Lactancia materna en España y factores relacionados con su instauración y mantenimiento: estudio LAyDI (PAPenRed) / Breastfeeding in Spain and the factors related to its establishment and maintenance: LAyDI Study (PAPenRed)

Objetivo: Conocer estadísticas reales sobre lactancia materna en España, así como factores socioculturales y perinatales que afectan a su inicio y mantenimiento. Diseño: Estudio prospectivo, multicéntrico, longitudinal, de ámbito nacional (estudio LAyDI). Sitio: Consulta de pediatras de atención primaria. Participantes: Cohorte de recién nacidos entre abril de 2017 y marzo de 2018 en España que se siguieron hasta los dos años en ocho visitas. Medidas principales: Se analizaron las tasas de los diferentes tipos de lactancia en cada visita y también se analizaron variables relacionadas con la gestación, el parto, el período neonatal, sociales, económicas y biológicas. Resultados: Muestra inicial de 1.946 (50,1% varones). El 90,7% decidieron iniciar lactancia materna al nacimiento. La cifra de lactancia materna exclusiva (LME) fue del 66,4% a los 15días y del 35,2% a los 6meses. Cualquier tipo de lactancia materna (lactancia materna total [LMT]) a los 6meses fue del 61,7%. La supervivencia de LMT presentó una mediana de 6,0meses (IC95%: 6,0-6,1). Variables relacionadas con LME a los 15días: hijos previos, nivel de educación de madre, ausencia de enfermedad durante el embarazo, no separación madre e hijo al nacer, no utilización de chupete, no existencia de problemas en pezones, y momento de decisión tipo lactancia. Variables relacionadas con mayor duración LMT son: la relación mayor de 5años de los padres, no usar de chupete, colecho al mes de vida, decidir lactancia materna antes del embarazo, recibir información sobre lactancia durante el embarazo y utilizar apoyo de asociaciones. Conclusiones: El abandono temprano de la lactancia materna es un problema importante en las sociedades occidentales. Existen factores sobre los que se puede actuar para mejorar resultados.(AU)

Objective: To find out actual statistics on breastfeeding in Spain, as well as sociocultural and perinatal factors that affect its initiation and maintenance. Design: Prospective, multicentre, longitudinal, nationwide study (XXX study). Site: Primary care paediatricians’ office. Participants: Cohort of newborns born between April 2017 and March 2018 in Spain who were followed up to two years of age in 8 visits. Main measures: Rates of different types of breastfeeding were analysed at each visit and variables related to gestation, delivery, neonatal period, social, economic and biological variables were also analysed. Results: Initial sample of 1946 (50.1% male). 90.7% decided to initiate breastfeeding at birth. Exclusive breastfeeding (EBF) was 66.4% at 15days and 35.2% at 6months. Any type of breastfeeding (total breastfeeding [TBF]) at 6months was 61.7%. Median survival from TBF was 6.0months (95%CI: 6.0-6.1). Variables related to EBF at 15days: previous children, mother's level of education, absence of illness during pregnancy, no separation of mother and child at birth, no dummy use, no nipple problems, and time of decision to breastfeed. Variables related to longer duration of TBF: relationship of parents older than 5years, no dummy use, co-sleeping at one month of life, deciding to breastfeed before pregnancy, receiving information on breastfeeding during pregnancy and using support from associations. Conclusions: Early abandonment of breastfeeding is a major problem in Western societies. There are factors that can be worked on to improve outcomes.(AU)

[Breastfeeding in Spain and the factors related to its establishment and maintenance: LAyDI Study (PAPenRed)]. / Lactancia materna en España y factores relacionados con su instauración y mantenimiento: estudio LAyDI (PAPenRed).

OBJECTIVE: To find out actual statistics on breastfeeding in Spain, as well as sociocultural and perinatal factors that affect its initiation and maintenance. DESIGN: Prospective, multicentre, longitudinal, nationwide study (XXX study). SITE: Primary care paediatricians' office. PARTICIPANTS: Cohort of newborns born between April 2017 and March 2018 in Spain who were followed up to two years of age in 8 visits. MAIN MEASURES: Rates of different types of breastfeeding were analysed at each visit and variables related to gestation, delivery, neonatal period, social, economic and biological variables were also analysed. RESULTS: Initial sample of 1946 (50.1% male). 90.7% decided to initiate breastfeeding at birth. Exclusive breastfeeding (EBF) was 66.4% at 15days and 35.2% at 6months. Any type of breastfeeding (total breastfeeding [TBF]) at 6months was 61.7%. Median survival from TBF was 6.0months (95%CI: 6.0-6.1). Variables related to EBF at 15days: previous children, mother's level of education, absence of illness during pregnancy, no separation of mother and child at birth, no dummy use, no nipple problems, and time of decision to breastfeed. Variables related to longer duration of TBF: relationship of parents older than 5years, no dummy use, co-sleeping at one month of life, deciding to breastfeed before pregnancy, receiving information on breastfeeding during pregnancy and using support from associations. CONCLUSIONS: Early abandonment of breastfeeding is a major problem in Western societies. There are factors that can be worked on to improve outcomes.

Individualised, perioperative open-lung ventilation strategy during one-lung ventilation (iPROVE-OLV): a multicentre, randomised, controlled clinical trial.

