Comparación de desempeño de algoritmos para el diagnóstico de sífilis / Performance comparison of algorithms for the diagnosis of syphilis / Comparação de desempenho de algoritmos para o diagnóstico da sífilis

Resumen La sífilis es una de las infecciones de transmisión sexual con mayor incidencia en la Argentina. Para su diagnóstico, el Ministerio de Salud de la Nación avala distintos algoritmos, entre ellos, el algoritmo tradicional y el reverso. En el algoritmo tradicional, la VDRL constituye la prueba de screening y los resultados positivos se confirman con la prueba treponémica de aglutinación de partículas (TPPA). El algoritmo reverso con un test rápido, avalado más recientemente, consiste en la realización de un test rápido treponémico como screening y posterior VDRL en las muestras que resulten positivas. Se realizó una comparación entre ambos algoritmos para evaluar si era factible y conveniente la implementación del algoritmo reverso con un test rápido en el laboratorio del H.I.G.A. Dr. Oscar Alende. El objetivo fue determinar la concordancia entre el algoritmo tradicional, utilizado actualmente en la institución (VDRL seguido por TPPA), y el nuevo algoritmo propuesto (test rápido treponémico Alere Determine Syphilis TP seguido por VDRL-USR). Para ello se realizó un estudio prospectivo de desempeño de métodos cualitativos. Se realizó VDRL-USR, TPPA y test rápido Alere Determine Syphilis TP en muestras de 580 pacientes, de los cuales 558 cumplieron con los criterios de inclusión. Se obtuvieron 51 muestras con resultados positivos y 507 con resultados negativos para el diagnóstico de sífilis por ambos algoritmos, con un porcentaje de concordancia global del 100%, lo cual indica que podría reemplazarse el algoritmo tradicional por el reverso en aquellas situaciones que lo requieran en la población estudiada.

Abstract Syphilis is one of the sexually transmitted infections with the highest incidence in Argentina. For its diagnosis, the Ministry of Health of the Nation endorses different algorithms, among them, the traditional algorithm and the reverse. In the traditional algorithm, VDRL constitutes the screening test and positive results are confirmed with particle agglutination assay TPPA. The reverse algorithm with rapid test, endorsed more recently, consists of performing a rapid treponemal test as screening and subsequent VDRL in the samples that are positive. A comparison was made between both algorithms to evaluate if the implementation of the reverse algorithm with rapid test in Dr. Oscar Alende Hospital would be feasible and convenient. The objective of this work was to determine the concordance between the traditional algorithm, currently used in the institution (VDRL followed by TPPA), and the new algorithm proposed (rapid treponemal test Alere Determine Syphilis TP followed by VDRL-USR). For that purpose, a prospective study of the performance of qualitative methods was carried out. VDRL-USR, TPPA and Alere Determine Syphilis TP Rapid Test were performed on samples from 580 patients, of which 558 met the inclusion criteria. A total of 51 samples with positive results and 507 with negative results for the diagnosis of syphilis were obtained by both algorithms, with an overall concordance percentage of 100%, which indicates that the traditional algorithm could be replaced by the reverse in those situations that require it in the studied population.

Resumo A sífilis é uma das infecções sexualmente transmissíveis com maior incidência na Argentina. Para o seu diagnóstico, o Ministério da Saúde da Nação endossa diversos algoritmos, incluindo o algoritmo tradicional e o reverso. No algoritmo tradicional, o VDRL constitui o teste de triagem e os resultados positivos são confirmados com o teste treponêmico de aglutinação de partículas (TPPA). O algoritmo reverso com teste rápido, endossado mais recentemente, consiste na realização de um teste rápido treponêmico como triagem e posterior VDRL nas amostras positivas. Foi feita uma comparação entre os dois algoritmos para avaliar se a implementação do algoritmo reverso com um teste rápido no laboratório H.I.G.A. Dr. Óscar Alende era viável e conveniente. O objetivo foi determinar a concordância entre o algoritmo tradicional, atualmente utilizado na instituição (VDRL seguido de TPPA), e o novo algoritmo proposto (teste rápido treponêmico Alere Determine Syphilis TP seguido de VDRL-USR). Para tanto, foi realizado um estudo prospectivo de desempenho de métodos qualitativos. O VDRL- -USR, o TPPA e o teste rápido Alere Determine Syphilis TP foram realizados em amostras de 580 pacientes, dos quais 558 preencheram os critérios de inclusão. Foram obtidas 51 amostras com resultados positivos e 507 com resultados negativos para o diagnóstico de sífilis por ambos os algoritmos, com um percentual de concordância global de 100%, o que indica que o algoritmo tradicional poderia ser substituído pelo reverso nas situações que o exigissem na população estudada.

SARS-CoV-2 and the ocular surface: test accuracy and viral load / SARS-CoV-2 e a superfície ocular: acurácia dos testes e carga viral

ABSTRACT Purpose: This study aimed to evaluate the pre-sence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) RNA in the ocular surface of individuals clinically suspected of coronavirus disease 2019 (COVID-19) and determine the accuracy of different approaches of molecular testing on the ocular surface based on the nasopharyngeal positivity status for COVID-19. Methods: A total of 152 individuals with suspected COVID-19 symptoms who simultaneously underwent nasopharyngeal and two different tear film collection techniques for quantitative reverse-transcriptase polymerase chain reaction (RT-qPCR) were included. Tears were collected and randomized: one eye had the filter strip for the Schirmer test and the contralateral eye had conjunctival swab/cytology in the inferior fornix. All patients underwent slit lamp biomicroscopy. The accuracy of various ocular surface collection techniques used for the detection of SARS-CoV-2 RNA was determined. Results: Of the 152 patients enrolled in the study, 86 (56.6%) had COVID-19 confirmed by nasopharyngeal PCR. Both tear film collection techniques detected viral particles: the Schirmer test was positive in 16.3% (14/86) and the conjunctival swab/cytology in 17.4% (15/86), with no statistically significant differences. No positive ocular tests were found among those with negative nasopharyngeal PCR tests. The overall agreement of the ocular tests was 92.7%, and in combination, the sensitivity would increase to 23.2%. The mean cycle threshold values in the nasopharyngeal, Schirmer, and conjunctival swab/cytology tests were 18.2 ± 5.3, 35.6 ± 1.4, and 36.4 ± 3.9, respectively. Compared with the nasopharyngeal test, the Schirmer (p=0.001) and conjunctival swab/cytology (p<0.001) tests had significantly different Ct values. Conclusion: The Schirmer (16.3%) and conjunctival swab (17.4%) tests were comparably capable of detecting SARS-CoV-2 RNA in the ocular surface by RT-PCR accurately based on nasopharyngeal status and demonstrated indistinct sensitivity and specificity. Simultaneous specimen sampling and processing from the nasopharyngeal, Schirmer, and conjunctival swab/cytology tests demonstrated significantly lower viral load in both ocular surface approaches than in the nasopharyngeal test. Ocular manifestations detected by slit lamp biomicroscopy were not associated with ocular RT-PCR positivity.

