pubmed, Web of Science, Scopus y SportDISCUS, entre las fechas de enero de 2010 hasta mayo de 2020. RESULTADOS: la búsqueda concluyó que el patrón de lesión isquiosural más concurrido es el de jugador de edad avanzada, con mayores valores de fuerza y menores valores de flexibilidad, y con un mayor grado de anteversión pélvica. El envejecimiento, los movimientos compensatorios en patrones motores fundamentales y otros factores de la competición se presentaron como las principales causas de lesión en jugadores profesionales. CONCLUSIONES: la lesión previa, con el mayor número de casos registrados de incidencia lesional, se estableció como principal factor de riesgo de lesión de la musculatura isquiosural

OBJECTIVES: to identify the main causes of hamstring injury in the different training stages, from the under-12 stage to the professional stage, and to establish the influence of the previous hamstring injury as the main cause of suffering a new injury. METHOD: the bibliographic search was carried out in Dialnet, Pubmed, Web of Science, Scopus and SportDISCUS, between the dates of January 2010 to May 2020. RESULTS: the search concluded that the most frequent hamstring injury pattern is that of an elderly player, with higher strength values ​​and lower flexibility values, and a higher degree of pelvic anteversion. Aging, compensatory movements in fundamental motor patterns and other factors of the competition were presented as the main causes of injury in professional players. CONCLUSIONS: previous injury, with the highest number of recorded cases of injury incidence, was established as the main risk factor for hamstring injury

OBJETIVOS: identificar as principais causas de lesão de isquiotibiais nas diferentes etapas do treinamento, desde a fase de menores de 12 anos até a profissional, e estabelecer a influência da lesão anterior de isquiotibiais como principal causa de nova lesão. MÉTODO: o levantamento bibliográfico foi realizado no Dialnet, Pubmed, Web of Science, Scopus e SportDISCUS, entre as datas de janeiro de 2010 a maio de 2020. RESULTADOS: a pesquisa concluiu que o padrão de lesão dos isquiotibiais mais comum é o de um jogador idoso, com maiores valores de força e menores valores de flexibilidade, e com maior grau de anteversão pélvica. O envelhecimento, os movimentos compensatórios nos padrões motores fundamentais e outros fatores da competição foram apresentados como as principais causas de lesões em jogadores profissionais. CONCLUSÕES: a lesão prévia, com maior número de casos registrados de incidência de lesões, foi apontada como o principal fator de risco para lesão de isquiotibiais

DNA barcode analysis of the endangered green turtle (Chelonia mydas) in Mexico1.

Technological and analytical advances to study evolutionary biology, ecology, and conservation of green turtles (Chelonia mydas) are realized through molecular approaches including DNA barcoding. We characterized the usefulness of COI DNA barcodes in green turtles in Mexico to better understand genetic divergence and other genetic parameters of this species. We analyzed 63 sequences, including 25 from green turtle field specimens collected from the Gulf of Mexico and from the Mexican Pacific and 38 already present in the Barcode of Life Data Systems (BOLD). A total of 13 haplotypes were identified with four novel haplotypes from the Pacific Ocean and three novel haplotypes from the Atlantic Ocean. Intraspecific distance values among COI gene sequences by two different models were 0.01, demonstrating that there is not a subdivision for green turtle species. Otherwise, the interspecific distance interval ranged from 0.07 to 0.13, supporting a clear subdivision among all sea turtle species. Haplotype and total nucleotide diversity values of the COI gene reflect a medium genetic diversity average. Green turtles of the Mexican Pacific showed common haplotypes to some Australian and Chinese turtles, but different from the haplotypes of the Mexican Atlantic. COI analysis revealed new haplotypes and confirmed that DNA barcodes were useful for evaluation of the population diversity of green turtles in Mexico.