BACKGROUND: It is uncertain whether individualisation of the perioperative open-lung approach (OLA) to ventilation reduces postoperative pulmonary complications in patients undergoing lung resection. We compared a perioperative individualised OLA (iOLA) ventilation strategy with standard lung-protective ventilation in patients undergoing thoracic surgery with one-lung ventilation. METHODS: This multicentre, randomised controlled trial enrolled patients scheduled for open or video-assisted thoracic surgery using one-lung ventilation in 25 participating hospitals in Spain, Italy, Turkey, Egypt, and Ecuador. Eligible adult patients (age ≥18 years) were randomly assigned to receive iOLA or standard lung-protective ventilation. Eligible patients (stratified by centre) were randomly assigned online by local principal investigators, with an allocation ratio of 1:1. Treatment with iOLA included an alveolar recruitment manoeuvre to 40 cm H2O of end-inspiratory pressure followed by individualised positive end-expiratory pressure (PEEP) titrated to best respiratory system compliance, and individualised postoperative respiratory support with high-flow oxygen therapy. Participants allocated to standard lung-protective ventilation received combined intraoperative 4 cm H2O of PEEP and postoperative conventional oxygen therapy. The primary outcome was a composite of severe postoperative pulmonary complications within the first 7 postoperative days, including atelectasis requiring bronchoscopy, severe respiratory failure, contralateral pneumothorax, early extubation failure (rescue with continuous positive airway pressure, non-invasive ventilation, invasive mechanical ventilation, or reintubation), acute respiratory distress syndrome, pulmonary infection, bronchopleural fistula, and pleural empyema. Due to trial setting, data obtained in the operating and postoperative rooms for routine monitoring were not blinded. At 24 h, data were acquired by an investigator blinded to group allocation. All analyses were performed on an intention-to-treat basis. This trial is registered with ClinicalTrials.gov, NCT03182062, and is complete. FINDINGS: Between Sept 11, 2018, and June 14, 2022, we enrolled 1380 patients, of whom 1308 eligible patients (670 [434 male, 233 female, and three with missing data] assigned to iOLA and 638 [395 male, 237 female, and six with missing data] to standard lung-protective ventilation) were included in the final analysis. The proportion of patients with the composite outcome of severe postoperative pulmonary complications within the first 7 postoperative days was lower in the iOLA group compared with the standard lung-protective ventilation group (40 [6%] vs 97 [15%], relative risk 0·39 [95% CI 0·28 to 0·56]), with an absolute risk difference of -9·23 (95% CI -12·55 to -5·92). Recruitment manoeuvre-related adverse events were reported in five patients. INTERPRETATION: Among patients subjected to lung resection under one-lung ventilation, iOLA was associated with a reduced risk of severe postoperative pulmonary complications when compared with conventional lung-protective ventilation. FUNDING: Instituto de Salud Carlos III and the European Regional Development Funds.

Mortality Risk Prediction in Abdominal Septic Shock Treated with Polymyxin-B Hemoperfusion: A Retrospective Cohort Study.

Endotoxin, a component of the cell membrane of gram-negative bacteria, is a trigger for dysregulated inflammatory response in sepsis. Extracorporeal purification of endotoxin, through adsorption with polymyxin B, has been studied as a therapeutic option for sepsis. Previous studies suggest that it could be effective in patients with high endotoxin levels or patients with septic shock of moderate severity. Here, we perform a retrospective, single-centre cohort study of 93 patients suffering from abdominal septic shock treated with polymyxin-B hemoperfusion (PMX-HP) between 2015 and 2020. We compared deceased and surviving patients one month after the intervention using X2 and Mann-Whitney U tests. We assessed the data before and after PMX-HP with a Wilcoxon single-rank test and a multivariate logistic regression analysis. There was a significant reduction of SOFA score in the survivors. The expected mortality using APACHE-II was 59.62%, whereas in our sample, the rate was 40.9%. We found significant differences between expected mortality and real mortality only for the group of patients with an SOFA score between 8 and 13. In conclusion, in patients with abdominal septic shock, the addition of PMX-HP to the standard therapy resulted in lower mortality than expected in the subgroup of patients with intermediate severity of illness.

Teletriagem de enfermagem no âmbito da saúde mental e psiquiátrica num serviço de saúde privado português / Nursing teletriage in the context of psychiatric and mental health in a Portuguese private healthcare service / Teletriaje de enfermería en el ámbito de la salud mental y psiquiátrica en un servicio de salud privado português

Resumo Introdução: Teletriagem compreende a avaliação remota preliminar de sinais e sintomas e a orientação do cliente para o cuidado de saúde adequado (emergente, urgente ou não urgente). A LUZ24 abrange a vídeoconsulta e a teletriagem, sendo esta última efetuada exclusivamente por enfermeiros, integrando enfermeiros especialistas em Enfermagem de Saúde Mental e Psiquiátrica. Objetivo: Mapear os resultados da atividade em teletriagem realizada por enfermeiros da LUZ24, no âmbito da saúde mental e psiquiátrica. Método: Análise documental que partiu da questão: Quais são os resultados da atividade em teletriagem, realizada por enfermeiros da LUZ24, no âmbito da saúde mental e psiquiátrica. Seguiram-se as diretrizes Strengthening the Reporting of Observational Studies in Epidemiology (STROBE). Estudo desenvolvido a partir da análise da base de dados de registos clínicos eletrónicos Oracle BI Publisher relativamente às teletriagens efetuadas no período entre janeiro de 2020 e dezembro de 2021. A análise e tratamento dos dados foi efetuada com recurso à ferramenta do Microsoft Excel versão 2021, tendo sido utilizadas medidas de estatística descritiva para a caracterização da amostra e para os dados clínicos. A investigação foi aprovada pela Comissão de Investigação e Comissão de Ética Competente do Hospital da Luz. Resultados: Do total de 63396 teletriagens do âmbito geral, foram analisadas 1005 (1,59%) no âmbito da saúde mental. A amostra é predominantemente feminina (64,78%), com idade média de 50,41 anos. A teletriagem foi realizada com recurso a algoritmos de tomada de decisão, designados de protocolos. Foram utilizados 10 protocolos, sendo os três mais prevalentes: Ansiedade ou crise situacional (47,16%), Insónia (26,77%) e Doença mental (14,33%). A orientação para a consulta foi o encaminhamento mais prevalente (63.98%). Conclusões: A teletriagem realizada por enfermeiros peritos - treinados na avaliação clínica remota e com recurso a protocolos - possibilitou a avaliação de sintomatologia no âmbito da saúde mental e psiquiátrica e o encaminhamento dos clientes.

