¿La imagen importa? Influencia de la vestimenta del traumatólogo en la elección y confianza del paciente / The impact of the orthopedic surgeons' attire on patient preferences

Background: The formal appearance of health care professionals may influence their trustworthiness. Aim: To determine the effect of the orthopedic surgeon's attire on patients' perceptions of credibility and reliability of professionals. Material and Methods: In a cross-sectional design, 351 patients (mean age 43 ± 17 years, 62% males) from the Department of Orthopedics and Traumatology of a Chilean regional hospital in southem of Chile were chosen to complete a questionnaire of attire preferences, in which five photographs with male and female orthopedic surgeons appeared (executive, formal attire, informal attire, scrubs and casual clothing). The influence of attire in the perception of physicians' trustworthiness to resolve medical situations was analyzed. Results: Forty four percent of patients had no physician gender predilection (p = 0.32). Forty three percent of male and 38% of female patients preferred the use of formal attire. In situations of credibility or confidence, all patients chose mostly the use of white coats with formal attire by professionals. The probability of choosing an orthopedic surgeon with a formal attire was significantly higher among patients who considered the attire and appearance of the professional to be very important (Odds ratio = 3.74; p < 0.01). Conclusions: Patients prefer orthopedic surgeons wearing white coats and formal attire, which improves credibility of these professionals to correctly solve medical situations.

Cytotoxicity and bacterial membrane destabilization induced by Annona squamosa L. extracts

ABSTRACT This study aimed to further investigate the cytotoxicity against tumor cell lines and several bacterial strains of Annona squamosa and its mode of action. Methanol extracts of A. squamosa leaves (ASL) and seeds (ASS) were used. ASL showed significant antibacterial activity against S. aureus, K. pneumoniae and E. faecalis with MIC values of 78, 78 and 39 µg/mL respectively. Moreover, ASL exhibited significant biofilm disruption, rapid time dependent kinetics of bacterial killing, increased membrane permeability and significantly reduced the cell numbers and viability. Regarding the cytotoxicity against tumor cell lines, ASS was more active against Jurkat and MCF-7 cells, with CI50 1.1 and 2.1 µg/mL, respectively. ASL showed promising activity against Jurkat and HL60, with CI50 4.2 and 6.4 µg/mL, respectively. Both extracts showed lower activity against VERO cells and reduced the clonogenic survival at higher concentrations (IC90) to MCF-7 and HCT-116 lineages. The alkaloids anonaine, asimilobine, corypalmine, liriodenine nornuciferine and reticuline were identified in extracts by UPLC-ESI-MS/MS analysis. This study reinforced that A. squamosa presents a remarkable phytomedicinal potential and revealed that its antimicrobial mechanism of action is related to bacterial membrane destabilization.