RESUMO Objetivo: Avaliar a presença de RNA de coronavírus 2 causador de síndrome respiratória aguda grave (SARS-CoV-2) na superfície ocular de indivíduos clinicamente suspeitos com COVID-19 e determinar a precisão de diferentes abordagens de testes moleculares na superfície ocular com base no status de positividade do RT-qPCR de nasofaringe para COVID-19. Métodos: 152 indivíduos com sintomas suspeitos para a COVID-19 foram submetidos a coleta de reação em cadeia da polimerase de nasofaringe simultaneamente a duas técnicas diferentes de coleta de filme lacrimal para RT-qPCR: aleatoriamente, um olho com a tira filtro do teste de Schirmer e, o olho contralateral, com citologia (swab) conjuntival no fórnice inferior. Todos os indivíduos foram submetidos à biomicroscopia com lâmpada de fenda. Resultados: Dos 152 pacientes, 86 (56,6%) tiveram a COVID-19 confirmada por PCR de nasofaringe. Ambas as técnicas de coleta detectaram partículas virais: o teste de Schirmer foi positivo em 16,3% (14/86) e a citologia conjuntival em 17,4% (15/86), sem diferenças estatisticamente significativas. Não houve testes oculares positivos entre aqueles com reação em cadeia da polimerase de nasofaringe negativo. A concordância geral dos testes oculares foi de 92,7% e, em combinação, a sensibilidade aumentaria para 23,2%. Os valores médios do limiar de ciclo nos testes de nasofaringe, Schirmer e citologia conjuntival foram 18,2 ± 5,3, 35,6 ± 1,4 e 36,4 ± 3,9, respectivamente. Conclusão: Os testes de Schirmer (16,3%) e swab conjuntival (17,4%) foram igualmente capazes de detectar RNA de SARS-CoV-2 na superfície ocular por RT-PCR e demonstraram sensibilidade e especificidade indistintas. A coleta simultânea de amostras ao processamento dos testes de RT-PCR de nasofaringe, Schirmer e citologia (swab) conjuntival demonstraram carga viral significativamente menor em ambas as abordagens da superfície ocular em comparação com o teste de nasofaringe. As manifestações oculares detectadas pela biomicroscopia com lâmpada de fenda não foram claramente associadas à positividade do RT-PCR ocular.

Confecção de guia multifuncional para planejamento de reabilitação implantossuportada: relato de caso / Preparation of a multifuncional guide for the planning of implant-supported rehabilitations: case report / Elaboración de una guía multifuncional para la planificación de rehabilitación implantosoportada: informede caso

Introdução:Em busca da estética e da função mastigatória,é cada vez mais crescente aprocurapor reabilitações implantossuportadas. O guia multifuncional surgepara orientar a disponibilidade óssea e contribuir no planejamento da instalação tridimensional dos implantes, seguindo os princípios do planejamento reverso.Objetivo:Descrever, por meio de um caso clínico, a possibilidade de obtenção de resultados de excelente previsibilidade em coroas unitárias implantossuportadas, por meio do uso de guias multifuncionais, no planejamento do início ao fim de tratamento.Relato decaso:Paciente A.M.F, 44 anos, sexo feminino, compareceu à clínica de Prótese dentária do Departamento de Odontologia/UFRN com queixa de insatisfação da sua prótese removível e harmonia do sorriso. Ao exame clínico e radiográfico, observou-se ausência do elemento 12, apresentando um espaço interoclusal de 5mm e distância médio-distal de 7mm. Foi confeccionado o guia em resina acrílica, o qual foi preenchido o espaço desdentado com um dente de estoque. Em seguida, o dente deste guia teve seu centro perfurado com uma broca esférica para peça reta na região de cíngulo e com isso, preenchida com guta percha em bastão. Após isso, o paciente foi encaminhado para realizar uma tomografia computadorizada cone beam com o guia multifuncional em posição.As imagens obtidas permitiram o planejamento para instalação do implante, como inclinação e posicionamento favorável, bem como ausência de disponibilidade óssea na região. Além disso, o guia funcionou em outras etapas do tratamento da paciente, como na fase provisória.Conclusão:Os guias auxiliam em diversas fases do tratamento e permitem maior previsibilidade dos resultados em reabilitações protéticas unitárias implantossuportadas, apresentando-se como um dispositivo promissorpara ocorreto posicionamento do implante (AU).

Introduction:In search of esthetics and improved masticatory function, the demand for implant-supported rehabilitation is increasing. Multifunctional guides emerge to assess bone availability and help plan the three-dimensional installation of implants, following the principles of reverse planning. Objective:To describe, through a clinical case, the possibility of obtaining excellent predictability in implant-supported single crowns, through the use of multifunctional guides, inthe planning of a treatment from beginning to end. Case report:Patient A.M.F, 44 years old, female, came to the Prosthodontics clinic at the Department of Dentistry/UFRN complaining of dissatisfaction with her removable prosthesis and the harmony of her smile. Clinical and radiographic examination revealed the absence of element 12, with an interocclusal space of 5mm and a mid-distal distance of 7mm. The acrylic resin guide was made and the edentulous space was filled with a stock tooth. The center of theguide tooth was then drilled with a spherical straight-bit burr in the cingulum region and filled with gutta-percha stick. The patient was then referred for a cone beam computed tomography with the multifunctional guide in position. The images obtained allowed planning for implant installation, such as favorable inclination and positioning, as well as the absence of bone availability in the region. In addition, the guide was effective during other stages of the patient's treatment, such as the provisional phase.Conclusion:The guides assist in various phases of treatment and allow greater predictability of results in implant-supported single prosthetic rehabilitations, presenting themselves as a promising device for correct implant positioning (AU).

