Factors influencing teamwork in healthcare applicable to interventional and diagnostic radiology.

Teamwork in healthcare has been analysed extensively in the literature, mainly in acute healthcare settings such as the operating room, emergency room, and intensive care unit, with limited evidence related to diagnostic and interventional radiology. Multiple factors that affect teamwork in different domains have been described, such as communication, hierarchy, and distractions. Teamwork is an important patient safety, job satisfaction and patient outcome determinant, with interprofessional and interdisciplinary healthcare education playing a relevant role in the different domains affecting team performance. The aim of this article is to review the literature to describe domains and specific factors that influence teamwork in diagnostic and interventional radiology practice. This is of particular interest for radiologist involved in quality improvement and/or patient safety initiatives development and implementation. The review will conclude with a summary table highlighting the most important factors that, according to the authors, appear relevant to the radiology practice.

In Vitro Activities of Novel Antimicrobial Combinations against Extensively Drug-Resistant Acinetobacter baumannii.

Extensively drug-resistant (XDR) Acinetobacter spp. have emerged as a cause of nosocomial infections, especially under conditions of intensive care. Unfortunately, resistance to colistin is increasing and there is a need for new therapeutic options. We aimed to study the effect of some novel combinations against XDR Acinetobacter baumannii in an in vitro pharmacokinetics-pharmacodynamics (PK/PD) model. Three nonrelated clinical strains of XDR A. baumannii were investigated. Antibiotic-simulated regimens were colistin at 3 MU every 8 h (q8h) (first dose, 6 MU), daptomycin at 10 mg/kg of body weight q24h, imipenem at 1 g q8h, and ertapenem at 1 g q24h. Combination regimens included colistin plus daptomycin, colistin plus imipenem, and imipenem plus ertapenem. Samples were obtained at 0, 1, 2, 4, 8, and 24 h. Among the single-agent regimens, only the colistin regimen resulted in significant reductions in log10 CFU per milliliter compared to the control for all the strains tested. Although colistin achieved bactericidal activity at 4 h, it was not able to reach the limit of detection (1 log10 CFU/ml). One strain had significant regrowth at 24 h without the emergence of resistance. Daptomycin-colistin combinations led to a significant reduction in levels of log10 CFU per milliliter that were better than those achieved with colistin as a single-agent regimen, reaching the limit of detection at 24 h against all the strains. The combination of imipenem plus ertapenem outperformed the colistin regimen, although the results did not reach the limit of detection, with significant regrowth at 24 h. Similarly, colistin-plus-imipenem combinations reduced the levels of log10 CFU per milliliter at 8 h, with significant regrowth at 24 h but with development of resistance to colistin. We have shown some potentially useful alternatives for the treatment of extensively drug-resistant A. baumannii. Among them, the daptomycin-colistin combination was the most effective and should be investigated in future studies.

Paediatric interventional radiology: it's not child's play.

Pediatric interventional radiology is a dynamic and growing subspecialty. The new training pathways in interventional radiology, the maintenance of skills with a small volume of cases or complex procedures, the limited availability of specific pediatric equipment and materials pose significant challenges and opportunities.

[Food insecurity levels and associated characteristics in pregnant women in Colombia in 2015]. / Niveles de inseguridad alimentaria y características asociadas en mujeres gestantes de Colombia en el 2015.

INTRODUCTION: Food insecurity is the inability of households to acquire safe, nutritionally adequate food that meets physiological needs for leading a healthy and active life. OBJECTIVE: To describe the levels of food insecurity and associated factors in pregnant women in Colombia. METHODOLOGY: Cross-sectional-analytical study; is a secondary analysis of the 2015 Nutritional Situation Survey of Colombia. 1393 pregnant women between 12 and 48 years old were examined. Food insecurity was assessed using the Latin American and Caribbean Food Security Scale. Sociodemographic, anthropometric and micronutrient characteristics were evaluated. The description of food insecurity distribution was made for each of the selected variables, through absolute and percentage frequencies. To estimate the association between the different variables and food insecurity, we used multivariate Poisson regression models. RESULTS: 60.4% (CI95% 55.6%-64,7%) of pregnant women resided in homes with some degree of food insecurity; severe: 9.4% (CI95% 7.4%-11.9%), moderate: 17.6% (CI95% 13.5%-22.8%) and light: 33.2% (CI95% 28.9%-37.8%); we found that Black/Mulatto/Afro-descendant pregnant women (PR 1.22 CI95% 1.01-1.47), belong to quartile 1 of wealth (PR 2.23 CI95% 1.41-3.68), and residing in the región Atlántica (PR 1.34 CI95% 1.08-1.67), was associated with some food insecurity level. CONCLUSION: A high proportion of pregnant women living in households with some food insecurity level. The pregnant women of low socioeconomic levels and those belonging to the black/mulatto/Afro-descendant ethnic group showed to be the main characteristics associated with residing in households with some degree of food insecurity.

