Total error in lymphocyte subpopulations by flow cytometry-based in state of the art using Spanish EQAS data.

OBJECTIVES: Flow cytometry analyses of lymphocyte subpopulations (T, B, NK) are crucial for enhancing clinical algorithms and research workflows. Estimating the total error (TE) values for the percentage and absolute number of lymphocyte subpopulations using the state-of-the-art (SOTA) approach with real data from an external proficiency testing (EPT) scheme was performed. A comparison with previously published Biological Variability (BV)-based specifications was carried out. METHODS: A total of 44,998 results from 86 laboratories over 10 years were analysed and divided into two five-year periods (2012-2016) and (2017-2021). Data come from the IC-1 Lymphocytes scheme of the Spanish External Quality Assurance System (EQAS) GECLID Program. This quantitative scheme includes percentages and absolute numbers of CD3+, CD3+CD4+, CD3+CD8+, CD19+, and CD3-CD56+CD16+ NK cells. The percentage of TE was calculated as: |reported value - robust mean|*100/robust mean for each laboratory and parameter. The cut-off for TE is set at 80 % best results of the laboratories. RESULTS: A significant reduction in the SOTA-based TE for all lymphocyte subpopulations in 2017-2021 was observed compared to 2012-2016. The SOTA-based TE fulfils the minimum BV-based TE for percentages of lymphocyte subpopulations. The parameter with the best analytical performance calculated with SOTA (2017-2021 period)-based TE was the percentage of CD3+ (TE=3.65 %). CONCLUSIONS: The values of SOTA-based specifications from external quality assurance program data are consistent and can be used to develop technical specifications. The technological improvement, quality commitment, standardization, and training, reduce TE. An update of TE every five years is therefore recommended. TE assessment in lymphocyte subsets is a helpful and reliable tool to improve laboratory performance and data-based decision-making trust.

[Impact of care for victims of gender violence on the health professionals]. / Impacto de la atención a las víctimas de violencia de género en los y las profesionales de la salud.

Professionals who work with women victims of gender violence face difficult emotional situations, and it is important to be aware of the emotions and feelings that the attitudes and behaviour of victims and aggressors generate in them. These emotions can become barriers to communication and seriously affect the professional's relationship with victims. Furthermore, they can generate situations of sustained stress, lead to emotional exhaustion, and affect their health, life, and work performance. We describe the consequences, risk factors and warning signs, as well as protective or resilience factors, that are important to know, and we list the current challenges and some recommendations for professionals and management in order to help prevent such effects and improve professional performance without health risks.

[The necessary response of health services to gender violence. Comprehensive care and provision of integrated services]. / La respuesta necesaria de los servicios de salud ante la violencia de género. Atención integral y prestación de servicios integrados.

Gender violence has multiple and serious consequences for the health of victims and their families, hence the reason for the important role that the health system plays in addressing it. Health professionals have a key role in the response, which must include early detection, care, and follow-up; actions in which primary care, because of its privileged position in the system, can play a fundamental part. This article establishes the necessary characteristics for the intervention to be effective: comprehensive care, multidisciplinary approach, intersectoral coordination, and integrated service provision; all of it community-oriented, person-centered, and adapted to its context (social factors and vulnerabilities) with an intersectional approach. The woman, her sons and daughters, and other cohabitants, as well as the perpetrator, are considered the object of intervention in the response, and specific guidelines for action are provided for detection, care, and follow-up. Reorientation of interventions, with emphasis on a community approach, is also proposed.

Toxic epidermal necrolysis-like acute graft-versus-host disease in pediatric bone marrow transplant patients: Case series and review of the literature.