Abstract Background: Teletriage comprises the preliminary remote assessment of clinical signs and symptoms and its consequent referral to the most appropriate healthcare services (emergent, urgent or non-urgent ones). LUZ24 covers videoconsultation and teletriage, the latter one being exclusively carried out by a team of nurses also composed by specialists in Mental Health and Psychiatric Nursing. Aim: To measure the results of the teletriage activity performed by LUZ24 nurses in a Mental Health and Psychiatry field. Methods: Document analysis that emerged from the following question: What are the results of the teletriage activity performed by nurses from LUZ24 in the context of psychiatric and mental health? The Strengthening Reporting of Observational Studies in Epidemiology (STROBE) guidelines were followed. Study developed from the analysis of the Oracle BI Publisher electronic clinical records database regarding teletriages carried out between January 2020 and December 2021. The analysis and consequent treatment of the data used the Microsoft Excel tool on its version 2021, with descriptive statistical measures being applied for the characterization of the sample and for the clinical data. The research was approved by the Research Commission and the Competent Ethics Commission of Hospital da Luz. Results: Out of a total of 63,396 general teletriage assessments, 1,005 (1.59%) were analyzed in the scope of mental health and psychiatry. The sample is predominantly female (64.78%), with an average age of 50.41 years. The teletriage was conducted using decision-making algorithms called protocols. Ten protocols were used, with the three most prevalent being Anxiety or Situational Crisis (47.16%), Insomnia (26.77%), and Mental Illness (14.33%). Referral to consultation was the most prevalent (63.98%). Conclusions: The teletriage conducted by expert nurses - trained in remote clinical evaluation and using protocols - enabled the evaluation of symptomatology in the scope of mental health and psychiatric, as well as the referral of clients.

Resumen Introducción: El teletriaje comprende la evaluación preliminar remota de signos y síntomas y la derivación del cliente al contexto de salud más adecuado (emergente, urgente o no-urgente). LUZ24 abarca la videoconsulta y el teletriaje, siendo esta última realizada exclusivamente por enfermeros, algunos de los cuales también especialistas en Salud Mental y Psiquiátrica. Objetivo: Mapear los resultados de la actividad de teletriaje realizada por enfermeros de LUZ24 en el campo de la Salud Mental y Psiquiátrica. Métodos: Análisis documental que surge de la cuestíon: ¿Cuáles son los resultados de la actividad en teletriaje realizada por enfermeros de LUZ24 en el campo de la salud mental y psiquiátrica? Se ha utilizado el guía de Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) para el efecto. Estudio desarrollado a partir del análisis de la base de datos de registros clínicos electrónicas Oracle BI Publisher con respecto de los teletriajes realizados en el período entre enero de 2020 y diciembre de 2021. El análisis y tratamiento de los datos se realizaron con la herramienta de Microsoft Excel en su versión 2021, utilizando medidas de estadística descriptiva para la caracterización de la muestra y datos clínicos. La investigación fue aprobada por la Comisión de Investigación y la Comisión de Ética Competente del Hospital da Luz. Resultados: De un total de 63396 teletriajes, se analizaron 1.005 (1,59%) en el ámbito de la salud mental y psiquiátrica. La muestra es predominantemente compuesta por elementos femeninos (64,78%) con una edad media de 50,41 años. El teletriaje presupone el manejo de algoritmos de toma de decisiones, también conocidos como protocolos. Se han utilizado diez protocolos, siendo los tres más prevalentes: ansiedad o crisis situacional (47,16%), Insomnio (26,77%) y enfermedad mental (14,33%). La derivación para consulta fue la más prevalente (63,98%). Conclusiones: El teletriaje realizado por enfermeros expertos - capacitados en la evaluación clínica a distancia y utilizando protocolos - aseguró la evaluación de la sintomatología en el contexto de la salud mental y psiquiatría y la derivación de clientes para consultas especializadas.

Intervenções autónomas de enfermagem na prevenção da confusão aguda: revisão integrativa da literatura / Autonomous nursing interventions to prevent acute confusion: integrative literature review / Intervenciones autónomas de enfermería en la prevención de la confusión aguda: revisión integradora de la literatura

Resumo Introdução: O delirium é frequente em adultos institucionalizados, caracterizado por perturbação da consciência, diminuição da capacidade de atenção, pensamento desorganizado e com evolução num curto espaço de tempo. O delirium tem uma apresentação sintomática mais detalhada do que a confusão aguda, sendo o primeiro um diagnóstico médico e o segundo um diagnóstico de enfermagem. A confusão aguda é muitas vezes sujeita a interpretações erróneas por parte dos enfermeiros. Objetivo: Identificar as intervenções autónomas de enfermagem passíveis de prevenir a confusão aguda. Métodos: Revisão Integrativa, partindo da questão: "Quais as intervenções autónomas de enfermagem passiveis de prevenir a confusão aguda?". Pesquisa realizada em outubro de 2020 com recurso às bases de dados: CINAHL®Complete; MEDLINE Complete; Nursing & Allied Health collection: Comprehensive; Cochrane Central Register of Controlled Trials; Cochrane Database of Systematic Reviews e SciELO, com os critérios de inclusão: artigos com texto integral, entre 2015 e 2020, em português, espanhol e inglês. Resultados: Identificaram-se 71 resultados, dez artigos foram incluídos. A seleção foi feita por leitura do título, eliminação de duplicados, leitura de resumos e textos integrais com recurso ao Preferred Reporting Items for Systematic Reviews and Meta-Analyses, de acordo com os critérios de inclusão determinados. Os artigos incluídos são: duas revisões sistemáticas; quatro meta-análises; dois estudos experimentais; um estudo quasi-experimental e uma revisão da literatura. Conclusões: As intervenções autónomas de enfermagem enquadram-se nos dez domínios das intervenções multicomponentes, percebendo-se uma heterogeneidade de intervenções. As intervenções multicomponentes são as que melhores resultados evidenciam, quando comparadas com as intervenções isoladas.