Introducción:En busca de estética y función masticatoria, la demanda de rehabilitaciones implantosoportadas es cada vez mayor. La guía multifuncional hasurgido para orientar la disponibilidad ósea y ayudar a planificar la instalación tridimensional de implantes, siguiendo los principios de la planificación inversa. Objetivo: Describir, a través de un caso clínico, la posibilidad de obtener una excelente predictibilidad en coronas unitarias implantosoportadas, mediante el uso de guías multifuncionales, en la planificación desde el início hasta el final del tratamiento. Informe de caso: Paciente A.M.F, 44 años, sexo femenino, compareció a la clínica de Prostodoncia del Departamento de Odontología/UFRN quejándose estar insatisfecha con su prótesis removible y con la armonía de su sonrisa. El examen clínico y radiográfico reveló la ausencia del elemento 12, con un espacio interoclusal de 5 mm y una distancia medio-distal de 7 mm. Se confeccionó una guía de resina acrílica y se rellenó el espacio edéntulo con un diente provisorio. A continuación, se perforó el centro del diente guía con una broca recta esférica en la región del cíngulo y se le rellenó con gutapercha en barra. Posteriormente, el paciente fue remitido a una tomografía computarizada cone beamcon la guía multifuncional en posición. Las imágenes obtenidas permitieron planificar la instalación del implante, como inclinación y posicionamiento favorables, así como la ausencia de disponibilidad ósea en la región. La guía también funcionó en otras fases del tratamiento del paciente, como en la fase provisional. Conclusión:Las guías ayudan en varias fases del tratamiento y permiten una mayor previsibilidadde los resultados en rehabilitaciones protésicas unitarias implantosoportadas, presentándose como un dispositivo prometedor para el correcto posicionamiento de los implantes (AU).

Inmunoensayo quimioluminiscente para sífilis en donantes de sangre: ¿Los valores de lectura se correlacionan con el estado de la infección? / Chemiluminescent immunoassay for syphilis in blood donors: do signal strength values correlate with the infection status? / Imunoensaio quimioluminescente para sífilis em doadores de sangue: os valores de leitura estão correlacionados com o estado da infecção?

Resumen El objetivo del trabajo fue comparar el desempeño del tamizaje treponémico y no treponémico en dos períodos próximos en el tiempo en donantes de sangre y analizar la asociación de la intensidad de la señal de la prueba quimioluminiscente (QL) con la reactividad del enzimoinmunoanálisis (ELISA) y la reagina plasmática rápida (RPR). Se realizó el tamizaje con pruebas treponémicas. Se analizó la distribución de los valores de señal/valor de corte (S/CO) obtenidos por QL en función del ELISA y RPR y se evaluó su asociación entre dos grupos de resultados de laboratorio (1) ELISA+/RPR+ y (2): ELISA+/RPR-. Se procesaron 76 794 donaciones voluntarias. Al comparar las medianas entre grupos, se encontró que la relación S/CO de QL fue significativamente mayor para los donantes del Grupo 1 (19,5 vs. 8,10; p<0,001). Se concluye que la intensidad de la señal de la prueba cualitativa QL estaría asociada con la reactividad de la RPR y guardaría relación con el curso de la infección.

Abstract The objective of this work was to compare the performance of treponemal and non-treponemal screening in two periods close in time in blood donors and to analyse the association of the signal strength (signal-to-cutoff, S/ CO) of the chemiluminescent immunoassay (CIA) with the reactivity of the enzymeimmunoassay (EIA) and the rapid plasma reagin (RPR). Donors were screened with treponemal tests. The distribution of the S/CO values obtained by CIA was analysed based on EIA and RPR, and its association was evaluated. Group 1: ELISA+/RPR+ donors and Group 2: ELISA+/RPR-. A total of 76,794 voluntary donations were processed. Comparing the means between groups, it was found that the CIA S/CO ratio was significantly higher for Group 1 donors (19.5 vs. 8.10; p<0.001). In conclusion, the signal strength of the qualitative CIA test would be associated with the reactivity of the RPR and would be related to the course of the infection.

Resumo O objetivo do trabalho foi comparar o desempenho da triagem treponêmica e não treponêmica em dois períodos próximos no tempo em doadores de sangue e analisar a associação da intensidade do sinal da prova quimioluminescente (QL) com a reatividade da análise imunoenzimática (ELISA) e a reagina plasmática rápida (RPR). Foi realizada uma triagem com provas treponêmicas. Foi analisada a distribuição dos valores de sinal/valor de corte (S/CO) obtidos por QL em função da ELISA e RPR, e também a associação entre dois grupos de resultados laboratoriais (1): ELISA+/RPR+ e (2) ELISA+/ RPR-). Foram procesadas 76 794 doações de sangue voluntárias. Ao comparar as medianas entre os grupos, obteve-se que a relação S/CO de QL foi significativamente maior para os doadores de sangue do grupo 1 (19,5 vs. 8,10; p<0,001). Em conclusão, a intensidade do sinal da prova qualitativa QL estaria associada com a reatividade da RPR e guardaria relação com o curso da infecção.

Cacería para autoconsumo durante la pandemia de COVID-19: el caso de las comunidades Matsigenkas del Parque Nacional del Manu

En este trabajo, se hipotetiza el periodo de aislamiento, la inmovilización y la migración inversa que sucedidos durante la pandemia del COVID-19 (años 2020 y 2021) incrementaron la capacidad de caza de las comunidades Matsigenkas asentadas en el Parque Nacional del Manu (PN Manu). Para esto, evaluamos los cambios en los patrones del volumen de extracción de la caza a través de un monitoreo participativo utilizando el modelo de monitoreo de la intensidad de cacería. Se evidenció que hubo un incremento de la capacidad de caza de las comunidades nativas. Los volúmenes más altos de extracción y el mayor incremento del número de cazadores, esfuerzo y área de cacería se dieron en el periodo 2020 - 2021, cuando las medidas de aislamiento e inmovilización fueron establecidas. Sin embargo, hubo una disminución de los indicadores para la temporada 2021 - 2022, año en que se flexibilizaron las medidas de aislamiento y se dio la reactivación económica, permitiendo que las personas retornaran a sus actividades económicas y educativas fuera del PN Manu. Se debe considerar que los efectos de solo un año de pandemia sobre los medios de subsistencia de las comunidades pudieron afectar la abundancia de la fauna silvestre, donde el mono maquisapa y mono choro (especies vulnerables) tuvieron altos incrementos de extracción. Por otro lado, nuestros resultados indicarían que el buen estado de conservación del PN Manu permitió la provisión de alimentos a las comunidades durante la pandemia. Se recomienda la planificación de programas que mitiguen los efectos negativos de pandemias o eventos semejantes, además se señala la importancia de medir el grado de resiliencia de las principales especies de caza, ya que el incremento de caza también podría tener efectos sobre la seguridad alimentaria de estas comunidades.