BACKGROUND/OBJECTIVES: Complications of hematopoietic stem cell transplant (HSCT) include acute graft-versus-host disease (aGVHD). Severe cutaneous aGVHD can present with generalized erythroderma, desquamation, and bullae which can mimic toxic epidermal necrolysis (TEN). TEN occurs in response to a culprit medication. Transplant patients are often on many medications, making it difficult to distinguish between the two conditions. Given that TEN-like aGVHD is rare, we describe a case series of pediatric patients and review the literature. METHODS: This is a multi-institutional case series of children who developed TEN-like aGVHD following bone marrow transplantation. Demographic, clinical, and treatment information was collected. RESULTS: Ten patients were identified. Median age at transplantation was 8.5 years (range 0.12-17 years). Median time from transplant to first skin symptoms was 35 days (range 6-110 days) and to first TEN-like symptoms was 40 days (range 16-116 days). 7/10 had other organ GVHD involvement. All patients were on concurrent medications at time of first skin symptoms including immunosuppression for GVHD prophylaxis, infection prophylaxis or treatment, and pain medication. Treatments for TEN-like aGVHD included immunosuppression. CONCLUSIONS: We observe that patients with > or equal to 50% BSA involvement of their skin with TEN-like aGVHD, extracutaneous GVHD, and lack of reepithelization tend to have poor outcomes. Given the rarity of this condition, multidisciplinary care of these patients is important for accurate and timely diagnosis and treatment.

[Prevention of mental health disorders in primary care: Pregnancy in adolescence]. / Prevención de los trastornos de la salud mental. Embarazo en la adolescencia.

Adolescent pregnancy is generally an unwanted pregnancy, a situation that involves significant biological, psychological and social overloads, with repercussions on the health of the mother and the child. But the psychosocially important fact is that an unwanted pregnancy in its entirety gives rise to the birth of an ambivalently wanted child, a high-risk child. Those born in Spain in 2020 to women under 20 years of age were 8,305, which corresponds to 1.97% of all births. This review presents measures and recommendations for the protection and prevention of the mental health of the mother and child when pregnancy takes place in adolescence.

[COVID-19 pandemic and mental health: Initial considerations from spanish primary health care]. / Pandemia de la COVID-19 y salud mental: reflexiones iniciales desde la atención primaria de salud española.

An approach is made to the psychological and psychosocial characteristics that the COVID-19 pandemic is acquiring in the countries of our socio-cultural environment. The scarcity of research in this regard and the necessary acceptance of uncertainty to face the situation, both socially, as well as health and psychological, are discussed. Consequently, a series of reflections and recommendations are proposed for the psychological care of the population, health workers and social organization based on: 1) The existence of psychological and psychosocial research into connected fields and 2) In the new neuroscientific perspectives on emotions and their elaboration in crisis situations.

[Mental health in epidemics: A perspective from the Spanish Primary Health Care]. / Salud mental en epidemias: una perspectiva desde la Atención Primaria de Salud española.

The pandemic of the disease known as COVID-19 (acronym for coronavirus disease-2019), which was first detected in the Chinese city of Wuhan in December 2019, has led to an international public health emergency. This due to several reasons (threat to the lives of many people, unprecedented health and socioeconomic crisis, cessation of school and work activities, or the need to adopt extraordinary measures, including quarantining entire cities or countries). The PAPPS Mental Health Group has considered it important to observe, reflect and investigate the phenomena that are occurring, and will occur, in what has possibly been one of the most extensive and radical public health interventions in recent history. This work makes an approach to the psychological and psychosocial characteristics that the COVID-19 pandemic is acquiring in the countries of our socio-cultural environment, and proposes a series of reflections and recommendations for the psychological care of the population, health workers, and social organisation.

Spontaneous Regression of a Plaque-Type Striated Muscle Hamartoma.

Striated muscle hamartoma (SMH) is a rare, congenital or acquired, benign tumor that predominantly affects children. Therapeutic management has classically been surgical intervention. We present a pediatric case of a facial plaque-type SMH with spontaneous regression that highlights the importance of clinical observation for a conservative approach.

Striated muscle hamartoma in a newborn.

Striated muscle hamartoma (SMH) is an uncommon benign lesion, that is usually congenital, polypoid, and primarily located on the head and neck. The key histopathologic sign is the existence of individualized fascicles of striated muscle affecting the dermis and subcutaneous fat tissue. Here we report the case of a newborn girl with an SMH, who presented with a congenital infiltrated plaque on her chin without any other associations.

Conformational selection in glycomimetics: human galectin-1 only recognizes syn-Ψ-type conformations of ß-1,3-linked lactose and its C-glycosyl derivative.