Abstract Background: Delirium is a common condition in institutionalized adults, characterized by disturbance of consciousness, decreased attention span and disorganized thinking, with an evolution in a short period of time. Delirium has a more detailed symptomatic presentation than acute confusion, being the first one a medical diagnosis and the second a nursing diagnosis. Acute confusion is often subject to misinterpretation by nurses. Aim: To identify autonomous nursing interventions capable of preventing acute confusion. Methods: Integrative Review, starting from the question: "Which autonomous nursing interventions can prevent acute confusion?" Research carried out in october 2020 using the following databases: CINAHL®Complete; MEDLINE Complete; Nursing & Allied Health collection: Comprehensive; Cochrane Central Register of Controlled Trials; Cochrane Database of Systematic Reviews and SciELO, with the inclusion criteria: articles with full text, between 2015 and 2020, in portuguese, spanish and english. Results: 71 results were identified and ten articles were included. The selection was made by reading the title, eliminating duplicates, reading abstracts and full texts, using Preferred Reporting Items for Systematic Reviews and Meta-Analyses, according to the inclusion criteria. The articles included are: two systematic reviews; four meta-analyses; two experimental studies; a quasi-experimental study and a literature review. Conclusions: Autonomous nursing interventions fit into the ten domains of multicomponent interventions, being perceived a heterogeneity of interventions. Multicomponent interventions are those that show better results, when compared to isolated interventions.

Resumen Introducción: El delirium es frecuente en adultos institucionalizados, caracterizado por alteración de la conciencia, disminución de la capacidad de atención, pensamiento desorganizado y con evolución en corto espacio de tiempo. El delirium tiene una presentación de síntomas más detallada que la confusión aguda, siendo el primero un diagnóstico médico y el segundo un diagnóstico de enfermería. La confusión aguda es, muchas veces, sujeta a malas interpretaciones por parte de los enfermeros. Objetivo: Identificar intervenciones autónomas de enfermería capaces de prevenir la confusión aguda. Métodos: Revisión integrativa, a partir de la pregunta: "¿Qué intervenciones autónomas de enfermería pueden prevenir la confusión aguda?". Investigación realizada en octubre de 2020 utilizando las siguientes bases de datos: CINAHL®Complete; MEDLINE Complete; Nursing & Allied Health collection: Comprehensive; Cochrane Central Register of Controlled Trials; Cochrane Database of Systematic Reviews y SciELO, con los criterios de inclusión: artículos con texto completo, entre 2015 y 2020, en portugués, español e inglés. Resultados: Se identificaron 71 resultados, se incluyeron diez artículos. La selección se realizó mediante lectura de título, eliminación de duplicados, lectura de resúmenes y textos completos utilizando el Preferred Reporting Items for Systematic Reviews and Meta-Análisis, de acuerdo con los criterios de inclusión determinados. Los artículos incluidos son: dos revisiones sistemáticas; cuatro metanálisis; dos estudios experimentales; un estudio cuasi-experimental y una revisión de la literatura. Conclusiones: Las intervenciones autónomas de enfermería encajan en los diez dominios de intervenciones multicomponientes, dándose cuenta de una heterogeneidad de intervenciones. Las intervenciones multicomponientes son las que muestran mejores resultados, en comparación con las intervenciones aisladas.

Programas de supervisión clínica para enfermeras de cuidados intensivos: protocolo de scoping review / Clinical supervision programs for critical care nurses: scoping review protocol

Introducción: La escasez global de enfermeras trajo consigo una mayor dificultad a la hora de contratar y retener a este tipo de profesionales durante la pandemia provocada por la COVID-19. La supervisión clínica en enfermería, por tratarse de un procedimiento sistemático y estructurado para el desarrollo de la práctica clínica en sus diferentes contextos, parece influir en los indicadores de resultados, en la formación continua y en la trayectoria profesional de las enfermeras. Objetivo: 1) Mapear los programas de supervisión clínica para la incorporación de enfermeras en cuidados intensivos. Método de revisión: método de scoping review definido por el Instituto Joanna Briggs a partir de la siguiente pregunta: ¿cuáles son las características de los programas de supervisión clínica para la incorporación de enfermeras en cuidados intensivos? A la hora de definir los criterios de inclusión, se utilizó la estrategia PCC (población, concepto y contexto), además de artículos escritos en portugués, inglés y castellano; estudios primarios de tipo cuantitativo, cualitativo y mixto; estudios secundarios que responden a la pregunta de la investigación; documentos de textos y de opinión, y estudios encontrados en las referencias bibliográficas secundarias. No se utilizan artículos sin el texto completo, fuera del ámbito de la pregunta de partida y cuyo contexto sean los cuidados intensivos pediátricos y neonatales. La búsqueda se realiza en PubMed/ MEDLINE, SCOPUS, LILACS, OpenGrey, Google Scholar, Web of Science y EBSCOhost, y en las bases de datos asociadas. Presentación e interpretación de los resultados: los dados analizados se presentarán de manera esquemática, tabular y narrativa. (AU)