In this work, we hypothesize that the period of isolation, immobilization, and reverse migration that occurred during the COVID-19 pandemic (years 2020 and 2021) increased the hunting capacity of the Matsigenka communities settled in Manu National Park (PN Manu). To evaluate this, we assessed changes in hunting volume patterns through participatory monitoring using the hunting intensity monitoring model. It was evident that there was an increase in the hunting capacity of Matsigenka communities. The highest extraction volumes and the greatest increase in the number of hunters, hunting effort, and hunting area occurred in the 2020-2021 period, the year in which isolation and immobilization measures were established. However, there was a decrease in the indicators for the 2021-2022 period, the year in which isolation measures were relaxed and economic reactivation occurred, allowing people to return to their economic and educational activities outside PN Manu. It should be considered that the effects of only one year of the pandemic on the livelihoods of the communities could have affected the abundance of wildlife, with vulnerable species such as maquisapa monkeys and choro monkeys experiencing high extraction rates. On the other hand, our results indicate that the good conservation status of PN Manu provided food provisions for the communities during the pandemic. Planning programs to mitigate the negative effects of pandemics or similar events is recommended, and the importance of measuring the resilience of key hunting species is emphasized, as increased hunting could also have effects on the food security of these communities.

Remodelado eléctrico reverso en pacientes tratados con terapia de resincronización cardíaca / Reverse electrical remodeling in patients under cardiac resynchronization therapy

RESUMEN Introducción : La terapia de resincronización cardíaca (TRC) se indica en pacientes que habitualmente presentan remodelado cardíaco generado por dilatación y disincronía contráctil. La TRC contribuye al remodelado reverso, relacionado con menor mortalidad y hospitalizaciones por insuficiencia cardíaca (IC). Se han observado además mejoras en la conducción intraventricular, con reducción del tiempo de activación. La cuantificación del remodelado eléctrico reverso se ha subutilizado como parámetro de respuesta, con escasos reportes sobre su asociación con la respuesta clínica-estructural. Objetivo : Analizar el remodelado eléctrico reverso intraventricular como parámetro de respuesta a la TRC. Métodos: Se incluyeron pacientes con más de 6 meses de implante. Se obtuvo un ECG con estimulación desactivada (QRS intrínseco, QRSi, post TRC), y por ecocardiograma transtorácico se definió la fracción de eyección ventricular izquierda (FEVI), el diámetro de fin de diástole del ventrículo izquierdo (DFDVI) y la presencia de insuficiencia mitral. Se clasificó a los pacientes según la respuesta clínica-estructural. El remodelado eléctrico se caracterizó con la comparación de la duración del QRS pre y post TRC y la valoración de los cambios del QRS (ΔQRSi) entre grupos. Resultados : Se incluyeron 23 pacientes. Un 39% presentó disminución >10 mseg del QRSi. Observamos un QRSi de -9,3 ± 20,7 mseg en respondedores, y 11,25 ± 18,9 mseg en no respondedores (p = 0,027), más acentuada en los hiper respondedores (ΔQRSi: -14,44 ± 17,40 mseg, p = 0,026). Las mujeres con QRS ≥150 mseg pre TRC exhibieron disminución significativa del QRSi (p = 0,0195). Conclusiones : El remodelado eléctrico reverso se comprobó en 39% de los pacientes que recibieron TRC. Observamos una relación significativa del QRSi con la respuesta clínica-estructural, mayor en hiper respondedores. Mujeres con QRS ancho pre-TRC exhiben remodelado eléctrico reverso más acentuado. Este es un parámetro de fácil acceso e interpretación durante los controles ambulatorios.

ABSTRACT Introduction : Cardiac resynchronization therapy (CRT) is indicated in patients who often present cardiac remodeling due to dilatation and contractile dyssynchrony. CRT contributes to reverse remodeling which is associated with reduced mortality and heart failure (HF) hospitalizations. Improvements in intraventricular conduction with decreased ventricular activation time have also been observed. The quantification of reverse electrical remodeling has been underused as a parameter of response, and there are few reports on its association with the clinical-structural response. Objective : To analyze intraventricular reverse electrical remodeling as a parameter of response to CRT in living individuals. Methods : We included patients implanted at least 6 months ago. A deactivated stimulation ECG (post-CRT intrinsic QRS) was obtained, and by means of transthoracic echocardiography (TTE), the left ventricular ejection fraction (LVEF), the left ventricular end-diastolic diameter (LVEDD) and the presence of mitral regurgitation were defined. Patients were classified according to their clinical-structural response. Electrical remodeling was characterized by comparing pre- and post-CRT QRS duration and assessing QRS changes (ΔiQRS) between groups. Results : A total of 23 patients were included, 39% of which showed a >10 ms decrease in iQRS. We observed a iQRS of -9.3±20.7 ms in responders, and of 11.25±18.9 ms in non-responders (p=0.027), more marked in hyper-responders (ΔiQRS: -14.44±17.40 ms, p=0.026). Women with pre-CRT QRS ≥150 ms showed a significant decrease in iQRS (p=0.0195). Conclusion : Reverse electrical remodeling was found in 39% of the patients under CRT. We noted a significant relationship between iQRS and clinical-structural response, higher in hyper-responders. Women with wider pre-CRT QRS showed more marked reverse electrical remodeling. This parameter is accessible and easy to read in outpatient visits.