Intervención educativa para mejorar conocimientos sobre úlceras por presión en enfermeros de Veracruz, México / Educational intervention aimed at improving knowledge on pressure ulcers in nurses from Veracruz, Mexico / Intervenção educativa para melhorar o conhecimento sobre úlceras por pressão em enfermeiros de Veracruz, México

Resumen Introducción: En México, las úlceras por presión (UPP) son un indicador de calidad en el Sistema Nacional de Salud, se otorga relevancia a los conocimientos de los profesionales de la salud en cuanto al abordaje integral de las úlceras para el mejoramiento de la seguridad del paciente. Objetivo: Evaluar la efectividad de una intervención educativa como herramienta para mejorar los conocimientos de enfermería en la prevención y tratamiento de las UPP. Método: Estudio pre-experimental basado en una intervención educativa aplicada a un grupo con medición pre y post. La muestra estuvo constituida por 90 licenciados de enfermería que laboran en hospitales públicos de segundo y tercer nivel de atención, ubicados en el puerto de Veracruz. Se diseñaron doce sesiones de 120 minutos cada una para la intervención; en estas se abordaron tópicos de prevención, cuidado y tratamiento de las úlceras. Resultados: La variable prevención, en el indicador adecuado según tus conocimientos, obtuvo un promedio inicial de 74±15 que incrementó en la segunda medición a 91±9. t (p=.003). En la variable tratamiento, el indicador adecuado según tus conocimientos, obtuvo un promedio inicial de 57±16 y en la segunda medición pasó a 76±9. t (p=.002). Conclusión: La aplicación de la intervención educativa permitió mejorar el conocimiento sobre prevención y tratamiento de las UPP, aunque la utilización en la práctica asistencial fue menor.

Abstract Introduction: In Mexico, pressure ulcers are a quality indicator of the National Health System. In order to improve patient security, health professionals need to demonstrate adequate knowledge regarding the handling and addressing of pressure ulcers. Objective: To assess the effectiveness of an educational intervention aimed at improving the knowledge of nursing professionals regarding the prevention and treatment of pressure ulcers. Method: This is a pre-experimental study based on an educational intervention with pre and post measurements. The sample was constituted by 90 graduate nurses working in public hospitals of second and third level located at the port of Veracruz, Mexico. Twelve 120 minutes educational sessions were designed to address the topics of prevention, care, and treatment of pressure ulcers. Results: The variable prevention had a score of 74±15 at pre measurement and 91±9 at post measurement t (p=.003). The variable treatment had an initial score of 57±16, which then increased to 76±9, t (p=.002) after the intervention. Conclusion: The educational intervention improved the knowledge on prevention and treatment of pressure ulcers, without evidence of improving nursing care practice.

Resumo Introdução: No México, as úlceras por pressão (UPP) são um indicador de qualidade no Sistema Nacional de Saúde, sendo relevantes os conhecimentos dos professionais de saúde quanto à abordagem integral das úlceras para o melhoramento da segurança do paciente. Objetivo: Avaliar a efetividade de uma intervenção educativa como ferramenta para melhorar os conhecimentos de enfermagem na prevenção e tratamento das UPP. Método: Estudo pré-experimental baseado em uma intervenção educativa aplicada a um grupo com pré e post medição. A amostra esteve constituída por 90 graduados de enfermagem que laboram em hospitais públicos de segundo e terceiro nível de atenção, localizados no porto de Veracruz. Desenharam-se doze sessões de 120 minutos cada uma para a intervenção; nestas foram abordados tópicos de prevenção, cuidado e tratamento das úlceras. Resultados: A variável prevenção, no indicador adequado segundo com seus conhecimentos, obteve uma média inicial de 74±15 que incrementou na segunda medição para 91±9. t (p=.003). Na variável tratamento, o indicador adequado conforme seus conhecimentos, obteve uma média inicial de 57±16 e na segunda medição passou a 76±9. t (p=.002). Conclusão: A aplicação da intervenção educativa possibilitou melhorar o conhecimento sobre a prevenção e o tratamento das UPP, embora a utilização na prática assistencial tenha sido menor.

Computational aided acetaminophen - phthalic acid molecularly imprinted polymer design for analytical determination of known and new developed recreational drugs.