Background: The global shortage of nurses, considered one of the priority areas of intervention by the World Health Organization, has exposed increased difficulties in recruiting and retaining nurses during the COVID-19 pandemic. Clinical supervision in nursing, as a systematized and structured process for the development of clinical practice in different contexts, seems to contribute to outcomes, in continuous training and in the course of nurses’ professional experience. Aim: 1) To map clinical supervision programmes for the integration of nurses in critical care. Review method: Joanna Briggs Institute method for Scoping review, starting from the question: what are the characteristics of clinical supervision programs for the integration of nurses in critical care? In the inclusion criteria definition, the PCC strategy (population, concept and context) was used; articles written in Portuguese, English and Spanish; quantitative, qualitative, mixed type studies, secondary studies which answer the research question, text and opinion documents and studies found in secondary bibliographic references. Articles without full text, outside the scope of the starting question, and whose context is pediatric and neonatal critical care will be excluded. The search will be carried out in PubMed/ MEDLINE, SCOPUS, LILACS, OpenGrey, Google Scholar, Web of Science and EBSCOhost, with associated databases. Presentation and interpretation of results: The analyzed data will be presented in a diagrammatic, tabular and narrative form. (AU)

Allosteric coupling asymmetry mediates paradoxical activation of BRAF by type II inhibitors.

The type II class of RAF inhibitors currently in clinical trials paradoxically activate BRAF at subsaturating concentrations. Activation is mediated by induction of BRAF dimers, but why activation rather than inhibition occurs remains unclear. Using biophysical methods tracking BRAF dimerization and conformation we built an allosteric model of inhibitor-induced dimerization that resolves the allosteric contributions of inhibitor binding to the two active sites of the dimer, revealing key differences between type I and type II RAF inhibitors. For type II inhibitors the allosteric coupling between inhibitor binding and BRAF dimerization is distributed asymmetrically across the two dimer binding sites, with binding to the first site dominating the allostery. This asymmetry results in efficient and selective induction of dimers with one inhibited and one catalytically active subunit. Our allosteric models quantitatively account for paradoxical activation data measured for 11 RAF inhibitors. Unlike type II inhibitors, type I inhibitors lack allosteric asymmetry and do not activate BRAF homodimers. Finally, NMR data reveal that BRAF homodimers are dynamically asymmetric with only one of the subunits locked in the active αC-in state. This provides a structural mechanism for how binding of only a single αC-in inhibitor molecule can induce potent BRAF dimerization and activation.

Cuidados en mujer mayor con fragilidad y doble proceso infeccioso por Clostridium difficile y COVID-19 en el ámbito hospitalario / Care for an elderly frail woman with double infection by Clostridium difficile and COVID-19 in the hospital setting

El objetivo fue presentar un plan de cuidados enfermero individualizado para una mujer de 94 años, con fragilidad, sin deterioro cognitivo, procedente de residencia sociosanitaria, que ingresó en la Unidad de Medicina Interna derivada de Urgencias por presentar infección por Clostridium difficile e infección respiratoria por COVID-19. Tras realizarle una valoración al ingreso siguiendo los patrones funcionales de Marjory Gordon se priorizaron los siguientes diagnósticos NANDA: síndrome de anciano frágil, integridad de la piel deteriorada y dolor crónico. Para cada uno se establecieron los resultados NOC deseados: Estado nutricional, movilidad, conocimiento: prevención de caídas, integridad tisular: piel y membranas mucosas, dolor: efectos nocivos, dolor: respuesta psicológica adversa. Las intervenciones NIC y sus correspondientes actividades consiguieron una mejora en la puntuación basal de todos los indicadores alcanzando la puntuación diana. Es fundamental que la atención al paciente mayor se cumpla desde las esferas: físico, mental, funcional y social.(AU)

The objective was to present an individualized nursing plan of care for a 94-year-old woman, presenting frailty, without cognitive deterioration, coming from a nursing home and admitted to the Internal Medicine Unit by referral from the Emergency Unit, due to presenting infection by Clostridium difficile and respiratory infection by COVID-19. After assessment at admission, following Marjory Gordon’s functional health patterns, the following NANDA diagnoses were prioritized: frailty syndrome of the elderly, skin integrity deterioration, and chronic pain. The desired NOC outcomes were determined for each: nutritional status, mobility, knowledge: prevention of falls, tissue integrity: skin and mucous membranes, pain: harmful effects, pain; adverse psychological response. The NIC interventions and their corresponding activities achieved an improvement in the basal score of all indicators, reaching the target score. It is essential to address care for elderly patients from the physical, mental, functional and social areas.(AU)

Thermal Treatment to Obtain 5-Hydroxymethyl Furfural (5-HMF), Furfural and Phenolic Compounds from Vinasse Waste from Agave.

Vinasses represent important final disposal problems due to their physical-chemical composition. This work analyzed the composition of tequila vinasses and increased 5-hydroxymethylfurfural, furfural, and phenolic compounds using thermal hydrolysis with hydrogen peroxide as a catalyst. A statistical Taguchi design was used, and a UPLC-MS (XEVO TQS Micro) analysis determined the presence and increase of the components. The treatment at 130 °C, 40 min, and 0.5% of catalyst presented the highest increase for 5-HMF (127 mg/L), furfural (3.07 mg/L), and phenol compounds as chlorogenic (0.36 mg/L), and vanillic acid (2.75 mg/L). Additionally, the highest removal of total sugars (57.3%), sucrose (99.3%), and COD (32.9%). For the treatment T130:30m:0P the syringic (0.74 mg/L) and coumaric (0.013 mg/L) acids obtained the highest increase, and the treatment T120:30m:1P increased 3-hydroxybenzoic (1.30 mg/L) and sinapic (0.06 mg/L) acid. The revaluation of vinasses through thermal treatments provides guidelines to reduce the impact generated on the environment.