Knowledge regarding reverse osmosis (R.O) waste water utilization among general public in urban areas

Introduction: Reverse osmosis (RO) is a water purification process that uses a partial permeable membrane to remove ions, unwanted molecules and larger particles from drinking water. In reverse osmosis, an applied pressure is used to overcome osmotic pressure, a colligative property that is driven by chemical potential differences of the solvent, a thermodynamic parameter. In the process of reverse osmosis the amount of water that is drained is a concern area for the people using the R.O. filtration device in their household because it wasted about 70% of the water to purify just one liter of water. This R.O. waste water can be utilized for various purposes such as washing vehicle like car bike etc, cleaning toilet this study is aimed to assess the knowledge reverse osmosis waste water utilization among general public at Indore. Objectives: 1. To assess the pretest knowledge regarding reverse osmosis (R.O) waste water utilization among general public. 2. To assess the posttest knowledge regarding reverse osmosis waste water utilization among general public. 3. To evaluate the effectiveness of structured teaching program on reverse osmosis (R.O) waste water utilization among general public. Hypothesis: H1- there will be significant difference between pretest and posttest knowledge who received structured teaching program regarding the utilization of waste R.O water. Materials and Methods: Quantitative, pre-experimental, one group pretest posttest design was adopted for the study. Total of 60 general public selected by using simple randomized sampling technique was used. Description of Tools: Structured knowledge questionnaire. Result: Data was analyzes using descriptive and inferential statistics. Major Finding: In the pre-test majority of the sample (44 out of 60, 73.3%) had inadequate knowledge and in the post-test, majority (54 out of 60, 90%) had adequate knowledge regarding reverse osmosis. A paired‘t’ test was done and it showed a‘t’ value of 22.34 at 0.05 level of significance, this indicates the effectiveness of structured teaching programme in enhancing the knowledge of the general public. There was no association found between the mean pre-test knowledge of the general public. There was no association found between the mean pre-test knowledge scorer with the selected socio-demographic variable such as age (?2 = 8.643), gender (?2 = 4.455), education qualification (?2 = 4.706), Occupation (?2 = 2.531), number of family member (?2 = 5.653) and previous knowledge about reverse osmosis filter water (?2 =0.393). Conclusion: There is a significant difference between the mean pre-test and post-test knowledge score among general public regarding reverse osmosis waste water utilization.

Factores de riesgo tradicionales de enfermedad cardiovascular y su valor predictivo en el adulto mayor

Introducción: En la vejez, el valor predictivo de los factores de riesgo tradicionales es inconsistente. Con el aumento de la edad, las asociaciones entre los factores de riesgo tradicionales y las enfermedades cardiovasculares cambian. Objetivo: Recopilar información sobre los factores de riesgo tradicionales de enfermedad cardiovascular y su valor predictivo en el adulto mayor. Métodos: En el policlínico "Ramón López Peña" de Santiago de Cuba, en el período comprendido entre enero y mayo de 2022, se realizó una revisión sobre el tema. La búsqueda se realizó a partir de las bases de datos Pubmed, Infomed y SciELO, sin restricción de fechas, en los idiomas español e inglés. Resultados: Los hallazgos más recientes sugieren que los factores de riesgo tradicionales para la enfermedad cardiovascular podrían ser predictores más débiles del riesgo futuro en los ancianos, mientras que la fuerza de otros factores aumenta con la edad. Las personas mayores constituyen un subgrupo especial en el que otros factores como la polifarmacia, la hipotensión ortostática, la depresión y la condición física han demostrado ser determinantes potencialmente importantes de su riesgo cardiovascular. Conclusiones: El valor predictivo de la presión arterial, el colesterol y la obesidad en los ancianos disminuye o incluso se invierte, mientras que otros como la polifarmacia, la fragilidad y el deterioro cognitivo parecen ser prometedores.

Introduction: In old age, the predictive value of common risk factors is inconsistent. With increasing age, the associations between common risk factors and cardiovascular disease change. Objective: To collect information on the common risk factors for cardiovascular disease and their predictive value in the elderly. Methods: A review on this subject was carried out at Ramón López Peña community clinic in Santiago de Cuba, from January to May 2022. The search was carried out from Pubmed, Infomed and SciELO databases, with no date restrictions, in Spanish and English. Results: The most recent findings suggest that common risk factors for cardiovascular disease might be weaker predictors of future risk in the elderly, while the strength of other factors increases with age. Older people constitute a special subgroup in which other factors such as polypharmacy, orthostatic hypotension, depression, and physical condition have been shown to be potentially important determinants of their cardiovascular risk. Conclusions: The predictive value of blood pressure, cholesterol and obesity in the elderly decreases or even reverses, while others such as polypharmacy, frailty and cognitive impairment appear to be promising.

Perfusão arterial reversa gemelar: revisão da literatura / Twin reverse arterial perfusion: literature review

A perfusão arterial reversa gemelar é uma anormalidade rara que pode ocorrer em gestações gemelares monocoriônicas. Consiste em uma alteração na circulação fetoplacentária, com desvio de sangue de um dos gemelares para o outro, por meio de anastomoses arterioarteriais e venovenosas na superfície placentária e anastomoses arteriovenosas em áreas de circulação placentária compartilhada. O feto bombeador pode desenvolver insuficiência cardíaca devido ao aumento do débito cardíaco, e o feto receptor, perfundido por sangue pobre em oxigênio por meio do fluxo reverso, é severamente malformado, incompatível com a vida extrauterina. Este artigo apresenta o caso de uma gestação gemelar monocoriônica diamniótica, com manejo clínico conservador. O objetivo é relatar um caso de complicação rara de gestações monozigóticas e revisar condutas para diagnóstico e manejo adequado.(AU)

Twin reverse arterial perfusion is a rare abnormality that can occur in monochorionic twin pregnancies. It consists of an alteration in the fetal-placental circulation, with blood diversion from one of the twins to the other, through arterio-arterial and veno- venous anastomosis on the placental surface and arterio-venous anastomosis in areas of shared placental circulation. The pumping fetus may develop heart failure due to increased cardiac output, and the recipient fetus, perfused by oxygen-poor blood through reverse flow, is severely malformed, incompatible with extrauterine life. This article presents the case of a monochorionic diamniotic twin pregnancy, with conservative clinical management. The objective is to report a case of rare complication of monozygotic pregnancies and review procedures for diagnosis and adequate management.(AU)