COVID-19 in donation and transplant.

SARS-CoV-2 infection has had a major impact on donation and transplantation. Since the cessation of activity two years ago, the international medical community has rapidly generated evidence capable of sustaining and increasing this neccesary activity. This paper analyses the epidemiology and burden of COVID-19 in donation and transplantation, the pathogenesis of the infection and its relationship with graft-mediated transmission, the impact of vaccination on donation and transplantation, the evolution of donation in Spain throughout the pandemic, some lessons learned in SARS-CoV-2 infected donor recipients with positive PCR and the applicability of the main therapeutic tools recently approved for treatment among transplant recipients.

[Analysis of psychological factors influencing peritoneal dialysis selection]. / Análisis de la influencia de los factores psicológicos en la elección de diálisis peritoneal.

BACKGROUND: Peritoneal dialysis (PD) is not frequently used in our setting. OBJECTIVE: To analyze the psychological factors involved in the choice of renal replacement therapy (RRT). MATERIAL AND METHODS: A prospective observational study of stable patients without cognitive or sensory deficits who were informed about RRT from January 2004 to July 2006 and agreed to participate. The patients were given and completed the Beck Depression Inventory and the Eysenck personality questionnaire. Clinical and sociodemographic data and RRT choice were recorded. End of follow-up: 2007/10/31. RESULTS: 44 patients were studied: age, 65.4 +/- 13.1 years, 48% male, 34% diabetic. When choosing RRT, 36% of patients had symptoms of depression. Neither depression symptoms nor personality traits were related to the choice of dialysis type. The youngest patients chose PD (41%). After a mean followup of 8 +/- 8 months, 70% of patients started RRT (68% haemodialysis [HD], 32% PD). None of the patients who chose HD changed their mind, but 3 of the 13 patients (23%) who chose PD finally commenced HD, usually in the context of a worsening of the disease. Half of the patients with depression symptoms when choosing PD and a third of the patients with higher levels of neuroticism changed their decision and finally opted for HD. CONCLUSIONS: When choosing RRT, the prevalence of depression symptoms is high. Neither depression nor personality traits influenced the initial choice of RRT, although these factors may be involved in subsequent changes to the decision.

Root morphology of mandibular molars: a cone-beam computed tomography study.

BACKGROUND: The aim of the study was to assess the number and anatomical classification of roots and root canals of first and second mandibular molars using cone-beam computed tomography (CBCT) in a Chilean population. MATERIALS AND METHODS: This study evaluated the CBCT scans of 289 patients aged between 14 and 86 years, obtaining a sample of 1022 mandibular first and second molars. The number of roots and root canals was evaluated according to the anatomical classification proposed by Ahmed in 2016. Data were analysed using Pearson's chi-squared test and ANOVA. RESULTS: Nine hundred fifty-one (93.05%) molars had two roots, while the remaining 71 (6.95%) molars had one root. The most frequent root and root canal morphologies found were: ²MM M² D¹ (29.65%), ²MM M²â»¹ D¹ (22.3%) and ²MM M¹ D¹ (13.4%) (M - mesial, D - distal), with a total of 32 different anatomical distributions. C-shaped canals were present in 56 molars and were more frequently found in women than in men (7.1% vs. 3.88%; p = 0.024). CONCLUSIONS: The analysis of internal anatomy using CBCT revealed a highly variable distribution of root canals. The most frequent morphology found in mandibular molars in a Chilean population was two roots and three canals.

Sirtuin gene expression in human mononuclear cells is modulated by caloric restriction.

BACKGROUND: Sirtuins may provide novel targets for treating some diseases associated with oxidative stress, such as obesity and its comorbidities. However, there are a few in vivo studies in humans about the potential role of sirtuins as therapeutic targets among obese patients undergoing caloric restriction. Therefore, the aim of this study was to assess if the gene expression of sirtuins is modulated in peripheral blood mononuclear cells (PBMC) by a hypocaloric diet devised to lose weight in humans. MATERIALS AND METHODS: Gene expression of two sirtuins (SIRT1 and SIRT2) in the PBMC of obese subjects (32.3 +/- 5.5 kg m(-2)) before and following an 8-week hypocaloric diet was investigated. NADH-coenzyme Q reductase (NDUFS2) and cytochrome c oxidase assembly protein (COX15) gene expression was selected together with plasma antioxidant power and nitric oxide as markers of antioxidant status. A quantitative real-time polymerase chain reaction approach was performed to assess the nutrigenomics outcome. Moreover, 2-keto[1-(13)C]isocaproate breath test (KICA-BT) parameters were evaluated to study mitochondrial oxidation in vivo. RESULTS: The intervention up-regulated the expression of both sirtuins, being inversely associated with total antioxidant capacity and directly related to nitric oxide, mitochondrial oxidation assessed by the KICA-BT and the expression of the mitochondrial proteins COX15 and NDUFS2. CONCLUSION: SIRT1 and SIRT2 may serve as key regulators for some obesity comorbidities related to antioxidant status, while PBMC could be a model to study the effect of the sirtuin response in obesity therapy.