Evaluación del sistema parasimpático durante procedimientos dolorosos en neonatología / Parasympathetic evaluation for procedural pain assessment in neonatology

Introducción: El monitor NIPE (Newborn Infant Parasympathetic Evaluation) es una herramienta rápida, continua y objetiva de evaluación del disconfort neonatal. Los objetivos fueron describir los cambios del NIPE tras una extracción sanguínea y los factores implicados en su variación. Material y métodos: Estudio observacional analítico con recogida de datos prospectiva. Se incluyeron los recién nacidos ingresados en cuidados intensivos entre junio y diciembre de 2021 a quienes se les realizó extracción sanguínea. Se recogieron variables demográficas, las relacionadas con la realización del procedimiento, la puntuación NIPE, la frecuencia cardiaca previa y en los minutos 1, 2, 3, 4, 5, 10 y 15 posteriores. Resultados: Se incluyeron 86 registros de 49 pacientes. Durante los primeros cuatro minutos tras el procedimiento hubo un descenso significativo en la puntuación NIPE, siendo el descenso máximo de un 22,8% respecto al valor basal, produciéndose el nadir a los 2,79 minutos. El mayor descenso del NIPE ocurrió en pacientes prematuros, varones, con menor Apgar a los cinco minutos, en procedimientos ya realizados previamente, tras cesárea y en horario matutino. No hubo diferencias con la realización en canguro. La correlación entre NIPE y frecuencia cardíaca fue débil. Conclusiones:Tras un procedimiento doloroso, como una extracción sanguínea, el monitor NIPE mostró un descenso significativo los primeros cuatro minutos, agudizándose el descenso con la prematuridad, la reiteración de procedimientos o el nacimiento tras cesárea. El monitor NIPE puede ayudar a identificar eficazmente a aquellos neonatos que sufren dolor agudo tras un procedimiento, complementándose con las escalas de valoración clínica. (AU)

Introduction: The Newborn Infant Parasympathetic Evaluation (NIPE) index is an instrument that enables continuous, fast and objective assessment of neonatal discomfort. The aim of the study was to analyse changes in NIPE values after performance of blood draws and the factors involved in this variation. Material and methods: We conducted a prospective observational study. We included infants admitted to the neonatal intensive care unit between June and December 2021 who underwent blood draws. We recorded demographic data, aspects related to the procedure, the NIPE index and the heart rate at baseline and 1, 2, 3, 4, 5, 10 and 15min after the procedure. Results: The study included 86 records for 49 patients. In the first 4min after the procedure, there was a significant decrease in the NIPE index, with a maximum decrease of 22.8% relative to baseline and the nadir at 2.79min. The decrease in NIPE values was greater in infants born preterm, male, with lower 5-min Apgar scores and following procedures that had been performed previously, after caesarean section or in the morning. There were no differences when the blood draw was obtained during kangaroo care. The correlation between the NIPE index and the heart rate was weak. Conclusions: After a painful procedure, such as a blood draw, the NIPE monitor showed a significant decrease in the first 4min, which was more pronounced in preterm infants, in repeated procedures or after caesarean delivery. The NIPE index could help identify infants experiencing acute procedural pain, complementing clinical rating scales. (AU)

Neuroinflammation and neuroprogression produced by oxidative stress in euthymic bipolar patients with different onset disease times.

Bipolar disorder (BD) is associated with systemic toxicity, represented by changes in biomarkers associated with mood episodes, leading to neurological damage, which may reflect cognitive functions and functionality and the progression of the disease. We aimed to analyze the effect of four biomarkers, superoxide dismutase (SOD), catalase (CAT), glutathione peroxidase (GSH-Px), and thiobarbituric acid reactive substances (TBA-RS), related to oxidative stress in BD and to correlate them with cognitive functions and functionality. We studied 50 bipolar types I/II patients in the euthymic phase, which was divided into two subgroups with 25 patients each (≤ 3 years and ≥ 10 years of diagnosis, from the first episode of mania) and 25 control patients. To analyze frontal cognitive functions and functionality, we used the Frontal Assessment Battery (FAB) and Functioning Assessment Short Test (FAST) tests, respectively. The scores of the FAST and FAB tests showed an increase and decrease respectively, in both bipolar groups, when compared to the control group, demonstrating impairment in cognitive functions and functionality since the disease onset. In addition, changes occurred in all six domains of the FAST test, and in four domains of the FAB test in bipolar patients when compared to the control group. Regarding oxidative stress biomarkers, we did not find changes in SOD and GSH-Px activities; however, a significant increase in CAT activity and lipid peroxidation was observed in both groups, although the patients were euthymic and medicated. These results allow us to raise the hypothesis that since the beginning of the disease, the euthymic bipolar patient has presented a level of oxidative stress, which gets worse with the evolution of the disease, promoting impairments in the frontal cognitive functions and functionality gradually.

Parasympathetic evaluation for procedural pain assessment in neonatology.

INTRODUCTION: The Newborn Infant Parasympathetic Evaluation (NIPE) index is an instrument that enables continuous, fast and objective assessment of neonatal discomfort. The aim of the study was to analyse changes in NIPE values after performance of blood draws and the factors involved in this variation. MATERIAL AND METHODS: We conducted a prospective observational study. We included infants admitted to the neonatal intensive care unit between June and December 2021 who underwent blood draws. We recorded demographic data, aspects related to the procedure, the NIPE index and the heart rate at baseline and 1, 2, 3, 4, 5, 10 and 15 min after the procedure. RESULTS: The study included 86 records for 49 patients. In the first 4 min after the procedure, there was a significant decrease in the NIPE index, with a maximum decrease of 22.8% relative to baseline and the nadir at 2.79 min. The decrease in NIPE values was greater in infants born preterm, male, with lower 5-min Apgar scores and following procedures that had been performed previously, after caesarean section or in the morning. There were no differences when the blood draw was obtained during kangaroo care. The correlation between the NIPE index and the heart rate was weak. CONCLUSIONS: After a painful procedure, such as a blood draw, the NIPE monitor showed a significant decrease in the first 4 min, which was more pronounced in preterm infants, in repeated procedures or after caesarean delivery. The NIPE index could help identify infants experiencing acute procedural pain, complementing clinical rating scales.