Evaluation on genotoxicities of raceanisodamine hydrochloride injection / 药学实践杂志

Objective To study the genotoxicities of raceanisodamine hydrochloride injection. Methods Bacterial reverse mutation test, in vitro Chromosomal aberration test and in vivo Micronucleus test were performed to investigate the genotoxicities of raceanisodamine hydrochloride injection. Results The Ames test showed that raceanisodamine hydrochloride injection did not increase mutagenicity for TA1535, TA102, TA100, TA98 and TA97 strains at the dosage of 0.5, 5, 50, 500, 5000 μg per plate under two parallel system conditions (±S9). Results of CA test indicated that there was no statistical difference between raceanisodamine hydrochloride injection groups (doses of 58.75,117.5 and 235.0 μg/ml) and the solvent control group under two parallel system conditions (±S9). In MNT test, with doses of 7.5, 15.0 and 30.0 mg/kg respectively, the micronucleus induction rate of bone marrow of ICR mice was not statistically significant (P>0.05) when compared with that of vehicle control group in all dose groups. Conclusion Under the conditions of these study, the results indicated that raceanisodamine hydrochloride injection had no mutagenicity to Salmonella typhimurium, had no aberration effect on the chromosome of mammalian cultured cells, and had no effect on inducing micronucleus of bone marrow polychromatic erythrocytes in ICR mouse. All test results showed that raceanisodamine hydrochloride injection had no potential carcinogenicities and genetic toxicities under the test conditions.

Effect of tuberosity repair on functional outcome of reverse shoulder arthroplasty in proximal humerus fractures / 中华创伤杂志(英文版)

PURPOSE@#Unsatisfactory results of hemiarthroplasty in Neer's 3- and 4-part proximal humerus fractures in elderly, have led to the shift towards reverse shoulder arthroplasty (RSA). The objective of our study was to repair the tuberosities that are generally overlooked during RSA and observe its impact on the functional outcome and shoulder scores.@*METHODS@#We include elderly patients with acutely displaced or dislocated 3- or 4-part proximal humerus fractures from July 2013 to November 2019 who were treated with RSA along with tuberosity repair by non-absorbable sutures and bone grafting harvested from the humeral head. Open injuries and cases with neuro-muscular involvement of the deltoid muscle were excluded. According to the tuberosity healing on radiographs of the shoulder at 9th postoperative month, the patients were divided into 2 groups, as the group with successful tuberosity repair and the other with failed tuberosity repair. Statistical analysis of the functional outcome and shoulder scores between the 2 groups were done by independent t-test for normally distributed parameters and Mann-Whitney test for the parameters, where data was not normally distributed.@*RESULTS@#Of 41 patients, tuberosity healing was achieved in 28 (68.3%) and failed in 13 (31.7%) cases. Lysis of the tuberosity occurred in 5 patients, tuberosity displacement in 2, and nonunion in 2. Mean age was 70.4 years (range 65 - 79 years) and mean follow-up was 58.7 months (range 18 - 93 months). There were no major complications. Group with successful tuberosity repair showed improvement in mean active range of movements, like anterior elevation (165.1° ± 4.9° vs. 144.6° ± 9.4°, p < 0.000), lateral elevation (158.9° ± 7.2° vs. 138.4° ± 9.6°, p < 0.000), external rotation (30.5° ± 6.9° vs. 35.0° ± 6.3°, p = 0.367), internal rotation (33.7° ± 7.5° vs. 32.6° ± 6.9°, p = 0.671) and in mean shoulder scores including Constant score (70.7 ± 4.1 vs. 55.5 ± 5.7, p < 0.000), American shoulder and elbow surgeons score (90.3 ± 2.4 vs. 69.0 ± 5.7, p < 0.000), disability of arm shoulder and hand score (22.1 ± 2.3 vs. 37.6 ± 2.6, p < 0.000).@*CONCLUSION@#Successful repair and tuberosity healing around the RSA prosthesis is associated with statistically significant improvement in postoperative range of motion, strength and shoulder scores. Standardized repair technique and interposition of cancellous bone grafts, harvested from the humeral head can improve the rate of tuberosity healing.

Study on the influencing factors and mechanism of cholesterol polyps and cholesterol calculus in gallbladder / 中华肝胆外科杂志

Objective:To explore the pathogenesis of gallbladder cholesteryl polyps (GCP) and gallbladder cholesterol calculus (GCC) by studying the different changes of mucin (MUC) expression and reverse cholesterol transporter (RCT) in gallbladder mucosa epithelium.Methods:The data of 10 GCP patients (GCP group), 10 GCC patients (GCC group) and 5 patients with normal gallbladder resection (control group) were retrospectively analyzed, who underwent cholecystectomy in the Department of General Surgery, Xuanwu Hospital, Capital Medical University from January to December 2021. Among the 10 patients in the GCP group, there were 5 males and 5 females, aged (43.40±9.59) years old. Among the 10 patients in the GCC group, 5 males and 5 female, aged (45.00±8.13) years old. Among the 5 patients in the control group, there were 3 males and 2 females, aged (43.80±6.01) years old. Immunohistochemical analysis was used to investigate the expression differences of various subtypes of MUC and RCT [ATP binding cassette transporter G1 (ABCG1) and B group type I scavenger receptor (SR-BI)] among each group.Results:Compared with the control group, the expression of MUC1 (3.40±0.70 vs. 0), MUC5AC (1.50±0.53 vs. 0), MUC6 (4.70±0.48 vs. 0), and ABCG1 (3.50±0.53 vs. 1.60±0.55) in the gallbladder mucosa of the GCP group increased, while the expression score of SR-BI decreased (1.70±0.48 vs. 3.40±0.55), with statistical significance (all P<0.001). Compared with the control group, the expression of MUC1 (4.80±0.42 vs. 0), MUC5AC (4.70±0.48 vs. 0), MUC6 (3.30±0.67 vs. 0), and ABCG1 (3.40±0.52 vs. 1.60±0.55) in the gallbladder mucosa of the GCC group increased, while the expression score of SR-BI decreased (0 vs. 3.40±0.55), with statistically significant differences (all P<0.001). Conclusion:The different expression levels of MUC1, MUC5AC, MUC6, and RCT proteins lead to the differential formation of GCP and GCC on the basis of the co-pathogenesis in high cholesterol in bile.