The human lectin galectin-1 (hGal-1) translates sugar signals, that is, ß-galactosides, into effects on the level of cells, for example, growth regulation, and has become a model for studying binding of biopharmaceutically relevant derivatives. Bound-state conformations of Galß-C-(1→3)-Glcß-OMe (1) and its ßGal-(1→3)-ßGlc-OMe disaccharide parent compound were studied by using NMR spectroscopy (transferred (TR)-NOESY data), assisted by docking experiments and molecular dynamics (MD) simulations. The molecular recognition process involves a conformational selection event. Although free C-glycoside access four distinct conformers in solution, hGal-1 recognizes shape of a local minimum of compound 1, the syn-Φ/syn-Ψ conformer, not the structure at global minimum. MD simulations were run to explain, in structural terms, the observed geometry of the complex.

Delineation of commonly deleted chromosomal regions in meningiomas by high-density single nucleotide polymorphism genotyping arrays.

Despite recent advances in the identification of the cytogenetic profiles of meningiomas, a significant group of tumors still show normal karyotypes or few chromosomal changes. The authors analyzed the cytogenetic profile of 50 meningiomas using fluorescence in situ hybridization and high-density (500 K) single nucleotide polymorphism (SNP) arrays. Our results confirm that del(22q) (52%) and del(1p) (16%) (common deleted regions: 22q11.21-22q13.3. and 1p31.2-p36.33) are the most frequent alterations. Additionally, recurrent monosomy 14 (8%), del(6q) (10%), del(7p) (10%), and del(19q) (4%) were observed, while copy number patterns consistent with recurrent chromosomal gains, gene amplification, and copy number neutral loss of heterozygosity (cnLOH) were either absent or rare. Based on their overall SNP profiles, meningiomas could be classified into: (i) diploid cases, (ii) meningiomas with a single chromosomal change [e.g., monosomy 22/del(22q)] and (iii) tumors with ≥2 altered chromosomes. In summary, our results confirm and extend on previous observations showing that the most recurrent chromosomal abnormalities in meningiomas correspond to chromosome losses localized in chromosomes 1, 22 and less frequently in chromosomes 6, 7, 14, and 19, while chromosomal gains and cnLOH are restricted to a small proportion of cases. Finally, a set of cancer-associated candidate genes associated with the TP53, MYC, CASP3, HDAC1, and TERT signaling pathways was identified, in cases with coexisting monosomy 14 and del(1p).

Extended reality as a training method for medical first responders in mass casualty incidents: A protocol for a systematic review.

INTRODUCTION/BACKGROUND: Mass-casualty incidents (MCIs) and disasters require an organised and effective response from medical first responders (MFRs). As such, novel training methods have emerged to prepare and adequately train MFRs for these challenging situations. Particular focus should be placed on extended reality (XR), which encompasses virtual, augmented and mixed reality (VR, AR, and MR, respectively), and allows participants to develop high-quality skills in realistic and immersive environments. Given the rapid evolution of high-fidelity simulation technology and its advantages, XR simulation has become a promising tool for emergency medicine. Accordingly, this systematic review aims to: 1) evaluate the effectiveness of XR training methods and 2) explore the experience of MFRs undergoing such training. METHODS: A comprehensive search strategy will encompass four distinct themes: MFRs, disasters/MCIs, education and simulation, and XR. Four databases (MEDLINE, EMBASE, CINAHL and LILACs) will be searched along with an in-depth examination of the grey literature and reference lists of relevant articles. MetaQAT will be used as a study quality assessment tool and integrated into Covidence as part of the data extraction form. Given the predicted high heterogeneity between studies, it may not be possible to standardise data for quantitative comparison and meta-analysis. Thus, data will be synthesised in a narrative, semi-quantitative manner. DISCUSSION: This review will examine the existing literature on the effectiveness of XR simulation as a tool to train MFRs for MCIs, which could ultimately improve preparedness and response to disasters. TRIAL REGISTRATION: Protocol registration: PROSPERO CRD42021275692.

Two-dimensional HPLC coupled to ICP-MS and electrospray ionisation (ESI)-MS/MS for investigating the bioavailability in vitro of arsenic species from edible seaweed.