A single-cell transcriptional gradient in human cutaneous memory T cells restricts Th17/Tc17 identity.

The homeostatic mechanisms that fail to restrain chronic tissue inflammation in diseases, such as psoriasis vulgaris, remain incompletely understood. We profiled transcriptomes and epitopes of single psoriatic and normal skin-resident T cells, revealing a gradated transcriptional program of coordinately regulated inflammation-suppressive genes. This program, which is sharply suppressed in lesional skin, strikingly restricts Th17/Tc17 cytokine and other inflammatory mediators on the single-cell level. CRISPR-based deactivation of two core components of this inflammation-suppressive program, ZFP36L2 and ZFP36, replicates the interleukin-17A (IL-17A), granulocyte macrophage-colony-stimulating factor (GM-CSF), and interferon gamma (IFNγ) elevation in psoriatic memory T cells deficient in these transcripts, functionally validating their influence. Combinatoric expression analysis indicates the suppression of specific inflammatory mediators by individual program members. Finally, we find that therapeutic IL-23 blockade reduces Th17/Tc17 cell frequency in lesional skin but fails to normalize this inflammatory-suppressive program, suggesting how treated lesions may be primed for recurrence after withdrawal of treatment.

Unraveling the interplay between iron homeostasis, ferroptosis and extramedullary hematopoiesis.

Iron participates in myriad processes necessary to sustain life. During the past decades, great efforts have been made to understand iron regulation and function in health and disease. Indeed, iron is associated with both physiological (e.g., immune cell biology and function and hematopoiesis) and pathological (e.g., inflammatory and infectious diseases, ferroptosis and ferritinophagy) processes, yet few studies have addressed the potential functional link between iron, the aforementioned processes and extramedullary hematopoiesis, despite the obvious benefits that this could bring to clinical practice. Further investigation in this direction will shape the future development of individualized treatments for iron-linked diseases and chronic inflammatory disorders, including extramedullary hematopoiesis, metabolic syndrome, cardiovascular diseases and cancer.

Active revegetation after mining: what is the contribution of peer-reviewed studies?

Knowing the state of the art on research related to post-mining active revegetation can help to improve revegetation success and identify research gaps. We performed a systematic review about active revegetation after mining and identified 203 relevant studies. Most studies were performed in the USA (34%), in regions with a temperate climate (59%) and in abandoned coal mines (45%). The studies were focused on the plantation of woody species (59%) or sowing of herbaceous species (39%). The most widely evaluated treatments were the addition of amendments (24%) and fertilizers (21%), mainly with positive and neutral effects; in general, organic amendments presented more positive effects than inorganic amendments and fertilizers. We also identified studies on the effects of plowing, inoculation of microorganisms, nurse plants, herbivore exclusion and watering. The results of these treatments should be taken with caution, because they can vary according to the functional strategies of the introduced species and the local context, such as the degree of nutrient limitation in the mining area and abiotic conditions. Further research is needed in non-temperate climates, involving long-term monitoring and with detailed descriptions of the interventions to better interpret results and general implications of active revegetation of mining areas.

High-fat diet activates splenic NOD1 and enhances neutrophil recruitment and neutrophil extracellular traps release in the spleen of ApoE-deficient mice.

In the course of atherogenesis, the spleen plays an important role in the regulation of extramedullary hematopoiesis, and in the control of circulating immune cells, which contributes to plaque progression. Here, we have investigated the role of splenic nucleotide-binding oligomerization domain 1 (NOD1) in the recruitment of circulating immune cells, as well as the involvement of this immune organ in extramedullary hematopoiesis in mice fed on a high-fat high-cholesterol diet (HFD). Under HFD conditions, the absence of NOD1 enhances the mobilization of immune cells, mainly neutrophils, from the bone marrow to the blood. To determine the effect of NOD1-dependent mobilization of immune cells under pro-atherogenic conditions, Apoe-/- and Apoe-/-Nod1-/- mice fed on HFD for 4 weeks were used. Splenic NOD1 from Apoe-/- mice was activated after feeding HFD as inferred by the phosphorylation of the NOD1 downstream targets RIPK2 and TAK1. Moreover, this activation was accompanied by the release of neutrophil extracellular traps (NETs), as determined by the increase in the expression of peptidyl arginine deiminase 4, and the identification of citrullinated histone H3 in this organ. This formation of NETs was significantly reduced in Apoe-/-Nod1-/- mice. Indeed, the presence of Ly6G+ cells and the lipidic content in the spleen of mice deficient in Apoe and Nod1 was reduced when compared to the Apoe-/- counterparts, which suggests that the mobilization and activation of circulating immune cells are altered in the absence of NOD1. Furthermore, confirming previous studies, Apoe-/-Nod1-/- mice showed a reduced atherogenic disease, and diminished recruitment of neutrophils in the spleen, compared to Apoe-/- mice. However, splenic artery ligation reduced the atherogenic burden in Apoe-/- mice an effect that, unexpectedly was lost in Apoe-/-Nod1-/- mice. Together, these results suggest that neutrophil accumulation and activity in the spleen are driven in part by NOD1 activation in mice fed on HFD, contributing in this way to regulating atherogenic progression.

Sequence and tissue targeting specificity of ZFP36L2 reveals Elavl2 as a novel target with co-regulation potential.