Genetic differentiation in pointing dog breeds inferred from microsatellites and mitochondrial DNA sequence.

Recent studies presenting genetic analysis of dog breeds do not focus specifically on genetic relationships among pointing dog breeds, although hunting was among the first traits of interest when dogs were domesticated. This report compares histories with genetic relationships among five modern breeds of pointing dogs (English Setter, English Pointer, Epagneul Breton, Deutsch Drahthaar and German Shorthaired Pointer) collected in Spain using mitochondrial, autosomal and Y-chromosome information. We identified 236 alleles in autosomal microsatellites, four Y-chromosome haplotypes and 18 mitochondrial haplotypes. Average F(ST) values were 11.2, 14.4 and 13.1 for autosomal, Y-chromosome microsatellite markers and mtDNA sequence respectively, reflecting relatively high genetic differentiation among breeds. The high gene diversity observed in the pointing breeds (61.7-68.2) suggests contributions from genetically different individuals, but that these individuals originated from the same ancestors. The modern English Setter, thought to have arisen from the Old Spanish Pointer, was the first breed to cluster independently when using autosomal markers and seems to share a common maternal origin with the English Pointer and German Shorthaired Pointer, either via common domestic breed females in the British Isles or through the Old Spanish Pointer females taken to the British Isles in the 14th and 16th centuries. Analysis of mitochondrial DNA sequence indicates the isolation of the Epagneul Breton, which has been formally documented, and shows Deutsch Drahthaar as the result of crossing the German Shorthaired Pointer with other breeds. Our molecular data are consistent with historical documents.

Organ donors with exceptional medical conditions also count!

All organ donors, even those who have died under exceptional conditions, can provide at least one valid organ for transplantation. It is thus necessary to evaluate the outcomes of donors with unusual diseases. We reviewed 909 organ donors at six hospitals over the last 15 years. Of these, 29 (3.19%) were considered to be exceptional either because of prior disease, the circumstance of death, or complications arising during admission. Among the 53 organs transplanted from all these donors (except two), the mean number of valid organs per donor was 1.88 rather than 2.36 for standard donors. One patient who received a liver transplant died due to the same infection as that diagnosed in the donor. The remaining recipients experienced no primary graft failure or transmission of problems present in the donor.

Specific insulin sensitivity and leptin responses to a nutritional treatment of obesity via a combination of energy restriction and fatty fish intake.

BACKGROUND: Nutritional strategies to treat obesity often influence neuroendocrine factors related to body weight control. The present study aimed to investigate whether the inclusion of three fatty fish servings per week within a hypocaloric diet may have specific healthy effects on insulin and leptin functions. METHODS: Thirty-two subjects (body mass index = 31.6 +/- 3.5 kg m(-2)) aged 36 +/- 7 years, were assigned to a control or fish-based energy-restricted diet over an 8-week period. Anthropometry, body composition, lipid profile, leptin and insulin values were measured at the start and at the end of the dietary intervention. RESULTS: Both experimental diets resulted in a similar mean weight loss (control = 5.3 +/- 2.6% versus fish-based = 5.5 +/- 2.5%; P = 0.783). A significant reduction in insulin resistance, as determined by the homeostatic model assessment index (HOMA-IR = insulin x glucose/22.5), was observed after the fish-based intervention. The change in circulating leptin was higher in the fish-based diet compared to the control group. Sixteen percent of the variability in the change of adjusted-leptin could be explained (P = 0.034) by the HOMA index change and the type of diet. CONCLUSIONS: Three servings a week of fatty fish included in an energy-restricted diet appears to be a valid strategy for specifically improving insulin sensitivity and leptin levels in obese subjects, which could involve a better body weight regulation after a nutritional intervention period.

Energy restriction in obese subjects impact differently two mitochondrial function markers.