In recent times, abuse drug consumption rates have been increasing. In addition, authorities have detected a trend in the development of new substances expressly created to avoid legislation. These novel psychoactive substances (NPS) are non-registered formulations, closely chemically related to outlawed ones to maintain the same psychotropic effects while circumventing legal restrictions. This issue arises enormous social, sanitary, and road safety problems since there is no way to detect nor quantify these non-registered substances. The aim of this work is the development of a high selective material able to pre-concentrate and detect NPS. On that account, molecularly imprinted polymers (MIPs) designed with an imprinted cavity that matches the cathinones structural shape were proposed to detect both conventional and new cathinone derived recreational drugs. The increasing number of illicit drug modifications that is being reported requires developing a receptor valid for not only known molecules but also for incoming ones; thus, a virtual procedure must be carried out to take a step forward towards future modifications. Accordingly, a computational MIP design is proposed as the most appropriated method to effectively design this receptor. By means of molecular dynamics and molecular docking, several combinations are studied regarding their pre-polymerization complex stability but also their rebinding capacity against the proposed analytes. Hence, a phthalic acid - acetaminophen MIP is selected as the most well-suited receptor, valid for current and forthcoming cathinone recreational drugs.

Revisiones Sistemáticas Exploratorias como metodología para la síntesis del conocimiento científico / Scoping Reviews as a methodology for scientific knowledge synthesis / Revisões Exploratórias Sistemáticas como metodologia para a síntese do conhecimento científico

RESUMEN Introducción: En la actualidad los sistemas de salud alrededor del mundo apuestan por una toma decisiones clínicas basadas en la evidencia científica. Para ello, es necesario que los profesionales de la salud consulten los resultados de las investigaciones científicas. Sin embargo, dada la gran cantidad de literatura, los investigadores han desarrollado metodologías de revisión para compilar los estudios científicos dentro de un área específica. Aun cuando existen más de 10 tipos de metodologías para la revisión de la literatura, la Revisión Sistemática Exploratoria (RSE) ha recibido poca atención en la literatura sobre métodos de investigación científica de habla hispana. Objetivo: Detallar la metodología de la RSE, sus propósitos y las fases para su desarrollo. Desarrollo: Este trabajo detalla las generalidades de la RSE basándose en la metodología propuesta por Arksey y O'Malley. Así mismo, se describen las áreas o ámbitos donde este tipo de revisión se puede emplear, las fases para desarrollar la revisión y ejemplos de las RSE. Conclusiones: Las RSE tienen la fortaleza de hacer saber a los profesionales de la salud sobre un tema en específico que permita incidir en las políticas públicas. Al igual que las Revisiones Sistemáticas, las RSE utilizan una metodología clara y replicable, aportando datos confiables y científicos para los profesionales de la salud.

ABSTRACT Introduction: Currently, health systems around the world are betting on making clinical decisions based on scientific evidence. For this, it is essential that healthcare providers consult the results of scientific research. However, given the large amount of literature, researchers have developed knowledge synthesis methodologies to compile scientific studies within a specific area. Although there are more than 10 types of methodologies for reviewing the literature, Scoping Reviews have received little attention in the literature on Spanish-speaking scientific research methods. Objective: Detail the Scoping Review methodology, its purposes and the phases for its development. Development: This paper details the generalities of Scoping Reviews based on the methodology proposed by Arksey & O'Malley. It also describes the areas where this type of review can be employed, the phases to develop the review and examples. Conclusions: Scoping Reviews have the strength to inform healthcare providers and policy on a specific topic of interest. Like Systematic Reviews, Scoping Reviews uses a clear and replicable methodology, providing reliable and scientific data for healthcare providers, policy makers and researchers.

RESUMO Introdução: Atualmente, os sistemas de saúde em todo o mundo apostam em tomar decisões clínicas baseadas em evidências científicas. Para isso, é necessário que os profissionais de saúde consultem os resultados da pesquisa científica. No entanto, dada a grande quantidade de literatura, os pesquisadores desenvolveram metodologias de revisão para compilar estudos científicos dentro de uma área específica. Embora existam mais de 10 tipos de metodologias para a revisão da literatura, a Revisão Explorada Sistemática (ESR) recebeu pouca atenção na literatura sobre métodos de pesquisa científica de língua espanhola. Objetivo: Detalhar a metodologia da RSC, seus propósitos e as fases para o seu desenvolvimento. Desenvolvimento: Este artigo detalha as generalidades da RSC com base na metodologia proposta por Arksey e O'Malley (2005). Ele também descreve as áreas ou áreas onde esse tipo de revisão pode ser usado, as fases para desenvolver a revisão e exemplos de RSC. Conclusões: As RSCs têm a força para permitir que os profissionais de saúde conheçam uma questão específica que permite influenciar as políticas públicas. Como as Revisões Sistemáticas, a RSE usa uma metodologia clara e replicável, fornecendo dados confiáveis ​​e científicos para profissionais de saúde.