Zinc finger protein 36 like 2 (ZFP36L2) is an RNA-binding protein that destabilizes transcripts containing adenine-uridine rich elements (AREs). The overlap between ZFP36L2 targets in different tissues is minimal, suggesting that ZFP36L2-targeting is highly tissue specific. We developed a novel Zfp36l2-lacking mouse model (L2-fKO) to identify factors governing this tissue specificity. We found 549 upregulated genes in the L2-fKO spleen by RNA-seq. These upregulated genes were enriched in ARE motifs in the 3'UTRs, which suggests that they are ZFP36L2 targets, however the precise sequence requirement for targeting was not evident from motif analysis alone. We therefore used gel-shift mobility assays on 12 novel putative targets and established that ZFP36L2 requires a 7-mer (UAUUUAU) motif to bind. We observed a statistically significant enrichment of 7-mer ARE motifs in upregulated genes and determined that ZFP36L2 targets are enriched for multiple 7-mer motifs. Elavl2 mRNA, which has three 7-mer (UAUUUAU) motifs, was also upregulated in L2-fKO spleens. Overexpression of ZFP36L2, but not a ZFP36L2(C176S) mutant, reduced Elavl2 mRNA expression, suggesting a direct negative effect. Additionally, a reporter assay demonstrated that the ZFP36L2 effect on Elavl2 decay is dependent on the Elavl2-3'UTR and requires the 7-mer AREs. Our data indicate that Elavl2 mRNA is a novel target of ZFP36L2, specific to the spleen. Likely, ZFP36L2 combined with other RNA binding proteins, such as ELAVL2, governs tissue specificity.

Evaluación cronobiológica en estudiantes universitarios y su relación con el rendimiento académico / Chronobiological evaluation of students and its relationship with academic performance

Fundamentos: La adaptación a la vida universitaria puede generar problemas cronobiológicos en losestudiantes. Los objetivos del estudio fueron estimar el índice de masa corporal (IMC), nivel de actividad físicay aspectos cronobiológicos en relación con el rendimiento académico de los estudiantes residentes en elcampus de una universidad internacional ubicada en Honduras.Métodos: El estudio fue transversal, aplicándose encuestas de autopercepción relacionadas con ritmos desueño, actividad física e índice de calidad de sueño; además, se tomaron medidas antropométricas. Lamuestra fue representativa (87) y los estudiantes fueron seleccionados al azar. Se realizaron test de análisisde frecuencias, ANDEVA, prueba Duncan (p<0,05) y Chi cuadrado.Resultados: Los resultados se compararon por rendimiento académico (< y > 88%). Se estimó que enpromedio la población estudiantil se encuentra en un rango normal de IMC, con actividad física alta ycronotipos intermedio-vespertino e intermedio-matutino. Estudiantes con menos del 88% de rendimientoacadémico presentaron un IMC promedio de sobrepeso (25,4 kg/m2). Con respecto al rendimientoacadémico, no se encontraron diferencias en horas, déficit, patrón y cronotipos de sueño.Conclusiones: Se encontraron diferencias en la calidad de sueño y el rendimiento académico. No sedeterminó relación directa entre el rendimiento académico, cronotipos y patrón de sueño. (AU)

Background: Adapting to university life can generate chronobiological problems in students. The objectivesof the study were to estimate the body mass index (BMI), level of physical activity and chronobiologicalaspects in relation to academic performance of students residing on the campus of an international universitylocated in Honduras.Methods: The study was cross-sectional, applying self-perception surveys related to sleep rhythms, physicalactivity, sleep quality index; in addition, anthropometric measurements. The sample was representative (87)and the students were randomly selected. Frequency analysis, ANDEVA, Duncan test (p<0,05) and Chi-squaretest were performed.Results: Results were compared by academic performance (< and > 88%). It was estimated that, on average,the student population was in a normal BMI range, with high physical activity and intermediate-afternoon andintermediate-matutine chronotypes. Students with < 88% of academic performance presented an averageoverweight BMI (25,4 kg/m2). With respect to academic performance, no differences were found in hours,deficit, pattern and chronotypes of sleep.Conclusions: Differences were found in sleep quality and academic performance. No direct relationship wasdetermined between academic performance, chronotypes and sleep pattern. (AU)

NOD1 splenic activation confers ferroptosis protection and reduces macrophage recruitment under pro-atherogenic conditions.

The bioavailability and regulation of iron is essential for central biological functions in mammals. The role of this element in ferroptosis and the dysregulation of its metabolism contribute to diseases, ranging from anemia to infections, alterations in the immune system, inflammation and atherosclerosis. In this sense, monocytes and macrophages modulate iron metabolism and splenic function, while at the same time they can worsen the atherosclerotic process in pathological conditions. Since the nucleotide-binding oligomerization domain 1 (NOD1) has been linked to numerous disorders, including inflammatory and cardiovascular diseases, we investigated its role in iron homeostasis. The iron content was measured in various tissues of Apoe-/- and Apoe-/-Nod1-/- mice fed a high-fat diet (HFD) for 4 weeks, under normal or reduced splenic function after ligation of the splenic artery. In the absence of NOD1 the iron levels decreased in spleen, heart and liver regardless the splenic function. This iron decrease was accompanied by an increase in the recruitment of F4/80+-macrophages in the spleen through a CXCR2-dependent signaling, as deduced by the reduced recruitment after administration of a CXCR2 inhibitor. CXCR2 mediates monocyte/macrophage chemotaxis to areas of inflammation and accumulation of leukocytes in the atherosclerotic plaque. Moreover, in the absence of NOD1, inhibition of CXCR2 enhanced atheroma progression. NOD1 activation increased the levels of GPX4 and other iron and ferroptosis regulatory proteins in macrophages. Our findings highlight the preeminent role of NOD1 in iron homeostasis and ferroptosis. These results suggest promising avenues of investigation for the diagnosis and treatment of iron-related diseases directed by NOD1.