Excessive fat deposition is the key feature in obesity, which is empowered by cytokines overproduction and stimulation of cell oxidative stress processes, but little is known about energy availability in the form of ATP and mitochondrial function in the obese subjects. Thus, the aim of this study was to evaluate the possible changes in energy metabolism after a 8-weeks balanced-hypocaloric diet in obese subjects by measuring the ATP-content in leukocytes, by assessing 2-keto[1-13C]isocaproate breath test (KICA-BT) parameters related to mitochondrial function and by analyzing inflammatory and oxidative stress biomarkers. All the recruited obese subjects (n = 19) lost body weight after dieting (-5.55 +/- 2.88%). The hypocaloric treatment induced a decrease in leptin levels and lipid peroxidation markers. Interestingly, the ATP content in blood leukocytes increased (49.9 +/- 32.5 vs 36.2 +/- 27.9 pmol/mg prot.; p < 0.05), while KICA tracer mitochondrial oxidation decreased (30.9 +/- 5.9 vs. 33.1 +/- 4.5 % 13C; p < 0.05) after weight loss. These results show that two minimally invasive methods were able to detect changes in mitochondrial function as induced by a hypocaloric diet, which is of great interest in order to understand oxidative processes associated with weight homeostasis as well as to establish newer anti-obesity therapeutic targets by using mitochondrial function markers in vivo.

Multilevel correlates of household anthropometric typologies in Colombian mothers and their infants.

BACKGROUND: The aim of this study was to establish the association of maternal, family, and contextual correlates of anthropometric typologies at the household level in Colombia using 2005 Demographic Health Survey (DHS/ENDS) data. METHODS: Household-level information from mothers 18-49 years old and their children <5 years old was included. Stunting and overweight were assessed for each child. Mothers were classified according to their body mass index. Four anthropometric typologies at the household level were constructed: normal, underweight, overweight, and dual burden. Four three-level [households (n = 8598) nested within municipalities (n = 226), nested within states (n = 32)] hierarchical polytomous logistic models were developed. Household log-odds of belonging to one of the four anthropometric categories, holding 'normal' as the reference group, were obtained. RESULTS: This study found that anthropometric typologies were associated with maternal and family characteristics of maternal age, parity, maternal education, and wealth index. Higher municipal living conditions index was associated with a lower likelihood of underweight typology and a higher likelihood of overweight typology. Higher population density was associated with a lower likelihood of overweight typology. CONCLUSION: Distal and proximal determinants of the various anthropometric typologies at the household level should be taken into account when framing policies and designing interventions to reduce malnutrition in Colombia.

Ophthalmic features of spinocerebellar ataxia type 7.

PurposeTo analyze the relation between ophthalmologic and motor changes in spinocerebellar ataxia type 7 (SCA7).Patients and methodsThis was a case series study. Sixteen SCA7 patients underwent a comprehensive ophthalmic examination, including ocular extrinsic motility testing, color vision test, and optical coherence tomography of the optic nerve and macula. Changes in the corneal endothelium, electroretinographic patterns, and a complete neurologic evaluation using the Scale for the Assessment and Rating of Ataxia (SARA) were evaluated. Correlations of endothelial cell density (ECD) with number of CAG repetitions and the SARA scores were estimated.ResultsAll patients showed various degrees of visual impairment mainly due to macular deterioration. Notably, they also presented decreased ECD. Pairwise correlations of ECD with number of CAG repeats and severity of motor symptoms quantified with the SARA scores were inverse (r=-0.46, P=0.083 and r=-0.64, P=0.009, respectively). Further analyses indicated an average ECD decrease of 48 cells/mm2 (P=0.006) per unit of change on the number of CAG repeats, and of 75 cells/mm2 (P=0.001) per unit of change on the SARA scores.ConclusionsThe results agree with previous ophthalmological findings regarding the widespread effect of SCA7 mutation on the patient's visual system. However, the results also show a significant negative correlation of decreased ECD with both CAG repetitions and SARA scores. This suggests that motor systems could degenerate in parallel with visual systems, although more research is needed to determine whether the degeneration is caused by the same mechanisms.

A GHEP-ISFG collaborative study on the genetic variation of 38 autosomal indels for human identification in different continental populations.

A collaborative effort was carried out by the Spanish and Portuguese Speaking Working Group of the International Society for Forensic Genetics (GHEP-ISFG) to promote knowledge exchange between associate laboratories interested in the implementation of indel-based methodologies and build allele frequency databases of 38 indels for forensic applications. These databases include populations from different countries that are relevant for identification and kinship investigations undertaken by the participating laboratories. Before compiling population data, participants were asked to type the 38 indels in blind samples from annual GHEP-ISFG proficiency tests, using an amplification protocol previously described. Only laboratories that reported correct results contributed with population data to this study. A total of 5839 samples were genotyped from 45 different populations from Africa, America, East Asia, Europe and Middle East. Population differentiation analysis showed significant differences between most populations studied from Africa and America, as well as between two Asian populations from China and East Timor. Low FST values were detected among most European populations. Overall diversities and parameters of forensic efficiency were high in populations from all continents.