Research into the fixation stability of the glenoid baseplate in reverse shoulder arthroplasty / 中华创伤骨科杂志

Reverse shoulder arthroplasty (RSA) was proposed to deal with rotator cuff tear arthropathy in the 1970s and improved from 1985 to 1995 by Dr. Grammont who designed the contemporary type of reverse shoulder prosthesis successfully. The number of RSAs has grown rapidly over the past decade. Currently, the indications for RSA include, in addition to rotator cuff tear arthropathy, massive rotator cuff tears which can not be repaired, proximal humerus fractures or their sequelae, inflammatory shoulder disease, osteoarthritis with abnormal glenoid morphology, anatomic revision after failed total shoulder arthroplasty or hemiarthroplasty, and shoulder tumors. Absolute contraindications to RSA include infection, complete axillary nerve palsy, neuropathic shoulder arthropathy, and glenoid bone loss. At present, the stability of the glenoid baseplate, an important factor affecting the incidence of postoperative complications, is mainly achieved by implantation of the screws for the glenoid baseplate base. Therefore, correct implantation of the screws is of great significance to reduce the complications in RSA.

Treatment of tibial plateau fractures using modified double reverse traction technique / 中华创伤骨科杂志

Objective:To study the clinical efficacy of our modified double reverse traction technique in the treatment of tibial plateau fractures.Methods:A retrospective study was conducted of the 66 patients with tibial plateau fracture who had been treated by our modified double reverse traction technique at Articular Department, Zhongshan Hospital of Traditional Chinese Medicine from March 2019 to December 2021. There were 37 males and 29 females, with an age of (44±14) years. The double reverse traction technique was used in all patients for reduction of the tibial plateau fracture, and their collapsed articular surfaces were restored by our self-designed universal high affinity prying technique, or by fibular graft support, or by the hooping technique to restore the transverse diameter of the tibial plateau which had been widened. The outcomes of fracture reduction at 2 days postoperation were recorded and evaluated by Rasmussen imaging assessment. Complications were also recorded. The visual analog scale (VAS) pain scores and Hospital for Special Surgery (HSS) scores were compared between preoperation, 3 and 6 months postoperation and the rates of fracture healing between 3 and 6 months postoperation.Results:This group of 66 patients was followed up for 12.0(8.0, 16.5) months. The Rasmussen imaging assessment at 2 days postoperation: 60 excellent, 4 good, and 2 fair cases, yielding an excellent to good rate of 97.0% (64/66). At 3 and 6 months postoperation, the VAS scores [1 (0, 1) and 0 (0, 1)] and HSS scores [84 (78, 88) and 91 (85, 95)] were significantly improved compared with those before operation [4 (3, 5) and 36 (29, 39)], and the values at 6 months postoperation were significantly improved compared with those at 3 months postoperation ( P<0.05). The rate of clinical fracture healing at 6 months postoperation (100%, 66/66) was significantly higher than that at 3 months postoperation (77.3%, 51/66) ( P<0.05). Perioperatively, no adverse events were observed like incision infection, deep vein thrombosis of lower limbs, or failure or exposure of internal fixation, except for delayed incision healing in only one patient. Conclusion:In the minimally invasive surgery for tibial plateau fractures, our modified double reverse traction technique can result in excellent fracture reduction by imaging assessment, fine functional recovery of the knee joint and relief of pain.

Diagnosis and treatment of posterior shoulder dislocation combined with reverse Hill-Sachs lesion / 中华创伤骨科杂志

Objective:To explore the diagnosis and treatment of posterior shoulder dislocation combined with reverse Hill-Sachs lesion.Methods:Two male patients were treated at Department of Joint Surgery, Affiliated Hospital of Qingdao University for posterior shoulder dislocation combined with reverse Hill-Sachs lesion from August to November 2022. Case 1 was a 46-year-old man, admitted 1 day after right should injury, and case 2 a 57-year-old man, admitted 2 days after right should injury. The injury was caused by electric shock in both, and their fractures were fresh with an injury area>50%. After anatomical reduction of the collapsed humeral head via the pectoralis major deltoid approach, an artificial bone was implanted and fixated with countersunk screws in both cases to reduce the shoulder joint. The Constant-Murley scale and visual analogue scale (VAS) were used to evaluate the functional recovery of the shoulder and pain after treatment.Results:No such perioperative complications as incision infection, brachial plexus injury or vascular injury was observed in either of the 2 patients. Reexamination 3 months after surgery showed in case 1: 110° of shoulder anterior flexion, 90° of shoulder abduction, 30° of external rotation (neutral position), 70° of internal rotation (neutral position), 70 points of Constant-Murley shoulder score, and 3 points of VAS pain score; in case 2: 130° of shoulder anterior flexion, 120° of shoulder abduction, 50° of external rotation (neutral position), 80° of internal rotation (neutral position), 70 points of Constant-Murley shoulder score, and 2 points of VAS pain score.Conclusion:For patients with posterior shoulder dislocation complicated with reverse Hill-Sachs lesion and humeral head collapse greater than 50%, open reduction and screw internal fixation combined with artificial bone grafting can achieve good short-term curative efficacy.

Genetic variation characteristics of HA gene of influenza A virus (H3N2) in Guizhou province from 2017 to 2019 / 中国基层医药

Objective:To analyze the genetic variation characteristics of the HA gene of influenza A virus (H3N2) in Guizhou province from 2017 to 2019. Methods:Twenty strains of influenza A virus (H3N2) were randomly selected from 10 network laboratories in Guizhou province for RNA extraction. Reverse transcriptase-polymerase chain reaction and sequencing were performed. The products were analyzed using bioinformatics software.Results:The nucleotide homology of the HA gene of the 20 strains was 97.7%-100%, which was highly homologous to the vaccine strains A/Hong-Kong/4801/2014 recommended by WHO in 2017 and A/Singapore-INFIMH/16-0019/2016 recommended by WHO in 2018, but they were significantly different from the vaccine strain A/Kansas/14/2017 recommended by WHO in 2019. Genetic analysis showed that the 20 strains were divided into two branches, and the strains that were prevalent in 2019 were located in different branches, with marked genetic differences. Key site analysis showed mutations in antigenic determinants A, B, C, and E and mutations in the anterior and posterior walls of receptor binding sites. Key site analysis also showed that there was an increase in the number of glycosylation sites compared with the vaccine strains prevalent in the same year. Genetic distance, antigen sites, and glycosylation sites were slightly different between virus strains prevalent in 2017-2018 and virus strains prevalent in 2019. Conclusion:The HA gene of the influenza A virus subtype H3N2 in Guizhou province from 2017 to 2019 showed heterogeneity and gene mutation, especially in 2019. Therefore, close monitoring of the genetic evolution of the influenza A virus subtype H3N2 is necessary.