Edible seaweed consumption is a route of exposure to arsenic. However, little attention has been paid to estimate the bioaccessibility and/or bioavailability of arsenosugars in edible seaweed and their possible degradation products during gastrointestinal digestion. This work presents first use of combined inductively coupled plasma mass spectroscopy (ICP-MS) with electrospray ionization tandem mass spectrometry (ESI-MS/MS) with two-dimensional HPLC (size exclusion followed by anion exchange) to compare the qualitative and quantitative arsenosugars speciation of different edible seaweed with that of their bioavailable fraction as obtained using an in vitro gastrointestinal digestion procedure. Optimal extraction conditions for As species from four seaweed namely kombu, wakame, nori and sea lettuce were selected as a compromise between As extraction efficiency and preservation of compound identity. For most investigated samples, the use of ammonium acetate buffer as extractant and 1 h sonication in a water bath followed by HPLC-ICP-MS resulted in 40-61% of the total As to be found in the buffered aqueous extract, of which 86-110% was present as arsenosugars (glycerol sugar, phosphate sugar and sulfonate sugar for wakame and kombu and glycerol sugar and phosphate sugar for nori). The exception was sea lettuce, for which the arsenosugar fraction (glycerol sugar, phosphate sugar) only comprised 44% of the total extracted As. Interestingly, the ratio of arsenobetaine and dimethylarsinic acid to arsenosugars in sea lettuce extracts seemed higher than that for the rest of investigated samples. After in vitro gastrointestinal digestion, approximately 11-16% of the total As in the solid sample was found in the dialyzates with arsenosugars comprising 93-120% and 41% of the dialyzable As fraction for kombu, wakame, nori and sea lettuce, respectively. Moreover, the relative As species distribution in seaweed-buffered extracts and dialyzates was found to be very similar. Collection of specific fractions from the size-exclusion column to be analysed using anion-exchange HPLC-ESI-MS/MS enabled improved chromatographic selectivity, particularly for the less retained arsenosugar (glycerol sugar), facilitating confirmation of the presence of arsenosugars in seaweed extracts and dialyzates. Using this approach, the presence of arsenobetaine in sea lettuce samples was also confirmed.

Cavitary pneumonia and skin lesions.

Tularemia is a worldwide zoonosis caused by Francisella tularensis. The most frequent forms of tularemia are ulceroglandular, followed by typhoidal forms, glandular, and oculoglandular. Respiratory involvement is an uncommon presentation. Cutaneous lesions secondary to respiratory infections occur in 30% of cases. We present a case of tularemia with cavitary pneumonia and skin lesions.

Immune Response of Senegalese Sole against Betanodavirus Mutants with Modified Virulence.

Nervous necrosis virus (NNV), genus Betanodavirus, the etiological agent of the viral encephalopathy and retinopathy (VER), presents a genome with two positive-sense single-stranded RNA segments. Striped jack nervous necrosis virus (SJNNV) and red-spotted grouper nervous necrosis virus (RGNNV), together with reassortants RGNNV/SJNNV, are the betanodaviruses predominantly isolated in Southern Europe. An RGNNV/SJNNV reassortant isolated from Senegalese sole (wt160) causes high mortalities in this fish species. This virus presents differences in the sequence of the 3' non-coding region (NCR) of both segments compared to RGNNV and SJNNV reference strains. Previously, it has been reported that the reversion of two of these differences (nucleotides 1408 and 1412) in the RNA2 3'NCR to the SJNNV-type (recombinant r1408-1412) resulted in a decrease in sole mortality. In the present study, we have applied an OpenArray® to analyse the involvement of sole immune response in the virulence of several recombinants: the r1408-1412 and two recombinants, developed in the present study, harbouring mutations at positions 3073 and 3093 of RNA1 3'NCR to revert them to RGNNV-type. According to the correlation values and to the number of expressed genes, the infection with the RNA2-mutant provoked the most different immune response compared to the immune response triggered after the infection with the rest of the viruses, and the exclusive and high upregulation of genes related to the complement system. The infection with the RNA1-mutants also provoked a decrease in mortality and their replication was delayed at least 24 h compared to the wt160 replication, which could provoke the lag observed in the immune response. Furthermore, the infection with the RNA1-mutants provoked the exclusive expression of pkr and the downregulation of il17rc.