Choroidal haemangioma and photodynamic therapy. Anatomical and functional response of patients with choroidal hemangioma treated with photodynamic therapy. / Hemangioma coroideo y terapia fotodinámica. Respuesta anatómica y funcional de los pacientes con hemangioma coroideo tratados con terapia fotodinámica.

OBJECTIVE: To study the effectiveness and limitations of photodynamic therapy (PDT) as treatment of choice in patients with symptomatic circumscribed choroidal haemangioma. METHODS: A retrospective study was conducted on 16 patients (13 men and 3 women, with mean age of 54.88 years) with circumscribed choroidal haemangioma, who attended our centre and were treated with PDT in the last 7 years. RESULTS: All patients had circumscribed choroidal haemangioma, which caused a decrease in visual acuity (VA) secondary to the presence of intraretinal microcystic oedema or neurosensory detachment. The mean initial VA was 0.23, and the final mean VA after performing PDT was 0.38 (all the VA were measured in decimal scale). It should be noted that patients needed a mean of 1.69 PDT sessions. Three of the patients needed rescue treatment with trans-pupillary thermotherapy, intravitreal injection of anti-vascular endothelial growth factor (ranibizumab, aflibercept) or a dexamethasone intravitreal implant (Ozurdex®). The indication for a change of treatment was the persistence of intraretinal microcystic oedema and/or neurosensory detachment (or incomplete resolution) after 3 PDT sessions. As overall results, 62.5% of patients evolved into anatomical and functional (increase in AV or stability) resolution. CONCLUSIONS: PDT is a straight forward and fast procedure, with a good anatomical and functional response, causing minimal damage to adjacent vessels.

Agresores sexuales seriales en Colombia: dos estudios de casos de las ciudades de Bogotá y Cali / Serial sex offenders in Colombia: two case studies from the citiesof Bogotá and Cali

El presente artículo, luego de ilustrar al lector sobre la naturaleza de los agresores sexuales seriales, desarrolla puntualmente dos casos de estudio documentados por la Procuraduría Delegada para el Ministerio Público en Asuntos Penales y la Policía Nacional, extraídos de las líneas investigativas que implementan estas instituciones desde años atrás. Este ejercicio investigativo conforma un estudio de caso múltiple que busca ampliar el conocimiento disponible sobre la materia, haciendo los respectivos análisis frente a la naturaleza de los individuos que cometen esta clase de transgresiones y a sus dinámicas delincuenciales. Se encuentran los resultados de diferentes entrevistas, revisión de expediente judicial, aplicación de pruebas psicométricas en dos sujetos capturados y condenados por la comisión de agresiones sexuales de similares características. En ambos casos, el delito sexual es el objetivo de la actividad, en el que predomina amenaza con arma cortopunzante. En los dos casos estos comportamientos se presentan después de los 18 años, el sujeto (1) presenta 23 víctimas registradas en el sistema judicial, y el sujeto (2), 15 víctimas reconocidas; en cuanto a las características psicológicas, los dos tuvieron problemas en el acatamiento de normas, con baja tolerancia a la frustración y actitudes machistas durante su infancia y adolescencia.

Pericardial effusion and cardiac tamponade in pediatric stem cell transplant recipients.

Pericardial effusion and cardiac tamponade is a rarely reported complication following stem cell transplant (SCT). The incidence among pediatric SCT recipients is not well defined. To assess the frequency of clinically significant pericardial effusions, we retrospectively examined clinically significant cardiac effusions at our center. Between January of 1993 and August 2004, clinically significant pericardial effusions were identified in nine of 205 patients (4.4%). The median age at the time of transplant was 9 years (range 0.6-18 years) and seven received an allogeneic transplant. All nine had normal cardiac function prior to transplant. The effusion developed at a median of 30 days (range 18-210 days). All allogeneic recipients had acute or clinically extensive graft-versus-host disease (GVHD) at the time the effusion was diagnosed. Seven patients (78%) required pericardiocentesis or surgical creation of a pericardial window. No patient died as a complication of the effusion or the therapeutic procedures. Clinically significant pericardial effusions are more common than previously reported in pediatric SCT recipients. Acute and chronic GVHD is an associated factor.