Positron range effects of 66Ga in small-animal PET imaging.

PURPOSE: Gallium-66 is a non-conventional positron emitter that stands out not only for its high potential to label peptides, proteins and antibodies, but also because it can provide spatio-temporal information of relatively slow physiological processes in the body due to its conveniently long half-life of 9.5 h. However, 66Ga emits the most energetic positrons for PET imaging. The lack of information of the positron range effect on spatial resolution for this positron emitter is an issue, particularly in preclinical imaging. METHODS: The line spread function (LSF) in tissue-equivalent materials with densities between 0.2 and 1.93 g/cm3 was obtained with 66Ga and 18F. A complementary study with the NEMA NU 4-2008 image quality phantom is also included. RESULTS: High-energy positrons moving in lower density materials produce far-reaching activity distributions. The LSFs were characterized with Lorentzian-Gaussian fits, with spatial resolution (FWHM) in the 2.14-3.2 mm range, and long tails extending a few tens of mm depending on the material type and density. A narrowing of the LSF was observed for lung-equivalent materials, indicating the lack of enough material for the positron annihilation to take place. The NEMA NU 4-2008 image quality phantom produced blurred images, notoriously observed in the hot and cold cylinders used for evaluation of recovery coefficients (RC) and spill-over ratios (SOR), producing very low RC and very large SOR. CONCLUSIONS: Quantitative PET imaging with the non-conventional 66Ga is hampered due to the large range of its high-energy positrons affecting both spatial resolution and activity concentration quantification.

Comparative Anatomy of the Forearm and Hand of Wildcat (Leopardus geoffroyi), Ocelot (Leopardus pardalis) and Jaguar (Panthera onca)

Introduction The thoracic limbs of cats facilitate jumping and represent one of their main ways for pursuing and capturing prey. The main muscles and nerves involved in these activities are present in the region of the forearm and of the hand. The scant anatomical reference availabe on South American cats species justifies the present comparative study. Materials and Methods The forelimbs of wildcat, ocelot and jaguar wild felines were fixed. Images of the dissected limbs were captured using a digital camera. Measurements were made using a caliper. Results The long and short heads of the extensor carpi radialis muscle of the ocelot and of the jaguar showed a great development in comparison with those of the wildcat. The flexor digitorum profundus muscle in the three felines is formed by five heads. In the jaguar, the radial or deep head presented two sesamoid bones. The brachioradialis muscle of the jaguar and of the ocelot is insertedmedially at the distal end of the radius and at the proximal row of the carpus by a thick and flattened tendon. The pronator teres muscle of the jaguar extended to the carpal region. In the wildcat and in the ocelot, this muscle was less developed Conclusions The main variations observed between the forearms and the hands of these South American cats were found between the supinator and the pronator muscles, presenting a variation in the size of their bellies and tendons. Our study of the muscular characteristics represents a contribution to the homologies and differences of the forearm and hand muscles of each of these species of felines.

OptiPharm: An evolutionary algorithm to compare shape similarity.

Virtual Screening (VS) methods can drastically accelerate global drug discovery processes. Among the most widely used VS approaches, Shape Similarity Methods compare in detail the global shape of a query molecule against a large database of potential drug compounds. Even so, the databases are so enormously large that, in order to save time, the current VS methods are not exhaustive, but they are mainly local optimizers that can easily be entrapped in local optima. It means that they discard promising compounds or yield erroneous signals. In this work, we propose the use of efficient global optimization techniques, as a way to increase the quality of the provided solutions. In particular, we introduce OptiPharm, which is a parameterizable metaheuristic that improves prediction accuracy and offers greater computational performance than WEGA, a Gaussian-based shape similarity method. OptiPharm includes mechanisms to balance between exploration and exploitation to quickly identify regions in the search space with high-quality solutions and avoid wasting time in non-promising areas. OptiPharm is available upon request via email.