Evidence summary of exercise reversal intervention for elderly patients with cognitive frailty / 中国实用护理杂志

Objective:To retrieve, evaluate and summarize the best evidence of exercise reversal intervention in the elderly with cognitive frailty, and to provide evidence for guiding exercise in elderly patients.Methods:This study was a summary of evidence-based nursing evidence. Based on the PIPOST (P: Population; I: Intervention; P: Professional; O: Outcome; S: Setting; T: Type of evidence) mode, the evidence of exercise reversal intervention in the elderly with cognitive frailty in 25 relevant guideline network and association websites, Chinese and foreign language comprehensive databases such as PubMed, CINAHL, Web of Science, Embase, Chinese Biomedical Database, China National Knowledge Internet and others were searched, extracted and integrated. The retrieval time was from January 1, 2013 to February 14, 2022.Results:A total of 22 articles were included, including 3 guidelines, 2 expert consensuses, 1 clinical decision-making, 1 evidence summary, 9 Meta analysis, and 6 randomized controlled trials. Finally, 28 pieces of the best evidence including 7 dimensions were namely formulate principles,overall assessment, exercise mode, exercise intensity, exercise time and frequency, exercise management, health guidance.Conclusions:This study summarized the best evidence of exercise intervention in the elderly with cognitive frailty, which are systematic, comprehensive, rigorous, and reliable. It can provide references for healthcare administrators to dynamically evaluate patients′cognitive frailty status, formulate personalized exercise programs, and standardize exercise guidance for patients, so as to delay or even reverse cognitive frailty.

Research progress on reversal of drug resistance to Sorafenib in primary liver cancer / 国际外科学杂志

Hepatocellular carcinoma (HCC) is a malignant tumor with high incidence rate and mortality worldwide. However, most patients are not suitable for radical treatment at the time of first diagnosis. As one of the important schemes for the treatment of HCC, one of the most representative drug is Sorafenib, which has certain survival benefits for HCC patients at different stages. However, the drug resistance of HCC to Sorafenib greatly limits its efficacy. So far, people have found that some natural substances, experimental agents and biological macromolecules can reverse the drug resistance of HCC to Sorafenib through tumor cell microenvironment, metabolism and other mechanisms. This article will summarize the above substances and their mechanism in order to provide research ideas for the improvement of Sorafenib′s treatment program.

The Clinical Effect of Pretreatment with Heat-sensitive Moxibustion on Primary Dysmenorrhea and Its Influence on Uterine Artery Blood Flow： A Randomized， Blinded Controlled Trial / 中医杂志

ObjectiveTo compare the clinical effect of heat-sensitive moxibustion before menstruation and since the first day of menstruation on primary dysmenorrhoea （PD）， thereby optimizing the clinical treatment plan. MethodsSixty patients with PD were randomly divided into pretreatment group （treated before menstruation） and conventional treatment group （treated since the first day of menstruation） of 30 cases each. For all patients， the area surrounded by bilateral Zigong （EX-CA1） and bilateral Guilai （ST 29） in the supine position， and that formed by bilateral Shenshu （BL 23） and Ciliao （BL 32） in the prone position were selected for circling moxibustion （2 min）， sparrow-pecking moxibustion （1 min）， and then moxibustion along the channels to stimulate the moxibustion sensation and obtain two heat-sensitive points with the best sensation for treatment. In the pretreatment group， moxibustion was applied 3-7 days before the onset of menstruation， and in the conventional treatment group， moxibustion was applied on the day of menstruation. Both groups were treated once daily for 7 days per menstrual cycle for 3 consecutive cycles. The clinical outcomes of the two groups were measured before and after treatment in terms of the COX menstrual pain symptom scale （CMSS） scores， visual analogue scale for pain （VAS） scores， and uterine artery hemodynamic indicators including blood pulsation index （PI） and resistance index （RI）， and the clinical effect was compared. ResultsAfter treatment， the CMSS scores， VAS scores， PI and RI in the two groups decreased， and lower scores were found in the pretreatment group （P＜0.05 or P＜0.01）. The total effective rate after treatment was 93.3% （28/30） in the pretreatment group， which was better than 73.3% （22/30） in the conventional treatment group （P＜0.05）. ConclusionThe clinical effect of heat-sensitive moxibustion before the menstruation for PD was better than that implemented since the first day of menstruation， by significantly improving the patients' dysmenorrhoea symptoms and uterine artery blood flow index.

Construction and verification of recombinant chimeric vesicular stomatitis virus expressing rabies virus G protein / 中国生物制品学杂志

@#Objective To construct recombinant chimeric vesicular stomatitis virus(VSV)expressing G protein of rabies virus(RV)using VSV as vector.MethodsTo rescue the recombinant virus,G gene of VSV antigenome was replaced with G gene of RV vaccine CTN-1 strain,and co-transfected into 293T cells with helper plasmids coding T7 RNA polymerase and proteins N,P and L of VSV. The expression of RV G gene and G protein was detected by RT-PCR,immunofluorescence assay and Western blot. The recombinant virus was subcultured in Vero cells,the virus titer of different generations was detected and the virus growth curve was drawn.ResultsThe recombinant virus VSV-RVG was successfully rescued. RTPCR results demonstrated that the RV G gene was successfully inserted into the genome of the recombinant virus,and the expression of RVG protein was detected by immunofluorescence assay and Western blot. The recombinant virus was continuously passaged for 5 generations,and the virus titer was stable within 7. 5 ～ 8. 5 lgTCID50/mL.ConclusionThe recombinant chimeric VSV expressing RV G protein was successfully constructed with good genetic stability,which lays a foundation of the construction of reverse genetics technology platform based on VSV vector.